From knowledge to practice: Antibiotic prescribing behaviors and antimicrobial stewardship awareness among Iraqi dental students

Background Antimicrobial resistance (AMR) is a growing global health concern, with inappropriate antibiotic use in dentistry significantly contributing to this problem. While regional studies have examined dental students' antibiotic-related knowledge and practices, comprehensive evidence from Iraq remains limited. Objective The objective of this study is to evaluate the level of knowledge and awareness of antimicrobial stewardship principles and prescribing practices among Iraqi dental students and interns. Methods A cross-sectional, questionnaire-based study was conducted among dental students in the clinical phase of education (fourth and fifth years) and dental interns from multiple Iraqi universities. The survey was distributed from October 2023 to June 2025 to assess the knowledge of antibiotics, awareness of prudent antibiotic use, and self-reported prescribing practices. Correlation analyses were performed to examine associations between knowledge, awareness, and practice domains. Results The participants (n = 569) demonstrated strong theoretical knowledge of antibiotics and a high awareness of prudent antibiotic use. However, a consistent gap between knowledge and clinical practice was identified. Knowledge and awareness domains were positively correlated, while both were inversely associated with practice scores, thus indicating a more cautious prescribing behavior among students with higher knowledge levels. A limited access to prescribing guidelines, insufficient practical training, and variability in institutional support were identified as key factors that influence the prescribing behavior. Differences between universities highlighted the significant role of educational environment and curriculum structure (p < 0.05). Conclusion Although Iraqi dental students possess adequate knowledge and awareness regarding antibiotic use and AMR, translating this understanding into consistent clinical practice remains challenging. Higher knowledge levels were associated with restrained prescribing, thus reflecting responsible antimicrobial stewardship rather than poor practice. These findings underscore the need to integrate structured antimicrobial stewardship training, standardized prescribing guidelines, and practical decision-making support into dental education. Strengthening these components is essential to bridge the knowledge–practice gap and prepare future dental practitioners to contribute effectively to combating AMR through responsible, evidence-based prescribing.