students working 
 toward their dentistry course learn how to prescribe medication during their studies , 
 but , despite its importance , they generally do not learn about it in a systematized way . 

traditionally , brazilian dental students take basic pharmacology courses in their first 
 few semesters that teach the pharmacokinetics and pharmacodynamics knowledge needed to 
 understand pharmacotherapy .
however , a true understanding of the context in which 
 medications are prescribed comes in daily clinical practice and is not incorporated into 
 basic pharmacology coursework . in general
, students learn through observing their 
 teachers and more experienced colleagues , acquiring practice in prescribing as they 
 progress in their programs .
they are introduced to fields requiring clinical observation 
 from their fourth semester onwards . in brazil
, dentistry courses are usually organized 
 into 10 semesters taken over five years ( although there are some courses organized 
 according to year ) .
patients ' individual characteristics ( i.e. , age , gender , and 
 sociocultural profile ) and medical histories ( i.e. , comorbidities and use of other 
 medication ) are often not considered .
there are very few studies in the literature 
 concerning prescription errors in dentistry , particularly by 
 undergraduates .
moreover , the 
 lack of training in prescription and management of drug interactions has precipitated 
 issues with identifying patients ' problems and the therapeutic objective . according to the world health organization ( who ) 's recommendations
, prescriptions should 
 identify the professional , the patient , and the mode of administration , as well as the 
 medicine 's pharmaceutical form , its dosage , frequency of use , duration of treatment 
 together with patient guidance and information .
extreme care should be taken to avoid errors in medical 
 prescriptions as they may not only lead to difficulties and mistakes in dispensing 
 medicines , but may also result in incorrect drug use that can make treatments 
 ineffective or unsafe , which increases risks and healthcare costs . since the dental surgeon is a prescriber 
 and needs to use medicines as part of his or her clinical dental practice , lack of 
 adequate training for students is an important matter that impacts directly on the 
 quality of medical prescriptions provided .
although there are data pointing to flaws in the training of prescribers , many teaching 
 professionals , particularly those involved in clinical courses , have alleged that 
 students do develop the ability to prescribe over the course of their education . 
 therefore , the objective of this study was to evaluate changes in the pattern of 
 prescription over the dentistry course study in a brazilian 5-year program .
students in their fourth to tenth semester of studying dentistry at university 
 brasilia during the period from november 2010 to january 2011 who had completed their 
 basic pharmacology coursework were enrolled in this study .
all students volunteered after signing an 
 informed consent form ( approval no . 112/2010 , institutional ethics committee ) .
we asked the students to self - evaluate their knowledge of clinical pharmacology as 
 good , average , poor , or very poor .
then , we asked each participant to use an 
 appropriate prescription form to prescribe paracetamol to control pain in a sample 
 case of a dental extraction without complications .
we assigned a maximum score of 5 points to 
 each prescription , where the score was the sum of subscores from three main areas : 
 identification ( 1 point ) , pharmaceutical direction ( 2.5 points ) , and user information 
 ( 1.5 points ) .
the identification subscore ( 1 point ) included correct identification 
 of the prescriber ( 0.5 point ) and the patient ( 0.5 point ) .
the pharmaceutical 
 direction subscore ( 1.5 point ) included pharmaceutical form ( 0.5 point ) , 
 concentration ( 0.5 point ) , and quantity to be purchased ( 0.5 point ) . and
the user 
 information subscore ( 2.5 points ) included mode of administration ( 0.5 ) , posology 
 ( 0.5 ) , length of treatment ( 0.5 ) , warnings ( 0.5 ) , date and span of prescription 
 ( 0.5 ) .
we expressed the data as median values ( 95% ci ) and conducted comparisons 
 using the kruskal - wallis test followed by the dunn 's post - test test .
students in their fourth to tenth semester of studying dentistry at university 
 brasilia during the period from november 2010 to january 2011 who had completed their 
 basic pharmacology coursework were enrolled in this study .
all students volunteered after signing an 
 informed consent form ( approval no . 112/2010 , institutional ethics committee ) .
we asked the students to self - evaluate their knowledge of clinical pharmacology as 
 good , average , poor , or very poor .
then , we asked each participant to use an 
 appropriate prescription form to prescribe paracetamol to control pain in a sample 
 case of a dental extraction without complications .
we assigned a maximum score of 5 points to 
 each prescription , where the score was the sum of subscores from three main areas : 
 identification ( 1 point ) , pharmaceutical direction ( 2.5 points ) , and user information 
 ( 1.5 points ) .
the identification subscore ( 1 point ) included correct identification 
 of the prescriber ( 0.5 point ) and the patient ( 0.5 point ) .
the pharmaceutical 
 direction subscore ( 1.5 point ) included pharmaceutical form ( 0.5 point ) , 
 concentration ( 0.5 point ) , and quantity to be purchased ( 0.5 point ) . and
the user 
 information subscore ( 2.5 points ) included mode of administration ( 0.5 ) , posology 
 ( 0.5 ) , length of treatment ( 0.5 ) , warnings ( 0.5 ) , date and span of prescription 
 ( 0.5 ) .
we expressed the data as median values ( 95% ci ) and conducted comparisons 
 using the kruskal - wallis test followed by the dunn 's post - test test .
in total , we evaluated 92 dental students , grouped according to their year in the 
 program ( 2year , n=12 ; 3year , n=32 ; 4year , n=28 ; 
 5year , n=20 ) .
the mean age of the study participants was 22 years old 
 ( 1.54 ) .
the cohort was 73% women and 27% men . in their self - evaluation of their 
 knowledge of clinical pharmacology , the majority ( 62% ) of
only 10% described their knowledge as " good " , whereas 26% and 2% described 
 their knowledge as " poor " and " very poor " , respectively .
figure 1 summarizes how the quality of 
 prescriptions varied by year in the program .
as expected , there was an improvement in 
 prescription quality in relation to students ' time in the program ( p<0.0001 ) .
we 
 observed a significant difference between scores achieved by 1-year and 
 2-year students and scores achieved by students in their final two 
 years .
second - year students had a median prescription quality total score of 2.0 points 
 [ ( 1.5 - 2.5 ) , p<0.005 ] , whereas students in their final ( 5 ) year of 
 training had a median prescription quality total score of 3.5 points ( 3.4 - 3.8 ) . however , 
 this variation was not continuous , as there was no significant improvement between the 
 2 and 3years , or between the 4 and 
 5 years .
total score achieved by dentistry students for their paracetamol prescriptions in observing in detail the mistakes made by the students , we noted that failures to 
 identify the patient or the prescriber were common . although the 5-year 
 students generally performed better than their peers with fewer years in the 
 patient / prescriber identification subscore [ 0.6 ( 0.50 - 0.8 ) ] , that score differed 
 significantly only versus 2-year students [ 0.3 ( 0.1 - 0.5 ) ; p<0.05 ] ( figure 2 ) .
partial score for patient and prescriber identification , obtained from the 
 paracetamol prescriptions produced by dentistry program students with respect to form of presentation , quantity , and dose / posology of the prescription , 
 we observed that students in their final two years had scores similar to each other 
 [ 4year 1.4 ( 1.2 - 1.5 ) ; 5year 1.4 ( 1.3 - 1.5 ) ] .
their scores 
 were significantly higher than those achieved by students in their 2[0.6 
 ( 0.4 - 0.9 ) ] and 3 years [ 0.7 ( 0.5 - 0.9 ) ] , which did not differ from each 
 other ( figure 3 ) .
partial score for information about the medicine ( generic name , concentration , 
 posology ) on paracetamol prescriptions produced by dentistry program students students in their 5year of study generally performed better than the other 
 students in use instructions , information , and patient warnings about using paracetamol . 

they scored significantly higher [ 1.5 ( 1.4 - 1.6 ) ] than 2-year [ 1.0 
 ( 0.8 - 1.3 ) ] and 3-year [ 1.1 ( 1.3 - 1.6 ) ] students ( figure 4 ) .
partial score for warnings , use instructions , and side effects on paracetamol 
 prescriptions produced by dentistry program students
inclusion of correct drug indications based on scientific evidence and an appropriately 
 completed prescription are important parameters in the quality of pharmacotherapy 
 delivery .
our study showed that there was an aggregation of knowledge about drug prescribing over 
 the dentistry course program ; however , important deficiencies were still present at the 
 end of training .
clinical topics are introduced during the 2and 
 3 years of the program , albeit with a low level of complexity . at this 
 stage , students have the greatest difficulty with making prescriptions , which was most 
 evident in terms of information about dosage / posology .
this problem diminishes but does 
 not disappear in the more advanced stages of the program , when students receive more 
 practice at prescribing .
nevertheless , we observed that the acquisition of knowledge was 
 not continuous in that there were no significant differences between the performance of 
 4-year versus 5-year students in the general quality of 
 their prescriptions .
the most common prescription flaws were failure to identify the 
 patient , lack of information about the mode of administration or possible side effects , 
 and absence of non - pharmacological directions . a study conducted by rauniar , et al . 

( 2008 ) evaluated the prescribing abilities of 258 1-and 2-year 
 students in medicine and dentistry following a three - hour interactive session in 
 clinical pharmacology using the objective structured practical examination .
they 
 evaluated two main components , the first of which concerned the prescriber 
 ( identification of the prescriber and patient , diagnosis , and signature ) and the second 
 of which concerned the drug ( correct selection , dosage / posology , and quantity ) . in terms 
 of prescriber data , 2-year students in both programs made more mistakes 
 than 1-year students in either program .
however , in terms of the 
 information provided about the drugs , 2-year students in medicine had a 
 higher level of accuracy than 1year students , while the opposite pattern 
 emerged for the dentistry students .
they reported that students acquired limited 
 prescribing abilities in the pre - clinical stages of their programs .
our results provide a clear demonstration 
 that students acquire knowledge up to a certain point ( apparent plateau at 
 4year ) and that they finish their training with important deficiencies 
 that may influence their future actions in professional practice .
a prior analysis of prescriptions , conducted by dental surgeons working in public health 
 units in brazil , showed that prescriptions commonly contained abbreviations and/or 
 illegible letters and often lacked information about mode of administration , the total 
 quantity of the drug being prescribed , dosage / posology , duration , and/or guidance about 
 the proposed treatment . 

professionals who have completed their degrees should not make these mistakes , and it is 
 very likely that the propensity for such mistakes may be traced back to gaps in their 
 pre - doctoral preparation . although a study conducted with medical students showed low levels of perception about 
 the importance of this question and a lack of awareness of the mistakes made , the students in our study appeared aware 
 of their difficulties . curiously , while most of the students evaluated their knowledge 
 of clinical pharmacology as " average " ( 62% ) , a considerable number evaluated their 
 knowledge as " poor " ( 26% ) .
lack of knowledge on the name of the drug , its posology , and 
 duration of treatment , doubts about how to fill out the prescription form , and 
 uncertainty about the correct indication and possible allergies were the main 
 difficulties indicated by students who were in their final year of the dentistry program 
 at a mexican university .
still , the 
 students themselves are capable of recognizing that they had difficulties and doubts 
 that made them feel insecure about prescribing .
researchers have discussed the issue of the lack of integration of clinical knowledge 
 into the basic knowledge curriculum , 
 as well as the issues of insufficient time being devoted to teaching clinical 
 pharmacology , and the lack of specific clinical training . based on our study 's results
, we suggest that there 
 should be more emphasis on teaching good prescribing practices to dentistry program 
 students on a progressive and continual basis from the early semesters , when students 
 have their first contact with clinical fields , through the final semester . to improve 
 student involvement and motivation
, teaching strategies should include internet tools in 
 instructional units about prescribing based on scientific evidence as well as discussion 
 of clinical cases and problem - based learning .
although dentistry students show a general improvement in their prescribing performance , 
 deficiencies remain even in advanced students , particularly in relation to uses of the 
 drug being prescribed .
the data suggest that teaching of good prescription practices 
 should extend throughout the later phases of pre - professional dental education .
 objectivethe main objective of this study was to evaluate changes in prescribing pattern of 
 dentistry students throughout academic course.methodsa case of non - complicated dental extraction was presented to all students that had 
 completed their pharmacology coursework ( from 4th semester to the last semester ) . 
 
 the students were grouped according to year of study and were asked to prescribe 
 paracetamol for pain control . 
 a maximal score of 5 points was calculated from 
 three subscores for identification of professional and patient ( 1.0 point ) , drug 
 concentration , dosage , and quantity ( 1.5 points ) ; and drug information , 
 instructions , and warnings ( 2.5 points ) . 
 the data were expressed as medians [ 95% 
 confidence intervals ( cis ) ] and were compared using the kruskal - wallis test 
 followed by dunn 's post hoc test . 
 a p<0.05 value was considered statistically 
 significant . 
 a total of 92 students participated the study ( 2nd year , 
 n=12 ; 3rd year , n=32 ; 4th year , n=28 ; 5th year , 
 n=20).resultsthe quality of prescription showed improvement between 2nd - year 
 students [ 2.0 ( 1.5 - 2.5 ) ] and 4th - year students [ 3.2 ( 2.9 - 3.5 ) , 
 p<0.05 ] ; 4th- and 5th - year students [ 3.6 ( 3.5 - 3.8 ) ] 
 performed similarly . 
 lack of information about pharmacological treatment , side 
 effects , and administration route were the major deficiencies observed.conclusionalthough dentistry students present a general improvement in their prescribing 
 performance , deficiencies remain even in advanced students . 
 the data suggest that 
 the teaching of good prescription practices should extend throughout the later 
 phases of preprofessional dental education . 