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Background  This study aimed at investigating dental clinicians’ preferences on management of necrotic pulp with acute apical abscess (NPAAA) cases.    Methods  Following an ethical approval and two pilot studies, an electronic survey was emailed to 400 general dental practitioners (GDPs) and 56 endodontists. The email explained the study’s methods and assured that participants’ identities and information given would remain anonymous and confidential. A reminder email was sent after eight weeks. Responses were collected and data were analyzed using the Chi-square test at  p = 0.05 .    Results  The majority of respondents (86.3%) would deal with NPAAA cases “ differently”  from vital-pulp ones ( p < 0.001 ). More endodontists (40%) used two or three irrgants than GDPs (29.5%). Whilst the highest proportion of endodontists (29.7%)  rarely  prescribed antibiotics, the highest proportion of GDPs (26%)  generally did so  ( p < 0.001 ). Whilst the highest proportion of GDPs (26.9%)  over-instrumented the largest canal  in the first visit, most endodontists (56.8%) performed  complete cleaning & shaping  (C&S) ( p < 0.001) . In cases of non-stopped exudates, whilst the highest proportions of endodontists would either  let the patient wait till the exudates significantly reduce then continue their intended approach  (40.5%) or  insert ICMs and temporize the tooth  (40.5%), the highest proportion of GDPs (30.8%) would  insert only dry cotton pellet without temporizing the tooth (p = 0.002) . Of those who would  leave the tooth open  if non-stopped exudates presents in the first visit, the majority (81.9%) would temporize the tooth if  little exudates  present after C&S  (p < 0.001) .    Conclusions  Clinicians, especially GDPs, opted to treat teeth involved in NPAAA differently from those with vital-pulp, such as: were using different ICMs and irrigants, C&S to different apical size preparation. GDPs should improve their practice by implementing multi-irrigants protocol while C&S, limit prescribing antibiotics, perform complete debridement of the root canal system and not to leave the tooth open between visits. Clinicians, especially GDPs, relied on their own experiences in managing NPAA cases which necessitates scientific-based guidelines.    Electronic supplementary material  The online version of this article (10.1186/s12903-018-0574-7) contains supplementary material, which is available to authorized users.

Preferences of dentists and endodontists, in Saudi Arabia, on management of necrotic pulp with acute apical abscess