In the modern age, one persistent risk to our way of life is the ever-growing rates of antimicrobial resistance. Indeed, the World Health Organization has identified antimicrobial resistance as one of the top ten public health threats facing humanity.[i]
While we are currently able to treat the vast majority of infections, recent years have seen an increase in the number of “superbugs” – conditions caused by bacteria that cannot be treated using the antibiotics usually deployed to destroy them. Even without reaching superbug status, a wide range of conditions have started to become harder to treat on a global level, including sepsis and some bacterial, sexually transmitted and urinary tract infections.[ii]
But what causes antimicrobial resistance and how are dentists contributing to this phenomenon?
Evolution and resistance
Generally speaking, antimicrobial resistance occurs because bacteria and other pathogens have the ability to evolve and build resilience against anything developed to destroy them. It is for this reason that one of the main causes of antimicrobial resistance is the misuse and overuse of existing antibiotics.[iii]
In dentistry, it’s not always clear where antibiotics are necessary. In fact, a rather illuminating study found that 81% of dental antibiotic prescriptions were unnecessary.[iv] While I doubt the veracity of this figure (as always with studies like this, sample size and other factors hugely determine the outcome), it does go to show that there are dentists out there prescribing antibiotics when they shouldn’t be.
Furthermore, we can’t ignore what the pandemic meant for antibiotic prescriptions. As we were unable to see patients in person, there were instances where professionals prescribed antibiotics when they otherwise wouldn’t have in order to help ease dental pain. In fact, studies found that antibiotic prescribing rose by a minimum of 12.1% in some areas of the UK, and as much as 29.1% in others throughout 2020, meaning this was a nationwide occurrence.[v]
You would think, therefore, that the narrative surrounding this issue would be clearly in favour of dentists prescribing less. However, a recent article from the University of Sheffield suggested that we should be prescribing antibiotics in high-risk cases in order to prevent life-threatening heart conditions[vi] – so what should we do?
I think what it really comes down to is looking at each patient case more closely and ensuring that antibiotics are necessary. While this seems like common sense, there also needs to be a fundamental change in the way dentistry works to achieve this – really, we require more time with each patient and for services to help those in crucial need so that they aren’t prescribed antibiotics to tackle any pain they have while they wait. Certainly in endodontics the best treatment is often to open up at tooth rather than reach for the prescription pad .It would also help to have consistent messaging regarding antibiotics in the industry. I will say that, inevitably, our rates of antibiotic prescription will naturally fall now that things are returning to normal and we can see patients face-to-face again.
Ultimately, we’re stuck in a tricky situation where we can just try to do our best and hope. Antimicrobial resistance isn’t just a dentistry issue, it’s a whole world issue, and there are huge changes that need to be made to our way of life to resolve the problem entirely. Until then, as long as we’re very careful with what we prescribe, I believe we’re doing our best to stop the acceleration of antimicrobial resistance.
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[i] WHO. Antimicrobial Resistance. Link: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance [Last accessed November 22].
[ii]WHO. Antimicrobial Resistance. Link: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance [Last accessed November 22].
[iii] WHO. Antimicrobial Resistance. Link: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance [Last accessed November 22].
[iv] CIDRAP. Study finds 81% of dental antibiotic prescribing not needed. Link: https://www.cidrap.umn.edu/news-perspective/2019/05/study-finds-81-dental-antibiotic-prescribing-not-needed [Last accessed November 22].
[v] The University of Manchester. Dentists forced to prescribe unnecessary antibiotics for toothache in pandemic. Link: https://www.manchester.ac.uk/discover/news/dentists-forced-to-prescribe-unnecessary-antibiotics-for-toothache-in-pandemic/ [Last accessed November 22].
[vi] The University of Sheffield. Dentists should give antibiotics to high-risk patients to help prevent life-threatening heart infection. Link: https://www.sheffield.ac.uk/news/dentists-should-give-antibiotics-high-risk-patients-help-prevent-life-threatening-heart-infection#:~:text=18%20August%202022-,Dentists%20should%20give%20antibiotics%20to%20high%2Drisk%20patients%20to,prevent%20life%2Dthreatening%20heart%20infection&text=People%20who%20are%20at%20high,from%20the%20University%20of%20Sheffield. [Last accessed November 22].