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Antibiotics: Years of progress undone

We have warned that ongoing difficulties in accessing dental services risk fuelling the parallel health crisis of antibiotic resistance, as new data from the UK Health Security Agency shows a surge in dental prescriptions for antibiotics.

While all other healthcare settings recorded further drops in antibiotic prescribing, the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report shows dentistry alone saw an increase of almost a fifth in 2020. However, patient volumes fell by more than half that year. COVID restrictions radically reduced patient numbers, and staff were advised to adopt an 'AAA' model during the first lockdown – Advice, Analgesics or Antibiotics.

Reflecting on these challenges ahead of Antibiotic Awareness Week, BDA Chair Eddie Crouch said: "Antimicrobial resistance poses an even greater threat to human health than COVID. Sadly, the pandemic has wiped out years of progress in bringing down antibiotic use in dentistry. Placeholder prescriptions are now filling deficits in access and time, which the government has chosen not to factor in. Ministers have a responsibility to help dentists turn the page."

We have stressed that the Government must do more to increase access sustainably and ensure patients – particularly urgent cases – have the time for operative interventions to ensure they are not offered antibiotics as a placeholder. The current target-based NHS contract in operation in England has long represented a key barrier to progress.

Antibiotic prescribing in the NHS dental settings had been steadily decreasing from 2016 to 2019 (0.16 and 0.13 items per 1,000 inhabitants per day respectively, -18.4%). This decline was interrupted in 2020 with an increase of 17.6% reported (from 0.13 to 0.15 items per 1,000 inhabitants per day).

A failure to address the problem of antibiotic resistance could result in ten million deaths, every year, globally by 2050. As the pandemic continues and into the future, the BDA has stressed it is essential that dentists are supported to once again reduce the rate of antibiotics prescribed.

Dental teams are encouraged to use best practice and prescribe antibiotics only when indicated according to national guidelines: