The Department for Health in Northern Ireland has been consulting on a 5-year action plan on AMR and representatives from BDA Northern Ireland attended a workshop last September to discuss their plan and provide feedback.
That plan is now part of the UK-wide 5-year national action plan and 20-year vision for tackling AMR, which was launched last week and the BDA responded to that.
For dentistry, we know that improving stewardship through prevention; allowing dentists enough time to discuss treatment options with patients; appropriately funded urgent care and in- and out-of-hours' time, investment in clinical audit, education in the dental sector, and IT infrastructure, as well as action to reduce the waiting lists for GA extractions, are all required to lessen the impact of antibiotic resistance in the future.
What do we know about dentistry in Northern Ireland to help reduce AMR?
Northern Ireland has some of the worst levels of oral health amongst the UK and this is an issue which needs tackling.
In our response to the Department of Health in September, we highlighted the importance of reducing infections, to combat the need for antibiotics, as being especially relevant in a dental context.
The high levels of tooth decay in Northern Ireland means a knock-on problem in terms of patients presenting with infected teeth.
The rate for GA extractions for children is three times higher (pro rata) than for children in England. Sadly, a percentage of those will have been given antibiotics to treat infections, which could have been totally avoided.
Long waiting lists, particularly in the Belfast area, have meant children needing to be given antibiotics to manage the problem rather than promptly treat. This again, all could be avoided.
We are calling for protected and appropriately funded urgent treatment time to allow dentists to establish a diagnosis and provide the appropriate interventive treatment.
Ensuring dental patients understand what antibiotics will, or won't, fix
We know it's important that patients and the public understand the importance of restricting the use of antibiotics, and the choices made for the management of dental pain which doesn't necessarily require antibiotics.
There may also be instances where a patient has already been assessed by a dentist and not prescribed an antibiotic but then presents at a GP out of hours with dental pain and requests an antibiotic.
We'd like to see a campaign specifically focused on dentistry, raising awareness of the need to regularly see the dentist, to avoid the need for urgent treatment, and to highlight the message that 'antibiotics don't cure a toothache'.
We've also called on the Department of Health to provide additional investment into prevention initiatives to improve the oral health of the whole population, with a focus on pre-school children and the elderly.
Monitoring prescribing patterns
The dental profession has a role to play in the fight against AMR but the current barriers to reducing inappropriate prescribing must be addressed.
The UK rates for prescribing antibiotics via dentistry are falling. Dentistry accounts for a small part of prescribing, but we know it's still an important one.
The Department of Health have proposed gathering data on dentists' prescribing behaviour. We have concerns about this and have highlighted that this type of data should not be used in a punitive manner, more as a marker to encourage appropriate prescribing and to highlight the issues of patients' needing antibiotics as a stopgap whilst waiting for hospital extractions, or to get a dental appointment.
The DH is keen to promote dental practice-based clinical audits of antimicrobial prescribing, through clinical audit or peer-review schemes for GDS dentists.
Alongside partners at the FGDP, we have produced a prescribing toolkit, with the aim of self-auditing your prescribing patterns, using the current guidance.
We believe clinical audits are a good idea, but GDPs must be eligible for funding support to participated in these, as it is time away from treating patients and impacts on business sustainability.
A lack of investment in IT
The issues with our IT systems not being joined-up, hamper efforts to collate this type of data in a meaningful way. In fact, dental health service prescriptions are still done in hard copy written form. Without the ability to prescribe electronically, dentists are being left out in the cold when it comes to relaying data quickly and effectively to their Health Boards.
Investment needs to be made into ensuring dentists have access to appropriate IT infrastructure.
Can we make the plan a reality?
We believe in a joined-up approach, across the healthcare professions, to combat the problem of AMR.
Our overarching ask to the Department of Health is the need to ensure a more balanced-approach to tackling AMR, by incorporating additional actions aimed specifically at 'reducing infections', particularly in the dental context.
With no updated oral health strategy in place (something we have been calling for, for several years), we are simply using a sticking plaster approach and failing dental patients.
We fully support a joined-up, properly funded plan to tackle AMR in Northern Ireland over the next 5 years. We hope to work with the Department of Health, to make the plan a reality.
Roz McMullan, Chair BDA Northern Ireland Council
BDA Northern Ireland
BDA Northern Ireland supports, represents and promotes, the interests of all dentists working in Northern Ireland. Working with elected committee members, we negotiate on behalf of the profession on terms and conditions, pay and contracts. Join us.