Antimicrobial resistance (AMR) is considered one of the biggest threats facing human health. There are concerns that it could kill more than 10 million annually worldwide by 2050 if no action is taken.
Closer to home, rising rates of resistance will mean patients suffer longer illnesses as infections become more difficult to treat, with an increase in the number of deaths from resistant infections.
describing what they intended to do to halt the emergence and spread of resistance between now and 2024.
But what role does the dental profession have in minimising the problems associated with AMR?
Prescribing by dentists in the UK
Factors underlying the use of antibiotics by dentists
The reasons why dentists may prescribe an antibiotic when one is not indicated are complex. Whilst most practitioners would recognise that acute conditions are best managed by local operative treatment, there are instances where the practicalities of this can prove challenging.
We recognise that clinical time pressures, patients’ unwillingness to undergo surgical interventions, and requests for antibiotics, can all influence prescribing decisions.
Similarly, there can be instances where local measures fail, or where a patient is unable to cooperate with treatment, which can leave clinicians searching for another course of action.
What can dentists do in the fight against AMR?
Firstly, preventing dental problems arising in the first place will mean there is less need to use antibiotics, and therefore a lower risk of resistance.
This means providing evidence-based preventive interventions, such as fluoride varnish, fissure sealants, and smoking cessation advice when indicated, to prevent dental caries and periodontal disease.
Secondly, we need to use existing antimicrobials only when there is a clear clinical need. There is some evidence that progress towards this has already begun in dentistry.
The last decade has seen a fall in the number of antibiotics prescribed by dentists of 19.7% in England and 22% in Wales.
However, it’s not just about when to prescribe, it’s about what to prescribe too. In an audit of antimicrobial prescribing by general dental practitioners in Wales, nearly a fifth of antibiotics prescriptions were for incorrect doses, frequency or duration
Of particular concern was the number of excessively long courses of antibiotics (>5 days).
Since the longer the course of antibiotics, the most likely it is that resistance will occur, all practitioners should be encouraged to refer to clinical guidelines, such as those published by the Scottish Dental Clinical Effectiveness Programme
or the Faculty of General Dental Practice (FGDP)
Thirdly, it’s important that as a profession we try and involve patients and the public, making sure they not only understand what AMR is, but take ownership of the issue and solutions.
This is likely easier to be said than done, but one potential way of doing this may be to engage patients in a conversation about the appropriate use of antibiotics in dentistry before they present with an acute condition.
We really need to encourage patients to go to see a dentist if they have a dental infection, rather than going to a GP or to A&E, where it’s likely they’ll be prescribed antibiotics, and just referred back to a dentist for treatment.
Dr Anwen Cope, Specialty Trainee and Honorary Lecturer in Dental Public Health
Cardiff and Vale University Health Board
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