Key Themes:
This editorial in the Journal of Dental Research highlights the critical yet often underestimated role of dentistry in addressing the global emergency of antimicrobial resistance. The authors emphasize the significant contribution of dental antibiotic use to the overall problem and advocate for integrating oral health into global and national antimicrobial resistance strategies. The piece underscores the need for prevention, appropriate antimicrobial stewardship in dental practice, and universal access to oral healthcare to preserve the efficacy of antibiotics for the future.
Most Important Ideas and Facts:
The Historical Significance of Antibiotics and Dentistry:
The editorial begins by acknowledging the transformative impact of antibiotics and modern dentistry. It notes that “before antibiotics and modern dentistry, dental problems were among the most common causes of death.” This historical context underscores the importance of preserving the effectiveness of these life-saving drugs.
The Gravity of the Antimicrobial Resistance Crisis:
The authors outline the dire consequences of antimicrobial resistance, citing WHO and World Bank estimates. They state, “In 2019, antibacterial-resistant infections alone were responsible for more deaths than HIV and malaria.” They also project that “by 2050, deaths due to antimicrobial resistance are projected to surpass cancer, exceeding 10 million annually.”
Dentistry’s Contribution to Antibiotic Use and Antimicrobial Resistance:
The editorial emphasizes that “Dentistry is responsible for an estimated 10% of antibiotic use across human health care and thus has a critical yet often overlooked role to play in tackling the development and spread of antimicrobial resistance.” This highlights the significant impact of dentistry on the overall landscape. The authors also note the use of antiseptics in dentistry as a contributing factor.
Inappropriate Antibiotic Prescribing in Dentistry:
Research indicates a high rate of unnecessary antibiotic use in dentistry. “Research highlights that up to 80% of antibiotic prescribing in dentistry is unnecessary or inappropriate. They define unnecessary as aligning with guidelines for acute conditions or for the prophylaxis of infections during dental procedures.” This signifies a major area for intervention and improvement.
The Importance of Prevention and Access to Oral Healthcare:
The authors argue that preventing dental infections is crucial in reducing the demand for antibiotics. “Universal access to oral health services is therefore a crucial element in global antimicrobial resistance efforts. This ensures that antibiotics are used only when strictly necessary. Reducing dental disease lowers the demand for antibiotics and hence the development and spread of resistant bacteria.” They advocate for upstream measures such as reducing sugar intake and promoting oral hygiene.
WHO’s Recognition and Efforts:
The editorial highlights the WHO’s Global Action Plan on antimicrobial resistance and its emphasis on using antimicrobials only when strictly necessary. It also mentions the WHO’s 2023 “people-centered approach” which focuses on access to healthcare for infection prevention, diagnosis, and treatment. The WHO’s Global Oral Health Strategy and Action Plan (2023–2030) is also mentioned as supporting global antimicrobial resistance efforts through antibiotic stewardship and strengthened oral health systems.
International Collaboration and Advocacy:
The editorial notes the joint side meeting on antimicrobial resistance co-hosted by the International Association for Dental, Oral, and Craniofacial Research and the FDI World Dental Federation during the WHO Global Oral Health Meeting in Bangkok in November 2024. It also mentions the FDI’s statement at the 2024 United Nations General Assembly, emphasizing the need for universal access to oral healthcare, awareness that antibiotics don’t cure toothache, and integration of oral health into policies.
Future Directions and Research Needs:
The WHO’s priority research agenda for antimicrobial resistance, encompassing prevention, diagnosis, and treatment, is mentioned. Furthermore, the upcoming policy statement on antimicrobial resistance from the International Association for Dental, Oral, and Craniofacial Research in 2025 is highlighted as a means to guide research and support the oral health profession in addressing this global emergency.
Clinical Management vs. Antibiotics:
The authors point out that “While most dental infections can be managed through clinical procedures without antibiotics…,” emphasizing the importance of prioritizing these interventions and reserving antibiotics for strictly necessary cases.
Quotes:
- “Antibiotics save lives. Thanks to antibiotics and access to oral health care, dental infections are now seldom life-threatening.”
- “Today, antibiotics are recognized as strategic assets underpinning modern medicine. Without effective antibiotics, cancer treatment and organ transplant will be unsafe and common infections increasingly untreatable.”
- “Antimicrobial resistance is a global public health and socioeconomic priority…ranked among the WHO’s top 10 threats.”
- “Dentistry is responsible for an estimated 10% of antibiotic use across human health care and thus has a critical yet often overlooked role to play in tackling the development and spread of antimicrobial resistance.”
- “Research highlights that up to 80% of antibiotic prescribing in dentistry is unnecessary or inappropriate…”
- “Universal access to oral health services is therefore a crucial element in global antimicrobial resistance efforts, ensuring that antibiotics are used only when strictly necessary.”
Conclusion:
This editorial effectively argues that the dental profession has a significant responsibility and opportunity to contribute to the fight against the global antimicrobial resistance emergency. By highlighting the volume of antibiotic use in dentistry, the potential for inappropriate prescribing, and the importance of preventive care and universal access, the authors urge for greater integration of oral health into global and national antimicrobial resistance strategies. The piece underscores the need for continued research, policy development, and a shift towards antimicrobial stewardship within dental practice to preserve the effectiveness of antibiotics for future generations.
