Antibiotic resistance – an updateUncategorised
Posted by: Dental Design 15th June 2020
Antibiotics are a crucial part of almost all aspects of modern medicine. They allow us to treat infections that were once fatal and safeguard procedures that were previously unthinkable. The availability of antibiotics has created an assurance of health which we now take for granted. However, we currently face a global crisis as antibiotics are being rendered ineffective due to the ability of bacteria to develop resistance. According to a report published by the Interagency Coordination Group on Antimicrobial Resistance (IACG), drug resistant infections kill at least 700,000 people a year and could kill 10 million people per year by 2050 without a sustained effort to contain antimicrobial resistance.[i]
It is widely understood that bacteria have a natural ability to adapt, which means that a certain level of antimicrobial resistance (AMR) is to be expected. Nevertheless, persistent misuse and overuse of antibiotics in humans and animals means that the pace of resistance has accelerated. Therefore, as we move forward in this new decade, governments, academics, the life sciences industry, international health agencies and healthcare providers are being asked to prioritise the AMR challenge with a co-ordinated global response.
It is imperative to push investment and incentives forward to advance and develop new antimicrobial medicines, safe and effective alternatives to antimicrobials, diagnostics, vaccines, waste management, alternative practices and research into human, animal and plant health.i Over the last decade, international agents have developed strategies and guidance that identify and recommend evidence-based interventions and, in 2017, the AMR Industry Alliance was established to drive progress on AMR.
The AMR Industry Alliance is committed to action in four key areas: research and science, access, manufacturing and appropriate use. It ensures that investment is focused on the research and development of advanced diagnostics and AMR-relevant products including antibiotics and antifungals, as well as novel approaches, innovation, vaccines, diagnostic platforms and assays to address microorganisms that pose the greatest threats to human health. Activities are underway to address supply chain challenges and implement both systems and controls to build supplier capacity and strengthen stocks of vaccines / antimicrobials. The AMR Industry Alliance is also working hard to raise awareness and prevent substandard or fake medical products from being supplied on the black market, which can contribute to the spread of drug-resistant infections and endanger patients. In addition, the alliance has set up a new manufacturing framework and is successfully meeting targets to reduce the environment risks posed by antibiotics in waste-water emissions from factories and manufacturing plants. Furthermore, the AMR Industry Alliance is working with governments and public health agencies to support programmes and initiatives aimed at patients, clinicians and the public to promote the safe and appropriate use of antimicrobials.[ii]
Antibiotics make up the vast majority of medicines prescribed by dentists and account for 7 percent of all community prescriptions of antimicrobials.[iii] Although this represents a relatively small proportion of prescriptions it is, however, significant. Antibiotics such as amoxicillin, penicillin, metronidazole, amoxicillin and clavulanate are commonly prescribed to manage orofacial pain, infections and inflammatory conditions. However, the National Centre for Disease Control and Prevention estimates that approximately one-third of these prescriptions may be unnecessary.[iv] Moreover, the Faculty of General Dental Practice (FGDP) UK also state that there is increasing evidence of the inappropriate use of antimicrobials in dentistry which may contribute to antimicrobial resistance.[v]
Practitioners prescribe antibiotics for treatment and the prevention of infection. Despite this, it has been confirmed that clinical situations that require antibiotic therapy are limited. Pulpitis and periapical periodontitis, for example, are common dental infections that require fillings, root canal therapy or extraction if the tooth is not restorable, yet some dentists still prescribe antibiotics for these conditions. In most cases, dental and periodontal diseases are best managed by operative intervention or more ideally, oral hygiene measures. iv
As always, prevention is key. By showing patients how to achieve and maintain optimum oral health, dental professionals can contribute considerably to the prevention of disease and in turn, slow down the pace of antimicrobial resistance. To perform a thorough oral hygiene routine, patients are advised to brush twice a day with a fluoride toothpaste and to clean interdentally each day. Of course, some patients find flossing tiresome or difficult, but Waterpik® have developed a range of oral health care products to make flossing easy and effective for everyone. The Waterpik® Water Flosser is accredited by the Oral Health Foundation and is likely one of the most thoroughly researched and tested home care products on the market. Certainly, clinical studies prove that when used as an adjunct to toothbrushing, the Waterpik® Water Flosser is more effective for removing plaque and for reducing gingival inflammation and bleeding than both string floss [vi]and interdental brushes.[vii]
All dental professionals have a statutory duty to reduce the risk of antimicrobial resistance. Firstly, by ensuring the appropriate use of antibiotics and secondly, by providing education and oral health instruction to help patients prevent dental decay and disease.
Waterpik® products are available from Amazon and
in store or online at Asda, Boots and Superdrug.
Author – Maxwell O’Neill, professional educator for Waterpik
[i] Interagency Coordination Group on Antimicrobial Resistance (IACG) Report to the Secretary-General of the United Nations. No time to wait: securing the future from drug resistant infections. April 2019. https://www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG_final_report_EN.pdf?ua=1 [Accessed 31st March 2020]
[ii] AMR Industry Alliance. AMR Industry Alliance 2020 Progress report. January 2020. https://www.medicinesforeurope.com/wp-content/uploads/2020/01/AMR-Industry-Alliance-2020-Progress-Report-Prepublication-Copy_embargo-til-16Jan2020.pdf [Accessed 31st March 2020]
[iii] Sweeney L.C Antibiotic resistance in general dental practice – a cause for concern? J Antimicrob Chemother. 2004 Apr;53(4):567-76. https://www.ncbi.nlm.nih.gov/pubmed/14985274 [Accessed 31st March 2020]
[iv] Saeed dar-Odeh N. et al. Antibiotic prescribing practices by dentists: a review. Ther Clin Risk Manag. 2010; 6: 301–306. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909496/#b3-tcrm-6-301 [Accessed 31st March 2020]
[v] Faculty of General Dental Practice (FGDP) UK. Prescribing Antimicrobials. Antimicrobial Prescribing or General Dental Practitioners, chapter 3. 2014. https://www.fgdp.org.uk/antimicrobial-prescribing-standards/prescribing-antimicrobials#Prescribing%20Antimicrobials [Accessed 31st March 2020]
[vi] Barnes C.M. et al Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent. 2005;16(3):71-7. https://www.ncbi.nlm.nih.gov/pubmed/16305005 [Accessed 31st March 2020]
[vii] Goyal C.R. et al. Comparison of water flosser and interdental brush on reduction of gingival bleeding and plaque: a randomized controlled pilot study. J Clin Dent 2016. 27: 23-26. https://www.ncbi.nlm.nih.gov/pubmed/28390208 [Accessed 31st March 2020]
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