Think before you prescribe: how dentistry contributes to antibiotic resistance

Abstract

Antibiotic resistance presents a daunting challenge to health professionals worldwide and has the potential to create major problems for modern health care, resulting in more medical expenditure, extended hospital stays and increased morbidity and mortality. Advanced genome sequencing technologies present a complex picture of resistance, extending our understanding beyond the pharmacotherapeutic interface between pathogens and antibiotics. This review discusses the global scope and scale of antibiotic resistance and contextualizes it for the dental practitioner, emphasizing the role we must play in limiting the progression of resistance through antibiotic stewardship and disease prevention.

Antimicrobial Prescription Habits of Dentists Performing Dental Implant Treatments in Santo Domingo, Dominican Republic

“…On the other hand, the risk of these undesirable effects is cumulative and related to increased exposure [ 16 ]; this overprescription promote the proliferation of antibiotic-resistant bacteria [ 10 , 13 , 15 , 17 , 18 ]. Moreover, it has been reported that 66% of antibiotics prescribed in connection with dental procedures are not clinically indicated [ 19 ] because bacterial cultures and sensitivity tests are rarely performed; therefore, broad-spectrum antimicrobials are prescribed as a result of non-evidence-based assumptions [ 20 ]. This proves all the more important when it is estimated that 10% of antimicrobials are prescribed by dentists [ 21 ].…”

Discrepancy in Therapeutic and Prophylactic Antibiotic Prescribing in General Dentists and Maxillofacial Specialists in Australia

“…Systemic complications with antibiotic usage include anaphylaxis, development of resistant strains, interaction with other medicines, and side effects, including nausea, vomiting, diarrhea, and pseudomembranous colitis [ 22 , 31 ]. These adverse effects are a major cause of morbidity and mortality for patients [ 11 , 36 ]. The frequent comment from practitioners of ‘better healing’ associated with the use of antibiotics noted in this survey may reflect a tendency to prescribe antibiotics, despite risks of adverse effects, in an attempt to aid wound healing post-surgery.…”

“…Defined as the appropriate, safe, and discriminate use of antimicrobials for therapy and prophylaxis, antibiotic stewardship has been championed by governments, international health organizations, and initiatives to reduce issues associated with antibiotic-resistant pathogens [ 4 , 11 ]. With regards to following the principles of antibiotic stewardship, dental practitioners may be falling short.…”

“…With regards to following the principles of antibiotic stewardship, dental practitioners may be falling short. A reported 66% of antibiotics prescribed in a dental setting are not clinically indicated [ 11 ]. In the present study, one-third of practitioners prescribed antibiotics routinely for third molar surgical extraction.…”

“…Dental practitioners prescribe antibiotics for both therapeutic and prophylactic reasons. However, indications for antibiotic treatment in dentistry are limited, as the majority of dental infections can be treated effectively with direct operative measures [ 2 , 4 , 7 , 11 ]. Reliance on antibiotic therapy alone, particularly when using broad-spectrum rather than specific antibiotic agents, may not only result in a failure to control an infection, but it also risks the development of resistant bacterial strains and associated adverse effects for the individual patient [ 1 , 2 ].…”