FDI World Dental Federation

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Iveta Ramonaite, Dental Tribune International

Wed. 11. September 2024

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Antimicrobial resistance (AMR) is an increasingly critical global health issue. According to the World Health Organization (WHO), bacterial AMR was directly responsible for 1.27 million deaths and contributed to 4.95 million deaths globally in 2019. In this interview, Dental Tribune International speaks with Dr Wendy Thompson, who is a dentist and chair of FDI’s Preventing AMR and Infections Task Team. Dr Thompson shares insights on the vital role antibiotics play in modern dental practices, the dangers of overprescribing and the urgent need for stewardship within the dental community. She also discusses the importance of preventive care, the responsibilities of dental professionals and the upcoming UN General Assembly meeting on AMR.

Dr Wendy Thompson is a clinical senior lecturer in primary dental care at the University of Manchester in the UK. (Image: Wendy Thompson)

Dr Thompson, you are one of the leading advocates for the safe and responsible use of antibiotics. Could you start by explaining the importance of antibiotics in dentistry and why it is crucial to use them only when needed?
Antibiotics are life-saving drugs when people really need them, and they must work effectively when required. They underpin modern medicine: without effective antibiotics, many procedures would simply be unsafe. Our modern way of life relies heavily on antibiotics, and we are already seeing life expectancies being reduced globally owing to antibiotic resistance. Dental infections can lead to sepsis, which is a significant concern. Therefore, ensuring that antibiotics work is crucial for patient safety.

Dentists are high prescribers of antibiotics, and misuse contributes to antibiotic resistance. Dentists have a vital responsibility to use antibiotics only when absolutely necessary. We are equipped and trained to treat dental infections early, identifying potential problems before they become infections through routine check-ups and preventive care. By nipping issues in the bud, we can prevent infections and thus reduce the need for antibiotics, keeping them effective for life-threatening situations, both dental and otherwise.

Globally, dentists are responsible for about 10% of antibiotic prescribing, and studies have shown that a significant proportion of these prescriptions are unnecessary. For example, studies in the US show that up to 80% of antibiotics prescribed by dentists are not necessarily needed. The situation can be even more pronounced in developing countries, where the impact of antibiotic resistance can be disproportionately severe. Infections do not respect boundaries, so this is a global issue. The adverse outcomes of antibiotics, such as anaphylaxis and Clostridioides difficile infections, highlight the need for judicious use of these drugs.

Repeated exposure to antibiotics promotes antibiotic resistance. Could you explain why this could be dangerous?
Repeated exposure to antibiotics is dangerous because each time you take an antibiotic, it kills susceptible bacteria, but some bacteria will always survive because they are not affected by that particular antibiotic. This can lead to overgrowth of resistant bacteria or fungi, such as thrush, which thrive when the susceptible bacteria are eliminated. For instance, C. difficile can colonise the gut after antibiotics clear out other bacteria, producing toxins that can cause severe illness or death. Similarly, if a patient with methicillin-resistant Staphylococcus aureus (MRSA) is given antibiotics, the susceptible bacteria are cleared out, leaving the resistant ones to proliferate, potentially leading to life-threatening infections.

WHO emphasises patient advocacy to explain AMR to the public. People often do not realise the true cause of death in cases where resistance has played a significant role. Vanessa Carter’s story is a poignant example of AMR. Her facial prosthesis failed due to a MRSA infection after multiple antibiotic treatments for various injuries. Her experience highlights the dangers of repeated antibiotic exposure.

You are the lead author of FDI’s white paper on dental antibiotics. What role does the dental team play in AMR, and how can they be better supported in tackling the issue?
The dental team’s role in tackling antibiotic resistance involves three key areas from WHO’s national action plan: raising awareness, preventing and controlling infections, and antibiotic stewardship. Firstly, raising awareness is crucial not only within our professional circles but also among the general population. All dental team members, including receptionists, should be knowledgeable about antibiotic resistance. They should be able to explain why antibiotics may not be the best solution and the risks involved, thus seeking to keep patients safe.

Secondly, preventing and controlling infections is about more than just disinfection and decontamination. Dental infections are common globally, and preventing them through good oral hygiene, dietary advice and timely dental care is vital. By treating issues early, we can avoid the need for antibiotics. During the COVID-19 pandemic, dentistry proved effective in infection control, showing that we are well equipped to handle such challenges.

“People often do not realise the true cause of death in cases where resistance has played a significant role.”

Lastly, antibiotic stewardship means prescribing antibiotics only when strictly necessary. This requires access to time and resources for proper dental procedures rather than resorting to antibiotics as a quick fix. WHO has guidelines for dental conditions that may need antibiotics, such as dental abscesses and noma—a neglected tropical disease that starts as gingivitis. Each country should tailor these guidelines to their specific context to balance risks and benefits effectively.

To make FDI’s white paper more accessible, we produced an interactive online course and a pledge committing to these principles for national dental associations to sign. We are currently analysing feedback from these associations to improve our approach further and will be presenting the results in the coming months.

This September, the UN General Assembly will hold its second high-level meeting on AMR, providing world leaders with the opportunity to address the threat of AMR to global health. Could you tell us a bit about the significance of this event and how it will contribute to reducing the spread of infections that are resistant to antimicrobial medicines?
The UN General Assembly’s involvement in AMR highlights its global importance. This is only the fourth health issue that the UN General Assembly has taken up, after HIV/Aids, Ebola and non-communicable diseases. The first high-level meeting on AMR in 2016 recognised the severe threat AMR poses to human health, animal health and the environment.

The 2024 high-level meeting will update the global action plan on AMR, emphasising a One Health approach that integrates human, animal and environmental health. This collaboration between WHO, the World Organisation for Animal Health, the UN’s Food and Agriculture Organization and the UN Environment Programme aims to address AMR comprehensively. Ensuring that oral health is included in this agenda is crucial, as dental infections and antibiotic use play a significant role in AMR.

How is FDI preparing for this meeting to ensure that oral health is included in the antimicrobial stewardship agenda?
FDI is working with various partners, including the World Medical Association and the World Health Professions Alliance, to ensure that oral health is part of the AMR agenda. We have had discussions with WHO to determine how best to contribute to this effort. At the UN high-level meeting, we will advocate for universal access to oral healthcare as a crucial component of AMR prevention and control.

We will also highlight the effectiveness of dental infection prevention and control measures and the need for proper guidelines to reduce unnecessary antibiotic use. Educating the public and healthcare professionals about the appropriate use of antibiotics in dental care is essential to combat AMR. By raising awareness and promoting best practices, we can play a significant role in reducing the spread of resistant infections.

Everyone has a role to play in tackling AMR. We must all work together to keep antibiotics effective for future generations.

Editorial note:

Dr Wendy Thompson will be one of the speakers in the session titled “Antibiotics are supposed to help, aren’t they? The risks and benefits of antibiotics in dentistry”, which will be held on Thursday, 12 September, from 11:30 to 12:30 at the 2024 FDI World Dental Congress. The session will take place in the Hisar hall on the Rumeli mezzanine floor of the Istanbul Lutfi Kirdar International Convention & Exhibition Centre. More information about the event can be found here.