Since the discovery of Penicillin in 1928, antimicrobials became an integral part of medicine and saved millions of lives over the years. However, after decades of reliance on antibiotics, we now face a growing public health threat due to the increasing risks of antimicrobial resistance (AMR). Fuelled by excessive use (and abuse) of antibiotics in human and veterinary medicine as well as agriculture, AMR is now has recognised by the World Health Organization (WHO) as one of the top 10 global public health threats facing humanity1. An estimated 4.59 million deaths were linked to bacterial antimicrobial resistance (AMR) in 2019, positioning it as one of the leading causes of death worldwide2. Although AMR can affect all individuals, the morbidity and mortality associated with AMR are particular concerns in hospitalised patients and translate into a heavy cost to the economy.

The threats of AMR are recognised by the government and the UK’s 20-year vision for AMR centres on optimising the use of antimicrobials in humans by achieving further improvements in prescribing behaviours3. The English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report 2022-23 shows that there was a 5.3% reduction in the use of antibiotics from 2018 to 2022 in primary and secondary care settings in England4. Although a reduction in antibiotic prescriptions is a positive trend, to curb the tide of AMR, contemporary medicine must continue to advance and maintain treatment options. Without such progress, infections related to surgical procedures and cancer chemotherapy could become a significant threat, potentially rendering these interventions unfeasible.

The British Dental Association continues to work on reducing the risks of AMR in dental settings and it is estimated that dentists contribute to up to 10% antibiotic prescriptions in primary care settings in the UK5. The main category of antimicrobials prescribed by dentists in primary care are antibiotics, while anti-fungal and anti-viral medications are prescribed less frequently. A study on prescriptions by dentists in England showed that dental prescriptions accounted for 10.8% of all oral antibiotic prescribing, 18.4% of amoxicillin and 57.0% of metronidazole prescribing in primary care settings6. A fundamental message which needs to reiterated is that antibiotics are not a suitable treatment option for most dental problems and their use must be restricted to specific clinical situations. Also, antibiotics should not be used as a bail-out option for sub-optimal operative management of dental disease. The guidance by the Scottish Clinical Dental Excellence Programme (SDCEP) is a useful resource to facilitate informed decision-making regarding antibiotic prescriptions in clinical dental practice7.

A particular situation in clinical practice which may prompt dentists to prescribe antibiotics is the emergency management of patients with acute dental pain and infection. Limited appointment time, difficulty in obtaining effective local anesthesia, and patient expectations to receive antibiotics may contribute to inappropriate prescptions8,9. Contemporary clinical guidelines advise against antibiotic prescription for acute dental pain of pulp origin. Similarly, localised dental infections such as dental abscesses are best managed by achieving drainage using appropriate means such as root canal access opening or tooth extraction10. On the other hand patients with signs of spreading infection with systemic involvement and/or risks to the airway should be referred immediately to secondary care hospital settings for evaluation and management as inpatients.

Dental professionals must continue to demonstrate a commitment to prevent inappropriate use of antibiotics in their own settings to reduce the risks of AMR. The antibiotic guardian site at https://antibioticguardian.com/ provides useful resources on prevention of antibiotic resistance including materials for patient education. Improving public behaviours on maintenance of oral hygiene and prevention of dental disease remains the most fundamental strategy to combat the risks of acute dental infection and potential misuse of antibiotics. Dentists are encouraged to actively educate their patients on the risks of AMR with the aid of patient information leaflets, and posters. These may be made available in the dental practice and also shared on dental practice websites. Disseminating risks of AMR to patients can help to achieve responsible and judicious antibiotic prescriptions. Other measures include routine clinical audit on antibiotic prescriptions in general dental practice, continuing professional development activities, and developing clear referral pathways in collaboration with maxillofacial departments at local hospitals. Tackling AMR is challenging and requires perseverance, commitment, vigilance and a shared sense of responsibility to ensure that the bugs do not outsmart humans!