NHS dentistry and oral health update: dentistry and antimicrobial resistance (AMR)

24 November 2021
4 min read

Sara Hurley, chief dental officer England, and Professor Dame Sally Davies, UK special envoy on antimicrobial resistance, recently provided an NHS dentistry and oral health update with a focus on antimicrobial resistance.

They write, “Every corner of our health system depends on antibiotics but the increasingly alarming issue of antimicrobial resistance (AMR) - and its most serious form, antibiotic resistance - is a silent pandemic that is growing in the shadows.

Antimicrobial Awareness Week presents an opportunity for reflection on what we can all do to avoid the further emergence and spread of drug-resistant infections. The almost four per cent increase in hospitalisations from serious antibiotic-resistant infections from the previous year is highly concerning, and failing to urgently tackle the root cause of this issue could result in ten million deaths every year, globally, by 2050.

“Healthcare professionals, and dentists in particular, will be crucial to preventing further increases in these statistics by ensuring they play their part to reduce inappropriate antibiotic use. Between 2016 and 2020, primary care NHS dentists in England prescribed 10.3 per cent of all antimicrobial prescription items in the whole of NHS primary care.

“Prioritising the need to address this problem becomes even more imperative as we consider the impact the Covid-19 pandemic has had; during 2020, dentistry was the only discipline within the NHS to see an increase (rising by 22.1 per cent between 2019-20) in prescriptions for antibiotics. 

“The move to providing emergency dental care through local triage led urgent dental care pathways, where patients were managed remotely as much as possible with advice, analgesia or antimicrobials (AAA), was a vital element during the initial phase of the national response to the pandemic in the summer of 2020.

“We trust our healthcare professionals to use their clinical judgement when applying guidance around patient management. As you know, as service levels have increased the need for AAA has been limited for some time. Urgent care should be prioritised over less urgent work, as has previously been communicated to you and AAA is not an excuse for not providing the quality of care to patients which our professional standards, and the NHS contract, expect.

“Included within this bulletin are several tools and resources that have been created for dentists, and healthcare professionals more broadly, to help ensure best practice on prescriptions for antibiotics is followed. These include the Antimicrobial Prescribing in Dentistry Good Practice Guidelines, a self-audit tool for clinicians to review how their prescribing aligns with the guidelines and the dental Antimicrobial Stewardship toolkit.

“There are also training courses and studies that are available to help keep up to date on the most recent recommendations for ways of working. 

“It is recognised and appreciated that dental professionals have done sterling work in reducing the use of unnecessary antibiotics in the years prior to the pandemic, for example dental hospitals in England saw a decreasing trend of 15.3 per cent between 2016 and 2019. 

“We need to get this great work back on track so that, as a profession, dentistry continues to fight the threat of global antibiotic resistance.

“We recently celebrated National Dental Nurses Day. We are all very grateful for every dental nurse's hard work and continued dedication to dentistry and oral health.”

Good practice guidelines 
Sara and Sally then highlight ‘The good practice guidelines’, which were updated in December 2020. They affirm, “The guidance is clear that antimicrobials should only be used when there is a strong clinical indication to do so, and the guidelines provide a helpful resource to support dentists to prescribe appropriately and responsibly.”

The full Good Practice Guidelines can be accessed here.

Following this, they also touch on the role of self-auditing. They explain, “It is important to recognise the crucial role that dentists have in tackling antimicrobial resistance. As a reminder, a clinical tool does exist to help dentists do a simple self-audit for their own antibiotic prescribing actions and can also be used for a more comprehensive review of the management of dental infections. 

“Auditing can be done using the new Good Practice Guidelines previously mentioned as the standard against which to compare their practice.  This is a great opportunity for dentists to check whether they are prescribing in line with current recommendations and to reflect on how they can continually improve the care they provide to patients. “

The audit tool can be accessed on the College of General Dentistry website.

The dental antimicrobial stewardship toolkit
In addition, they also share ‘The dental antimicrobial stewardship (AMS) toolkit’, which was developed to promote responsible use of antimicrobials to help control bacterial resistance. The toolkit aims to influence prescribers and patients attitudes to encourage good practice in antibiotic prescribing.

The toolkit includes:

  • A patient information leaflet, with the messaging that ‘antibiotics don’t cure toothache’. The leaflet advises patients on the numerous issues that can create dental problems, and makes clear that dental treatment is usually always needed alongside the use of antibiotics.
  • An antibiotics guardian poster, which summarises the content in the patient information leaflet and can be displayed in dental surgeries.
  • Information on the 'Keep Antibiotics Working' This includes further resources, shared learning, and webinars on antibiotics for healthcare professionals and the general public. The campaign also includes a call to action for healthcare professionals and the public to pledge to make better use of antibiotics.

It is worth noting that whilst the ‘Keep Antibiotics Working’ campaign, which is in its second year, is not specific to dentistry, it is a useful tool for highlighting to the public the risks of taking antibiotics inappropriately and the potential impact of antimicrobial resistance. 

The toolkit can be found here.

The United Nations
The update also shares information on the ‘Antimicrobial resistance and the United Nations sustainable development cooperation framework’. They explain, “The newly published UN guidelines on antimicrobial resistance is worth a read for those interested in the potential wider impact antimicrobial resistance could have on the world. It outlines the detrimental effect it will have on areas of global health, food safety and security, economic growth, poverty alleviation and the environment. 

“To find out what action the UN and countries are taking to tackle AMR, and the current barriers to tackling this problem effectively, the full framework can be accessed here.”