Ross Walker considers the dangers associated with antimicrobial resistance (AMR).
Antimicrobials are crucial for safe and effective dental treatment in certain situations. They are designed to prevent, disrupt and destroy pathogens, reducing the risk of infection. However, overuse or incorrect use of antimicrobials is exacerbating the threat of antimicrobial resistance (AMR), so it is important that dental professionals understand the risks and are aware of the protocols or products available to help.
The global threat of AMR
AMR has become a major concern around the globe. The urgency of the situation comes from the potential for bacteria, viruses, fungi and parasites to change in a way that makes them impervious to the drugs and medicines that were previously used to destroy them. In particular, certain pathogens have developed a level of immunity to antibiotics, which render traditional treatment useless and put people at risk of serious harm to their health. The World Health Organization (WHO) states that common bacterial infections such as urinary tract infections, sepsis and sexually transmitted infections, as well as mycobacterium tuberculosis (TB), now show high rates of resistance to the antibiotics once used to treat them. Drug-resistant HIV is also becoming a growing concern, alongside the threat of malaria due to drug-resistant parasites.
According to the UK Health Security Agency, the reported number of severe antibiotic resistant infections rose by 2.2 per cent between 2020 and 2021 in England. Prior to the pandemic – which led to increased antibiotic prescriptions – this figure was increasing by more every year.
The impact of AMR is significant and far-reaching. A systematic review in The Lancet estimated that 1.27 million deaths worldwide were the direct result of AMR in 2019, with a further 4.95 million deaths associated with AMR. In Europe alone, one study calculated the financial cost of extra or prolonged hospital stays to treat those with resistant infections to be in excess of €62 million (approximately £53 million).
The main causes of antimicrobial resistance are systematic misuse and excessive use of the drugs, so understanding the processes involved and ensuring appropriate prescribing are essential to tackle the problem. Dental professionals have an important role to play in both areas. Not only can you educate patients and raise their awareness of the issue, but you can also help ensure appropriate prescription of antimicrobials by healthcare professionals. Though ESPAUR found that dentistry only accounted for approximately 4.3 per cent of total antibiotic prescriptions in 2021, it’s essential that we continue or even accelerate the current downward trend in overall antibiotic consumption.
Best practice protocols
Professional guidelines are available for clinicians that promote best practice protocols and support individuals in the appropriate use of antimicrobials. One of the most recent is the ‘Antimicrobial prescribing in dentistry’ from the Faculty of General Dental Practice (FDGP) and the Faculty of Dental Surgery. This document highlights the importance of utilising these drugs as an adjunct to other management techniques for oral infections or on a short-term basis to prevent infections after specific dental procedures. It also suggests there may be a need to use antimicrobials if treatment is temporarily delayed due to referral pathways or appointment waiting times.
Of equal importance for clinicians is remaining up-to-date with the latest recommendations regarding when antimicrobials should be used. A growing body of evidence suggests that antibiotics may not be necessary in some of the procedures that dentists commonly prescribe them for. For example, Yue Ti et al found that antibiotics were not associated with lower post-operative infection rates after tooth extractions, despite many dentists prescribing the drugs in such a situation.
It is not just antimicrobial prescriptions in dentistry that contribute to AMR – some of the oral hygiene products like mouthwashes used before, during and after dental treatment also play a part. Buxser et al found increased resistance to chlorhexidine among certain pathogens, including Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii. Though more research is needed in the area, questions remain about the future of chlorhexidine as an antimicrobial in dentistry.
For this and other reasons, many leading UK clinicians are turning to an alternative mouth rinse, Clinisept+ Dental Mouthwash – which is not subject to anti-microbial resistance. Clinisept+ contains a unique, next generation hypochlorous solution that provides exceptional microbial control, yet has a neutral pH and is completely safe for dental enamel and oral mucosa. Clinisept+ is also on-toxic, anti-inflammatory, non-irritant and hypoallergenic, and contains no alcohol for superior patient comfort and peace of mind.
Staying in control
The prevention of infection is important to ensure patients receive the best possible dental treatment. Microbial control is essential for this and dental professionals can achieve this safely – and without contributing to the growing threat of antimicrobial resistance – with the right protocols and products.