World Antimicrobial Awareness Week: Recommendations for the Dental Profession

November 18 to 24 is World Antimicrobial Awareness Week (WAAW), an annual worldwide event that aims to increase awareness of antimicrobial resistance and to encourage best practices among the public, health care workers and policy makers to avoid the further emergence and spread of drug-resistant infections.

In the below video, Dr. Benoit Soucy, Chief Knowledge Officer at the Canadian Dental Association (CDA), offers a timely recap on the source and scope of this important issue and outlines how both individual dentists and the dental profession can be part of the solution.

Here are the key takeaways from the conversation:

ANTIMICROBIAL RESISTANCE

• Antimicrobial resistance occurs when agents that are used to kill bacteria, viruses and other microbial life only kill certain species and do not eliminate the entire microbial population. As a result, the bacteria that are most resistant are “selected” and can multiply and become common.
• When we use an antibiotic, we are making it easier for resistant bacteria to grow and take over, while bacteria that are sensitive to the antibiotic are eliminated.
• Because the generational life of bacteria is very short, they tend to mutate often. Sometimes these mutations can, by chance, generate resistance in the bacteria.
• There are concerns that some resistant traits are transferable. In other words, one species of bacteria could transfer resistance to another bacterial species by mechanisms that we do not fully understand.

GLOBAL APPROACH

• Best estimates from the World Health Organization (WHO) indicate that currently, approximately 700,000 deaths per year worldwide are a result of antibiotic resistance. WHO forecasts suggest that by 2050, that number could grow to 10 million deaths per year.
• The problem of Antimicrobial Resistance is often compared with climate change in that it is not an issue that will be solved locally. The intervention of a single country is not going to solve the problem. A global approach is required.
• This global approach must consider animals as well as humans. The biggest use of antibiotics globally is in animal husbandry (farming). This practice can create antibiotic resistance that can affect human beings. Intervention in any one sector alone will not solve the problem.

RECOMMENDATIONS FOR THE DENTAL PROFESSION

Follow Advice

• Stay up to date: Guidelines and review articles on antibiotic use for the dental profession are constantly published and updated. One of the most recent examples was published by the American Dental Association in September 2020.

Treat the Tooth, Not Only the Infection

• Although recommendations not to use antibiotics for the emergency treatment of acute periapical periodontitis in patients who show no signs of systemic infection have been around for more than 20 years, antibiotics are still often prescribed to knock down an infection and get the patient out of pain. But if the patient has been relieved from pain, they are less likely to return and have the tooth treated. Unfortunately, odontogenic infections treated with antibiotics can become acute again and require further antibiotic treatment until the source of the infection is removed.
• This misuse of antibiotics is often the result of access to care issues that drive patients to hospital emergency rooms that are not equipped to treat dental problems.
• It is essential to ensure that patients have good access to oral healthcare to prevent as many odontogenetic infections as possible. In cases where they still occur, these infections must be treated properly in the first instance.

Antibiotic Prophylaxis

• BACTERIAL ENDOCARDITIS – the number of conditions requiring antibiotic prophylaxis before dental treatment has been falling over the years. There are now only a handful of conditions that require the use of antibiotics.
• JOINT PROSTHESES – there are no pre-established conditions that make a patient more susceptible to a joint infection after an oral treatment. As such, there is no need for antibiotic prophylaxis in patients who have joint prostheses. In June 2016, a consensus statement stating exactly this, was approved by the Canadian Dental Association (CDA), the Canadian Orthopedic Association (COA), and the Association for Medical Microbiology and Infectious Disease Canada (AMMI).

Antibiotic Stewardship

• Antibiotic stewardship is the most important thing dentists can do as a profession to combat antimicrobial resistance. It is crucial that dentists know how to use antibiotics and that they have all the educational material that they need.
• A prescription audit, where an expert reviews the prescription practice of a health care professional and offers advice on how to improve it, is a proven way to reduce unnecessary antibiotic prescriptions that is underused. Prescription audits work best when conducted in a non-threatening way, outside of the regulatory framework, with the view to educate people and helping them learn in a constructive environment.
• INFORM PATIENTS – it can be difficult for a practitioner to say no to a patient who requests an antibiotic prescription. It is important that patients are educated on why antibiotics will not help their individual case.

HELPFUL LINKS

• American Dental Association: Antibiotic Stewardship
• Canadian Dental Association: Consensus Statement: Dental Patients with Total Joint Replacement
• FDI World Dental Federation: Antibiotic Stewardship in Dentistry
• Public Health Agency of Canada: Antibiotic (antimicrobial) resistance
• World Health Organization: World Antimicrobial Awareness Week

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team