The “hidden pandemic” of antibiotic resistance: it’s time to refocus
Featured Products Promotional FeaturesPosted by: Dental Design 13th January 2022
At the end of 2021, health officials warned of a “hidden pandemic” of antibiotic-resistant infections.[i] Data had showed that the recorded total number of bloodstream infections fell in 2020, with less social mixing, enhanced hand hygiene and more care and consultations delivered remotely the likely reasons for the decline.[ii] But the actual proportion of infections grew; in the UK, antibiotic-resistant infections are now at a higher level than they were six years ago.[iii]
Antimicrobial resistance (AMR) has been a major area of concern for some time. The WHO called it a global threat that will lead to more serious and prolonged illness, also increased hospital admissions putting a huge strain on health systems and economies.[iv] In 2015, NICE published guidelines for antimicrobial stewardship, and these have perhaps contributed to the year-on-year decrease in antibiotic prescribing in the UK.[v] Notable in the 2020 data, however, was an increase in antibiotic prescribing by dentists during the pandemic. It should also be noted that in many countries outside the UK, antibiotics are freely available to buy without a prescription – to echo the WHO, this is a worldwide problem.
In our own practices, we must now be focussing on issues beyond the pandemic. Antibiotics are vital in the prevention or treatment of certain, often serious or life-threatening bacterial infections, such as pneumonia, meningitis and sepsis. In 2018, a campaign was launched to increase dental teams’ awareness of sepsis, which can be triggered by an infection in the mouth.[vi] Antibiotics can also protect patients who are having chemotherapy, those at risk of endocarditis and some patients post-surgery.
Where antibiotics have little or no effect, is against most indications of a cold, things like coughs and sore throats, as well as other symptoms of flu-like viruses, which are not bacterial. Responsible prescribing is fundamental to the issue of AMR – NICE does state that its guidelines do not “override the responsibility (of practitioners) to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian” – but people must also understand their role in protecting themselves. The bottom line is, should they ever have an infection that requires treatment with an antibiotic, to destroy dangerous bacteria or slow down its growth, they want their medication to work.
The Covid crisis raised important questions about empowerment, accountability and patients’ decision making. As healthcare practitioners, we can inform, educate and support, but people must be self-motivated. Our job, then, is to encourage them to have faith in us, be willing to work with us, to listen and to learn.
If you can build a good relationship with your patients, so they trust you when you tell them antibiotics are not always the answer, this will lead to better outcomes. If they are feeling unwell, they should stay home and try simple things to feel better, such as drinking plenty of water and resting before calling their GP. They should be vigilant about any symptoms that are unusual for them, then take positive action; a preventive approach to healthcare means being aware of your body, including your mouth, so you notice changes, especially those that don’t go away. If they are prescribed antibiotics, be it by their GP or dentist, they must trust that this is the correct recommendation and be sure to complete the course to optimise their treatment.
Good hygiene is the first line of defence against viruses and bacterial infections, including those that come with significant complications. The power of regular, correct handwashing will forever be tied to the Covid pandemic, but we are thinking beyond Covid, to create healthier communities that are more engaged with their health than ever before. Good hygiene includes oral hygiene, with many dental conditions fully preventable if a good oral hygiene routine is followed. A patient who knows how to maintain a beautifully clean mouth, reducing their risk of dental disease and infection, and who has the awareness to call the practice when they see or feel something strange or different, will be a happier, healthier individual. Elevated homecare routines are key, so instruct people in how to achieve a thorough clean every time they brush, including interdentally. A new tool for comfortable and effective interdental cleaning is the TANDEX WOODI, in a range of sizes and with a responsibly sourced birchwood handle, to tick the sustainability box.
The overuse and misuse of antibiotics has been a problem for some time. As we come out of the pandemic, we must refocus on issues which may have slipped from the public consciousness but without action, could lead to another crisis. Help patients understand what antibiotics can do and what they can’t. Knowledge is power, and hopefully our patients can develop a new understanding of prevention and protection, and how long-term health requires a collaboration between themselves and the professionals who are there, ready, willing and able to offer their support.
Author Kimberley Lloyd- Rees on behalf of Tandex
Kimberley graduated from the University of Sheffield in 2010, where she now works as a clinical tutor in Dental Hygiene and Therapy as well as working in practice. She has spent her career working across a variety of specialist private and mixed dental practices, for the MOD and volunteering her time to a dental charity in Nepal.
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[i] Hidden pandemic of antibiotic-resistant infections, health officials warn. BBC, 17 November 2021. Link: https://www.bbc.co.uk/news/health-59310099 (accessed November 2021).
[ii] Antibiotic-resistant infections fell in 2020 for first time since 2016, but UKHSA warns drop likely temporary. Gov.co.uk, 17 November 2021. Link: https://www.gov.uk/government/news/antibiotic-resistant-infections-fell-in-2020-for-first-time-since-2016-but-ukhsa-warns-drop-likely-temporary (accessed November 2021).
[iii] Gov.co.uk, 17 November 2021.
[iv] Antimicrobial resistance. Key Facts. WHO, link: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance (accessed November 2021).
[v] Antimicrobial stewardship: systems and processes for effective microbial medicine use. NICE guidelines (NG15), published August 2015 (updated January 2018). Link: https://www.nice.org.uk/guidance/ng15 (accessed November 2021).
[vi] Sepsis awareness in dental practices. BDJ Team 5, 18122 (2018). https://doi.org/10.1038/bdjteam.2018.122
