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Table of Contents   
LETTER TO EDITOR  
Year : 2021  |  Volume : 32  |  Issue : 2  |  Page : 272-273
Anti-microbial resistance and dentistry


Department of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, India

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Date of Submission02-Jan-2021
Date of Decision04-Feb-2021
Date of Acceptance23-May-2021
Date of Web Publication22-Nov-2021
 

How to cite this article:
Verma AR, Mathur VP. Anti-microbial resistance and dentistry. Indian J Dent Res 2021;32:272-3

How to cite this URL:
Verma AR, Mathur VP. Anti-microbial resistance and dentistry. Indian J Dent Res [serial online] 2021 [cited 2021 Dec 8];32:272-3. Available from: https://www.ijdr.in/text.asp?2021/32/2/272/330851


The clinical definition of antibiotic resistance or antimicrobial resistance is based on the reduction in the efficacy of an antibiotic against a pathogenic strain at the minimum inhibitory concentration (MIC).[1] Micro-organisms are termed “antimicrobial-resistant” or “drug-resistant” when they are no longer inhibited by an antimicrobial to which they were previously sensitive. Such resistance is called “acquired resistance” and is encoded by resistance genes in the Deoxy Ribo Nucleic Acid (DNA) of the microbe. Resistance genes can arise through spontaneous mutations in the microbial DNA, but some have evolved over many years due to natural selection by natural antimicrobials in the environment.[2] Many factors have contributed to the rise in antimicrobial resistance, including unnecessary use or misuse of antimicrobials, pressure on general physicians to prescribe antimicrobials, patient failure to complete their full course of treatment, self-medication of drugs, and over-the-counter access to antimicrobials in many countries.[3]

The use of antibiotics in dental practice is characterised by an empirical prescription based on clinical and bacteriological factors, resulting in the use of a very narrow range of broad-spectrum antibiotics for short periods. This has led to the development of antimicrobial resistance (AMR) in a wide range of microbes and the consequent inefficacy of the commonly used antibiotics.[4] As per the estimates in a research in Australia, Dentistry accounts for approximately 3–11% of all antibiotic prescriptions.[5] As prescribing health care professionals, dentists should not underestimate their contribution to antibiotic resistance. A systematic review done by Aidasani B, et al. (2019)[6] shows over-prescription of antibiotics in non-indicated conditions and for non-scientific reasons. There is a lack of adherence to the guidelines and a lack of knowledge of antibiotic stewardship programmes. As per a study done in the UK by Patrick A (2018),[7] 66% of antibiotics prescribed in a dental setting are not clinically indicated. The Centre for Disease Control and Prevention (CDC) (2015) reported that 30–50% of prescribed antibiotics are either not necessary or not optimally prescribed.[8] Epstein JB (2000) surveyed all licensed dentists practising in Canada and reported that antibiotic prescribing recommendations were not very clear to dental practitioners. The inappropriate prescribing practices like improper dose and duration of therapy were evident.[9] A common example of inappropriate antibiotic use is for the treatment of acute endodontic infections without commencing endodontic treatment to alleviate pain. The pathophysiology of pulpal diseases means there is reduced blood circulation in the root canal system. Antibiotics cannot eliminate the pathogens as they cannot reach the pulp. Surgical intervention is required to resolve symptoms and primary infection. Yet, worldwide, dentists continue to prescribe antibiotics for localised infection without systemic involvement.[10] There is now a clear evidence linking the dental prescribing of these antimicrobial agents to the emergence of penicillin resistance in the community.[11]

Antibiotic resistance presents a challenge to health professionals worldwide and has the potential to create major problems for modern health care, resulting in more medical expenditure, extended hospital stays, and increased morbidity and mortality. The Centre for Disease Control and Prevention (CDC) in 2019 reported that more than 2.8 million antibiotic-resistant infections occur in the US each year, and more than 35,000 people die as a result.[12] In India, it is estimated that 58,000 neonatal sepsis deaths are attributable to drug-resistant infections.[13] Each time an antibiotic is used non-judiciously, there is an increased risk of developing an antibiotic-resistant infection in both the patient taking the antibiotic and those in the community who come into contact with the patient. There are several deadly bacteria for which a few antibiotics are effective, making treatment of infections associated with these pathogens costlier and less successful.[14] We have begun to enter a post-antibiotic era in which certain infectious diseases are no longer treatable and the risk from resistant organisms precludes chemotherapeutic treatment, bone marrow and organ transplant, and many elective surgeries. Inappropriate antibiotic use also disrupts the normal healthy microbiome, potentially leading to other long-term consequences, such as asthma and obesity.[15]

Not only the dental profession but the general public must understand the importance of restricting the use of antibiotics to those true cases of severe infection that require them. All efforts must be made to convince patients, families, dentists, and doctors that it is both appropriate and safe to treat toothache and the majority of acute dental conditions without the use of an antibiotic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Martínez JL, Baquero F. Emergence and spread of antibiotic resistance: Setting a parameter space. Upsala J Med Sci 2014;119:68-77.  Back to cited text no. 1
    
2.
Zankari E, Hasman H, Cosentino S, Vestergaard M, Rasmussen S, Lund O, et al. Identification of acquired antimicrobial resistance genes. J Antimicrob Chemother 2012;67:2640-4.  Back to cited text no. 2
    
3.
Abushaheen MA, Fatani AJ, Alosaimi M, Mansy W, George M, Acharya S, et al. Antimicrobial resistance, mechanisms and its clinical significance. Disease-a-Month 2020;66:100971.  Back to cited text no. 3
    
4.
Oberoi SS, Dhingra C, Sharma G, Sardana D. Antibiotics in dental practice: How justified are we. Int Dent J 2015;65:4-10.  Back to cited text no. 4
    
5.
Teoh L, Stewart K, Marino RJ, McCullough MJ. Part 1. Part 1. Current prescribing trends of antibiotics by dentists in Australia from 2013 to 2016. Aust Dent J 2018. doi: 10.1111/adj. 12622. Online ahead of print.  Back to cited text no. 5
    
6.
Aidasani B, Solanki M, Khetarpal S. Antibiotics: Their use and misuse in paediatric dentistry. A systematic review. Eur J Paediatr Dent 2019;20:133-8.  Back to cited text no. 6
    
7.
Patrick A, Kandiah T. Resistance to change: How much longer will our antibiotics work? Fac Dent J 2018;9:103-11.  Back to cited text no. 7
    
8.
Demirjian A, Sanchez GV, Finkelstein JA, Ling SM, Srinivasan A, Pollack LA, et al. CDC grand rounds: Getting smart about antibiotics. MMWR Morb Mortal Wkly Rep 2015;64:871-3.  Back to cited text no. 8
    
9.
Epstein JB, Chong S, Le ND. A survey of antibiotic use in dentistry. J Am Dent Assoc 2000;131:1600-9.  Back to cited text no. 9
    
10.
Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, et al. Antibiotics in endodontics: A review. Int Endod J 2017;50:1169-84.  Back to cited text no. 10
    
11.
Lewis MA. Why we must reduce dental prescription of antibiotics: European union antibiotic awareness day. Br Dent J 2008;205:537-8.  Back to cited text no. 11
    
12.
CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.  Back to cited text no. 12
    
13.
Laxminarayan R, Matsoso P, Pant S, Brower C, Barter D, Klugman K, et al. Access to effective antimicrobials: A worldwide challenge. Lancet 2015;387:168-75.  Back to cited text no. 13
    
14.
Fair RJ, Tor Y. Antibiotics and bacterial resistance in the 21st century. Perspect Medicin Chem 2014;6:25-64.  Back to cited text no. 14
    
15.
Langdon A, Crook N, Dantas G. The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation. Genome Med 2016;8:39.  Back to cited text no. 15
    

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Correspondence Address:
Dr. Vijay Prakash Mathur
Department of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.ijdr_4_21

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