Access Crisis Undermines Fight Against Antibiotic Resistance
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- Published: Wednesday, 12 March 2025 09:22
- Written by Peter Ingle
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Reducing the use of antibiotics in dentistry is a major part of the fight against increasing antimicrobial resistance (AMR).
The dental antimicrobial stewardship (AMS) toolkit for primary care was developed by the Dental Subgroup of the UK Health Security Agency’s (UKHSA) and first released in 2016.
Guidelines on the use of antimicrobials in dentistry have been produced by the Scottish Dental Clinical Effectiveness Programme (SDCEP) and CGDent, and dental teams are expected to follow them.
All of this was hastily sidelined during the pandemic when the ability to provide definitive treatment and sometimes even diagnosis, was severely limited. Now the guidelines and audits are back. Unfortunately access has declined and as a result many more dental patients are reaching a point where antibiotics are being prescribed.
After 9 months, the government’s ambitions appear limited to providing 700,000 mainly emergency appointments. With NHS England reckoning that unmet need is more than three times greater at 2.2 million, even if delivered the 700,000 will not be enough to stop antibiotics becoming a substitute for treatment.
In an open letter to Health Secretary Wes Streeting, the BDA have warned that a failure to properly meet demand for urgent dental care will increase the pressures on the health service, as antibiotics become a substitute for treatment.
The BDA has reported that the chance of a dental appointment resulting in an antibiotic prescription increased tenfold during the pandemic. Recent research from the University of Manchester confirm that even in 2025 prescribing levels have not returned to the downward trend seen before the pandemic.
In their letter the BDA welcome the recent start to commissioning the promised extra appointments but add that it will not meet the level of need and that there are no plans for ongoing care for those that do receive one of the 700,000 urgent appointments. The BDA also refer to the inherent inadequacies of the current contract: “Even before COVID, ‘normal’ was excessive, because under the UDA system dentists simply are not given the time to care for patients requiring urgent treatment.”
Careful diagnosis is required to diagnose the cause of an urgent dental problem and whether antibiotics are necessary for treatment. GPs and pharmacists are advised not to treat dental problems because specialist skills and equipment are required. Antibiotic only treatment plans are rarely appropriate.
Shiv Pabary, Chair of the General Dental Practice Committee closes the BDA letter: “We hope you do not lose sight of the fact that the huge unmet need that we see for urgent dental care is indicative of the failure of the system we work under, and measures you just announced only temporarily address the problems created by our flawed contract. The only way to reduce this need – and avoidable antibiotic prescribing in dentistry – is to move at pace to reform the failed contract fuelling the crisis in this service.”
Study author Dr Wendy Thompson, a member of the British Dental Association’s Health and Science Committee added: “Even before the COVID-19 pandemic, we know that dentistry was responsible for around 10% of antibiotic prescriptions and that rates of unnecessary use were high. During the early part of the COVID-19 pandemic, the amount of antibiotic prescribing by NHS dentists increased dramatically.
Dr Thompson adds that UK Health Security Agency researchers have linked the increase in prescriptions to the use of teledentistry. Her latest research has shown just how slowly antibiotic prescribing in NHS dentistry is returning to its pre-pandemic pattern.
There is also a call to integrate general practice dentistry into NHS digital systems as part of national efforts to help keep patients safe by ensuring antibiotics are only prescribed when strictly necessary. “Until prescribing for dentists is digitised, for example via electronic prescribing, routine monitoring of antibiotic prescribing by dentists providing care to NHS patients will be impossible.”
Dr Thompson also is a Clinical Senior Lecturer at University of Manchester, leads on Antimicrobial Stewardship for the College of General Dentistry, and is chair of Preventing AMR and Infections for FDI World Dental Federation.
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