Unraveling Antibiotic Resistance in Dentistry
Imagine a world where a simple dental infection could become life-threatening because antibiotics no longer work. This isn't science fiction—it's a growing global reality fueled by the overuse and misuse of antibiotics in various medical fields, including dentistry. Dentists worldwide prescribe approximately 10% of all antibiotics, and alarming research reveals that 66-80% of these prescriptions may be unnecessary1 3 . This article explores the prescription patterns of antibiotics among dental professionals and their awareness of the looming antibiotic resistance crisis—a topic that affects not just your oral health, but global public health.
Antimicrobial resistance occurs when microorganisms evolve to withstand the drugs designed to kill them. This natural process is accelerated by the misuse and overuse of antibiotics, making common infections harder to treat and increasing the risk of disease spread, severe illness, and death. The World Health Organization (WHO) has declared AMR one of the top 10 global public health threats5 , with estimates suggesting it could cause 10 million deaths annually by 20505 .
Dentists are significant contributors to antibiotic prescribing. Studies show that:
This overprescription creates a dangerous cycle: exposing patients to unnecessary antibiotics increases the risk that these drugs will fail when genuinely needed, while also promoting the spread of resistant bacteria to families and communities1 .
A recent comprehensive survey conducted in Nellore, India, provides fascinating insights into antibiotic prescription patterns among dental professionals1 4 .
250 dental professionals including house surgeons, postgraduates, general dentists, and specialty practitioners
Questionnaire with 20 multiple-choice and 2 open-ended questions covering demographics, prescribing habits, and AMR awareness
| Characteristic | Categories | Percentage |
|---|---|---|
| Gender | Male | 33.2% |
| Female | 66.8% | |
| Practice Type | Academicians | 60.4% |
| Private Practice | 24.0% | |
| Private Employee | 10.0% | |
| Government Employee | 5.6% |
The survey revealed crucial patterns in how dentists prescribe antibiotics:
The Indian survey findings reflect global trends observed in other studies:
A study focused on pediatric patients found that while dentists had sufficient knowledge about antibiotic use in children, there was still a lack of information about when antibiotics should not be prescribed2 .
Research on dental implant placement revealed that 48.7% of dentists prescribed antibiotics both before and after the procedure, 27.6% before only, and 22.4% after only. Only 1.3% did not prescribe antibiotics for implant placement7 .
A comparative e-survey in Croatia, Bosnia and Herzegovina, and Serbia showed that while dentists generally possessed good knowledge of antibiotic use, there were significant discrepancies between this knowledge and actual prescribing practices8 .
A pioneering study in Kerala, India, tested whether educational interventions could improve antibiotic stewardship among dental house surgeons5 .
43 dental interns
Adapted from WHO's Antimicrobial Stewardship MOOC
Two 90-minute sessions with clinical scenarios
| Domain | Pre-test Score (Mean ± SD) | Post-test Score (Mean ± SD) | p-value |
|---|---|---|---|
| Knowledge | 7.11 ± 1.00 | 7.39 ± 1.39 | 0.262 |
| Attitude | 6.23 ± 0.78 | 7.04 ± 0.92 | <0.001* |
| Practice | 6.18 ± 1.13 | 5.95 ± 1.55 | 0.390 |
| Clinical Scenarios | 1.23 ± 1.08 | 1.74 ± 1.51 | 0.102 |
The intervention significantly improved attitudes toward antimicrobial resistance but didn't substantially change knowledge or practice scores5 . This suggests that while education is crucial, it alone may not be sufficient to change prescribing behaviors.
The studies reveal several factors contributing to inappropriate antibiotic prescribing:
Many dentists prescribe antibiotics "just in case" to avoid potential complications3
Patients sometimes expect antibiotics and pressure dentists for prescriptions8
ASPs are coordinated programs designed to improve antibiotic use through:
Based on the research findings, several approaches could promote better antibiotic stewardship in dentistry:
The silent threat of antibiotic resistance demands urgent action across all medical specialties, including dentistry. While dental professionals generally possess good knowledge about antibiotics, significant gaps remain between knowledge and practice. The cross-sectional survey among Indian dental professionals reveals concerning prescription patterns, particularly the tendency to prescribe antibiotics without clear indication1 4 .
Addressing this challenge requires a multifaceted approach: enhanced education, clear guidelines, diagnostic support, and effective patient communication. As the Kerala intervention study showed, educational programs can improve attitudes toward antimicrobial resistance, even if changing practice patterns proves more challenging5 .
The time to act is now. By promoting responsible antibiotic use in dentistry, we can help preserve these miracle drugs for future generations and avoid a return to the pre-antibiotic era where simple infections became life-threatening conditions. Every prescription decision matters in this collective effort to combat antimicrobial resistance—one of the most significant public health challenges of our time.