Your NHS dentistry and oral health update

Special focus bulletin: Dentistry and antimicrobial resistance (AMR) 

 Monday 22 November 2021 (Issue 33)

An update from Sara Hurley and Dame Sally Davies 

Dear colleague,

Every corner of our health system depends on antibiotics but the increasingly alarming issue of antimicrobial resistance (AMR) - and its most serious form, antibiotic resistance - is a silent pandemic that is growing in the shadows.

Antimicrobial Awareness Week presents an opportunity for reflection on what we can all do to avoid the further emergence and spread of drug-resistant infections. The almost 4% increase in hospitalisations from serious antibiotic-resistant infections from the previous year is highly concerning, and failing to urgently tackle the root cause of this issue could result in ten million deaths every year, globally, by 2050.

Healthcare professionals, and dentists in particular, will be crucial to preventing further increases in these statistics by ensuring they play their part to reduce inappropriate antibiotic use. Between 2016 and 2020, primary care NHS dentists in England prescribed 10.3% of all antimicrobial prescription items in the whole of NHS primary care.

Prioritising the need to address this problem becomes even more imperative as we consider the impact the Covid-19 pandemic has had; during 2020, dentistry was the only discipline within the NHS to see an increase (rising by 22.1% between 2019-20) in prescriptions for antibiotics. 

The move to providing emergency dental care through local triage led urgent dental care pathways, where patients were managed remotely as much as possible with advice, analgesia or antimicrobials (AAA), was a vital element during the initial phase of the national response to the pandemic in the summer of 2020.

We trust our healthcare professionals to use their clinical judgement when applying guidance around patient management. As you know, as service levels have increased the need for AAA has been limited for some time. Urgent care should be prioritised over less urgent work, as has previously been communicated to you and AAA is not an excuse for not providing the quality of care to patients which our professional standards, and the NHS contract, expect.

Included within this bulletin are several tools and resources that have been created for dentists, and healthcare professionals more broadly, to help ensure best practice on prescriptions for antibiotics is followed. These include the Antimicrobial Prescribing in Dentistry Good Practice Guidelines, a self-audit tool for clinicians to review how their prescribing aligns with the guidelines and the dental Antimicrobial Stewardship toolkit.

There are also training courses and studies that are available to help keep up to date on the most recent recommendations for ways of working. 

It is recognised and appreciated that dental professionals have done sterling work in reducing the use of unnecessary antibiotics in the years prior to the pandemic, for example dental hospitals in England saw a decreasing trend of 15.3% between 2016 and 2019. 

We need to get this great work back on track so that, as a profession, dentistry continues to fight the threat of global antibiotic resistance.

Today is National Dental Nurses Day. We are all very grateful for every dental nurse's hard work and continued dedication to dentistry and oral health.

Sara and Dame Sally 

Antimicrobial Prescribing in Dentistry

Good Practice Guidelines

The Good Practice Guidelines were updated in December 2020, so now is a great time for dentists to brush up on their knowledge and have a read.

The new guidelines, which update the 2012 guidance on Antimicrobial Prescribing for General Dental Practitioners, have a newly widened scope. They're now applicable to all healthcare prescribers in primary and secondary dental care, rather than only general dental practice, as was previously the case. 

The guidance is clear that antimicrobials should only be used when there is a strong clinical indication to do so, and the guidelines provide a helpful resource to support dentists to prescribe appropriately and responsibly.

Please see here for access to the full Good Practice Guidelines.

On 25 November, the College of General Dentistry and ProDental CPD is hosting a webinar on these guidelines to shine a light on global efforts to tackle antimicrobial resistance locally, which will be free to view live for all members of the dental professions. 

The use of antimicrobials: Self-auditing in dentistry 

It is important to recognise the crucial role that dentists have in tackling antimicrobial resistance. As a reminder, a clinical tool does exist to help dentists do a simple self-audit for their own antibiotic prescribing actions and can also be used for a more comprehensive review of the management of dental infections. 

Auditing can be done using the new Good Practice Guidelines previously mentioned as the standard against which to compare their practice.  This is a great opportunity for dentists to check whether they are prescribing in line with current recommendations and to reflect on how they can continually improve the care they provide to patients. 

The audit tool can be accessed on the College of General Dentistry website.

Dental antimicrobial stewardship

In addition to the guidelines, audit and training resources mentioned earlier, the toolkit also includes:

• A patient information leaflet, with the messaging that ‘antibiotics don’t cure toothache’. The leaflet advises patients on the numerous issues that can create dental problems, and makes clear that dental treatment is usually always needed alongside the use of antibiotics.

• An antibiotics guardian poster, which summarises the content in the patient information leaflet and can be displayed in dental surgeries.

• Information on the 'Keep Antibiotics Working' campaign. This includes further resources, shared learning, and webinars on antibiotics for healthcare professionals and the general public. The campaign also includes a call to action for healthcare professionals and the public to pledge to make better use of antibiotics.

The United Nations' global guidance

Antimicrobial resistance and the United Nations sustainable development cooperation framework

The newly published UN guidelines on antimicrobial resistance is worth a read for those interested in the potential wider impact antimicrobial resistance could have on the world. It outlines the detrimental effect it will have on areas of global health, food safety and security, economic growth, poverty alleviation and the environment. 

The key messages include the following:

• AMR is currently one of the greatest global threats. It results in millions of deaths, long-lasting disabilities and increased health care costs.
• Rising levels of AMR will hinder progress towards many of the Sustainable Development Goals (SDGs), particularly those focusing on health and well-being, poverty reduction, food security, environment and economic growth.
• Tackling AMR effectively will require concerted action across all sectors, applying the so-called 'One Health approach'. For context, 'One Health'  is an approach to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes. This requires close collaboration across sectors, stakeholders and countries. 

To find out what action the UN and countries are taking to tackle AMR, and the current barriers to tackling this problem effectively, the full framework can be accessed here.

Training, webinars and studies 

Please note that some of these webinars and courses are only free for CGDent and/or Pro Dental CPD members.

Training

• The British Association of Oral Surgeons - Antimicrobial Stewardship e-learning Modules
• FDI World Dental Federation - Tackling Antibiotic Resistance: What Should Dental Teams Do?

Webinars

• The College of General Dentistry and ProDental CPD - Webinar on antimicrobial prescribing in dentistry

Research papers

• British Dental Journal - An investigation into possible factors that may impact on the potential for inappropriate prescriptions of antibiotics: a survey of general dental practitioners' approach to treating adults with acute dental pain

• Multidisciplinary Digital Publishing Institute - Clinician and Patient Factors Influencing Treatment Decisions: Ethnographic Study of Antibiotic Prescribing and Operative Procedures in Out-of-Hours and General Dental Practices

• International Journal of Pharmacy Practice - Antibiotics and toothache: a social media review

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Previous NHS dentistry and oral health bulletins this year

Previous bulletins can be accessed by clicking on the links below:

NHS primary care bulletin

The NHS primary care bulletin provides resources on health policy and practice and we encourage you to sign up for this, too. It is aimed at teams across general practice, dentistry, community pharmacy and optometry. 

COVID-19 advice, guidance and resources

Communications resources for NHS dental practices

Click on the links below to view and download useful communication resources:

• Click here for social media image cards and patient leaflets
• Click here for social media assets and posters explaining IPC requirements
• Click here to download website/social media copy and scripts for answer machine message, text message and emails.

NHS updates to the profession 

Key letters from the Chief Dental Officer and the NHS dentistry and oral health team are online here. 

Transition to Recovery: Dentistry's standard operating procedure

The latest version was published on Friday 16 July 2021. Changes to the previous SOP are in yellow. You can read the SOP online here. 

COVID-19: infection prevention and control dental guidance

The guidance is an appendix to and should be read in conjunction with the national guidance on infection prevention and control for COVID-19 . You can read the general guidance and the specialist dental appendix online here.

Avoidance of doubt note: provision of phased treatments

This document is to support dental professionals, and to clarify where it might be appropriate to provide phased treatment spanning over several courses of treatment (CoT). You can read it online here.

Health and wellbeing support