middle-income countries bear the heaviest burden of deaths from infectious disease. What about Canada? Resistant bacterial infections kill an estimated 1.27 million people every year across the globe. In 2018, about 1 million bacterial infections were reported in Canada, a quarter of which were resistant to first-line antibiotics.5 Resistant infections were directly responsible for about 5,400 deaths in Canada at a cost to the health care system of more than $2 billion, according to a Council for Canadian Academies (CCA) report from 2019 called When Antibiotics Fail. The report explains that in a world where antibiotics are less effective, everyone will be at greater risk of illness and death from infectious diseases. By 2050, if resistance to all first-line antimicrobials reaches 40%, a scenario the report considers highly plausible, 13,700 people in Canada would die each year from resistant bacterial infections, and cumulatively Canada’s population decline would reach almost 400,000 by 2050. Role of dentistry Historically, dentists have prescribed antibiotics for tooth pain. However, this practise is not supported by evidence because most tooth pain cases could be better managed with a dental procedure and/or pain medication.6 In 2022, dentists accounted for almost 10% of all antibiotic prescriptions in Canada. There is an opportunity for dentistry to contribute to the fight against antimicrobial resistance. “Antibiotics are very important drugs in dentistry,” says Dr. Susan Sutherland, chief of dentistry at Sunnybrook Health Sciences Centre and president of the Canadian Association of Hospital Dentists. “We really need them, and we really need them to work when there are patients that have infections.” She acknowledges that dental infections were a leading cause of death a few centuries ago. “But research has shown that up to 80% of antibiotics prescribed by dentists may be unnecessary,” says Dr. Sutherland. Choosing Wisely Canada, an organization that advocates for reducing unnecessary tests and treatments, recommends that dentists don’t prescribe antibiotics for toothaches or a localized dental abscess. Toothaches occur when the dental pulp is damaged due to decay, trauma, or large fillings. The How to Influence Antibiotic Use in Dentistry Overuse of antibiotics is rarely addressed publicly or scientifically in dentistry, in contrast to general medicine.1 Reasons cited by dentists for prescribing antibiotics is a desire to avoid clinical complications, the fear of losing patients and perceived patient pressure. “Prescribers of antimicrobial drugs have dual, somewhat contradictory responsibilities,” according to an article in Virulence.2 “On the one hand they want to offer optimal therapy for the individual patient under their care; on the other hand, they have a responsibility to the same and other patients in the future and to public health to preserve the efficacy of antibiotics and minimize the development of resistance.” The authors suggest that antimicrobial resistance and appropriate antibiotic use should be included at every level of education for prescribers. A small study in the US showed that after training in antibiotic stewardship by infectious diseases experts, dentists optimized their antibiotic prescribing.3 A Canadian study of antibiotic prescribing for respiratory tract infections and urinary tract infections found that educational intervention with prescribers was fairly effective and suggests CE courses in antibiotic stewardship would be helpful for all prescribers.4 References 1. Löffler C, Böhmer F. The effect of interventions aiming to optimise the prescription of antibiotics in dental care—A systematic review. PLoS ONE. 2017. 12(11): e0188061. 2. Pulcini C, Gyssens IC. How to educate prescribers in antimicrobial stewardship practices. Virulence. 2013 Feb 15;4(2):192-202. 3. Goff DA, Mangino JE, Trolli E, Scheetz R, Goff D. Private Practice Dentists Improve Antibiotic Use After Dental Antibiotic Stewardship Education From Infectious Diseases Experts. Open Forum Infect Dis. 2022 Jul 25;9(8):ofac361. 4. Leis JA, Born KB, Ostrow O, Moser A, Grill A. Prescriber-led practice changes that can bolster antimicrobial stewardship in community health care settings. Can Commun Dis Rep. 2020 Jan 2;46(1):1-5. 23 Issue 3 | 2025 | Issues and People
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