dentists. As a profession that champions human health and relies on having antibiotics that work, I have great confidence that dentistry will do its part to combat this problem,” she says. What does the future hold? Changing how antibiotics are used and prescribed will help slow antimicrobial resistance. Preventing the spread of infectious disease will, too. New antibiotics need to be discovered or created; bacteria will continue to evolve to protect themselves from both old and new antibiotics. Researchers believe that only a very small percentage of soil bacteria have been sampled and suggest that bacteria in the marine environment are mostly unknown to science. In 2003, the marine bacteria genus Salinospora proved to have many medically useful natural products, including one that became a drug to treat glioblastoma. Many bacteria are difficult to culture in lab settings. But new approaches have succeeded in growing previously hard-to-culture bacteria. New tools such as CRISPR/Cas9mediated genome editing, a precise method of altering DNA that is used in many areas of research and medicine, are available to exploit new discoveries in nature. In the CCA report When Antibiotics Fail, its expert panel concluded that “the most effective approach to addressing antimicrobial resistance is globally coordinated, multifaceted, and combines elements of four mitigation strategies—surveillance, infection prevention and control, stewardship, and research and innovation.” The CCA report also says that Canada is “in the middle of the pack” among high-income countries when it comes to antibiotic use, antibiotic efficacy, and mitigation efforts. “Modeling suggests an alarming future if we do not aggressively address antimicrobial resistance,” says Dr. Sutherland. “It is incredibly important work and there is still a lot of work to be done.” intense pain is caused by inflammation of the dental pulp and the tissue surrounding the root, not by bacterial infection. Thus, antibiotics aren’t useful. In the case of an acute dental abscess (a localized infection that occurs due to an untreated infection of the dental pulp) root canal therapy or extraction of the tooth, along with drainage of the abscess, is required to remove the infected tissue. Antibiotics are of no additional benefit, unless the patient also has systemic complications, such as fever, lymph node involvement, or a spreading infection. In such cases of spreading infection, source control to remove the cause of the infection is key, with antibiotics used as an adjunct to treatment. “There have been great efforts in medicine to reduce antibiotic overuse, and we’ve seen about a 25% decrease in the past five years or so,” says Dr. Sutherland. “Using antibiotics as judiciously as possible so that they continue to work when we really need them requires a culture shift. Some patients just expect them from their doctors and References: 1. Hutchings MI, Truman AW, Wilkinson B. Antibiotics: past, present and future. Curr Opin Microbiol. 2019 Oct:51:72-80. 2. Lobanovska M, Pilla G. Penicillin’s Discovery and Antibiotic Resistance: Lessons for the Future? Yale J Biol Med. 2017 Mar 29;90(1):135-45. 3. Uddin TM, Chakraborty AJ, Khusro A, Redwan BM, Zidan M, et al. Antibiotic resistance in microbes: History, mechanisms, therapeutic strategies and future prospects. J Infect Public Health. 2021 Dec;14(12):1750-66. 4. Hunt D, Kates OS. A Brief History of Antimicrobial Resistance. AMA J Ethics. 2024; 26(5): E408-17. 5. The Canadian Council of Academies. When Antibiotics Fail: The Expert Panel on the Potential Socio-Economic Impacts of Antimicrobial Resistance in Canada, 2019. Available: https://cca-reports.ca/reports/the-potential-socio-economic-impacts-of-antimicrobial-resistance-in-canada/ 6. Suda KJ, Calip GS, Zhou J, Rowan S, Gross AE, et al. Assessment of the Appropriateness of Antibiotic Prescriptions for Infection Prophylaxis Before Dental Procedures, 2011 to 2015. JAMA Netw Open. 2019;2(5):e193909. Watch a CDA Oasis conversation with Dr. Sutherland about antimicrobial resistance: bit.ly/40Vdymm Taking the Bite Out of Tooth Pain A toolkit on using antibiotics wisely for managing tooth pain in adults Choosing Wisely Canada created a toolkit for dentistry reviewed and supported by the Canadian Dental Association, the Canadian Association of Hospital Dentists, and the Royal College of Dental Surgeons of Ontario. Access the toolkit at: bit.ly/3FeDMbl 24 | 2025 | Issue 3 Issues and People
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