Fighting the Antimicrobial Resistance Global Emergency: The Lifesaving Role of Dentistry

Antibiotics save lives. Thanks to antibiotics and access to oral health care, dental infections are now seldom life-threatening. It is hard to imagine a world without antibiotics, yet it is <100 years since Sir Alexander Fleming discovered a “contaminating mould” on his Petri dish that inhibited bacterial growth and just 80 years since his Nobel Prize for the discovery of penicillin (Fleming 1945). Before antibiotics and modern dentistry, dental problems were among the most common causes of death (Appleby and Stahl-Timmins 2018).

Antibiotics were initially seen as miracle drugs, despite Fleming’s warning that misuse could enable bacteria to evolve resistance (Fleming 1945). Today, antibiotics are recognized as strategic assets underpinning modern medicine. Without effective antibiotics, cancer treatment and organ transplant will be unsafe and common infections increasingly untreatable.

Antimicrobial resistance (AMR) arises from genetic changes in microbial pathogens that render them insensitive to antibiotics, antifungals, antivirals, antiparasitics, and antiseptics, reducing the treatment options for infectious diseases. AMR is a global public health and socioeconomic priority (World Health Organization [WHO] 2023b), ranked among the WHO’s top 10 threats (WHO 2019). The World Bank estimates that AMR could reduce the global gross domestic product by 3.8% each year and push 28 million people into poverty by 2050 (Jonas et al. 2017). In 2019, antibacterial-resistant infections alone were responsible for more deaths than HIV and malaria (Murray et al. 2022). By 2050, deaths due to AMR are projected to surpass cancer, exceeding 10 million annually (Naghavi et al. 2024).

The WHO Global Action Plan on AMR emphasizes the need to use antimicrobials only when strictly necessary to minimize the evolutionary pressure selecting for resistance and the more immediate risk of side effects to the medication (WHO 2015). These effects are commonly diarrhea or rash and more rarely life-threatening conditions, such as anaphylaxis or Clostridioides difficile infection (Thompson et al. 2021). Preventing infections and optimizing antimicrobial use across One Health (human, animal, plant, and environmental sectors) are vital ways to safeguard patient safety and global health by keeping antibiotics working for future generations. The WHO’s 2023 people-centered approach refocuses away from AMR as a microbiological phenomenon and toward people accessing health care services for infection prevention, diagnosis, and treatment (WHO 2023b).

Dentistry is responsible for an estimated 10% of antibiotic use across human health care and thus has a critical yet often overlooked role to play in tackling the development and spread of AMR (Thompson et al. 2021). In some countries, COVID-19 pandemic restrictions on dental services increased antibiotic prescribing by >40%, with high rates enduring well beyond lockdown restrictions (Bowman-Newmark et al. 2025; Stenlund et al. 2024). Additionally, antiseptics are widely used in dental offices and oral home care, adding to the pressure on AMR (Cieplik et al. 2019).

While most dental infections can be managed through clinical procedures without antibiotics (Lockhart et al. 2019), untreated dental infections can quickly escalate to life-threatening conditions. Universal access to oral health services is therefore a crucial element in global AMR efforts, ensuring that antibiotics are used only when strictly necessary. Reducing dental disease lowers the demand for antibiotics and hence the development and spread of resistant bacteria.

As largely preventable noncommunicable diseases, dental infections need to be addressed through upstream measures that reduce risks and determinants of oral diseases, such as lowering sugar intake, promoting and enabling healthy choices, and prioritizing oral hygiene (WHO 2024). Through promotion of prevention, early intervention, and improved infection control, the WHO Global Oral Health Strategy and Action Plan (2023–2030) supports global AMR efforts by calling for national policies that encourage antibiotic stewardship and strengthen oral health systems to preserve antibiotic efficacy for future generations (WHO 2023a).

Research highlights that up to 80% of antibiotic prescribing in dentistry is unnecessary or inappropriate, not aligning with guidelines for acute conditions or for the prophylaxis of infections during dental procedures (Cope et al. 2016; Murphy et al. 2024; Sefah et al. 2022). The oral health and dental care profession therefore has an important role to play in addressing AMR and keeping people and populations safe from infection and antibiotics. Clinical guidelines for dental antibiotic use vary by country, reflecting local contexts such as access to dental care services and patterns of antibiotic resistance (Thompson et al. 2021). For countries without their own guidance, the WHO produced The AWaRe (Access, Watch, Reserve) Antibiotic Book, including a chapter on oral and dental infections (WHO 2022). While it currently covers only therapeutic indications, a new chapter is anticipated on the prophylaxis of local- and distant-site infections (e.g., for those at risk of infective endocarditis).

In November 2024, the International Association for Dental, Oral, and Craniofacial Research and the FDI World Dental Federation cohosted a side meeting on AMR during the first-ever WHO Global Oral Heath Meeting, Bangkok, Thailand. The session opened with the WHO’s AMR survivor group chair, Vanessa Carter, sharing her story of a life-threatening antibiotic-resistant infection (methicillin-resistant Staphylococcus aureus) following injuries from a traffic accident and how a maxillofacial surgeon saved her life (see the full interview on YouTube: www.youtube.com/watch?v=A8yUai1Bg80). Leaders and activists from around the world shared their experiences and recommended stewardship interventions and tangible action to strengthen the oral health profession’s role in tackling AMR.

Additionally, at the 2024 United Nations General Assembly, the second High Level Meeting on AMR was convened in New York. The FDI World Dental Federation delivered a statement to Multi-stakeholder Panel 1, emphasizing 3 key areas:

• Universal access to oral health care is essential for preventing and treating dental problems.

• Awareness that antibiotics do not cure toothache is needed across health care.

• Oral health and dental care must be integrated into global and national AMR policies and plans.

To guide new evidence generation for policy makers, researchers, funders, and other stakeholders, the WHO has developed a priority research agenda for AMR, encompassing prevention, diagnosis, and treatment. In 2025, the International Association for Dental, Oral, and Craniofacial Research will be publishing a policy statement on AMR, identifying research areas to support the oral health profession in addressing this global health emergency. As AMR increasingly poses a significant threat to global health and wealth, strengthening oral health research, education, and practice is critical to preserving antibiotic efficacy and protecting patient safety and public health.

Author Contributions

W. Thompson, contributed to conception, design, data acquisition, analysis, and interpretation, drafted and critically revised the manuscript; F. Cieplik, contributed to conception, design, data interpretation, critically revised the manuscript; L. Teoh, contributed to design, critically revised the manuscript; N. Jakubovics, contributed to conception and design, critically revised the manuscript; H. Benzian, contributed to conception, design, data acquisition, analysis, and interpretation, critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of the work.