National Action Plans (NAPs) for Dentists

The WHO Global Action Plan advocates multi-sectoral National Action Plans (NAPs) to manage delivery of their agenda to tackle antibiotic resistance, including identifying local, national and regional priorities and assessing resource needs for delivery.

With around 10% of worldwide antibiotic use originating with dentists and with different factors influencing dental prescribers compared to medics, it is important to ensure that dentistry is explicitly included within these NAPs. It is recommended that each National Dental Association should make a clear and public commitment to tackling antibiotic resistance through awareness raising, infection prevention and control, and stewardship.

Tailoring national approaches relevant to the specific context first requires a thorough analysis of the problem as significant differences do exist between countries relating to dental care and antibiotic use. For example, whether therapeutic or prophylactic use contributes most to unnecessary use of antibiotics is a key factor which will fundamentally affect the type of antibiotic stewardship programme required. Furthermore, different issues may be relevant to low- and middle-income countries, such as the availability of antibiotics for purchase (over the counter in pharmacies, from grocery stores and from street vendors). In more remote parts of the world, access to dental professionals and/or to online resources may be limited. People working in these areas need to consider how relevant information and guidance is provided to those who need it.

Resources for you to adopt/adapt to meet your local needs are included in the FDI White Paper’s on-line library of resources from around the world. The White Paper includes signposts to a freely available dental antibiotic stewardship toolkit from the United Kingdom, and to a research paper by Gross et al (2019) about a dental antibiotic stewardship programme in the United States. Various authors have proposed core elements for antimicrobial stewardship programmes in different settings; see papers by Sanderson & Williams for dentistry and Sanchez et al for generic outpatient settings.

In some cases, significant investment and resources may be required to implement local and national action plans, for example to develop appropriate, evidence-based guidance. Rather than relying on existing research (which has generally been undertaken in high income countries) new research in the local context may be required to produce a more relevant evidence base. Multi-disciplinary collaboration with microbiology/infectious disease specialists and pharmacists is important for the development of guidelines that fit into the wider context, for example relating to antibiotic resistance patterns for common pathogens in the local area.