Wendy Thompson
Wendy Thompson is an NIHR Clinical Lecturer in Primary Dental Care at the University of Manchester. Her research is about the use of antibiotics in dentistry, with a focus on toothache and abscesses.
Location United Kingdom
Activity
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@WilliamDavis Thought you might like this editorial - I had a lecturer who used the same phrase, so I borrowed it for the title of this piece: https://www.nature.com/articles/s41415-022-5147-0
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An interesting observation. Education is certainly important, but to change prescribing behaviour takes more than just education. Exactly what’s needed changes from place to place. It might, for example, need enough time during urgent appointments too.
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@VictoriaMartin Hey - hope you enjoy it.
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@JoeyShepherd - we’ve just produced an online module aimed at UoManchester’s 3BDS undergrads. Happy to share the link if you’d find it useful. My email is wendy.thompson15@nhs.net
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Thank you!
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There are many side effects to antibiotics - I guess in some countries you might hear about some of them more than others. In the US, for example, the epidemiologists identified so clear a link between dental prescribing of clindamycin and the incidence of C diff in the community that they changed the dental antibiotic prescribing guidelines.
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You're welcome
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This is a real difficulty in many countries and is one of the differences between countries which make it hard to implement one international guideline. What are rates of resistance to amoxicillin like in Syria?
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Yes - it's a good point. As you will find in later modules of this course, different areas may need different guidelines due to different patterns of antibiotic resistance and access to dental procedures between countries.
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Glad you enjoyed it!
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Great that you've heard of it now - how will you celebrate it this year (18-24 November)?
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Now you know that it's in two week's time - how will you celebrate it?
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WAAW is in two weeks' time - do you have a plan for how you will celebrate it in your school? Maybe a feature in a newsletter? Or posters about the antibiotic guardian pledge?
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There is work through the FDI GARD early career researcher network to identify and compare guidelines around the world. Maybe you could get involved with that?
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This is a great idea - teaching older dentists new ways of working.
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Thank you - I look forward to reading that systematic review!
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A national campaign in Italy? There are other dentists interested in doing this too. There is an FDI Early Career Researcher network on antibiotics which they are a member of.
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Yes - and 50-80% of UK dentist's antibiotics are unnecessary! We have a long way to go yet.
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Great educator of your patients - this World Antimicrobial Awareness Week we are encouraged to Spread Awareness - Stop Resistance. You are doing this already - well done!
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Wendy Thompson replied to Bisma Ali
Absolutely - be confident that when someone really needs antibiotics you will prescribe them
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Sounds like resources to help clinicians explain AMR to patients might be helpful?
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Check out this paper - there is some comparison of guidelines in the discussion section: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/A27AA596BD210E6185D101C00CFAAED9/S0899823X21000878a.pdf/patterns_of_dental_antibiotic_prescribing_in_2017_australia_england_united_states_and_british_columbia_canada.pdf
And this one too:...
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Thanks Anna!
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Well this was certainly the case before covid - but since the increase early in 2020, rates have been alow to reduce I’m afraid.
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Good luck! @AndrewKhazali
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My first degree was microbiology - and I started that as a general biology degree and then chose to specialise to micro part way through. Subjects often change when you get to uni, so having flexible options are really great.
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Good luck!
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Wendy Thompson replied to Bilal Idris
Good luck!
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Absolutely - this is the case for some. You might find this paper of some interest: https://academic.oup.com/ijpp/article/29/3/210/6227947?guestAccessKey=5624c2ee-c5eb-4931-8cd5-0f824d1d22e3
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Differences in the context for antibiotic prescribing between nations is so interesting.
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Unfortunately over the period of the covid pandemic, the reductions in the UK use of dental antibiotics has been reversed and is slow to reduce. You are right that more need to be done to educate the public, and there need to be consistent messages from all healthcare practitioners 'walking the walk' as well as 'talking the talk'.
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Wendy Thompson replied to Eleni Savva
Sorry - I don't know any dental nurse courses in Germany. If you'd like to come work in the UK then dental nursing is an apprenticeship so you'd study part time whilst working as a dental nurse.
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It's interesting to hear that sometimes a dentist's license gets cancelled due to inappropriate prescribing of antibiotics. That doesn't happen often - but it's good to hear that it does happen.
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This is a bit concerning as most people who think they have an allergy do not - and the secondary drugs are often less effective at treating the infection whilst also being better at leading to resistant infections - a double whammy!
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Thank you for sharing this useful study. Do you know whether they have used the results to develop local solutions?
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And this is why antibiotic resistance is higher in India than other countries. We all have a role to play in tackling antibiotic resistance. Hopefully this course will help you play yours.
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Restricted access to dentistry is a really important driver of antibiotic use which we all need to work hard to address. If someone's condition is bad enough that they might need antibiotics, then it's bad enough that they need to see a dentist for a procedure. I work in clinical practice in England and my antibiotic prescribing also increased during the...
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Wendy Thompson replied to Hima George
What a great use of your time - I hope you enjoy this course and find it useful.
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Wendy Thompson replied to William Rymer
Thank you. If you do twitter, follow me @wendythedentist and I can introduce you to antimicrobial stewardship experts in Ireland to look at how to move the dental AMS agenda with IDA.
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Absolutely - here is a paper you might like: https://academic.oup.com/ijpp/article/29/3/210/6227947?login=true However this is not the public attitude in all countries - for example in The Netherlands the culture is that people do not want antibiotics unless they absolutely need them. A big question is why the differences between countries which are so close...
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Hi William - there is an antimicrobial pharmacist in Dublin called Gerry Hughes who is really interested in dental antimicrobial stewardship. Happy to put you in contact with him if IDA would like to move this agenda forward. Wendy
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There is already a high rate of resistance to erythromycin and the WHO advises against its use in order to preserve it for cases in which it is essential. https://www.who.int/medicines/news/2019/WHO_releases2019AWaRe_classification_antibiotics/en/
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Our microbiome (the bacteria which live in and on our bodies) become resistant rather than the body itself. Sometimes these bacteria become unbalanced or invaded by more virulent bacteria which cause an infection. When these bacteria causing an infection are resistant to antibiotics, then they will block the medication.
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Yes - it's in progress. International organisations work slowly but steadily towards a goal. Bringing along all nations to commit to this agenda is so important. Now we need all dental organisations to come along too.
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Wendy Thompson replied to Riju John
Excellent - as a clinic owner you have a really important role in ensuring your team are all trained and using antimicrobials responsibly.
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@CésarOmarRamosGregorio My email is wendy.thompson15@nhs.net if you would like to email me about approaches in your country.
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Absolutely - getting top down commitment from the government and dental organisations is a really important element of efforts to optimise antibiotic use.
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Great insight Cesar - dentistry is certainly responsible for 10% of antibiotic prescribing - whether that translates to being responsible for 10% of antimicrobial resistance is another question. Do let me know if you would like to work on addressing the issue in your country.
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Wendy Thompson replied to Claire Harrison
Absolutely - there is a self-audit tool in the dental antimicrobial stewardship toolkit to which you might like to introduce the staff.
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That is understandable as you don't work in dentistry. You have clearly worked hard to think through the issue though and I bet you have gained some insight in the process. It is interesting to see how many factors relate between different clinical areas whereas some are relevant only to dentistry.
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Surveillance of resistant pathogens internationally is so important and highlights why different clinical guidelines are required in different parts of the world. Unfortunately there are currently no dental pathogens included in GLASS.
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Yes - the ANTRUK charity is important - if you are not already involved with the charity, do look out opportunities to get more involved. I am a member of the education committee and am interested in how members of the public view antibiotics and dentistry.
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Wendy Thompson replied to ebrahim patel
Hopefully dentists strictly follow guidelines too - although the evidence is that 80% of dental antibiotics in UK are not in accordance with guidelines.
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Wendy Thompson replied to Claire Harrison
And you don't just need to be a dentist on these pledges - a senior dentist I know put herself down as a pet owner and chose a pledge related to her horses.
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Cool! I look forward to seeing how you go about raising awareness of this important subject next year.
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Yes - important messages! We need more oral surgeons to instill that message in student and young dentists. Unfortunately too often once graduates come into practice they are encouraged to use antibiotics as a way of managing time.
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I recognise (1) as something which dentists sometimes do - but I would always advise that if someone's condition is bad enough that they might need antibiotics then it is bad enough for them to need to be seen face to face. The risks of antibiotics are not well understood by dental teams and giving them is seen by some as a low risk option. Unfortunately we...
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Incredibly hard wasn't it - access to face to face dental care is such an important part of dental antimicrobial stewardship. COVID demonstrated this well - but it's always an issue to some extent. Did you see this paper we published later year? https://www.nature.com/articles/s41415-020-2336-6
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Wendy Thompson replied to [Learner left FutureLearn]
Do you know what pharmacists learn about care for people with toothache? We are working with FDI World Dental Federation to develop material to support them atm.
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You might be interested in a recent paper which I published with colleagues from Australia, England, US and British Columbia (Canada):...
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Hi Joey
Check out the UK dental antimicrobial stewardship toolkit for the most up to date UK specific information: https://www.gov.uk/guidance/dental-antimicrobial-stewardship-toolkit
In the toolkit you'll find a set of microdramas which were developed as part of my PhD at University of Leeds. Hopefully the students will find them something a bit different... -
Thanks Mitali - There is some fantastic research coming out of Victoria at the moment. Try Googling Leanne Teoh's papers.
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Absolutely - many issues to overcome to meet that aim though, including defining ‘necessary’ in the eyes of the medicolegal experts.
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Treatment of dental disease usually requires procedures not prescriptions. Finding a practice which your trust to deliver the care that you need is important.
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Sounds like a good call - and of course only use antibiotics when they are absolutely necessary. Could you work with your national dental association to develop national antibiotic guidelines?
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Self diagnosis and using antibiotics is a big problem in some parts of the world. Maybe this is one reason why India has one of the highest rates of antibiotic resistance.
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Yes - less than 30 years away!
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Hi Cesar - as you progress through the course you will learn that antibiotic guidelines differ rather a lot around the world due to the different contexts in which dentistry is provided. There are also differences in the rates of antibiotic resistance to be taken into account. And in addition some countries interpret the evidence about the risks/benefits of...
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Wendy Thompson made a comment
Welcome everyone. Thank you for joining us from around the world.
What a year this has been for dentistry and infections! The impact of COVID-19 on dentistry and on antibiotic prescribing has been very different around the world. Maybe you can share some of your experiences with each other through the group exercises.
As you progress through the course,...
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@WessamA Clinical guidelines together with clinical judgement underpin decision making. For dentists, there are few indications in which antibiotics are crucial. Usually it is possible to fixg a problem when the initial pain starts, so prevents progression of a condition to the point where it is crucial for the patient to have antibiotics. In situations where...
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This is good to hear. Does your national action plan for AMR include dentistry?
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Wendy Thompson replied to Jeffrey Jamgbadi
Welcome Ambassador Jamgbadi!I look forward to hearing more about your work in this important area.
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Wendy Thompson replied to Jeffrey Jamgbadi
Excellent point! Thank you for taking this on.
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Wendy Thompson replied to varghese jaison
Welcome
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Wendy Thompson replied to Cristel Navarrete
Brillante. Ya lo estoy.
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Wendy Thompson replied to Nicola James
Thanks Nicola - glad you enjoyed it and hope that you find ways of putting this into practice and sharing it with your family, friends and colleagues.
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Wendy Thompson replied to Nicola James
Absolutely - so many people automatically associate toothache with antibiotics. Yet dental procedures not prescriptions are appropriate for toothache - they almost always the quickest fix and safest for the patient as they help avoid antibiotic resistance and other adverse outcomes.
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Brilliant - the website provides you a certificate when you make your pledge. You could print it out and display in your practice - when patients or other team members comment on it, you can encourage them to make their pledge too. Thank you!
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@julianRuiz This is an important area for improved understanding in order to tackle antibiotic resistance. Do you have ideas about how to tackle this?
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Wendy Thompson replied to julian Ruiz
Good to meet you - I hope you love this learning as much as you love surgery.
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Wendy Thompson replied to J Y
Welcome
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Wendy Thompson replied to Zahra K
A very interesting interest! There are certainly health inequalities for AMR - that's for sure.
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Wendy Thompson replied to Jeffrey Jamgbadi
Welcome!
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Yes this may be. Hopefully we all try to make the best decisions for our patients at the time based on their condition and their long term safety.
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Wendy Thompson replied to Nicola James
Absolutely - as you go through the course you might find other factors which also drive antibiotic prescribing in your context. Equally though - please do be confident to prescribe antibiotics when your patient needs them.
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In places where antibiotics are only given for acute dental conditions - such as the UK - antibiotic prescribing generally went up. You may have seen our paper in the British Dental Journal at the end of last year: https://www.nature.com/articles/s41415-020-2336-6
In places where antibiotic prescribing is generally given as prophylaxis ahead of routine...
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Thank you - I am interested to hear about the antimicrobial stewardship initiatives the ministries are delivering - and importantly whether there are any dental specific ideas. Tell me more :-)
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Absolutely! When people really need antibiotics they really need them to work. Antibiotic resistance is drive by the unnecessary use of antibiotics. So the trick to ensuring antibiotics remain as effective as possible for as long as possible is to use them only when needed for a spreading infection and to provide dental procedures wherever possible.
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Wendy Thompson made a comment
Welcome everyone. Thank you for joining us from around the world.
What a year 2020 was for dentistry and infections! World Antimicrobial Awareness Week (last November) saw a big focus on the dental profession and antibiotics, including a new FDI World Dental Federation white paper on the important role of dental teams tackling antibiotic resistance.
The...
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Welcome Rachael - I hope you enjoy the course.
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Here is a link which may be useful for you: https://www.fdiworlddental.org/news/20201214/the-world-dental-development-fund-for-oral-health-is-accepting-applications-on-a
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Wendy Thompson replied to Linda Trenouth
Education is good but engagement is better. Many studies have shown that public education (one directional telling people what to do) doesn't bring about behaviour change. Two way engagement is better - which is why Twitter works well for disseminating public health messages.
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Funding for research can be hard to find. However, FDI World Dental Federation is currently inviting grant applications: https://www.fdiworlddental.org/news/20201214/the-world-dental-development-fund-for-oral-health-is-accepting-applications-on-a
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These are interesting differences don't you think. Maybe they are based on differences in the resistance profile of the bacteria causing dental infections in Sri Lanka compared to Scotland.
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Wendy Thompson replied to Caroline Campbell
Brilliant - I look forward to hearing how you will take this forward. I'm talking for Lanarkshire LDN in February if that's anywhere near you.
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The only healthcare reason people need a deep clean is for the treatment of periodontal disease. If someone doesn't have periodontal disease then it is better for them to learn excellent homecare which will keep their teeth clear of scale and help reduce the risk of developing periodontal disease. In the UK the NHS will only pay for 'clinically necessary'...
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Agree - although in dentistry 'infection control' is conventionally focused on disinfection and decontamination of surgeries an equipment. And in primary dental care the 'infection control team' is generally just one person who isn't a prescriber.
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Wendy Thompson replied to ANASTASIA THEO
@ANASTASIATHEO Oh dear - sorry to hear this.
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It will be interesting to hear what guidelines are agreed.
