Policy Statement on Antimicrobial Resistance (AMR)
W. Thompson, A. Al-Ahmad, F. Cieplik, A. Hbibi, N. Jakubovics, K.J. Scholz, L. Teoh, M. Charles-Ayinde, and C. Fox
The International Association of Dental, Oral and Craniofacial Research (IADR) recognizes Antimicrobial Resistance (AMR) as one of the most significant public health threats facing humanity today. AMR is responsible for an estimated 1.27 million deaths annually, with nearly 4.95 million deaths associated with drug-resistant infections, based on data from 2019 [1]. Recent forecasts indicate that without effective intervention, these figures could rise to 1.91 million deaths attributable to AMR and 8.22 million deaths associated with AMR by 2050 [2]. This alarming trend underscores the urgent need for coordinated action across all sectors, including dentistry.
Accordingly, the World Health Organization (WHO) has identified AMR as a top global health priority and has approved a political declaration at the 79th United Nations General Assembly (UNGA) High-Level Meeting on AMR, committing to a clear set of targets and actions, including reducing the estimated 4.95 million human deaths associated with bacterial antimicrobial resistance (AMR) annually by 10% by 2030 [3].
Resistance is driven by misuse and overuse of antimicrobials (i.e., antibiotics, antivirals, antifungals and antiseptics). Across human health, dentistry is responsible for an estimated 10% of antibiotics used globally [4]. In addition, large scale antiseptic use occurs both in-office and for oral home care [5]. High rates of misuse and overuse (up to 90%) of antibiotics have been identified in countries around the world, including the United States [6], UK [7] and Ghana [8]. This highlights the urgent need for improved antimicrobial stewardship in dentistry worldwide to reduce unnecessary use to help combat AMR and other adverse outcomes such as Clostridioides difficile infections [9].
The IADR supports WHO and FDI World Dental Federation about the important contribution oral health and dental care teams can make to tackling AMR [10, 11]. Based on the WHO global research priorities for AMR in human health [12, 13] (including within the WHO Immunization Agenda 2030: Why Gender Matters [14]), the following research priorities have been identified*:
- Prevention:
Integrate oral health promotion and disease prevention efforts within primary health care to reduce the incidence and prevalence of oral and dental diseases, thereby minimizing the need for antimicrobial interventions; investigate the impact and contribution of comprehensive oral health interventions, including professional care, public health initiatives, and patient education on the burden of AMR across all income settings, and identify effective, acceptable and feasible multimodal infection prevention and control strategies on reducing health care-associated infections, improving waste management and preventing oral and dental infections; - Diagnosis:
Investigate and evaluate rapid point-of-care tests to discriminate bacterial versus non-bacterial infections (for use in places where conventional specialist investigations, such as radiographs, are not available); and diagnostic tests for detecting pathogens and antimicrobial susceptibility of bacterial and fungal pathogens. Additionally, develop new technologies and improved techniques for measuring resistance at the microbial community level [15]; - Treatment and care:
Investigate antimicrobial stewardship interventions (including but not limited to enhancing awareness and education) that are context specific, feasible, sustainable, effective and cost-effective in outpatient and inpatient settings; determine optimal methods, metrics and targets to monitor antimicrobial use and consumption; determine the patterns and drivers of appropriate and inappropriate prescribing, use and consumption; and investigate contextually-appropriate antimicrobial treatment regimens for infections; conduct health services research to ensure timely access to appropriate oral and dental care to prevent the progression of infection and reduce reliance on antimicrobials. - Cross-cutting:
Investigate how antimicrobials are used appropriately and inappropriately across different health systems, including formal and informal care settings, to better identify effective stewardship models and highlight examples of good practice; investigate factors driving colonization of resistant bacterial and fungal taxa in the oral microbiome and exchange of AMR-related genes and plasmids; investigate mechanisms of resistance toward antimicrobials; investigate the environmental fate of antimicrobials used in dentistry; identify optimal surveillance methods to generate accurate and reliable data on the epidemiology and burden of AMR; determine the most cost effective behaviour change interventions to mitigate AMR emergence and spread, including self-medication by patients; evaluate the implementation of AMR-related policies and regulations and their effectiveness in mitigating AMR and improving health outcomes; investigate implementation strategies for national policies, legislation and regulations to improve infection prevention, patient care and the use of antimicrobial medicines; and investigate strategies to integrate AMR interventions into broader oral health initiatives and oral health financing structures and evaluate their impact. - Gender disparities:
Promote research to strengthen the evidence base on the intersection between gender and AMR, including: report patients’ sex, age and, where feasible, other social determinants of health within routine surveillance systems on AMR and antimicrobial use, and apply a gender analysis in regular audits to identify unconscious bias or inequities in prescribing practices; develop culturally sensitive and gender responsive health services for the prevention, diagnosis and treatment of (drug-resistant) infections without leaving behind vulnerable populations; produce context-specific messaging, language and images in AMR awareness and education materials that actively address gender norms and promote gender equality; improve hygiene and waste management infrastructure in health and community settings to ensure safe access for all genders which does not perpetuate stigma and discrimination; support gender mainstreaming across the entire immunization program cycle [14];
By adopting this policy statement, IADR aims to position itself as a leader and a trusted collaborator in addressing AMR within the oral health and dental care community while contributing to global health initiatives aimed at combating this urgent threat. The IADR is committed to fostering a culture of responsibility among oral health and dental professionals and ensuring that effective antimicrobial treatments remain available for future generations.
*IADR acknowledges that while dental professionals play a significant role in the use of antimicrobials, the landscape of access and prescribing is far more complex—particularly in countries where formal dental services are limited or inaccessible. In many low- and middle-income countries (LMICs), and even in some underserved communities in high-income countries, antimicrobials are frequently prescribed for oral and dental conditions by general medical practitioners or obtained over the counter by patients due to limited access to affordable and timely dental care. This reality underscores the need for a comprehensive, systems-level approach to antimicrobial resistance (AMR). Therefore, the research priorities outlined in this policy are intended to be flexible, inclusive, and applicable across diverse health system structures.
