The complexity of antibiotic development presents yet another hurdle. “As scientific and economic challenges hamper progress in creating new, effective antibiotic agents, without new treatments, resistance may outpace our ability to combat infections,” Professor Edlund warns.
Antibiotic resistance in dentistry: A unique concern
AMR is a significant concern in dentistry, where antibiotics are frequently prescribed to treat dental infections or as a prophylaxis to prevent the spread of infection. Dentists account for approximately 10% of all antibiotic prescriptions for humans, contributing to the development of antibiotic-resistant bacteria. According to the World Dental Federation (FDI), many of these prescriptions are in fact unnecessary, further exacerbating the problem of antibiotic resistance.2
Professor Edlund highlights that minimizing antibiotics in dentistry involves addressing the underlying causes of infection and prioritizing procedures such as abscess drainage, endodontic treatments, and necessary extractions. She adds that antibiotics should be reserved as a supportive measure, used only when systemic infections are present.
While many countries have national recommendations for antibiotic use in dentistry, many still lack comprehensive guidelines that promote responsible antibiotic use, with some only addressing either antibiotic treatment or prophylaxis. Professor Edlund emphasizes that it is crucial for guidelines to be developed through a rigorous, quality-assured process. However, she points out that simply publishing guidelines is insufficient.
“Guidelines must be thoroughly implemented and accompanied by educational efforts to motivate adherence. Additionally, monitoring prescription behavior and providing feedback to clinicians are the key strategies for improving adherence,” Professor Edlund explains.
Combating antibiotic resistance in dentistry with novel methods
Tommi Pätilä, a cardiac and transplant surgeon at the New Children’s Hospital (HUS) in Helsinki, Finland, emphasizes the importance of limiting antibiotic use in all treatments as new antimicrobial-resistant bacterial strains continue to emerge.3 Given the rise of AMR, there is a growing need for alternative methods to treat and prevent serious infections. For instance, photodynamic therapy (PDT) is expected to play an increasingly important role in medicine.
Unlike traditional antibiotics, antibacterial PDT (aPDT) uses light-activated photosensitizers to produce reactive oxygen species (ROS) that damage bacterial cells. This mechanism makes it difficult for bacteria to develop resistance, studies show. Additionally, PDT has shown effectiveness against antibiotic-resistant strains and offers immediate action compared to the delayed effects of antibiotics.4,5
PDT has been used in dental clinics to treat periodontal infections by targeting and destroying pathogenic bacteria. It can also be applied in root canal treatments to eliminate bacteria within the root canal system. PDT is also used in medicine to detect cancerous changes in oral lesions, treat early and advanced oral cancers, and target bacterial and fungal infections.6,7
“The most promising aspect of the method is the absence of developing bacterial resistance. This is based on a physical phenomenon. So far, no resistance has been detected in large-scale studies,” Dr. Pätilä says.
The Lumoral treatment is an innovative solution that allows light-activated therapy to be performed at home, complementing traditional oral hygiene methods such as brushing and flossing. This method combines an antibacterial mouth rinse with a targeted light-activated antibacterial therapy. Together, they work to reduce the buildup of harmful plaque bacteria in the mouth, helping to lower the risk of oral infections such as periodontitis. Lumoral is used in some European and Asian countries but is not yet available in the US.
According to Dr. Pätilä, unlike chlorhexidine (CHX), which is a chemical antiseptic, the Lumoral method operates through a distinct mechanism that reduces the risk of bacteria developing resistance.
CHX is a widely used antiseptic in dental care, but there is growing concern about bacterial resistance. Studies have shown that bacteria such as Klebsiella pneumoniae and Pseudomonas aeruginosa can develop resistance to CHX.8 Resistance to CHX has also been linked to cross-resistance to certain antibiotics, such as colistin.9
“Light-activated antibacterial treatment has a different mode of action that reduces the likelihood of bacteria developing resistance. The ROS generated during aPDT cause oxidative damage to bacterial cells, a process that bacteria find challenging to resist. Therefore, Lumoral treatment offers an effective antibacterial approach with a lower risk of contributing to AMR compared to traditional chemical antiseptics like CHX.”
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