Join the Fight: Responsible Treatments for Oral Disease This Antimicrobial Week!

When it comes to tackling the issue of antibiotic development, the road ahead is anything but smooth. “As we face scientific and economic challenges in creating new, effective antibiotic agents, we find ourselves in a race against time; without innovative treatments, antibiotic resistance could outstrip our efforts to combat infections,” warns Professor Edlund.

Antibiotic Resistance in Dentistry: A Growing Concern

Antimicrobial resistance (AMR) isn’t just a buzzword; it’s a pressing issue in the dental world. Dentists often prescribe antibiotics for dental infections or as preventive measures, accounting for around 10% of all antibiotic prescriptions issued in the U.S. This significant contribution to antibiotic use has a dark side: the development of antibiotic-resistant bacteria. Alarmingly, many of these prescriptions are unnecessary, as highlighted by the World Dental Federation (FDI), further fueling the antibiotic resistance crisis.²

To combat this trend, Professor Edlund emphasizes the importance of addressing the root causes of dental infections. By prioritizing procedures like abscess drainage, endodontic treatments, and necessary extractions, we can minimize the need for antibiotics, reserving them for systemic infections only.

While various countries have established recommendations for antibiotic use in dentistry, a comprehensive approach is often missing. Many guidelines focus solely on either treatment or prophylaxis, leaving a gap in responsible antibiotic usage. Professor Edlund insists that it’s not enough to simply create guidelines; they must be rigorously developed and effectively implemented. “It’s crucial to pair guidelines with educational initiatives that inspire adherence and to monitor prescription behaviors while providing valuable feedback to clinicians,” she explains.

Innovative Approaches to Combat Antibiotic Resistance in Dentistry

Tommi Pätilä, a cardiac and transplant surgeon at the New Children’s Hospital (HUS) in Helsinki, underscores the need to limit antibiotic use across all treatments as new antimicrobial-resistant strains continue to emerge.³ With AMR on the rise, there’s a growing demand for alternative strategies to treat and prevent serious infections. One promising option is photodynamic therapy (PDT), which is poised to revolutionize how we approach dental infections.

Unlike traditional antibiotics, antibacterial PDT (aPDT) employs light-activated photosensitizers to generate reactive oxygen species (ROS) that effectively damage bacterial cells. This innovative mechanism makes it challenging for bacteria to develop resistance. Research suggests that PDT can work wonders even against antibiotic-resistant strains, offering rapid action compared to the slower onset of traditional antibiotics.^4,5

In dental clinics, PDT has been utilized to treat periodontal infections by targeting harmful bacteria. It can also enhance root canal treatments by eradicating bacteria from the root canal system. Beyond dentistry, PDT is advancing in the medical field for detecting cancerous changes in oral lesions and managing both early and advanced oral cancers, along with bacterial and fungal infections.^6,7

“The most remarkable aspect of this method is its lack of bacterial resistance development, which is rooted in a physical phenomenon. So far, large-scale studies have shown no resistance,” Dr. Pätilä states.

Enter Lumoral, an innovative treatment that allows for light-activated therapy to be performed at home, supplementing traditional oral hygiene practices like brushing and flossing. This cutting-edge method combines an antibacterial mouth rinse with targeted light-activated therapy to combat harmful plaque bacteria, significantly lowering the risk of oral infections such as periodontitis. Although Lumoral is already making waves in European and Asian countries, it remains unavailable in the U.S.

Dr. Pätilä points out that unlike chlorhexidine (CHX), a commonly used chemical antiseptic, the Lumoral method offers a distinct mechanism for preventing bacterial resistance.

CHX is widely utilized in dental care, yet concerns about bacterial resistance are mounting. Studies indicate that bacteria like Klebsiella pneumoniae and Pseudomonas aeruginosa can develop a resistance to CHX.⁸ Furthermore, resistance to CHX has been linked to cross-resistance with certain antibiotics, such as colistin.⁹

“Light-activated antibacterial treatment operates through a different mechanism that significantly reduces the chance of bacteria developing resistance. The oxidative damage caused by ROS during aPDT is a process that bacteria find challenging to overcome. Therefore, Lumoral presents an effective antibacterial option with a lower risk of contributing to AMR compared to traditional chemical antiseptics like CHX,” concludes Dr. Pätilä.