Dental antimicrobial stewardship: toolkit
Resources to help primary care practitioners promote the appropriate use of antibiotics in dental care.
The dental antimicrobial stewardship (AMS) toolkit for primary care was developed by the Dental Subgroup of the UK Health Security Agency’s (UKHSA’s) English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR).
The toolkit provides educational resources, support and guidance to dental teams and commissioners to reduce unnecessary and inappropriate antimicrobial prescribing. The toolkit contributes to international efforts to tackle antimicrobial resistance through increased awareness and improved antibiotic stewardship.
The dental AMS toolkit is updated to include the latest antimicrobial prescribing guidance and additional resources.
The toolkit
Guidance has been published by a range of organisations and professional bodies both within dentistry and wider healthcare professionals. These include:
General Dental Council guidance
- Guidance on Prescribing Medicines – General Dental Council (GDC)
Detailed prescribing guidance
- Recommended Antimicrobial Prescribing in Dentistry – Faculty of General Dental Practitioners (FGDP) and Faculty of Dental Surgery (FDS) of the Royal College of Surgeons of England
- Prescribing in Dental Practice – British National Formulary (BNF)
- Drug Prescribing for Dentistry – Scottish Dental Clinical Effectiveness Programme
- Prophylaxis against infective endocarditis – National Institute for Health and Care Excellence (NICE) Clinical Guideline 64 – this is supported by the Implementation advice for NICE Clinical Guideline 64 Prophylaxis against infective endocarditis – Scottish Dental Clinical Effectiveness Programme
Prescribing guidance summaries
- Chairside synopsis for common conditions – Antimicrobial Prescribing in Dentistry: Good Practice Guidelines – FDS and College of General Dentistry
- National analgesic advice sheet for dentists – NHS
Other guidance and information
- Dentists Medicine Advice Service – NHS Specialist Pharmacy Service
- Dental factsheets for community pharmacy – Health Education England
- Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance – Department of Health and Social Care
Education and training tools
- Dental SCRIPT, e-learning for dentists – Health Education England
- e-Den: Dentistry programme e-learning modules – e-learning for healthcare
- Antimicrobial resistance: e-learning introductory module – e-learning for healthcare
- Antimicrobial stewardship: e-learning modules – British Association of Oral Surgeons
- Tackling Antibiotic Resistance: What Should Dental Teams Do? – Fédération Dentaire Internationale (FDI) World Dental Federation and British Society for Antimicrobial Chemotherapy
- Keep Antimicrobials Working: Resources for students and junior practitioners – British Society for Antimicrobial Chemotherapy, in collaboration with UK Medical Schools
- From the Dentist’s Chair – a drama about antibiotics – Theatre of Debate
Personal development plans
Personal development plan (PDP) templates for prescribers and non-prescribers
The personal development plan templates were developed to support GDC registrants to include antimicrobial stewardship in their continuing professional development (CDP) plans.
Audit tool and action planning
Self-audit tool for dental prescribers
This tool was developed to help dental prescribers complete a clinical audit of their antimicrobial prescribing and management of dental infections. It is available from:
Dental hospitals national audit tools
These tools were developed to help dental prescribers working in a secondary healthcare setting to complete clinical audit of antibacterial prescribing for outpatient prophylactic prescribing and outpatient therapeutic prescribing.
Antibiotic guardian resources
Why the toolkit was developed
The inappropriate use of antibiotics can lead to the development of drug-resistant bacteria. The toolkit aims to help prescribers adopt best practice and promote the responsible use of antibiotics in dental care.
An independent review of antimicrobial resistance, the Antimicrobial Resistance (AMR) Review commissioned by the UK government in 2014 and chaired by Lord Jim O’Neill, analysed the global impact and estimates that a failure to address the problem of antibiotic resistance could result in:
- 10 million deaths every year globally by 2050
- a cost of £66 trillion ($100 trillion) to the global economy
Using the resources in the dental AMS toolkit can contribute to dental surgeries and practitioners demonstrating compliance with the Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance.
The toolkit also supports recommendations made in the NICE guideline NG15 Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use.
The latest data on antimicrobial prescribing is published in the ESPAUR report.
The ESPAUR Dental Subgroup
The Dental Subgroup of ESPAUR was established in 2015, with the aim of exploring surveillance and improving antimicrobial stewardship through prevention, development of resources, audit and education in the dental sector. The toolkit is based on work originally developed by NHS England Cheshire and Merseyside Local Dental Network.
In 2020 there was an increase in prescribing of antibiotics by dental prescribers. This was associated with the restricted access to face-to-face dental services during the COVID-19 pandemic. Although services have been resumed, prescribing has remained higher than pre-pandemic levels.
The Dental Subgroup reconvened in 2021 after a break due to the COVID-19 pandemic. The subgroup agreed that the toolkit should be reviewed to ensure it reflects current guidance and that dental teams had access to the most up-to-date resources.
A multi-organisational task group was set up to update the dental AMS toolkit, with representatives from:
- Office for Health Improvement and Disparities
- UKHSA
- NHS England Workforce Training and Education Directorate (formerly Health Education England)
- NHS England
- Association of Dental Groups
- College of General Dentistry
- British Dental Association
- Association of Clinical Oral Microbiologists
- Office of the Chief Dental Officer
- NHS Local Dental Network Chairs
- British Association for the Study of Community Dentistry
In addition to those in the task group, the ESPAUR Dental Subgroup also includes:
- British Association of Dental Nurses
- Care Quality Commission
- FDS, Royal College of Surgeons of England
- NHS Business Services Authority
- Association of Dental Hospitals
Updates to this page
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Updated toolkit with latest antimicrobial prescribing guidance and resources.
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Added link to drama video about antibiotic prescribing.
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Added links to antimicrobial stewardship e-modules and guidance on antibiotic prophylaxis against infective endocarditis and drug prescribing for dentistry.
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Added adult and child pain relief poster.
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Added 'Delivering better oral health: an evidence based toolkit for prevention' under guidance.
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First published.