Welcome to Julian Webber's blog where he muses on a range of topics including some of his most interesting cases,
stories from his travels, the latest from the clinic and news on our Saving Teeth Awareness Campaign.

The antibiotic revolution

1928 was an important year. Penicillin was first discovered and it revolutionised healthcare at the time, curing or controlling severe diseases such as tuberculosis, syphilis, pneumonia and other bacterial infections. What followed was a huge wave of optimism, as people believed the war on bacteria was over. In 1969, the Surgeon General of the United States even stated it was time to “close the book on infectious diseases.” Little did he know that several decades later bacteria would be fighting back.


Winning the battle against one of the most powerful organisms in the world isn’t that simple. One of their characteristics is that they reproduce exponentially and can tackle challenging conditions – such as the emergence of penicillin. This means that they can adapt to new circumstances and the longer they are subjected to an antibiotic, the more resistant they become. Weaker microorganisms will still be defeated by antibiotics, but the stronger ones survive, making each following generation of bacteria better armed to tackle future antibiotic challenges.


Infections in the pulp of the root canal are the most likely cause for dental patients to be prescribed antibiotics. Because patients come into my clinic for diagnosis and specialist treatment, I’m unlikely to find myself  under pressure to prescribe. On the contrary, I am able to tell the patient that a properly carried out root canal treatment will resolve an endodontic infection without the need for antibiotics. For general dentists however, it’s more difficult. Patients in pain will sometimes push for a prescription, believing this is the way to get rid of their symptoms.


In order to solve this problem, we need to make patients aware that antibiotics are not always required for managing an infection and removing the source of infection is a far better option. The Faculty of General Dental Practice in the UK has started a campaign, called Thunderclap, in which they ask dentists to pledge that they will “make more time to manage infection and only prescribe antibiotics in line with published guidelines”. (http://www.fgdp.org.uk/content/press-release/fgdpuk-urges-responsible-approach-to-antimicrobial.ashx)


A good start. As the American Association of Endodontists, of which I am a member, points out, Norway does not have killer bugs yet thousands of people in sophisticated hospitals in North America, other parts of Europe and Asia are dying from contagious infections. The reason is that in Norway, the number of antiobiotic presecriptions has been dramatically scaled down.


All healthcare professionals need to resist the temptation to hand out a prescription for antibiotics because that’s what the patient wants. And we all need to be signed up to it. Otherwise, as the World Health Organisation points out, we are heading for a post-antibiotic era in which common infections and minor injuries can kill.


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