Awareness regarding antimicrobial resistance and confidence to prescribe antibiotics in dentistry: a cross-continental student survey

Abstract

Background: The antimicrobial resistance (AMR) crisis is a major global threat and one of its biggest drivers is the overuse of antibiotics in humans. Dentists are responsible for 5-10% antibiotic prescriptions worldwide and recent data suggest that knowledge and prescribing practices need improvement.

Methods: A cross-sectional web-survey was sent to dental students from six universities in Norway, Canada, and Brazil. Topics addressed covered awareness, confidence to prescribe antibiotics, and education needs. Data were presented descriptively and statistical testing was employed to compare group means when applicable.

Results: In total, 562 responses were collected across the three countries with a response rate of 28.6%. 'Antibiotic resistance' was among the highest priorities (scale 1-10) with an average of 8.86 (SEM ± 0.05), together with 'Gender inequality' (8.68 ± 0.07) and 'Climate change' (8.68 ± 0.07). Only 28.8% thought that Dentistry was engaged in national/international campaigns promoting awareness on the topic and 8.9% stated to have heard about the 'One Health' concept. Final year dental students showed an average confidence to prescribe antibiotics of 7.59 (± 0.14). Most students demonstrated interest in receiving additional education on all topics listed, with the three most pressing being 'antibiotic prescription for treatment of infections' (82.9%), 'drug interactions' (80.9%), and 'spread of antibiotic resistance' (79.6%). A trend was observed between higher awareness regarding the topic and higher confidence to prescribe.

Conclusions: There is a need to revisit dental education on antibiotic resistance with a global perspective and to create more stewardship initiatives that promote awareness on the topic.

Keywords: Antibiotic resistance; Antimicrobial stewardship; Cross-sectional survey; Drug prescriptions; Health education; Microbiology.

Fig. 1

Perceived awareness on global issues for dental students on a scale from 1 to 10. A All participants in the survey, B participants from Norway, C participants from Canada, and D participants from Brazil. Statistics were performed with Kruskal–Wallis one-way analysis of variance with Dunn’s posthoc with the primary basis of comparison being ‘Antibiotic resistance’. **p < 0.01, ****p < 0.0001

Fig. 2

Knowledge of students regarding the involvement of dentistry in the antibiotic resistance crisis response. A Engagement in national and international campaigns promoting awareness on antibiotic resistance. B Knowledge of the concept of One Health. C Importance of the topic of antibiotic resistance for dentists

Fig. 3

Perception of dental students on which areas should be addressed to slow down the development of antibiotic resistance on a scale from 1 to 10. A All participants in the survey, B participants from Norway, C participants from Canada, and D participants from Brazil. Statistics were performed with Kruskal–Wallis one-way analysis of variance with Dunn’s posthoc. ****p < 0.0001

Fig. 4

Participants’ level of confidence concerning antibiotic prescriptions for treatment (five first statements) and prevention of infections (three last statements). Relative values (%) of responses are represented in the x-axis

Fig. 5

Level of confidence of final year dental students to prescribe antibiotics on a scale from 1 (I do not have enough knowledge) to 10 (I have enough knowledge). Symbols show averages of answers with error bars representing standard error of the mean (SEM). ‘T’ indicates total responses; ‘HA’—higher awareness on antibiotic resistance; ‘LA’—lower awareness on antibiotic resistance. Statistics comparing confidence level between higher and lower awareness groups were performed with Mann–Whitney test. *p < 0.05

Fig. 6

Interest of final year dental students in receiving further education and information on selected topics related to antibiotic resistance. Relative values (%) of responses are represented in the x-axis