Sir, we welcome the review on dentists, antibiotics and Clostridium difficile–associated disease highlighting challenges in antimicrobial prescribing and the alarming rise in inappropriate prescribing patterns.1

The Association of Clinical Oral Microbiologists (ACOM) is concerned about this negative development and considers that many of these short comings are associated with the decreasing number of consultant oral microbiologists (COMs). COMs have the necessary training and experience to teach undergraduates and postgraduates the prevention, diagnosis, surveillance and management of oral and maxillofacial infections in addition to the important principles of antimicrobial stewardship. The latter is essential to ensure the appropriate use of antimicrobial agents both in limiting serious side effects and reducing the emergence and spread of antibiotic resistance. The key requirements of 'high calibre skills base' and 'modernising the surveillance of drug resistance' have been recently highlighted in the O'Neill report2 on the Global Health Crisis caused by antimicrobial resistance.

The dental profession has relied too long on the assumptions that the microbiology of oral and maxillofacial infections is readily predictable, pathogens are always susceptible to first line antimicrobial agents and that oral and maxillofacial infections are associated with negligible adverse patient outcomes. Today, there is evidence to suggest that even metronidazole may be losing its effectiveness for some species of anaerobes.3

At present, ACOM is engaged with the Department of Health in the drafting of a guide for commissioners for the supporting specialties. This is a critical opportunity to recruit and train the next generation of dentally qualified COMs. Two of the biggest challenges to the dental profession over the last decade have included instrument decontamination and antimicrobial stewardship. There are currently too few COMs to adequately address these issues. ACOM proposes that a network of increased numbers of COMs is established as soon as possible to provide leadership in the management of these and other issues.

The need for COMs will increase further with the greater use of implantable biotechnologies and an ageing population with multiple co-morbidities predisposed to infection with more unusual and pan-resistant microorganisms. Advances in diagnostic technologies that increase our understanding of the oral microbiome will be accompanied by a need for clinical skills that integrate clinical microbiology and in-depth knowledge of the complexity of the oral microflora and its increasingly apparent role in systemic diseases. COMs are ideally placed to provide their expertise and leadership through further training at a specialist level but this requires the creation of the appropriate number of training and consultant posts.