From penicillin to precision: reframing AMR in dentistry through time – past lessons, present risks, and future solutions

Antimicrobial resistance (AMR) is a public health global threat projected to cause 10 million deaths annually by 2050 and a major health protection issue. Dentistry contributes approximately 10% of antibiotic prescriptions worldwide, often for conditions where antibiotics offer limited benefit. This article reframes AMR in dentistry through a historical, current, and future lens, integrating risk assessment principles, empirical prescribing trends, and precision strategies. We trace the trajectory from the penicillin era to modern stewardship challenges, examine the dental AMR burden and prescribing patterns using English Surveillance Programme for Antimicrobial Utilisation and Resistance 2023–2024 data, and explore innovative solutions including rapid diagnostics, microbiome restoration, and non-antibiotic therapies. Drawing on evolutionary insights from ancient microbiomes, we argue that AMR is not merely a clinical phenomenon, but a microbial ecological imbalance driven by industrialisation and antibiotic overuse. Future health protection strategies involving interdisciplinary working must combine stewardship with precision dentistry and microbial ecosystem restoration in a one-world setting to mitigate AMR risk while preserving microbial and host resilience. Public health plays an important role working with a range of other stakeholders/agencies in a multidisciplinary approach.