Antimicrobial Resistance and Causal Relationship: A Complex Approach Between Medicine and Dentistry
Giovanni Caivano, Fabio Massimo Sciarra, Pietro Messina, Enzo Cumbo, L. Caradonna, Emanuele Di Vita, Salvatore Nigliaccio, Dorotea Fontana, Antonio Scardina, Giuseppe Alessandro Scardina
Abstract
Antimicrobial resistance (AMR) is widely recognized as a major global public health threat, yet its origins and implications extend beyond the simple misuse or overuse of antibiotics. This study explores AMR as a complex, multifactorial phenomenon shaped by biological, clinical, dental, environmental, and social dynamics, with particular attention to the emerging role of dentistry. A narrative literature review was performed, drawing from textbooks, peer-reviewed articles, and official World Health Organization (WHO) reports, with emphasis on recent findings on periodontal biofilms as reservoirs of resistance genes. The analysis shows that AMR develops through bacterial mutations, horizontal gene transfer, environmental contamination, healthcare-associated practices, and patient behaviors, all of which interact to sustain its spread. Within dentistry, subgingival microresistances are gaining relevance, complicating treatment strategies and underscoring the need for more conscious clinical decision-making. The findings suggest that reducing antibiotic prescriptions or developing new drugs alone will not suffice; instead, a systemic, interdisciplinary approach is required, integrating microbiology, clinical practice, public health, and institutional responsibility. Such awareness is essential to confront the significant clinical, economic, and social implications of AMR and to foster strategies capable of addressing its complex and evolving nature.