COM crisis

Sir, clinical oral microbiologists (COMs) form a specialty that has been highlighted by the COVID-19 pandemic as vital to supporting the quality and safe delivery of dentistry. Their Association raised several concerns in 2016, still unaddressed, around meeting the needs of the population and profession.¹ Currently, there are only seven COMs on the GDC register, the most recent added in 2014, and no trainees. With the five-year duration of training the number is not projected to increase in the immediate future, meaning that there will have been no COM training posts open for a continuous seven years. COM are involved in education and training undergraduate and postgraduate dental students and actively undertaking research, but the small number means that this is not the case in every UK dental school. Recently, level 7 and 8 postgraduate programmes were launched in two UK universities, preparing future candidates to be eligible for competing on shorter training pathways (nationally and internationally).

COM are involved in specialist management of systemic and local oral and maxillofacial infections caused by microorganisms, and are trained in medical microbiology to make strategic decisions on the most effective therapy for acute and chronic infections guided by clinical presentation and laboratory reports. This highly specialised focus is needed and unlikely to be fulfilled by any other groups. For example, the successful management of infections such as osteomyelitis, stage II and III of medication-related osteonecrosis of the jaw (MRONJ) and actinomycosis in the head and neck region, requires specialist COM input with an appreciation of the anatomical region and key differential diagnoses. Laboratory diagnostic testing is one part of their role by providing appropriate clinical advice vital in achieving infection resolution and improving patient outcomes.

Two other major roles are in leading the antimicrobial stewardship programme and infection prevention and control in dentistry. This is of importance in the era of emerging complex and resistant infections that resulted in more than 3 million deaths secondary to COVID-19 since December 2019, and more than 700,000 annual deaths secondary to drug-resistant infections.² Additionally, treatment for patients with multiple co-morbidities is resulting in complex decision making that requires such specialist infection management. We wish to highlight the urgent need for prioritisation of workforce planning of COMs or this vital dental specialty faces a real threat of non-existence in future years.