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The impact of alcohol consumption on dental practice

9 August 2019

The impact of alcohol consumption on dental practice

When issuing more stringent alcohol consumption guidelines in January 2016, the Chief Medical Officers (CMOs) reduced the limit for the low risk category of alcohol consumption for men to the same level as for women. By this measure, both are now advised not to regularly drink more than 14 units per week.

The updated guidelines also state that there is no safe level of alcohol consumption and that, if you do drink as many as 14 units per week, to spread this evenly over three days or more. It is also safest to avoid drinking alcohol altogether during pregnancy.

The alcohol industry’s standards body, the Portman Group, initially told its members in 2017 they were not obliged to print the new limits on their products as the published guidance was voluntary.

However, they have now agreed, along with the Department of Health and Food Standards Agency, on a deadline of 1 September 2019 for the removal of out-of-date information and enactment of the new labelling guidelines.

The Portman Group advise that producers include, as a minimum, unit alcohol content per container (and optional per typical serve), visual warning against drinking during pregnancy and active signposting to the Drinkaware website.1

CMO Dame Sally Davies has welcomed the move, saying: “People often do not know the damage that regularly consuming more than 14 units a week can do to their health”.

Alcohol misuse in England is a significant public health problem with major health, social and economic consequences.

According to data reported in the Public Health England’s toolkit for ‘Delivering better oral health’, the consumption of alcohol has almost doubled since the 1950s and 25% of adults in England exceed the CMOs’ guidelines of no more than 14 units per week.2

Effects of alcohol misuse on oral health

Drinking above the lower risk guidelines adversely affects oral health in a range of ways. The most important effect is undoubtedly the significantly increased risk of oral cancers among drinkers.

Around 6,800 people are diagnosed with oral cancer each year in the UK.3

Public Health England reports that the incidence of oral cancer has steadily increased since the 1970s and oral cancer among men is now more common than cervical cancer in women.

There are also many wider health, social and psychological effects of alcohol, which may impact upon dental practice. Patients that are dependent on alcohol may struggle to attend appointments reliably and may struggle to comply with the self-care elements of treatment plans, for example.

Higher risk drinkers are also at risk of liver impairment, which can result in coagulopathy. Consequently, it is recommended that high risk drinkers with a positive bleeding history have haematological investigations, including a full blood count and coagulation screen, before oral surgery.4

Alcohol consumption is clearly an important risk factor to good oral health and should also be taken into account when risk stratifying patients for certain oral diseases.

Professional intervention

According to the Department of Health, more than half of adults in England were seen by a dentist in the last two years.

Dental teams are therefore in a unique position to provide very brief but tailored advice and support to members of the public who are drinking above the lower risk levels and give very brief advice and, where appropriate, signpost patients to GP and or local alcohol services.

‘Delivering better oral health’ advises that the level of alcohol consumption should be ascertained for all patients.

Medico-legally, it is very important to record alcohol consumption in the patient’s notes and record that appropriate feedback and advice has been given to patients. In the event of a claim against a dental professional for missed or delayed referral for oral cancer, this recorded evidence is crucial for a successful defence.5

With dentists being increasingly involved with wider health issues and working together with other health care professions to provide holistic care to patients, patient alcohol consumption is becoming ever more important for dental practitioners, particularly when considering the future introduction of a new NHS contract which is likely to be much more oriented towards prevention.

 

Sources:

[1] Portman Group, Communicating Alcohol and Health-Related Information. http://www.portmangroup.org.uk/codes/alcohol-marketing/communicating-alcohol-and-health-related-information-(toolkit) [accessed 8.8.19]

[2] Public Health England, Delivering better oral health: an evidence-based toolkit for prevention. https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention [accessed 8.8.19]

[3] National Health Service, Who’s affected by mouth cancer? https://www.nhs.uk/conditions/mouth-cancer/ [accessed 8.8.19]

[4] Quach S, Brooke A E, Clark A, Ellison S J. Blood investigations prior to oral surgery for suspected alcohol-induced coagulopathy. Are they necessary? https://www.ncbi.nlm.nih.gov/pubmed/26271868 [accessed 8.8.19]

[5] DDU Journal, Oral cancer: In the event of a claim. https://ddujournal.theddu.com/issue-archive/issue-2/oral-cancer [accessed 8.8.19]

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