The number of alcohol consumers in the UK has increased substantially over the last century1. Around 40 million British adults regularly consume alcoholic drinks and while many do so moderately, about 25% exceed Department of Health guidelines2. For men, this is drinking more than the recommended 3 to 4 units a day, such as drinking more than a strong pint of lager or beer ABV 5.2% daily and for women, drinking more than the recommended 2 to 3 units of alcohol a day, such as drinking more than a standard 175ml glass of wine ABV 13% on a daily basis3. UK alcohol related death rates continue to rise.
Excessive alcohol consumption impacts on oral health in several ways. Drinking hazardously is not only a risk factor for sustaining oro-facial injuries, either through falls, road traffic accidents or violence, but is also implicated in the aetiology of potentially fatal oral disease, including cancers of the mouth, larynx, pharynx and oesophagus4. Alcohol and lifestyles closely associated with alcohol misuse can also have detrimental effects on the dentition: dental erosion, dental caries and periodontal disease5. Tackling alcohol misuse is therefore important for primary care dental professionals from a purely dental perspective. Since alcohol misuse affects patients' general health, addressing this in primary dental care settings also enables dental professionals to meet wider health promotion responsibilities.
Unlike primary medical care, primary dental care services are used by patients on a regular, prevention-orientated basis, with the majority of people attending for a routine check-up irrespective of any oral health problem. This provides the primary dental healthcare team with unique opportunities to intervene, particularly as asking patients about their levels of alcohol consumption is a routine component of medical history taking6.
Recommendations for tackling alcohol misuse in primary dental care have been published. The new dental contract reflects the aims of the UK government to focus the attention of dental healthcare professionals on quality, treatment outcomes and how well their patients are looked after, rather than primarily on treatments delivered7. There is now more emphasis on health promotion, and dentists will be expected under the new contracts to carry out health assessments and to offer targeted advice when risky behaviours, including alcohol misuse, are identified. General Dental Council guidance on the education of dentists recommends that all dental healthcare professionals should be competent in and committed to promoting health and well-being8. The British Dental Association's Oral Health Inequalities Policy calls on members of the dental team to inform and advise patients about their oral and general health risks, including alcohol use9. A World Oral Health report published in 2003 recognises that dental professionals have an important role in general health promotion10.
Screening and treatment in primary dental care could involve similar strategies to those used by primary medical practitioners using the same valid and reliable questionnaires and motivational interventions developed in psychology. These have been found to be effective and cost beneficial in some dental settings6,11. The Alcohol Use Disorders Identification Test (AUDIT)12 and abbreviated versions of this (e.g. AUDIT-C) and the Fast Alcohol Screening Test (FAST)13 are practical examples of screening instruments. Patients who score highly for misuse could then be given motivational advice and those identified as dependent could be referred for specialist care in consultation with the patient's medical practitioner.
Although suitable screening tools and treatment interventions are available it is unclear which of these are most effective and precisely how and when they should be deployed in primary dental care and so further development is therefore necessary. It is clear however, that the dental team can contribute and that this contribution fits well with its responsibilities and interests.
The Authors: Jonathan Shepherd CBE FMedSci FDSRCS, Professor of Oral and Maxillofacial Surgery, Zairah Roked BSc BDS MJDF, Academic Clinical Fellow, School of Dentistry, Cardiff University, Heath Park, Cardiff CF14 4XY
1. British Medical Association. Under the influence: The damaging effect of marketing on young people. London: BMA Marketing and Publications; September 2009.
2. National Audit Office, Department of Health. Reducing Alcohol Harm: health services in England for alcohol misuse. London: The Stationery Office; October 2008.
3. The Department of Health. Change 4 life campaign leaflets: Don't let drink sneak up on you. January 2012.
4. Rehm J, Room R, Graham K, Monteiro M, Gmel G, Sempos CT. The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview. Addiction 2003; 98: 1209-28.
5. Amaral CSF, Vettore MV, Leao A. The relationship of alcohol dependence and alcohol consumption with periodontitis: A systematic review. Journal of Dentistry 2009; 37: 643-651.6.
6. Roked Z, Moore SC, Shepherd JP. Alcohol misuse: screening and treatment in primary dental care. Faculty Dental Journal 2012; 3: 73-77.
7. Boynton S, Henderson S. CQC and GDC: a practitoner's nightmare? How did we get here? Faculty Dental Journal 2011; 2: 53-8.
8. General Dental Council. The first five years - third edition. London; December 2008.
9. British Dental Association. The British Dental Association oral health inequalities policy. London: British Dental Association; 2009.
10. Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century - the approach of the WHO Global Oral Health Programme. Comm Dent Oral Epidemiol 2003; 31 (Suppl 1): 3-24.
11. Smith AJ, Hodgson RJ, Bridgeman K, Shepherd JP. A randomised controlled trial of a brief intervention after alcohol-related facial injury. Addiction 2003; 98: 43-52.
12. Sauders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of Alcohol Use Disorders Identification Test. WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 1993; 88: 791-804.
13. Hodgson RJ, Alwyn T, John B, Thom B, Smith A. The Fast Alcohol Screening Test. Alcohol Alcohol 2002; 37: 61-66.