A healthy word – lockdown and alcohol
New research reveals an increase in lockdown level drinking that could have a lasting impact and therefore devastating health consequences. So how can dental teams communicate the importance of lowering alcohol intake for better oral health? Anna Middleton explores.
Raising awareness is always important. Often, we do not know the risks due to a lack of information. Knowledge is power.
Discussing alcohol consumption and its effects is extremely important. Alcohol misuse in England is a significant public health issue with major health, social and economic consequences. Providing information and having open conversations can help patients at risk change their habits.
Set the record
Recording units of alcohol is vital for record keeping. It allows to identify if a patient is at risk from alcohol-related diseases and signpost accordingly.
The identification of those at risk and offering advice consist of three stages:
- Initial screening, determining if the patient is drinking above lower risk limits
- Offering brief advice to patients who are drinking above the lower risk levels
- Referring or signposting possible high-risk drinkers to their GP or local alcohol support service(s).
By doing this you are raising awareness of drinking guidelines, offering feedback about how drinking can impact their oral/general health and providing support.
If you have concerns, then you should refer. In doing so you are acting in the patient’s best interest and upholding your GDC standards.
Sadly, those who may have a high intake of alcohol or a dependency often do not access dental services. When they do, it usually is only as an emergency because they are in pain. Perhaps in some cases as a result from excessive alcohol consumption.
If you see this or have concerns this would be an opportunity to help but must be approached sensitively.
A picture says a thousand words. Having posters in the waiting room can help deliver messages, even if they are subtle.
I like the one that shows what 14 units (the weekly maximum recommended number of units) of alcohol looks like in a different number of drinks. It really helps patients to add up roughly how much they drink without too much number crunching.
There are also a variety of alcohol screening questionnaires developed for use in primary care settings (AUDIT; AUDIT-C; AUDIT-PC; FAST). All have been shown to be a reliable and valid means of detecting alcohol misuse among patients.
Empower patients to make healthier choices
I use my social media channels and blog to talk about a whole range of topics.
Something I have always been passionate about is promoting good oral health for overall wellbeing. By tackling various trends and topics I have been able to help my patients make well informed choices.
Address the impact of alcohol on aesthetics as well as health
Alcohol contains acid, and some alcohols contain more than others. It is found in beers, spirits and wine. Wine is especially acidic.
The most common acids found in wine are citric acid, tartaric acid and malic acid. The reality is acid is awful for teeth, and when left on the teeth for extended periods of time, it causes erosion. It eats away at the enamel, resulting in permanent and irreversible damage.
Acids also respond to bacteria in the mouth by creating lactic acid, which further destructs the enamel increasing the risk of decay and sensitivity.
Alcoholic drinks that boast deep, dark shades are generally the culprits staining teeth. These include beers, red wine, coffee liqueurs and other concentrated beverages. They cause discolouration and staining that can have long-lasting effects.
Oral cancer, caries, halitosis, periodontal disease and trauma
One of the most common causes of tooth decay is the continuous intake of sugars. Various forms of alcohol contain sugar. The sweeter the wine or alcohol tastes, the more sugar it contains.
Prosecco is one of the worst. Sipping the famous bubbles constantly means a double whammy of sugar and acid, which can wreak havoc on teeth as they are constantly attacked.
This can lead to demineralisation of the enamel resulting in erosion and decay. Healthy enamel is white and shiny, but too much fizz will dissolve the teeth leaving them dull, chalking and at risk of crumbling away.
Alcohol is linked to just under a third (30%) of all mouth cancers. Smoking and drinking together increases the risk of mouth cancer by up to 30 times.
Too much alcohol can lead to poor oral hygiene habits such as skipping brushing and cleaning interdentally, which can cause bad breath, decay and gum disease.
Excessive alcohol intake is also associated with dental trauma and facial injury. Either through accidental falls, road traffic accidents or violence, both domestic and street related.
Guidelines and advice
I always refer to the Delivering Better Oral Health toolkit for recommendations and guidelines.
Section eight covers alcohol misuse and oral health. There is also www.drinkaware.co.uk, which we can reference for advice, facts and resources.
Having alcohol-free days is a fantastic way of keeping within the guidelines. I make a conscious effort to not drink on weeknights. If I do decide to have a drink, I will opt for just one small glass of wine, single spirit with a sugar-free mixer or a bottle of light beer.
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