Dentists to screen for too much alcohol intake

By Dr. Ananya Mandal, MDApr 5 2012

Soon it may be dentists who routinely ask their patients how much they drink.

The UK Government is proposing that dentists should question their patients on alcohol consumption, or that dental receptionists hand out drinking questionnaires to patients to be filled in while they wait for appointments. The plans have been drawn up by dentists at Cardiff University to try to combat excessive drinking. Patients who are deemed to drink too much would be referred on to sessions with dental nurses or hygienists for advice on cutting down.

This comes after a recent proposal to give family doctors a bonus for asking patients about their drinking habits, though dentists feel they are better placed to spot any problems and warning signs of excessive drinking such as tooth decay or cancers.

Writing in the Royal College of Surgeon's Dental Journal, the team added, “Alcohol misuse can impact on the oral health of patients attending primary care services in numerous ways. Excessive alcohol consumption is not only a risk factor for sustaining orofacial injury (either through falls, road traffic accidents or interpersonal violence) but also implicated in the etiology of potentially fatal oral disease, including cancers of the mouth, larynx, pharynx and esophagus.”

They said patients who drink lots also suffer tooth decay and erosion of the tooth surface. Alcoholic drinks high in sugar may also contribute to the development of cavities. “After screening, the individuals identified as misusing alcohol could then be offered treatment, including brief motivational advice sessions delivered by hygienists or dental nurses,” said experts, including from the University of Cardiff. “Liaison with the patients' medical practitioner could also result in referral for specialist care should the patient demonstrate alcohol dependence or depression, for example.”

The team said patients tend to go to their GP because they are ill but often visit a dentist as a preventative measure for a routine check-up. “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 taking.”

Jonathan Shepherd, Professor of Oral and Maxillofacial Surgery at Cardiff University, drew up the recommendations. Prof Shepherd said an estimated one in five men and one in seven women in the UK regularly binge-drink, which costs the UK economy approximately £25 billion a year. “The dental team has a responsibility to promote overall health and not just dental health,” he added. “Dentists and the Government must work together to develop and deliver screening and treatment by intervening early.”

British Dental Association chief executive Peter Ward said, “We agree that the dental examination is an ideal time to promote oral and general health messages. It is well recognized that excessive alcohol consumption, alongside smoking, increases the risk of developing oral cancer and gum disease so the dentist has always had an important role to play in reinforcing these health messages and detecting such cancers. The opportunity for dentists to concentrate more on preventive messages is currently being tested in dental pilots in England.”