Alcoholism is a disease that can cause irreparable damage to the brain, liver and other organs, increase one’s risk of getting cancer, and is involved in the death of 29 Americans every day in motor vehicle crashes. Yet alcoholism is on the rise in the United States: A 2017 study published by the Journal of the American Medical Association (JAMA) found that the rate of alcoholism rose precipitously — nearly 50 percent — between 2000 and 2010, and that one in eight adults currently meets the criteria for alcoholism.
Many of alcohol’s most debilitating physical effects, such as liver and heart disease, are widely recognized. It’s also important to note that alcohol abuse has a marked impact on dental health. Alcoholics are at an elevated risk for tooth decay, gingival disease, and oropharyngeal cancers. Salivary glands become swollen, the tongue may become inflamed, and the acid in alcohol erodes tooth enamel (acidic contents from the stomach may enter the mouth through reflux or vomiting, which also contributes to erosion). Alcohol has a dehydrating effect on cell walls, making them more permeable and leaving the oral cavity vulnerable to the residual effects of toxins and carcinogens, which can lead to oral cancer.
Dentists can play an important interventional role with patients who exhibit the effects of alcohol abuse. In fact, the sooner dentists address a patient’s alcoholism, the more successful they’re likely to be in helping to prevent its deadly consequences. This guide offers information about the connection between alcoholism and dental health; how dentists can prevent and mitigate the effects of alcohol abuse on dental and periodontal health; and how alcoholics can fight back against this terrible disease. You will find strategies for maintaining dental health as well as information about how dental practitioners can support your efforts.
Screening for alcohol abuse
There are many oral and extra-oral symptoms that indicate alcohol abuse which a dentist can readily identify as cause for intervention. Some of the more obvious signs include:
- The smell of alcohol on the breath
- Broken teeth or dentures
- Swelling of the parotid gland
- A swollen and reddened tongue
Other, less noticeable signs may include:
- A red, bloated nose
- Dilated blood vessels
- Jaundiced or bloated skin
- Baggy eyes
- Elevated blood pressure
Alcoholic patients are especially vulnerable to hemorrhage and infection, because alcohol inhibits vitamin K absorption and damages the immune system. It is important to note that alcoholism may produce a high tolerance to local anesthesia, so it may be necessary to increase anesthesia dosage to maintain numbness. Consequently, longer appointments may be necessary.
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Precautions and dental treatment
Once the signs of alcoholism have been identified in a patient, dentists can take a number of precautions for improving dental health, including:
- The application of a fluoride varnish
- Use of mouthwash containing alcohol-free fluoride, as well as high-strength fluoride toothpaste (1,350 to 1,500 parts per million fluoride)
- The application of tooth mousse (which can be administered with a tray or by finger)
- The incorporation of special dietary measures, including the reduction of foods high in sugar and emphasizing foods high in fiber and protein
- The institution of a regular exercise program
If you’re anxious about visiting the dentist or receiving dental and periodontal care, sedation may be an option, though intravenous anesthetization should be approached with care if you have a history of intravenous drug use. And, of course, there’s no substitute for regularly brushing and flossing your teeth and scheduling frequent visits to the dentist — which is even more important if you’re battling dental problems.
It’s natural to want to brush your teeth immediately after having consumed alcohol, especially with drinks that leave stains. However, bear in mind that the acid in alcohol has a softening effect on tooth enamel, so brushing right after drinking can do lasting damage. Tooth enamel begins to harden again after about 20 minutes, so wait about a half-hour, and give your teeth a good rinsing with water before applying a toothbrush. Mouthwash can also be beneficial, but avoid using one within an hour of brushing your teeth to avoid counteracting the benefits of the toothpaste. Reducing or eliminating sugar-heavy drinks and foods from your diet will also help alleviate the problem.
Alcohol addiction intervention
Screening and Brief Interventions with Referral to Treatment (SBIRT) is an intervention protocol aimed at helping dentists identify the signs of alcoholism in patients, and help them get treatment for dependence and alcoholism’s many physically- and socially-debilitating symptoms. SBIRT is designed to help dentists who lack the knowledge and training to screen and counsel patients about alcoholism. It is based on two well-known theoretical interventional theories, including:
- Motivational Interviewing (MI), a client-focused form of counseling that incorporates active listening strategies along with strategic questioning and affirmation
- Personalized Normative Feedback (PNF), a strategy in which dental practitioners share observations and feedback with their patients on how their drinking compares with peer norms. PNF addresses the perception among many heavy drinkers that they actually drink less than their peers.
SBIRT is a valuable, practical and results-oriented approach for dentists, because:
- Approximately 64 percent of adults age 18 to 64 see a dentist at least once a year, which puts dental professionals in an excellent position to identify and intervene with patients’ alcohol misuse
- SBIRT is consistent with screening guidelines for alcoholism
- It’s well-suited to oral cancer-screening guidelines for dentistry
- Seventy-five percent of patients in a 2006 study indicated their willingness to accept alcoholism screening and counseling within a dental setting
SBIRT protocol in action
A survey of dental patients published in the Journal of Health Psychology (2012) has led to interventional recommendations for working with alcoholic dental patients; specifically, holding a face-to-face intervention with the hygienist (who typically spends more time with patients) acting as the lead interventionist as well as the dentist, who provides information and reinforcement for the hygienist’s message. This method, drawing heavily on MI techniques, emphasizes empathy, avoids confrontation, and stresses patient self-efficacy, inviting the patient to identify his or her own reasons for making a change. According to SBIRT practice, patients are assessed at 3 and 6 months to identify alterations in alcohol use and changes in alcohol-related problems.
Getting patients back on track
Alcohol addiction is by no means a “back burner” issue or afterthought for dentists. In fact, the American Dental Association (ADA) has made it a matter of policy, stating that its members have an ongoing responsibility to identify and aid patients who have an addiction to alcohol and/or drugs. Furthermore, dentists are required to ask questions aimed at investigating addiction and to develop a dental treatment plan whenever an addicted patient is identified. Dentists are also expected to refer alcoholic patients to appropriate local services for addiction counseling or treatment.
The ADA encourages dentists to consult with a patient’s physician if he or she has a history of alcoholism. The ADA also recommends that its members be familiar with local treatment resources for patients with substance abuse problems so they can make timely referrals; thus, dentists are effective (and confidential) resources for patients who need help with an alcohol problem. It’s worth noting that dentists have to be knowledgeable about alcohol and drug abuse so that the medications and other controlled substances they might prescribe don’t interact harmfully.
The nature of physical symptoms in alcoholic patients puts dentists in a good position to recognize the problem, intervene, and help patients find help. A 2006 study published by the Medical University of South Carolina revealed that 90 percent of more than 400 adults surveyed indicated that they would respond honestly and openly to their dentist if asked about their drinking habits. Furthermore, study subjects said that if advised by their dentists, they would reduce the amount they drink or quit altogether, which would seem to indicate that a dentist’s office is a familiar setting in which patients are open to feedback from people they know and trust to intervene in their best interests.
If you have struggled with an alcohol abuse problem now or in the past, it’s important to address your dental health. Your dentist can help you chart a course back to good oral health, and you can take a hand in achieving overall well-being by incorporating beneficial lifestyle habits and finding help for alcoholism. You can rely on your dentist to be an advocate and a means of support for your struggle with alcohol addiction.