Alcohol and the dental team

1. Alcohol and the dental team Lampros Flouris

2. Contents • Alcohol-Introduction • Current national guidelines • What does a unit of alcohol looks like? • Effects of alcohol on the body. • Dental problems associated with alcohol misuse. • Drugs Interactions • Screening tools • Roles and responsibility for providing dental advice. • Important points • Conclusion • References

3. Alcohol -Introduction • Over 90% of the adult population of England consume alcohol. • There has been an increase in alcohol misuse over the last years. • Recording alcohol is now firlmy embedded with taking of a social history. • Alcohol Consumption does have an impact on oral health. • Dentist and dental care proffesionals are primarily healthcare professionals. • Patients tend to underreport the alcohol intake.

4. Current National Guidelines • Chief Medical Officer-2016 published revised guidelines • “Advice” rather than a safe limit not to exceed 14 units/week and no more than 2 units/day for BOTH men and women. • Emphasize that there is no safe level for alcohol intake. • Pregnant women-Don’t drink alcohol

5. Whats does a unit of alcohol looks like? • One unit is 10ml or 8g of pure alcohol. Because alcoholic drinks come in different strengths and sizes, units are a way to tell how strong your drink is.  

6. Effects of Alcohol on the Body

7. Dental Problems associated with alcohol misuse.

9. Drug Interactions

10. Screening tools • How to recognise those who need advice?-Screening • 1. GAGE screening tool • 2.Alcohol Use Disorders Identification Test-AUDIT • 3.Scotland-FAST-Fast Alcohol Screening Test • Using 4 questions from AUDIT-Score>3->Potential Alcohol Problem • New Uk Guidance-I have notice from your social history questionnaire that you are drinking “x”. Were you aware that the guidance on how much we drink has recently changes?

11. GAGE

12. AUDIT ALCOHOL SCREENING TOOL Score 0-7 Lower risk 8-15 Increasing risk 16-19 Higher risk 20+ Possible dependence

13. Signs that may be seen in alcohol dependency • Bloated and/or plethoric face • Red beefy bulbous nose with ruddy appearance • The smell of alcohol on the patients breathe • Inappropriate manner • Tremor • Heavy nicotine staining • Palmar erythema • Bruising and scarring indicating recent falls or brawls

14. Roles and responsibility for providing alcohol advice • Dental Clinicians have a professional duty to enquire about alcohol intake-GDC fitness to practise hearings have concluded critical accounts of dentist either not delivery or not recording the delivery of risk • Embedded in the GDC Training Standards-The First Five Years to Preparing for Practise • 1.Clinical • 2.Communication • 3.Professionalism • 4.Management/Leadership • Taking accurate alcohol history may impact upon all four areas

15. Important Points • Alcohol Consumption does have an impact on oral health. • Advice not to exceed 14 units/ week and no more that 2 units/day for both men and women • Dentist and dental care proffesionals are primarily healthcare professionals. • Patients tend to underreport the alcohol intake-40% underreporting of what people say they drink in a typical week compared to alcohol sales

16. Conclusion • Alcohol is a drug and, as such, has side-effects and can lead to health problems and addiction. • Alcohol has interactions with prescriptions and over the counter medications. • Dentists as healthcare professionals may have an opportunity to refer a patient with an alcohol problem for a specialist help • In the taking of consent for those who are under the influence of alcohol, is under the judgement of the treating clinician-Key emphasis-Patients competence to give consent

17. References • 1. GDC-Dental Team –Learning outcomes. Preparing for practise • 2.The significance of Alcohol Misuse in the dental Team. Andrew Kwasnicki, Lesley Longman, Greg Wilkinson. • 3.Alcohol and the Dental Team. Relevance , Risk, Role and responsibility. Simon Shepherd, Graham Ogden • 4. https://www.drinkaware.co.uk/s • 5.www.alcoholconcern.org.uk