Alcohol Consumption and Advice: Is it a taboo subject?
Fiona Ellwood Chair of the National Oral Health Promotion Group and Patron of the Society of British Dental Nurses takes a closer look at how population level intervention can be played out in general dental practice.
What are we doing about alcohol consumption to support individuals and who is undertaking this work? Whilst this work stream is part and parcel of the commitment to population level public health outcomes it should be reflected across oral health and dental care settings. The National Oral Health Promotion Group consider this as one of its priorities, as a means of making every contact count and no missed opportunities but can we do more to encourage this work in the general dental practice?
Recently Public Health England (PHE) produced infographics reminding us of a cross section of topics, one being that of alcohol. The statistics shown by PHE suggest that “10.4 million people are drinking at levels of increasing risk and higher risk1…” This figure is more clearly broken down as “8.6 million at an increasing risk, and 1.8 million drinking at a higher risk … increasing risk being Identified as: 14 – 50 units for men and 14 – 35 units for women in a week and higher risk as >50 units for men and >35 units for women1”.
Identifying alcohol consumption and providing basic advice is no stranger to us as oral health education and promotion practitioners, yet all too often away from the population level delivered messages the topic of alcohol appears to be given little time and can be as little as asking how many units of alcohol do you drink in a week and a tick in a box, is this because we are simply ill-equipped to do so? This is something that has led to a work stream by Dr Julia Csikar a committee member of National Oral Health Promotion Group – developing audit tools and e-learning resources to enable the dental team to get involved, as well as leading on the alcohol consumption within the latest Delivering Better Oral Health Toolkit 2.
An earlier paper authored by Shah et al, (2015) titled Brief advice on alcohol: as easy as A…B…I?3, suggests that a large percentage of the population consumes alcohol and provides an estimated cost of alcohol to society. It suggests that more can be done in general dental practice to identify patients at risk and in offering brief advice; so we are in agreement. In an ideological place each dental practice should provide those all important messages to patients and help signpost or refer them to other trained professionals if the need arises.
So what do we know?
According to the 2014 Health Survey England 82% of adults were drinking alcohol, in 15 -49 yr olds alcohol is the leading risk factor of ill health… and sales of alcohol were reported as having increased by 42% 4 (PHE, 2016).
Hospital admissions relating to the consumption of alcohol are also high; from alcohol related diseases, injuries or conditions and alcohol has been identified as having a wider impact: on the family and social networks, health, crime and the workplace 5 (DH, 2008). According to the World Health Organization alcohol is linked to significant economic losses to individuals and a casual link has been made to mental health and behavioural disorders6.
So what is the oral health risk relating to the misuse of alcohol7
- Individuals are more likely to have an increased risk of periodontal
- There is the potential for an increased risk factor of oro-facial injuries due to falls, road traffic accidents or
- There is the potential for an increased risk of tooth decay.
- When individuals partake in both smoking and the consumption of alcohol the risk factors for a higher incidence of oral cancer is increased.
So how can the team make a difference?
- Provide brief advice – make information readily available.
- Have alcohol related manned displays/exhibitions.
- Arm the whole team with brief information and the knowledge of a referral pathway.
- Encourage conversations with patients about their possible drinking patterns.
- Make use of the already available resources i.e. the Delivering Better Oral Health Toolkit, the audit tools (Audit C) and posters from PHE and the Alcohol Guidelines Review (2016).
- Undertake the Identification and Brief Advice (IBA) training for dental teams. alcohollearningcentre.org.uk
Making Sense of the Unit Measurement to Support Patients
|Wine : 1 small glass||12%||1.6|
|1 standard glass||12%||2.1|
|1 large glass||12%||3|
Beer : ½ pint
|1 pint low strength||3.6%||2|
|1 pint high strength||5.2%||3|
|Spirits : 1 small single shot||40%||1|
Adapted from: Delivering Better Oral Health V38
On average 1 unit of alcohol = 10ml or 8g, the amount the average adult can process in 1 hr.
What are the recommendations of the Chief Medical Officer (2016)?9
- All adults: You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a lower level. If you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more
- Young people: Young people under the age of 18, should normally drink less than adult men and women
- Pregnant women: If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum
Are you geared up and confident to approach the topic of alcohol in the dental practice, if not why not – you could make a difference.
References are available