Oral Health and Health Promotion

GDC Learning Outcomes

• Oral health can be impacted by psychological and sociological factors
• Clinical examinations should be systematic, and include intra- and extra-oral checks
• Note changes in a patient's self-reported oral health, and act appropriately
• Healthcare professionals should refer patients appropriately
• Follow-up care should be organised
• Patient care should be underpinned by preventative measures that maintain long-term oral and general health
• Advice, referral, and support should address risks from diet, drugs, substance misuse, tobacco, and alcohol
• Communicate sensitively and effectively with patients and the public
• Use sensitivity when handling difficult conversations about alcohol and smoking

Intended Learning Outcomes

• Recognize the relationship between alcohol consumption and health in the UK
• Demonstrate how dental professionals can promote health messages
• Use appropriate screening tools for patients
• Evaluate data and provide appropriate advice regarding alcohol consumption
• Discuss the effects of alcohol on oral and general health

Assessment Methods

• Assessments include formative and summative approaches
• Formative assessment consists of unseen cases, class discussions, and clinical activities
• Summative assessment includes unseen cases and case presentations

Settings and Professionals

• Advice can be given in any setting
• Advice can be given by primary, secondary or tertiary healthcare workers
• Specialist, dentist, dental therapist, dental hygienist, dental nurse, orthodontic therapist and clinical dental technician can deliver support

Guidance for dental professionals

• Guidelines for dental professionals can be found in Chapter 12 of "Delivering Better Oral Health" November 2021, available on GOV.UK
• Medico-legal information about oral cancer is available at theddu.com
• Knowing units of alcohol is important
• The Alcohol Use Disorders Identification Test for Consumption (AUDIT C) is a key tool

Limits of Alcohol Consumption

• Guidelines historically differed on levels of alcohol
• The current advice is to regularly drink no more than 14 units a week
• There is no safe level of alcohol consumption
• If drinking, spread it over three days or more
• There is no safe level of alcohol consumption during pregnancy

Knowing Units

• One unit of alcohol corresponds to a half pint of "regular" beer, lager or cider
• This also corresponds to to half a small glass of wine or one single measure of spirits
• A pint of "regular" beer, lager or cider has 2 units
• A pint of "strong" or "premium" beer, lager or cider has 3 units
• An Alcopop or a 275ml bottle of regular lager has 1.5 units
• A 440ml can of "regular" lager or cider has 2 units
• A 440ml can of "super strength" lager has 4 units
• A 250ml glass of wine (12%) has 3 units
• A 75cl bottle of wine (12%) has 9 units

Calculating Units

• A 284ml half pint of 3.8% ABV lager is 1.1 units, whereas 5.2% ABV lager is 1.5 units
• A 440ml can of 3.8% ABV lager is 1.7 units, whereas 5.2% ABV lager is 2.3 units
• A 568ml pint of 3.8% ABV lager is 2.2 units, whereas 5.2% ABV lager is 3 units
• A 660ml bottle of 3.8% ABV lager is 2.5 units, whereas 5.2% ABV lager is 3.4 units
• A 125ml glass of 11% ABV wine is 1.4 units, whereas 14% ABV wine is 1.8 units
• A 175ml glass of 11% ABV wine is 1.9 units, whereas 14% ABV wine is 2.4 units
• A 250ml glass of 11% ABV wine is 2.8 units, whereas 14% ABV wine is 3.5 units
• A 750ml bottle of 11% ABV wine is 8.2 units, whereas 14% ABV wine is 10.5 units

Identification & Brief Advice (IBA)

• This relates to brief consultation in the dental practice

Lower Risk (score 0-4 on questionnaire)

• Should not exceed 14 units per week
• Inform patients on the low risk of long or short term harm
• Congratulate and give positive feedback

Increased Risk (score 5-10 on questionnaire)

• Advise patient that their level of drinking is increasing their risk of ill health
• Patient should not drink more than 14 units per week
• Units should be spread over at least 3 days
• Ensure the patient has several drink-free days per week

Higher Risk (score 11-12 on questionnaire)

• Drinking could be becoming a problem
• Consider referral to specialist addiction service or GP
• Do NOT advise to stop drinking as they may need support to do so safely

Apps

• The Drink Free Days app helps track drink-free days and provides tips and reminders
• The MyDrinkaware app tracks drinks, plans drink-free days and sets personalised goals

NHS Advice

• Even small amounts of alcohol can cause risk in certain circumstances
• The safest approach if pregnant or planning pregnancy is not to drink alcohol
• "How Much Is Too Much?" Simple Structured Advice Intervention Tool can be downloaded from app.box.com

Habits, Behaviour and Change

• Try to have several 'drink-free' days
• Set a limit and stick to it
• Quench thirst with non-alcoholic drinks
• Eat when you drink
• Switch to lower alcohol beer or lager
• Plan activities you would usually drink at
• Do something physical
• Set personal targets to adhere to
• Adults are advised to not regularly drink more than 14 units a week, which should be spread evenly over 3 or more days

Benefits

• Improved mood
• Improved relationships
• More time for hobbies and interests
• Reduced risk of drink driving
• Save money
• Sleep better and have more energy
• Reduced risk of injury
• Improved memory
• Better physical shape
• Reduced risk of high blood pressure, cancer, liver disease, and brain damage

Efficacy

• There is good evidence that advice in primary care is effective
• Kane et al.'s Cochrane Database Syst Rev 2007 found it leads to reductions in alcohol consumption
• Neff et al.'s J Health Psychol 2015 found that screening and brief intervention in dental practices reduced alcohol consumption for heavy drinkers

Signposting

• Further support can be found at these sites:
• https://www.e-lfh.org.uk/programmes/alcohol/
• https://www.nhs.uk/live-well/alcohol-support/
• https://www.alcoholics-anonymous.org.uk/

Resources

• Guidance for dental professionals can be found in Chapter 12 of "Delivering Better Oral Health"
• Information can be found at https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-12-alcohol
• Information on Alcohol Use Disorders Identification Test consumption (AUDIT C) can be found via UK Gov; 2019