Alcohol and Relevance in Dentistry UK Population Health PDF

Alcohol and Relevance in Dentistry - Impact of Alcohol on UK Population Health - Part 1 Sarah Balian Oral and Dental Sciences GDC Learning Outcomes Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases 1.1.11 and the suc...

Alcohol and Relevance in Dentistry - Impact of Alcohol on UK Population Health - Part 1 Sarah Balian Oral and Dental Sciences GDC Learning Outcomes Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases 1.1.11 and the success of treatment Recognise the importance of and carry out an appropriate systematic intra- and extra-oral clinical 1.2.1 examination Recognise the significance of changes in the patient’s reported oral health status and take appropriate 1.2.3 action 1.7.7 Refer to other members of the dental team or other health professionals 1.7.8 Recognise the need for and make arrangements for appropriate follow-up care Underpin all patient care with a preventive approach that contributes to the patient’s long-term oral health 1.10.3 and general health Describe the health risks of diet, drugs and substance misuse, and substances such as tobacco and alcohol 1.10.6 on oral and general health and provide appropriate advice, referral and support Communicate effectively and sensitively at all times with and about patients, their representatives and the 3.1 general public difficult circumstances, such as when breaking bad news, and when discussing issues, such as alcohol 3.1c consumption, smoking or  Intended Learning Outcomes Outline the relevance of alcohol consumption and its health impact in relation to the UK population. Develop and demonstrate the role of dental care professionals in delivering key general health messages. Loading… Screen patients with recommended screening toolkits Evaluate data and deliver appropriate advice to patients and signpost where needed. Discuss the impact of alcohol on oral and general health.  Assessment Formative Summative Unseen cases Unseen cases Class discussion Case presentations Clinical activity Health messages Loading… Alcohol Statistics 10.8 million adults in England are drinking at levels that pose some risk to their health (1 in 5 women and 1 in 3 men). Alcohol misuse across the UK is a significant public health problem with major health, social and economic consequences, estimated at between £21 and £52 billion a year. Each year there are over 1 million admissions to hospital for alcohol-related conditions. Government Statistics In 2019, 54% of adults In England reported drinking alcohol in the last week. Men were more likely to drink than women (59% of men and 50% of women drank alcohol during the previous week). Alcohol-specific conditions were responsible for 347,761 hospital admissions in England in 2019/20, (2% of all admissions). 7,544 alcohol-specific deaths in the UK in 2019. Alcohol Consumption in Children Government Agenda The 1997-2001 Labour Government’s Public Health White Paper Saving Lives: Our Healthier Nation March 2004, the Government published the Alcohol Harm Reduction Strategy for England June 2007 – Safe, Sensible, Social, the next steps in the national alcohol strategy The Coalition Government published The Government’s Alcohol Strategy in 2012 In 2016, official alcohol consumption guidelines were revised for the first time since the publication of the Sensible Drinking report in 1995. New strategy being developed but postponed as priorities are redirected elsewhere due to COVID-19. Alcohol-related hospital activity and treatment 15% hospital admissions in a&e admissions Loading…  Drug Treatment https://www.ndtms.net/ Collects data on individuals receiving treatment for alcohol and substance abuse in England. 2019/20 shows that that there were 104,880 adult clients (aged 18 and over) in alcohol-related treatment (39% of all adults in treatment): of these 74,618 (71%) were being treated for alcohol problems solely Alcohol Specific Deaths International Comparison GHO | Global Information System on Alcohol and Health (GISAH) | Alcohol-attributable fractions, all-cause deaths - by country (who.int)  Where do dental professionals fit in? mecc-resources-fact-sheet-v9-20180601.pdf Chapter 12: Alcohol - (makingeverycontactcount.co.uk) GOV.UK (www.gov.uk) 5 ASK 2 Questions 5 1 3 ADVISE Impact IBA Data https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-statistics https://alcoholeducationtrust.org/teacher-area/facts-figures/? gclid=EAIaIQobChMI0K6R5uDx9AIVYIBQBh23jgAdEAAYAiAAEgIS2_D_BwE https://www.drinkaware.co.uk/facts? gclid=EAIaIQobChMI0K6R5uDx9AIVYIBQBh23jgAdEAAYASAAEgKy5PD_Bw E https://researchbriefings.files.parliament.uk/documents/CBP-7626/CBP-7626.pdf Alcohol and Relevance in Dentistry - Brief Intervention and Advice – Part 2 Sarah Balian Oral and Dental Sciences GDC Learning Outcomes Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases 1.1.11 and the success of treatment Recognise the importance of and carry out an appropriate systematic intra- and extra-oral clinical 1.2.1 examination Recognise the significance of changes in the patient’s reported oral health status and take appropriate 1.2.3 action 1.7.7 Refer to other members of the dental team or other health professionals 1.7.8 Recognise the need for and make arrangements for appropriate follow-up care Underpin all patient care with a preventive approach that contributes to the patient’s long-term oral health 1.10.3 and general health Describe the health risks of diet, drugs and substance misuse, and substances such as tobacco and alcohol 1.10.6 on oral and general health and provide appropriate advice, referral and support Communicate effectively and sensitively at all times with and about patients, their representatives and the 3.1 general public difficult circumstances, such as when breaking bad news, and when discussing issues, such as alcohol 3.1c consumption, smoking or  Intended Learning Outcomes Outline the relevance of alcohol consumption and its health impact in relation to the UK population. Develop and demonstrate the role of dental care professionals in delivering key general health messages. Loading… Screen patients with recommended screening toolkits Evaluate data and deliver appropriate advice to patients and signpost where needed. Discuss the impact of alcohol on oral and general health.  Assessment Formative Summative Unseen cases Unseen cases Class discussion Case presentations Clinical activity  Any setting Specialist Dentist Primary Dental Therapist Dental Hygienist Secondary Loading… Dental Nurse Orthodontic Therapist Tertiary Clinical Dental technician Guidance for Dental Professionals Delivering Better Oral health – November 2021 Chapter 12: Alcohol - GOV.UK (www.gov.uk) Medico-legally Oral cancer (theddu.com) There is no safe level of alcohol consumption. Knowing units 14 units a week - should be spread over AUDIT C – Alcohol Use T 3 days or more. Disorders Identification Test for Consumption Knowing Units Know your units – how are they calculated? Strength of alcohol x volume %by 1000 Eg , 5.2 x568%1000= 2.9 3 units Identification & Brief Advice (IBA) Loading…  Lower risk Increased risk Higher Risk Score 0- 4 Score 5 - 10 Score 11 -12 Not exceeding 14 units Advise level of drinking Drinking could be per week increasing risk of ill becoming a problem. health Ask more questions Inform low risk of long Consider referral to or short health harm Not safe to drink more specialist addiction than 14 units per week service or GP. Congratulate Positive feedback If you do drink more Do NOT advise to stop than 14 units – spread drinking as they may over at least 3 days need support to do so safely. Have several drink-free Ask more questions days a week Apps NHS Brief Advice about alcohol & your health  Efficacy Kane E F, Beyer F, Dickinson H O et al. Effectiveness of brief There is good evidence that alcohol interventions in primary brief advice in primary care is care populations. Cochrane effective. A Cochrane review Database Syst Rev 2007; 2: found that it consistently led to CD004148. reductions in alcohol consumption. Neff J A, Kelley M L, Walters S Additionally, a randomised T et al. Effectiveness of a controlled trial in dental practice Screening and Brief Intervention found that screening and brief protocol for heavy drinkers in intervention for heavy drinkers dental practice: A cluster- resulted in significant randomized trial. J Health reductions in both the quantity Psychol 2015; 20: 1534–1548. and frequency of alcohol consumed.14 Signposting for professional help https://www.e-lfh.org.uk/programmes/alcohol/ Drink less - Better Health - NHS (www.nhs.uk) https://www.nhs.uk/live-well/alcohol-support/ https://www.alcoholics-anonymous.org.uk/ Find Alcohol addiction services - NHS (www.nhs.uk) Required reading and resources https://www.gov.uk/government/publications/delivering-better-oral-health-an- evidence-based-toolkit-for-prevention/chapter-12-alcohol UK government. Alcohol use disorders identification test consumption (AUDIT C). London: UK Gov; 2019. 2e917707-7c70-7978-37fb-14d41f2dd14a (800×1067) (khub.net) Alcohol and Oral Health – Part 3 Sarah Balian Oral and Dental Sciences GDC Learning Outcomes Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases 1.1.11 and the success of treatment Recognise the importance of and carry out an appropriate systematic intra- and extra-oral clinical 1.2.1 examination Recognise the significance of changes in the patient’s reported oral health status and take appropriate 1.2.3 action 1.7.7 Refer to other members of the dental team or other health professionals 1.7.8 Recognise the need for and make arrangements for appropriate follow-up care Underpin all patient care with a preventive approach that contributes to the patient’s long-term oral health 1.10.3 and general health Describe the health risks of diet, drugs and substance misuse, and substances such as tobacco and alcohol 1.10.6 on oral and general health and provide appropriate advice, referral and support Communicate effectively and sensitively at all times with and about patients, their representatives and the 3.1 general public difficult circumstances, such as when breaking bad news, and when discussing issues, such as alcohol 3.1c consumption, smoking or  Intended Learning Outcomes Outline the relevance of alcohol consumption and its health impact in relation to the UK population. Develop and demonstrate the role of dental care professionals in delivering key general health messages. Loading… Screen patients with recommended screening toolkits Evaluate data and deliver appropriate advice to patients and signpost where needed. Discuss the impact of alcohol on oral and general health.  Assessment Formative Summative Unseen cases Unseen cases Class discussion Case presentations Clinical activity Oral effects of Alcohol Cancer Periodontal Disease 1 8 Halitosis 2 7 Tooth Wear Loading… Friendliness of the pool staff Trauma 3 6 Caries 4 5 Staining Self-care Cancer Read this article and place your reasons for alcohol and increased risk of oral cancer on discussion board  Halitosis There has also been shown to be a significant association between increased drinking frequency and oral malodour Subjective Proposal of theories of malodour include the short term effect of the smell of the alcohol itself; increased dry mouth, because alcohol is a diuretic; worse oral hygiene and increased periodontal disease. Increased level of volatile sulphur compounds in daily drinkers to non daily drinkers “ Proposal of theories of malodour  Trauma Over a decade ago 22% of all facial traumas was related to alcohol consumption. Additionally, the prevalence of dental trauma is significantly higher in those that binge drink A positive association has also been found between high alcohol consumption and the lifetime risk of dental trauma  Red wine is the main alcoholic drink linked to tooth staining. It Staining is thought that dietary chromogens in the drink are adsorbed to the pellicle, leading to a layer of stained material, which is not easily removed Red wine also stains composite more than tea or coffee  Periodontal Disease Place your thoughts and findings regarding alcohol and periodontal Increased bleeding disease on discussion board. Impact on periodontal pathogens Loading… the sugar content of alcohol attracts pathogenic microbes to accumulate in the oral cavity. Alcohol causes dry mouth and Immunological pro-inflammatory cytokines decreased saliva flow. Lagos J P, Costa F, Corelli S et al. Alcohol consumption and periodontitis: quantification of periodontal pathogens and cytokines. J Periodontol 2015; 86: 1058–1068 Compliance / immunosuppression / diet  Sarrett D C, Coletti D P, Peluso A R. The effects of alcoholic beverages on composite Tooth wear wear. Dent Mater 2000; 16: 62–67. Patients with chronic alcoholism have significantly more wear. The cause of the possible increase in wear with alcohol Commonly palatal surfaces of consumption is yet unknown, but there are several upper anteriros. potential mechanisms. It may in part be due to increased vomiting with alcohol consumption. Alcohol has also been shown to induce gastro-oesophageal reflux It has also been demonstrated that drinks with a greater than 9% alcohol volume can result in the wear of composites pH of alcoholic and mixer drinks  Caries Multi-factorial More caries found in alcohol dependent groups compared to social drinkers Consider – salivary flow? Buffering capacity? Sugar in alcoholic drinks and mixers? Pace of drinking? Cravings? Self-care?  Sugar content of alcoholic and mixer drinks Self care Link about the impact of frequent increased above recommended allowance of alcohol: Place your thoughts and findings regarding alcohol and self care on discussion board. Motivation Relationships Priortities Behvaiours Exhaustion Listening ability Good decisions Required Reading Please refer to reading material on Moodle Page.  Additional reading Harris C K, Warnakulasiriya K A, Johnson N W, Gelbier S, Peters P J. Oral health in alcohol misusers. Community Dent Health 1996; 13: 199–203 Sarrett D C, Coletti D P, Peluso A R. The effects of alcoholic beverages on composite wear. Dent Mater 2000; 16: 62–67 Tezal M, Grossi S, Ho A, Genco R. Alcohol consumption and periodontal disease. The Third National Health and Nutrition Examination Survey. J Clin Periodontol 2004; 31: 484–488. Tezal M, Grossi S, Ho A, Genco R. The effect of alcohol consumption on periodontal disease. J Periodontol 2001; 72: 183–189. Alcohol and General Health  Alcohol and physical health Linked to more than 60 diseases and conditions Can be divided into Short-term and Long-term health risks. Short-term health risks Injuries Motor vehicle crashes Falls Drownings Burns Violence - death Suicide Sexual assault Intimate partner violence Alcohol poisoning Reproductive health Risky sexual behaviors Unintended pregnancy Sexually transmitted diseases, including HIV Miscarriage Stillbirth Fetal alcohol spectrum disorders Long term health risks Refer to liver disease lecture Cancer – group 1 carcinogen (IARC) – causative factor in cancers oral & other body. Weight gain and links  Long term health risks Some diseases affecting the liver as a result of alcohol damage are reversible Drinking to excess produces a spectrum of liver damage. Drinking a lot of alcohol can cause a build up of fats in the liver. This in itself is not harmful and quickly reverses when alcohol is withdrawn, but it is an indication of liver damage. Alocholic hepatitis – but dependent on severity. Liver cirrhosis occurs as a result of continuous damage; the liver becomes permanently scarred and stops functioning normally. Cancer Alcohol is classified by the International Agency for Research on Cancer (IARC) as a group 1 carcinogen, meaning it can cause cancer in humans. Tobacco and asbestos are other substances in this group. Heart -Regularly drinking too much can raise blood pressure over time. This in turn increases the risk of heart disease and stroke. Weight gain Alcoholic drinks are high in calories. A large glass of wine and pint of lager both contain around 200 calories, Being overweight carries a number of health risks including high blood pressure and diabetes. Malnutrtion - short, heavy bouts of drinking as well as heavy drinking over the longer term, may result in the development of gastritis with nausea, vomiting and stomach pain. Too much alcohol also makes it more difficult for the body to absorb valuable nutrients. The pancreas produces digestive enzymes and the hormones which regulate blood sugar levels. Heavy drinking can result in the development of acute and chronic pancreatitis; an inflammation of the pancreas.