Time to say bye-bye to booze? – Rachel Pointer

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  Posted by: The Probe      9th September 2018

A new and large study of American adults has found that alcohol is associated with variation in the human oral microbiome.[i]It concluded, “Heavy drinking may influence bacterial composition, including potential depletion of beneficial commensal bacteria and increased colonization of potentially pathogenic bacteria. Such changes potentially contribute to alcohol-related diseases, including periodontal disease (and) head and neck cancer.”

So, yet another reason to avoid heavy drinking to support oral health. Every now and again we see a ‘red wine is good for you’ headline – there was even a study from Spain that claimed polyphenols in red wine could help preventbacteria sticking to gum tissue[ii]– but patients expecting their dentist to recommend they drink more of it will be disappointed! For their part, the researchers on the Spanish project said their findings could ultimately lead to the development of new treatments for caries.

Alcohol is a risk factor for many diseases; a large body of evidence supports this. Click-bait articles may go for a positive spin, but no amount of alcohol should be defined as ‘good’ or ‘health giving’. In the UK, alcohol is cheap and assessible. Whereas our parents and grandparents would have associated a glass or two of something alcoholic with a celebration, modern drinking habits do not require an occasion. The last government survey found that nearly 30 million adults in Great Britain (age 16 years and over) drink regularly.[iii]Those aged between 16-24 are less likely to drink than other age groups, but if they do, they will binge on the days they imbibe. The biggest drinkers, according to the survey, are people working in managerial/professional occupations and higher earners – so, those with busy, pressured lifestyles and who are at a greater risk of work-related stress.

The Chief Medical Officer has issued guidelines, of course,[iv]but healthcare professionals know that there is often confusion over what constitutes an alcoholic ‘unit’, which means it’s easy to (unintentionally) drink too much. This latest research is just adding to what dental practitioners know already, that booze is bad news for oral health. And this is the message that we must find practical ways of getting across to our patients.

Dry mouth (or xerostomia) is a common feature of a morning-after-the-night-before hangover. Alcohol is a diuretic, and if patients repeatedly compromise the production of saliva – which protects the oral cavity – they will increase their risk of caries.[v]Alcohol affects quality of sleep; drink too much and you will feel tired and sluggish the next day. This will make you more likely to reach for sugary snacks or so-called ‘energy’ drinks for an instant boost. Poor-quality sleep on a regular basis can also impact on mental health.

Excessive alcohol consumption may heighten risk factors for periodontal disease and exacerbate the condition, leading to loss of attachment.[vi]Alcohol misuse is a risk factor for oral cancer; research suggests that it is the cause of around 30 per cent of mouth/oropharyngeal cancers.[vii]People who drink and smoke tobacco multiply that risk.[viii]Alcohol is acidic, especially when consumed frequently, which can lead to tooth wear. Tooth wear isn’t just a natural physiological process and dental practitioners must monitor it to help the patient avoid various problems. These can be functional (pain in the jaw or difficulty chewing because tooth surfaces have worn flat; hypersensitivity) or aesthetic (the teeth becoming chipped, or looking pitted and dull). Much has been made over the Brits’ love of prosecco; combining alcohol and carbonation with sweetness (around one teaspoon of sugar per flute), and with a pH of 3.25, regular overindulgence would be disastrous for oral health.

Your advice to patients? Well, advising them to take a look at their drinking habits – then moderate them accordingly – is a good place to start. A comprehensive programme of preventive care, whether given by a dentist, dental hygienist or therapist, must include a discussion about alcohol and tips to limit any damage. Effective brushing with a soft brush, using non-abrasive toothpaste, will clean the teeth without further damage to enamel softened by alcohol. A mouthwash containing fluoride will strengthen enamel, too. The TANDEX range of oral hygiene tools and adjunctive products, including PREVENT mouthwash, containing fluoride and chlorhexidine, and PREVENT GEL toothpaste with low abrasivity, has everything your patients need. Other tips include waiting an hour after consuming alcohol before brushing and drinking a glass of plain water in between every alcoholic beverage. Also, you may want to tell your patients of 45 and above that in the 16-44 years age group, teetotalism is on the increase; around 10 million in this bracket don’t drink at all![ix]

A glass of wine after a hard day might feel good, but alcohol just isn’tgood for anyone. With the case against it getting stronger with each new study, dental practitioners need to find practical ways to deliver the message and limit the damage it causes. The less alcohol we all drink, the better, and abstaining more often will help protect oral and general good health.

 

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References

[i]Xiaozhou Fan et al. Drinking alcohol is associated with variation in the human oral microbiome in a large study of American adults. Microbiome 20186: 59. Link: https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-018-0448-x(accessed May 2018).

[ii]Adelaida Esteban-Fernándezet al. Inhibition of Oral Pathogens Adhesion to Human Gingival Fibroblasts by Wine Polyphenols Alone and in Combination with an Oral Probiotic. J. Agric. Food Chem.  66, 9, 2071-2082

[iii]Office for National Statistics. Statistical bulletin. Adult drinking habits in Great Britain: 2017. Link: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/bulletins/opinionsandlifestylesurveyadultdrinkinghabitsingreatbritain/2017(accessed May 2018).

[iv]Gov.uk. Alcohol consumption: advice on low risk drinking. Published 25 August, 2016. Link: https://www.gov.uk/government/publications/alcohol-consumption-advice-on-low-risk-drinking(accessed May 2018).  

[v]Advani M, Mark J, Advani Z. Role of saliva in prevention of caries in exposure to ACBs. Link: http://www.dentistryiq.com/articles/2009/10/role-of-saliva-in.html(accessed May 2018).

[vi]American Academy of Periodontology. Study: alcohol consumption can have a negative impact on gum health. Posted 11 June, 2015. Found at: https://www.perio.org/consumer/alcohol-negative-effect-on-gum-health(May 2018).

[vii]Cancer Research UK. Mouth and oropharyngeal cancer. Risks and causes. Link: http://www.cancerresearchuk.org/about-cancer/mouth-cancer/risks-causes(accessed May 2018).

[viii]Cancer Research UK. How alcohol causes cancer. Link: http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/alcohol-and-cancer/how-alcohol-causes-cancer(accessed May 2018).

[ix]Gov.uk. Alcohol consumption: advice on low risk drinking. Published 25 August, 2016.


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