Days of wine and roses
Alcohol is known to negatively influence oral health and periodontal disease. But counseling a patient who you believe may be dependent on alcohol is an awkward and delicate situation.
Counseling alcohol-dependent patients in the hygiene operatory
Eileen Morrissey, RDH
I haven’t read much about alcohol consumption and periodontal disease. After learning about some scenarios from a dental hygiene colleague, I thought it might be timely to do some research—hence the topic for today’s column.
A female patient in the dental practice of Nancy, RDH, has ongoing periodontal disease, despite an excellent home-care regimen and otherwise healthy risk profile. Nancy has long suspected this person as someone whose periodontal status and treatment are being exacerbated further by excess alcohol consumption.
Note: There are few studies on periodontal status related to microbiologic and immunologic profiles among individuals that do not, or who just occasionally use alcohol, verses those with alcohol dependence. The goal of a 2015 Brazilian study was “to determine the effect of alcohol consumption on the levels of sub-gingival periodontal pathogens and pro-inflammatory cytokines (interleukin [IL]-1β and tumor necrosis factor [TNF]-α) in the gingival fluid among individuals with and without periodontitis.” Their conclusion was that “a negative influence of alcohol consumption was observed on clinical and microbiologic periodontal parameters, as well as a slight influence on immunologic parameters, signaling the need for additional studies.”1
When Nancy attempted to question her patient about alcohol use several years ago, the woman was in denial and the discussion went nowhere. The truth about her dependency surfaced years later, via the woman’s daughter. This patient continued her treatment in the practice despite having been gently confronted, and Nancy hopes that she has somehow planted a seed. Two other patients in the practice showed significant improvement in their periodontal status once each had eliminated daily alcohol use. Both the patients and Nancy observed the improvement, which inspires her to continue to raise excess alcohol consumption awareness with other clients.
With any discussion of this nature comes the risk of alienation. Another RDH colleague, Linda, reported that when she raised the topic of alcohol dependency with two different patients, both left the office and never returned! It is clear that for some, the need to regularly use alcohol trumps possible negative consequences, and it may be a professional conversation that some individuals are not ready to face.
We know that alcohol can be a risk factor for periodontal disease, and even more so for oral cancer. Patients who use alcohol in excess predispose themselves to its drying effects on the tissues, as well as the potential for an increase in biofilm formation. It may be a habit, if not a dependency, resulting in potentially negative outcomes in treatment. It would seem appropriate to talk with patients on the topic.
How might you broach such a topic? For a patient sincerely concerned with returning to optimum oral health, one might need look no further than a patient’s risk assessment or medical history. Nearly all histories or assessments ask how many drinks one consumes weekly. The response to this can be analyzed and presented to a patient in a matter-of-fact manner.
We might present the latest recommendations in terms of guidelines. How much alcohol is safe? Current guidelines state that women should have no more than one unit of alcohol daily, and men should have no more than two. A unit would be described as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits.2 Note that these daily amounts are not to be “stored up” for binge drinking later. These guidelines represent parameters on average that are acceptable for overall health and wellness. Having said this, realize that individual body chemistries and circumstances certainly vary. Guidelines are not one size fits all!
Realistic counsel in terms of oral health for someone who is consuming more alcohol than what is recommended would be to applaud the patient for at least recognizing he or she may be dependent, and to warn about the potential for adverse outcomes. Educate as needed on the possible consequences. Keep names and numbers of help lines handy. And be at peace if patients are not ready to change. Make sure they understand that contributing risk factors can increase an individual’s susceptibility to disease by modifying host response. Explain that it is more important than ever to practice optimum self and professional care to try to compensate. This would hold true for the presence of any risk factor that a person is not ready (or not able) to change at the moment.
Hygienists can play a huge role in counseling patients on their overall health and wellness. This can be hugely gratifying as an expansion of our clinical roles. Onward we go; it is in our hearts’ core!
EILEENMORRISSEY,RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Rowan College at Burlington County. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at firstname.lastname@example.org or 609-259-8008. Visit her website at www.eileenmorrissey.com.
1. Lages EJ, Costa FO, Cortelli SC, et al. Alcohol consumption and periodontitis: quantification of periodontal pathogens and cytokines. J Periodontol. 2015;86(9):1058-68. doi: 10.1902/jop.2015.150087.
2. US Department of Health and Human Services, US Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th edition. https://health.gov/dietaryguidelines/2015/guidelines/. Published 2015.