Alcohol

Question 1

How is alcohol metabolized

Answer 1

• In the liver
• Alcohol –> acetaldehyde –> acetate –> CO2 and water
• Removed at rate of 15mg/100ml/hr

Question 2

What are the effects of alcohol

Answer 2

• Mild sedative
• Mild anaesthetic
• Stimulates dopamine and serotonin
• Sense of relaxation and disinhibition
• Driving limit in Scotland is 50mg/100ml

Question 3

What is the recommended safe alcohol limit

Answer 3

• 14 units a week
• Spread over 3 days
• Risk of health problems increase the more you drink on a regular basis

Question 4

What are oral problems in chronic heavy drinkers

Answer 4

• Oral cancer – increased risk when also a smoker
• Oral ulceration, glossitis, angular cheilitis, gingivitis, nutritional deficiencies
• Dental neglect
• Dental trauma – chaotic lifestyle
• Lost dentures
• Sialosis
• Xerostomia
• Poor wound healing & osteomyelitis
• Suppression of immune system by alcohol
• Dental erosion
• Bruxism

Question 5

What is the effect on bleeding

Answer 5

• Reduced synthesis of clotting factors in damaged liver
• Reduced absorption of vitamin K which produces clotting factors 2, 7, 9, 10
• Low platelet levels & reduced platelet aggregation
• This results in prolonged bleeding

Question 6

What is the effect of alcohol on drug metabolism

Answer 6

• Warfarin effect will be enhanced if there is regular consumption of >3u a day
• Alcohol will interact with drugs producing a sedative effect
• Want to give them paracetamol as although it is processed in the liver, ibuprofen is more likely to cause gastric bleeding - alcohol is a gastric irritant and so are NSAIDS, combined with the enhanced bleeding, there is risk of gastric ulcers
• No metronidazole as it inhibits alcohol dehydrogenase

Question 7

What is the effect on alcohol on dentistry

Answer 7

• Impact on consent
• Oral cancer risk
• Trauma
• NCTSL

Question 8

How does alcohol increase risk of oral cancer

Answer 8

• Ethanol metabolite acetaldehyde promotes tobacco initiated tumours
• Damages DNA and alters oncogene production
• Alcohol facilitates absorption of carcinogenic substances across the oral mucosa partly due to thinning of oral mucosa due to nutritional deficiency

Question 9

What are screening tools that can be used to assess px alcohol habits

Answer 9

FAST or AUDIT

Question 10

What do screening tools ask px about their habits

Answer 10

• Have you ever felt you ought to cut down on your drinking?
• Do you get annoyed at criticism of your drinking?
• Do you ever feel guilty about your drinking?
• Do you take a drink in the morning?

Question 11

What are hte 3 types of drinkers

Answer 11

Hazardous drinkers – this group is at risk of developing a problem due to alcohol
* Amenable to brief intervention
Harmful drinkers – this group have problems due to alcohol which are evident
* Amenable to brief intervention
Dependent drinkers – this group display symptoms of dependence on alcohol
* Not amenable to brief intervention

Question 12

What is FRAMES

Answer 12

• Feedback = give patient feedback on their drinking
• Responsibility = make the patient feel they can make a change by giving them tips and advice
• Advice = advise on change
• Menu = menu of self directed options/treatment is offered
• Empathy
• Self-efficacy = empower the patient