The number of alcohol consumers in the UK has increased substantially over the last century. Around 40 million British adults regularly consume alcoholic drinks and while many do so moderately, about 25% exceed Department of Health guidelines. For men, this is drinking more than the recommended 3 to 4 units a day, such as drinking more than a strong pint of lager or beer ABV 5.2% daily and for women, drinking more than the recommended 2 to 3 units of alcohol a day, such as drinking more than a standard 175ml glass of wine ABV 13% on a daily basis. UK alcohol related death rates continue to rise.

Excessive alcohol consumption impacts on oral health in several ways. Drinking hazardously is not only a risk factor for sustaining oro-facial injuries, either through falls, road traffic accidents or violence, but is also implicated in the aetiology of potentially fatal oral disease, including cancers of the mouth, larynx, pharynx and oesophagus. Alcohol and lifestyles closely associated with alcohol misuse can also have detrimental effects on the dentition: dental erosion, dental caries and periodontal disease. Tackling alcohol misuse is therefore important for primary care dental professionals from a purely dental perspective. Since alcohol misuse affects patients’ general health, addressing this in primary dental care settings also enables dental professionals to meet wider health promotion responsibilities.

Table full of alcohol

Unlike primary medical care, primary dental care services are used by patients on a regular, prevention-orientated basis, with the majority of people attending for a routine check-up irrespective of any oral health problem. This provides the primary dental healthcare team with unique opportunities to intervene, particularly as asking patients about their levels of alcohol consumption is a routine component of medical history taking.

Recommendations for tackling alcohol misuse in primary dental care have been published. The new dental contract reflects the aims of the UK government to focus the attention of dental healthcare professionals on quality, treatment outcomes and how well their patients are looked after, rather than primarily on treatments delivered. There is now more emphasis on health promotion, and dentists will be expected under the new contracts to carry out health assessments and to offer targeted advice when risky behaviours, including alcohol misuse, are identified. General Dental Council guidance on the education of dentists recommends that all dental healthcare professionals should be competent in and committed to promoting health and well-being. The British Dental Association’s Oral Health Inequalities Policy calls on members of the dental team to inform and advise patients about their oral and general health risks, including alcohol use. A World Oral Health report published in 2003 recognises that dental professionals have an important role in general health promotion.

Screening and treatment in primary dental care could involve similar strategies to those used by primary medical practitioners using the same valid and reliable questionnaires and motivational interventions developed in psychology. These have been found to be effective and cost beneficial in some dental settings. The Alcohol Use Disorders Identification Test (AUDIT) and abbreviated versions of this (e.g. AUDIT-C) and the Fast Alcohol Screening Test (FAST) are practical examples of screening instruments. Patients who score highly for misuse could then be given motivational advice and those identified as dependent could be referred for specialist care in consultation with the patient’s medical practitioner.

Although suitable screening tools and treatment interventions are available it is unclear which of these are most effective and precisely how and when they should be deployed in primary dental care and so further development is therefore necessary. It is clear however, that the dental team can contribute and that this contribution fits well with its responsibilities and interests.


The Authors: Jonathan Shepherd CBE FMedSci FDSRCS, Professor of Oral and Maxillofacial Surgery, Zairah Roked BSc BDS MJDF, Academic Clinical Fellow, School of Dentistry, Cardiff University, Heath Park, Cardiff CF14 4XY


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Oral Health Foundation

The Oral Health Foundation is a charity that works to improve oral health by providing education, advice, and support to millions of people every year, changing lives for the better. Our mission is to support others in achieving a healthier life through better oral health. Our vision is to live in a world where everybody has a healthy mouth and is free of dental disease. Poor oral health can have a harmful and devastating effect on a person’s life – both for their physical health and mental wellbeing. We are determined to help more people achieve good oral health and have a better quality of life. Sadly, oral disease remains common, across the life course. We are taking the challenge to reduce the harm caused by poor oral health and the responsibility to create a healthier future for everybody. We do this because we believe that everybody deserves to have good oral health. To make sure this happens, by 2024, we will:

    • Work towards decreasing the prevalence of oral disease across communities.
    • Increase the number of people accessing our help and information services.
    • Diversify our range of resources to reach more communities.
    • Successfully campaign for policies which help people achieve healthier lives.
    • Generate new and nurture existing income streams that enable us to deliver our charitable objectives.

We are going to achieve success by:

    • Running awareness campaigns like National Smile Month and Mouth Cancer Action Month.
    • Giving anybody who needs it direct support through our Dental Helpline.
    • Influencing policy on subjects like dental access, sugar, and tobacco.
    • Providing consumer advice on oral health care products and working alongside manufacturers to make sure products do what they claim to do.
    • Creating resources and information that communicates positive oral health messages.
    • Working alongside others who share our passion for health and wellbeing.

To find out more about us, visit our website at

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