Chemical Dependency: Alcoholism
Center for Continuing Dental Education
Chemical Dependency: Alcoholism
Center for Continuing Dental Education
Next to dental disease, alcoholism is probably one of the most frequently encountered diseases encountered by the practicing dental professional. Most patients that are alcoholic will deny or be unaware of the full extent of their problem, however.
Diagnosis is difficult as most alcoholics maintain normal social and employment relationships and present a "normal" appearance. It is imperative, though, to be able to identify patients that have problems with alcohol. Dental professionals, by virtue of the fact that they may be seeing their patients for numerous appointments over extended periods of time and generally develop rapport with them, have the opportunity to detect the oral and general manifestations associated with alcohol abuse and alcoholism.
To begin with, a complete medical history, with an emphasis on alcohol use, organ damage, past medical care and hospitalizations needs to be taken with follow-up questions asked if alcohol problems are suspected. All patients should be asked if they are recovering from alcoholism and any other chemical dependency as part of the medical history interview. Neutral, non-judgmental screenings as described in Section 3 of this online course, such as the CAGE Questionnaire, can be used to determine if an alcohol problem exists. If a problem does indeed exist, we can provide information and direct the patient to the appropriate support groups for counseling and treatment of alcohol abuse.
The dentist and dental hygienist will need to develop appropriate treatment plans to accommodate their alcoholic (or alcohol abusing) patients' needs, taking into account these patients' generally unreliable nature. Many times appointments are not kept, and there is poor compliance with oral hygiene as well as maintenance of their general physical health.
Additionally, an alcoholic is more likely to present at a dental office for emergency treatment rather than for a routine dental exam. There is a strong need to consult with their physician and other health professionals that are involved in their medical care if any questions arise.
To begin, some general principles that should be followed when treating an alcoholic patient are to always examine their oral mucosa for pre-cancerous or cancerous indications, institute frequent recall appointments due to the increased risk of oral cancer, periodontal disease, caries and other soft tissue changes, and provide fluoride treatments and oral hygiene instructions at each appointment.
