Excessive Bleeding or Bleeding Disorders: Excessive alcohol use may damage the liver and bone marrow resulting in excessive bleeding during dental treatment. If excessive bleeding is observed, treatment should be stopped and digital pressure applied. Referral for medical evaluation and necessary blood coagulation tests should be requested before treatment progresses.
Effectiveness of Drugs: The drugs used in dentistry that are metabolized in the liver include amide local anesthetics and benzodiazepines. These drugs can have a reduced effect in the alcohol abusive patient. They can metabolize faster as compared to a routine patient. Dental anesthetics may not work as well at the injection site in the alcohol abuser and may be carried into the bloodstream more rapidly. Repeated doses may need to be reduced, or the interval between doses prolonged, to prevent excessive blood levels.18
Periodontal Disease: Several biological explanations exist for the detrimental effect that alcohol may have on the periodontium. Studies have shown neutrophilic phagocytosis is associated with periodontal disease. Alcohol also impairs neutrophil function, contributing to bacterial overgrowth which may lead to periodontal inflammation. Additionally, alcohol may have a direct toxic effect on periodontal tissue. Finally, high alcohol intake increases monocyte production of inflammatory cytokines (tumor necrosis factor-alpha (TNF-∂), interleukins-1 and 6), in the gingival crevice which is associated with periodontitis.33
Oral Cancer: Drinking alcohol has been associated with oral cancer. Evidence suggests that this is because alcohol breaks down into acetaldehyde, which can bind to the proteins in the oral cavity. This can trigger an inflammatory response in the body. In the most severe cases, cancerous cells can develop. Oral cancer most often appears on the lips or tongue but can occur under the tongue, on the palate or on the gingiva.42 An oral cancer screening should be performed at each dental exam.
Dental Caries: Heavy drinkers may experience dry mouth at night and neglect both personal and professional oral health care. They may also consume higher levels of refined carbohydrates to satisfy their “munchies.” Heavy drinking can also lead to frequent vomiting and the vomit is extremely acidic. All of these might increase their risk of developing dental caries.42
Xerostomia: Because alcohol will dehydrate the patient, their salivary flow may be compromised. An enlargement of the parotid salivary glands may be a sign of a chronic alcohol use problem.42 Educating the patient about the benefits of in-office and home therapeutic doses of calcium-phosphate fluoride varnishes and toothpastes will help to protect these patients from new or recurrent decay. Have the patient do a Caries Assessment Evaluationto discover their proper protocol for varnish and toothpaste regimens (Figure 7).
Blood Pressure: When treating an alcohol dependent patient, the clinician should consider the possibility of increased blood pressure and monitor vital signs at each appointment.