This guidance is issued jointly by the Department of Health and Social Care, the Welsh Government, the Department of Health Northern Ireland, Public Health England, NHS England and NHS Improvement and with the support of the British Association for the Study of Community Dentistry.
Delivering Better Oral Health has been developed with the support of the 4 UK Chief Dental Officers.
Whilst this guidance seeks to ensure a consistent UK wide approach to prevention of oral diseases, some differences in operational delivery and organisational responsibilities may apply in Wales, Northern Ireland and England. In Scotland the guidance will be used to inform oral health improvement policy.
In England, among people aged 15 to 49 years, alcohol is the leading cause of ill-health, disability, and death (1, 2). Alcohol misuse across the UK is a significant public health problem with major health, social and economic consequences, estimated at between £21 and £52 billion a year (3). Each year there are over 1 million admissions to hospital for alcohol-related conditions (4).
Alcohol consumption is a public health issue across Europe, which has the highest per capita consumption of alcohol of all regions globally, and the highest level of alcohol-related harms (5). Harmful use of alcohol contributes not only to the burden of non-communicable diseases (NCDs), but also to the burden of communicable diseases, as well as violence and injuries (6).
This chapter will highlight the extent of the problem and summarise the links between alcohol and oral health. It will outline brief advice and the use of a screening tool which dental team members can use to support their patients who drink alcohol, to lower their risk in relation to general and oral health.
Alcohol and health
The UK Chief Medical Officers (CMOs) advise that to keep the risk from alcohol low, adults should not regularly drink more than 14 units of alcohol per week. Alcohol adversely affects health in a range of ways and there is no definitively ‘safe’ lower limit – no level of regular alcohol consumption improves health. There is a significantly increased risk of oral cancers among drinkers, particularly when combined with smoking or any form of tobacco use. These behaviours are linked; it is therefore important to recognise that drinking alcohol during an attempt to stop smoking can potentially reduce the chances of effectively quitting and this needs to be considered carefully (7). Alcohol has a wide range of health impacts including cardiovascular disease, cancers (breast, bowel, throat and mouth), and drinking during pregnancy can lead to long-term harm to the baby (3).
For alcohol, frequency of consumption is more important than duration in years – higher consumption over a few years has a higher risk for oral cancer than a lower intake over many years (8), although duration is still important as a risk factor for other chronic diseases like cardiovascular disease. There is some variation by site, with evidence by head and neck cancer sites that drink-years are associated with more pharyngeal/oral cavity site cancer when compared with laryngeal cancer (8).
Around 21% of the adult population in England and 24% of adults in England and Scotland, regularly drink at levels that increase their risk of ill health (increasing risk and higher risk drinkers) (9). The latest health survey for England, in 2018, suggested that more than twice as many men than women drank at levels of increasing risk in a usual week (25% and 11% respectively); and, similarly at higher risk levels (5% of men drank over 50 units and 3% of women drank over 35 units) (10). Adults living in the least deprived areas were more likely to drink over 14 units of alcohol in a usual week than those living in the most deprived areas (27% compared with 18%) (10). Whilst younger adults are less likely to drink than any other age group, when they do drink, the evidence suggests that consumption on their heaviest drinking day tends to be higher than that of older people (9). There is emerging evidence that people who have a dry month such as ‘Dry January’ subsequently reduce their drinking (11).
What is a unit of alcohol?
One unit equals 10ml or 8g of pure alcohol, which is around the amount of alcohol the average adult liver can break down in an hour, although this will vary from person to person. If a wine label says ‘12% ABV’ or ‘alcohol by volume 12%’, it means 12% of the volume of that drink is pure alcohol (12). To work out how many units there are in any drink, multiply the total volume of a drink (in ml) by its ABV (measured as a percentage) and divide the result by 1,000. Figures 12.1 and 12.2 provide visual representation of drinks in relation to their units of alcohol.
One unit of alcohol is: one half pint of ‘regular’ beer, lager or cider, half a small glass of wine, one single measure of spirits, one small glass of sherry, one single measure of aperitifs. Drinks that are more than a single unit are: one pint of ‘regular’ beer, lager or cider (2), one pint of ‘strong’ or ‘premium’ beer, lager or cider (3), one Alcopop or a 275ml bottle of regular lager (1.5), one 440 ml can of ‘regular’ lager or cider (2), one 440 ml can of ‘super strength’ lager, one 250 ml glass of 12% wine (3), one 75cl bottle of 12% wine (9).
The number of units you are drinking depends on the size and strength of your drink.
|Wine||11% ABV wine||14% ABV wine||Beer||3.8% ABV lager||5.2% ABV lager|
|125ml glass||1.4 units||1.8 units||284ml half pint||1.1 units||1.5 units|
|175ml glass||1.9 units||2.4 units||440ml can||1.7 units||2.3 units|
|250ml glass||2.8 units||3.5 units||568ml pint||2.2 units||3 units|
|750ml bottle||8.2 units||10.5 units||660ml bottle||2.5 units||3.4 units|
Guidelines on alcohol
The UK CMOs’ low risk guidelines for alcohol consumption in 2016 provide clear recommendations on alcohol (15 to 17).
To keep health risks to a low level, it is safest not to drink more than 14 units per week. For adults who drink as much as 14 units per week, it is best to spread this evenly over 3 days or more.
An alcohol-free childhood is the healthiest and safest option.
The safest approach for women who are pregnant, or planning a pregnancy, is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk. The risk of harm to the baby is likely to be low if a woman has drunk only small amounts of alcohol before she knew she was pregnant or during pregnancy.
Cutting down alcohol consumption
A good way to help achieve this is to have several drink-free days each week.
Drinking risk categories
The term low risk drinking implies that no level of alcohol consumption is completely safe. Furthermore, the context can determine the level of risk, for example drinking and driving, in conjunction with medication or where there is pre-existing chronic illness.
The guidelines state the following.
Low risk drinking
‘Low risk’ is not regularly exceeding 14 units per week, spread evenly over the week. This level of consumption represents a low risk of long term or short-term health harm for a healthy adult.
Increasing risk drinking
Increasing risk means drinking in a way that raises the risk of ill health from drinking alcohol. For both men and women, this means regularly drinking more than the low risk guideline of 14 units per week and up to 35 units for women and 50 units for men.
Read More:Chapter 12: Alcohol