8 - Medical and dental issues associated with alcohol

Question 1

Describe alcohol metabolism.

Answer 1

• in liver (90%)
• distributed throughout body water
• concentrated in liver from stomach via portal vein
• does not enter body fat

Question 2

Describe alcohol absorption into the bloodstream.

Answer 2

• water soluble
• slowly absorbed by stomach, more quick in small intestine
• food slows absorption

Question 3

Describe the breakdown of alcohol.

Answer 3

Alcohol -> acetaldehyde -> acetate -> CO2 and H2O

Question 4

How does alcohol affect women different to men?

Answer 4

• smaller blood volume
• lower levels of alcohol dehydrogenase
• crosses placenta

Question 5

What what rate is alcohol removed from the blood?

Answer 5

15mg/100ml/hour

Question 6

Describe the effects of alcohol on the body.

Answer 6

• mild sedative
• mild anaesthetic
• stimulates dopamine and serotonin
• disinhibition

Question 7

At what concentration can alcohol be fatal?

Answer 7

> 400mg/100ml

Question 8

What are the weekly safe limits for alcohol?

Answer 8

14 units spread evenly over 3 or more days, with off-days in-between ideally

Question 9

What are the oral problems associated with heavy drinking? (10)

Answer 9

• oral cancer (increased by concurrent smoking)
• ulceration, glossitis, angular cheilitis, gingivitis due to nutritional deficiencies
• caries (neglect)
• trauma
• lost dentures
• sialosis
• xerostomia
• erosion (alcohol is acidic)
• bruxism
• poor wound healing

Question 10

What is the spectrum of liver disease?

Answer 10

Normal - steatosis - steato-hepatitis - cirrhosis

Question 11

What is steatosis?

Answer 11

Fatty liver disease

Question 12

What is cirrhosis?

Answer 12

• irreversible damage to liver
• presents with jaundice, ascites, bleeding, infections and encephalopathy
• deranged liver tests
• at risk of liver cancer

Question 13

How does liver cancer affect dentistry?

Answer 13

• reduced synthesis of clotting factors
• platelet aggregation is reduced due to reduced megakaryocyte maturation with leads to reduced numbers
• drug metabolism, increased liver enzymes metabolise drugs faster or cirrhosis reduces metabolism due to death of tissue

Question 14

What is the analgesia of choice for those who have liver damage?

Answer 14

Paracetamol, as NSAIDs can cause GI bleeds

Question 15

What is disulfiram?

Answer 15

• Antabuse
• inhibits alcohol dehydrogenase which prevents the conversion of alcohol to acetate
• acetaldehyde builds up in the system and causes nausea and vomiting

Question 16

How does alcohol affect patients with Hep C?

Answer 16

• 25% of Hep C patients develop cirrhosis
• alcohol increases rate at which this happens
• all Hep C patients should abstain from alcohol

Question 17

Describe the reaction between alcohol and heroin.

Answer 17

Sedative

Question 18

Describe the reaction between alcohol and cocaine.

Answer 18

• alcohol prolongs effect of cocaine
• cardiotoxic

Question 19

Describe the reaction between alcohol and cannabis.

Answer 19

• reduces absorption of alcohol
• increased confusion

Question 20

Describe the reaction between alcohol and amphetamines.

Answer 20

Increase impairment of judgement

Question 21

Describe the reaction between alcohol and ecstasy.

Answer 21

Alcohol increases intoxication but reduces fatal fluid retention of ecstasy

Question 22

How does alcohol affect stroke?

Answer 22

• mild consumption reduces chance of stroke
• 5 or more drinks a day increases risk of stroke by 400%

Question 23

How does alcohol affect hypertension?

Answer 23

• low grade hypertension
• reverses within 3 weeks after stopping drinking
• portal hypertension can cause oesophageal varices

Question 24

What protective features does alcohol have?

Answer 24

• reduces stroke
• reduces MI
• reduces CAD due to decreased plaques and HDL cholesterol
• reduced gall stones
• reduced macular degeneration

Question 25

How does alcohol impact oral cancer?

Answer 25

• promotes tobacco initiated tumours
• facilities absorption of carcinogenic substances across oral mucosa
• damages DNA
• thins mucosa (nutritional deficiency)

Question 26

What enzyme is involved in the breakdown of alcohol?

Answer 26

Alcohol dehyrdogenase