Alcohol Abuse and dependence, Psycophathology, medical management and dental implications

Resident: Roberts

Date: 5/25/11

Article: Alcohol Abuse and dependence, Psycophathology, medical management and dental implications

Author: Arthur F, Stephen M, et al.

Journal: JADA

Volume: 134

Year: 2003

Definitions

Alcohol abuse is distinguished by the harmful consequences of repeated use such as: impairment in judgement, slurred speech, mood change, inability to fulfill obligations at school, work or home.

Background

14 million americans are affected. It is the 3 largest progressive psychiatric illness in the U.S. It has physiological altering effects such as low-grade hypertension leading to an increase in triglycerides and low density lipoproteins leaving an individual susceptible to coronary artery and cerebrovascular diseases. It is an irritant to the G.I. tract and may cause gastritis, stomach or duodenal ulcers. 20% of people with long- term consumption are believed to have cirrhosis and pancreatitis. The oral cavity is at risk for an increased chance of cancer of the oral cavity, pharynx, hypo-pharynx, larynx, esophagus and stomach. Salivary glands(mainly parotid) have been shown to enlarge over time with complications of xerostomia, periodontitis, glossitis and angular cheilitis. Regions of the brain(frontal lobes, limbic structures, hippocampus and cerebellum) are susceptible to atrophy and shrinkage with heavy long-term use. Poor nutrition due to caloric displacement can leave an individual deprived of nutrients such as proteins, minerals, trace elements, riboflavin, pyridoxine, vitamin E, D, and K, as well as enhanced excretion of magnesium and zinc. Fetuses are susceptible to the effects of excessive alcohol intake and have been proven to have a lack of normal neural circuitry and a host of behavioral problems. Individuals who drink alcohol should be aware of complications with concomitant use of other medications such as acetaminophen, aspirin, ibuprofen, antibiotics(cephalosporins, erythromycin, metronidazole, tetracycline), anti fungal agents, barbiturates, chloral hydrate, and opioids may cause harmful interactions.

Treatment

Involves confrontation and overcoming patients denial of problem, removing alcohol from the body which takes about 5 days(in which a person may undergo withdrawal symptoms...), Beta blockers can be given to reduce heart rate and tremors, rest and adequate nutrition(including multiple vitamins, especially thiamine and magnesium), rescue medications can be given which can reduce a person interest in alcohol or have unpleasant physical effects when a person consumes alcohol.

Conclusion

An alcohol abusing parent may not be fully capable of caring for some or all of the needs of their children. As pediatric dentist we should be helpful in identifying these situations and intervening where possible. As noted in the article, adolescents who consume alcohol at an earlier age are more likely to abuse alcohol later in life. We should work to educate are patients and parents on the oral and systemic problems that are associated with alcoholism.