Alcohol use disorder

Oral health effects

• Gum disease (periodontal disease)

  Patients with alcohol use disorder show a higher prevalence and severity of periodontitis compared with non-drinkers.

  Mechanism: Alcohol impairs neutrophil and immune function and worsens plaque control during active use; nutritional deficiency and xerostomia compound the effect.

  Clinical management: Reinforce oral hygiene instruction, more frequent periodontal maintenance intervals, and address co-occurring tobacco use.

• Oral and oropharyngeal cancer risk

  Alcohol is an independent risk factor for head and neck cancer, and combined heavy drinking and smoking produce a greater-than-multiplicative increase in risk.

  Mechanism: Acetaldehyde (the carcinogenic metabolite of ethanol) damages mucosal DNA, and ethanol increases mucosal permeability to tobacco carcinogens.

  Clinical management: Perform a thorough soft-tissue/oral cancer screening at every visit, biopsy or refer persistent white/red lesions or non-healing ulcers, and support both alcohol and tobacco cessation.

• Xerostomia (reduced salivary flow)

  Chronic alcohol use reduces salivary output, producing dry mouth that accelerates caries and mucosal irritation.

  Mechanism: Alcohol has a diuretic/dehydrating effect and can directly irritate oral mucosa.

  Clinical management: Saliva substitutes, sugar-free xylitol gum, frequent water intake, high-fluoride toothpaste, and avoidance of alcohol-containing mouth rinses.

• Tooth erosion, swollen salivary glands (sialadenosis), and nutritional deficiency signs

  Recurrent vomiting and acidic/sugary mixers cause erosive tooth wear; painless bilateral parotid enlargement (sialadenosis) and angular cheilitis or glossitis from folate/B-vitamin deficiency are common in heavy drinkers.

  Clinical management: Fluoride and erosion-control advice, nutritional counseling or medical referral, and evaluation of parotid enlargement to rule out other causes.

• Bleeding tendency with alcohol-related liver disease

  Patients with alcohol-related cirrhosis can have thrombocytopenia and prolonged prothrombin time from impaired hepatic synthesis of clotting factors, raising bleeding risk during invasive dental procedures.

  Mechanism: Chronic liver injury reduces synthesis of vitamin K-dependent clotting factors and can cause splenic sequestration of platelets.

  Clinical management: A systematic review found the risk of clinically significant bleeding during oral surgery in cirrhotic patients is low, and local hemostatic measures are usually sufficient; pre-op coagulation/platelet labs and medical consult are still recommended for advanced disease.