Alcohol Abuse

Lord Colwyn Excerpts

Thursday 30th March 2017 Grand Committee

[Lord Colwyn (Con)]

My Lords, I am pleased to be associated with the short debate this afternoon in the name of the noble Lord, Lord Brooke of Alverthorpe, as it enables me to make a few comments relating to my personal expertise and draw the attention of noble Lords to the effects that alcohol and excess alcohol have on the mouth, larynx, pharynx and oesophagus and the consequential costs to the NHS. I declare my interest as a retired dental surgeon and a member and fellow of the British Dental Association. I am a vice-president of the British Fluoridation Society and a life vice-president of the Society for the Advancement of Anaesthesia in Dentistry.

Alcohol and lifestyles closely associated with alcohol can have detrimental effects on dentition—dental erosion, dental caries and periodontal disease being the most common. The new dental contract reflects the aims of the UK Government to focus the attention of dental healthcare professionals on quality, treatment outcomes and how well their patients are looked after. There is now more emphasis on health promotion. Since alcohol misuse affects patients’ general health, tackling that abuse is therefore important for primary care dental professionals from a purely dental perspective. Addressing this in primary care settings also enables dental professionals to meet wider health promotion responsibilities.

As we have already heard, alcohol causes at least seven different types of cancer, and oral cancers are among those most closely linked to drinking. About 70% of people diagnosed with oral cancer are heavy drinkers. There are almost 7,000 diagnoses a year. This means that almost 5,000 heavy drinkers will be struck by mouth cancer every year. The risk is even greater for those who tend to drink and smoke at the same time. It is estimated that heavy drinkers and smokers have 38 times the risk of developing oral cancer than those who abstain from both products.

This particularly debilitating disease, which kills thousands and leaves many of the survivors with disfigured faces and difficulty in eating and speaking, is, worryingly, one of the fastest-increasing types of cancer, with cases up by almost 40% in the past decade. It now kills more people in the UK than cervical and testicular cancer combined. Yet awareness of it and of the role that drinking and smoking play in causing it remains stubbornly low.

Dental professionals are on the front line in the fight against cancer. Dentists are uniquely placed to diagnose oral cancer very early on before the patient notices any symptoms and seeks help. This is crucial, as mouth cancer patients have a 90% chance of survival if the condition is detected early, but this plummets to just 50% if the diagnosis is delayed. As dental teams are the only health professionals who see healthy patients on a regular basis, they are also in a unique position to provide brief advice and support to their patients who drink above the lower risk levels, warning them not just of the increased risk of oral cancer but also of the possible periodontal disease and tooth erosion that is associated with drinking some types of alcohol. Where appropriate, dental professionals can signpost higher-risk patients to their GP or local alcohol services, with such early intervention helping to save the NHS money further down the line.

Screening and primary dental care would involve similar strategies to those used by primary medical practitioners, using the same valid and reliable questionnaires and motivational interventions developed in psychology. These have been found to be effective and cost-beneficial in some dental settings. Although suitable screening tools and treatment interventions are available, it is unclear which of them are most effective and precisely how and when they should be deployed in primary dental care. It is clear, however, that the dental team can contribute and that this contribution fits well with its responsibilities and interests.