87632588 © Nalidsa Sukprasert | Dreamstime.com
effects of alcohol on oral health

Exploring the risks and impact of alcohol on oral health

Jan. 13, 2025
Alcohol consumption significantly impacts oral health. Dental hygienists play a vital role in educating patients on these effects and advocating for preventive measures. Here are some facts you need to know.

Research continuously shows that alcohol misuse increases the risk of cancers in the oral cavity, esophagus, larynx, pharynx, liver, colon, and rectum. Alcohol’s classification as a group 1 carcinogen underscores its significant risk.1 Despite these risks, however, the public awareness of alcohol’s cancer potential remains blurred. Dental hygienists can play a critical role in informing patients about the adverse effects of alcohol and encouraging behavior changes.

The World Health Organization (WHO) identifies alcohol as a toxic psychoactive substance that can lead to dependence. Alcohol consumption even at low levels can bring health risks, but most alcohol-related harm comes from heavy continuous drinking. According to WHO, the risk of developing cancer increases substantially the more alcohol is consumed.2 The Centers for Disease Control and Prevention (CDC) states that you should not drink alcohol, period, but if you choose to, drink in moderation. Moderation is defined as one drink in a single day for women and no more than seven drinks in a week; for men, that would be no more than two drinks in a single day and no more than 14 drinks per week. For all adults aged 65 and older, the recommendation is no more than one drink a day and no more than seven per week. Excessive alcohol use is classified as binge drinking and is defined as four or more drinks for women and five or more drinks for men on a single occasion. Heavy drinking is defined as eight or more drinks per week for women, and 15 or more for men.3

It has been reported by the National Institute on Drug Abuse that an estimated 15 million people struggle with an alcohol use disorder, and more than 65 million Americans reported binge drinking in the past month. The National Institute on Alcohol Abuse and Alcoholism has stated that alcohol consumption increased more during the COVID-19 pandemic than in the last 50 years.

In the United States, a standard drink has 0.6 ounces (14 grams) of pure alcohol. The amount of pure alcohol in each drink depends on the alcohol content or percent of alcohol by volume (ABV).4

One standard drink is equivalent to:

  • 12 ounces of beer with 5% alcohol
  • 8 ounces of malt liquor with 7% alcohol
  • 5 ounces of wine with 12% alcohol
  • A shot or 1.5 ounces of liquor or distilled spirits (80-proof liquor)

Alcohol and the oral microbiome

Alcohol acts as a diuretic. This dehydration impacts the oral cavity, reducing saliva production and leading to a dry mouth, causing an imbalance in the oral microbiome. This dysbiosis can contribute to diseases such as caries, periodontal disease, and oral candidiasis.5 Saliva, with a stable pH of 6.5–7, is crucial for maintaining oral health by neutralizing acids and washing away debris. Alcohol’s impact on saliva production and oral pH can lead to a pathogenic microbiome.6

Alcohol is the most preventable risk factor for cancer

The National Cancer Institute highlights that alcohol significantly raises the risk of oral cancer with long-term use. The American Cancer Society notes that alcohol use is one of the most important preventable risk factors for cancer. Alcohol use accounts for 6% of all cancers and 4% of all cancer deaths in the United States.7 It has been reported by the CDC that approximately 20,000 adults in the US die each year from alcohol-related cancers. It is estimated that most of these deaths may have been prevented if all adults followed the recommended limits on alcohol use in the Dietary Guidelines for Americans. Clearly, reducing alcohol intake can lower the risk for developing oral cancer and improve overall health.8

Alcohol is an independent risk factor for periodontitis

Alcohol consumption is a risk factor for periodontitis, a major public health problem that arises from various contributing factors.9 Alcohol consumption impairs neutrophil, macrophage, and T-cell functions, increasing the likelihood of connective tissue inflammation and stimulation of alveolar bone resorption. A systematic review found that alcohol consumption is associated with an increased occurrence of periodontitis, suggesting it should be considered as part of periodontal risk assessments.10

Impact of alcohol on restorations

Alcoholic beverages can erode and alter composite restorations, promoting bacterial adhesion and secondary caries. Resin-based restorations are especially vulnerable to degradation from high concentrations of alcohol, reducing their lifespan and integrity.11

A study by DaSilva et al. found that alcohol exposure decreased microhardness.12 Resin-based restorations are particularly vulnerable to alcohol-induced degradation. Several studies have reported that glass ionomer-based materials are favorable restorations in patients who consume alcohol regularly.13

Alcohol-based mouth rinses

Patients may be surveyed on oral health products they use, including mouth rinses. Alcohol-based mouth rinses are popular but can have adverse effects on oral health. While they can reduce bacteria, they can also cause xerostomia and disrupt the microbiota balance.14 Alcohol-free mouth rinses are effective alternatives that do not alter the oral cavity’s pH.15 Given the evidence linking alcohol to oral health problems, dental hygienists are in the position to screen patients for alcohol use and advocate for alcohol-free products to maintain oral health.16

Health behavior change

Dental hygienists are in a unique position to facilitate behavior change and empower patients to take steps to improve their overall well-being. Screening for alcohol use can be a quick and effective way to get a more complete picture of patient patterns and use and determine whether patients are drinking at levels that may have adverse effects, allowing health-care professionals to provide guidance accordingly. By establishing a good rapport, using motivational interviewing techniques, and employing consistent nonjudgmental guidance and support, dental hygienists can effectively assist patients in reducing alcohol consumption and associated health risks.17

Conclusion

Alcohol consumption significantly impacts oral health. Dental hygienists play a vital role in educating patients on its effects and advocating for preventive measures. By raising awareness of alcohol’s effects on oral health, dental hygienists can enhance patient health outcomes and contribute to patients’ overall well-being. 

Editor's note: The article appeared in the January/February 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

  1. WHO Results Report 2023 shows notable health achievements and calls for concerted drive toward sustainable development goals. News release. World Health Organization. May 7, 2024. https://www.who.int/news/item/07-05-2024-who-results-report-2023-shows-notable-health-achievements-and-calls-for-concerted-drive-toward-sustainable-development-goals
  2. No level of alcohol consumption is safe for our health. News release. World Health Organization. January 4, 2023. https://www.who.int/Azerbaijan/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health
  3. Alcohol use and your health. Centers for Disease Control and Prevention. May 15, 2024. https://www.cdc.gov/alcohol/about-alcohol-use/index.html
  4. About standard drink sizes. Centers for Disease Control and Prevention. May 15, 2024. https://www.cdc.gov/alcohol/standard-drink-sizes/index.html
  5. Li X, Liu Y, Yang X, Li C, Song Z. The oral microbiota: community composition, influencing factors, pathogenesis, and interventions. Front Microbiol. 2022;13:895537. doi:10.3389/fmicb.2022.895537
  6. Enberg N, Alho H, Loimaranta V, Lenander-Lumikari M. Saliva flow rate, amylase activity, and protein and electrolyte concentrations in saliva after acute alcohol consumption. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(3):292-298. doi:10.1067/moe.2001.116814
  7. Alcohol use and cancer. American Cancer Society. Updated June 9, 2020. https://www.cancer.org/cancer/risk-prevention/diet-physical-activity/alcohol-use-and-cancer.html
  8. Harris EL. Association of oral cancers with alcohol consumption: exploring mechanisms. J Natl Cancer Inst. 1997;89(22):1656-1657. doi:10.1093/jnci/89.22.1656
  9. Kwon T, Lamster IB, Levin L. Current concepts in the management of periodontitis. Int Dent J. 2021;71(6):462-476. doi:10.1111/idj.12630
  10. Pulikkotil SJ, Nath S, Muthukumaraswamy, Dharamarajan L, Jing KT, Vaithilingam RD. Alcohol consumption is associated with periodontitis. A systematic review and meta-analysis of observational studies. Community Dent Health. 2020;37(1):12-21. doi:10.1922/CDH_4569Pulikkotil10
  11. Swamy UKP, Amravai AR, Mandadi SR, Habeeb A. Effect of alcoholic beverages on shear bond strength of composites to enamel. J Conserv Dent. 2018;21(5):542-545. doi:10.4103/JCD.JCD_180_18
  12. da Silva MAB, Vitti RP, Sinhoreti MAC, Consani RLX, da Silva-Júnior JG, Tonholo J. Effect of alcoholic beverages on surface roughness and microhardness of dental composites. Dent Mater J. 2016;35(4):621-626. doi:10.4012/dmj.2015-383
  13. Phin CH, Shetty K, Kunaparaju K. Effect of alcoholic beverages on the surface microhardness of three restorative materials. J Int Dent Med Res. 2020;13,(4):1268-1274.
  14. de A Werner CW, Seymour RA. Are alcohol containing mouthwashes safe? Br Dent J. 2009;207(10):E19. doi:10.1038/sj.bdj.2009.1014
  15. van Swaaij BWM, Slot DE, Van der Weijden GA, Timmerman MF, Ruben J. Fluoride, pH value, and titratable acidity of commercially available mouthwashes. Int Dent J. 2024;74(2):260-267. doi:10.1016/j.identj.2023.09.002
  16. Ivoš A, Matošić A, Gradiški IP, Orlović I. The effects of alcohol on oral health, a review. Arch Psychiatry. 2019;55(1):61-70. doi:10.20471/MAY.2019.55.01.05
  17. Ramseier C, Suvan JE, eds. Health Behavior Change in the Dental Practice. John Wiley & Sons; 2011.
About the Author

Margaret E. Flynn, BSc, PGC, RDH

Margaret E. Flynn, BSc, PGC, RDH, is a dedicated practicing dental hygienist with more than 25 years of experience in promoting oral health and education. Passionate about helping others to achieve optimum oral health, she specializes in preventive care in Boston, Massachusetts. With a strong commitment to staying current in the field of dental hygiene, Margaret is pursuing a master of science degree. When not practicing, Margaret enjoys fitness and being outdoors, reflecting a well-rounded approach to life and wellness.