Alcohol abuse and dependence: psychopathology, medical management and dental implications.
BACKGROUND
The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental treatment of patients with alcoholism.


METHODS
The authors conducted a MEDLINE search for 1995 through 2001 using the key terms of alcoholism, epidemiology, pathophysiology, treatment and dentistry. Reports selected for further review included those published in English in peer-reviewed journals. The authors gave preference to articles reporting randomized, controlled trials.


CONCLUSIONS
Alcoholism is a chronic and progressive psychiatric illness that afflicts more than 14 million Americans. It is characterized by a loss of control over the use of alcohol, resulting in impaired social functioning, and the consequent development of medical illnesses. The disease arises in genetically vulnerable people when they are overwhelmed by their cravings for the alcohol-associated euphoria that results from the actions of several neurotransmitter systems in the brain's pleasure center. New medications to counteract alcohol-induced neurotransmission imbalance may assist patients in reducing their craving.


CONCLUSIONS
The prevalence of dental disease usually is extensive because of a disinterest in performing appropriate oral hygiene techniques and diminished salivary flow. Concurrent abuse of tobacco products worsens dental disease and heightens the risk of developing oral cancer. Identification of the alcohol-abusing patient, a cancer-screening examination, preventive dental education, and use of saliva substitutes and anticaries agents are indicated. Special precautions must be taken when performing surgery and when prescribing or administering analgesics, antibiotics or sedative agents that are likely to have an adverse interaction with alcohol or psychiatric medications.
Friedlander
Arthur H
AH
VA Greater Los Angeles Healthcare System, Calif. 90073, USA. arthur.friedlander@med.va.gov
Marder
Stephen R
SR
Pisegna
Joseph R
JR
Yagiela
John A
JA
D000427:Alcohol Deterrents / Q000009:adverse effects; D019973:Alcohol-Related Disorders / Q000150:complications* / Q000628:therapy; D017742:Dental Care for Chronically Ill; D004347:Drug Interactions; D000431:Ethanol / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000150:complications*; D008337:Mandibular Fractures / Q000150:complications; D009062:Mouth Neoplasms / Q000150:complications; D009748:Nutrition Disorders / Q000139:chemically induced / Q000150:complications; D010510:Periodontal Diseases / Q000209:etiology*; D012798:Sialorrhea / Q000139:chemically induced / Q000150:complications; D012907:Smoking / Q000009:adverse effects; D014029:Tobacco Use Disorder / Q000150:complications; D014987:Xerostomia / Q000139:chemically induced / Q000150:complications
D000427:Alcohol Deterrents; D000431:Ethanol