Alcohol use and periodontal pocket development: findings from a 4‐yr longitudinal study

Alcohol and Periodontal Disease: A Narrative Review

The scientific literature dealing with alcohol and alcoholic beverages revealed that these drinks possess an adverse impact on periodontal tissues. Additionally, other principal risk factors include tobacco, smoking, poor oral hygiene, etc. It has been observed that among chronic alcoholics, there are further issues, such as mental, social, and physical effects, that promote alcoholism. These people may have weak immunity for defense against pathogenic organisms and bacteria. Thus, chances of gingival bleeding, swollen gums, bad breath, and increased bone loss are there. Different alcoholic beverages in the market cause less salivation; these beverages contain sugars that promote acid production in the oral cavity by pathogens that demineralize the enamel and damage gum and teeth. This chronic alcohol consumption can progress into different types of oral disorders, including cancer, halitosis, and caries, and is also associated with tobacco and smoking. Chronic alcohol consumption can cause alteration of the oral microbiome and increase oral pathogens, which lead to periodontal disease and an environment of inflammation created in the body due to malnutrition, diminished immunity, altered liver condition, brain damage, and gut microbiota alteration. Heavily colored alcoholic beverages produce staining on teeth and, due to less saliva, may cause other toxic effects on the periodontium. Over-dependency on alcohol leads to necrotizing lesions such as necrotizing gingivitis, necrotizing periodontitis, and necrotizing stomatitis. These pathological impairments instigate severe damage to oral structures. Therefore, proper counseling by the attending dental surgeon and related health professionals is urgently required for the patient on the basis that the individual case needs to go away from the regular heavy consumption of alcohol.

Differences in the subgingival microbial composition associated with alcohol intake: A systematic review

Objectives

This study aimed to conduct a systematic evaluation of the literature on whether individuals exposed to alcohol intake present differences in the subgingival microbial composition compared to those unexposed.

Methods

Five databases (MEDLINE, EMBASE, LILACS, SCOPUS and Web of Science) and one source of grey literature (Google Scholar) were searched by two independent reviewers up to December 2022 according to pre-specified eligibility criteria. No restrictions were imposed regarding the date and language of publication and the periodontal status of the participants. The Newcastle-Ottawa Scale was used for methodological quality appraisal and a narrative synthesis was performed.

Results

Eight cross-sectional studies and one cross-sectional analysis nested in a cohort were considered for qualitative analysis, including data of 4636 individuals. Overall, the studies exhibited considerable heterogeneity in terms of characteristics of the participants and microbiological methods. Four studies have high methodological quality. Exposed individuals have higher overall quantity of periodontal pathogens in shallow and moderate to deep pockets. Findings on richness, relative abundance, alpha- and beta-diversity were limited and inconclusive.

Conclusion

The subgingival microbiota of individuals exposed to alcohol intake has higher overall quantity of red (i.e., P. gingivalis) and orange-complex (i.e., F. nucleatum) bacteria when compared to those unexposed.

Alcohol Intake Influences the Occurrence and Progression of Periodontitis Differently According to Sex and Country Sociodemographic Development: A Two-Stage Systematic Review

AIMS

To conduct an overview and systematic evaluation of prospective cohort studies on whether alcohol intake is associated with the incidence and progression of periodontitis.

METHODS

Nine databases were searched by two independent reviewers up to November 2021 according to prespecified eligibility criteria. Risk of Bias in Systematic Reviews and Risk of Bias in Non-Randomized Studies of Interventions were used for risk of bias assessment and certainty of evidence was assessed using the GRADE approach. Random-effects pair-wise meta-analyses were performed with data from cohort studies on the effects of higher levels of alcohol intake compared with current non-drinking to determine risk ratios (RR) and confidence intervals of periodontitis.

RESULTS

The four systematic reviews were at high risk of bias and concluded that alcohol intake is associated with periodontitis regardless of the study design. Five reports from seven cohort studies contributed to the meta-analyses and no statistically significant differences were found for higher levels of consumption regarding the risk of periodontitis, except for men from countries with low- and high-middle socio-demographic index (RR = 1.30, 95% CI: 1.13-1.46), with low certainty evidence.

CONCLUSION

Higher levels of alcohol consumption seem to be part of the causal mechanism of periodontitis when cooccurring with male sex in underdeveloped countries. No conclusion can be drawn regarding alcohol use disorders or patterns of consumption.

Alcohol use disorders are associated with higher prevalence of periodontitis in a rural area of Brazil

OBJECTIVE

The aim of the present cross-sectional study was to determine whether alcohol use disorders (AUD) are independently associated with severe and extent cases of periodontitis in individuals living in a rural area of Brazil.

METHODS

A representative probability sample (N = 585) was evaluated using six-site full-mouth periodontal examination. AUD was assessed using the alcohol use disorders identification test (AUDIT) and considered in its unidimensional and bidimensional factor structures. The first address hazardous alcohol consumption [HAC (overall scores ≥8)], and the second deals with two distinct constructs, harmful use [HU (items 1-3 scores ≥4 for men or ≥3 for women)], and alcohol-related consequences [ARC (items 4-10 scores ≥1)]. Periodontal outcomes were defined based on the criteria proposed by the CDC-AAP (2012) and an adaptation of the EFP-AAP (2018) definition of generalized stages III or IV periodontitis (GP). Adjusted multilevel multinomial and binary logistic regression analysis were used with a conceptual hierarchical approach to calculate the odds ratios (OR) of periodontal outcomes.

RESULTS

In the adjusted model, HU (OR = 2.69; 95% CI: 1.29-5.58) and ARC (OR = 3.79; 95% CI: 1.51-9.51) were significantly associated with higher prevalence of severe periodontitis (SP). Higher occurrence of GP was detected in individuals presenting HAC (OR = 1.88; 95% CI: 1.05-3.37) and ARC (OR = 2.90; 95% CI: 1.61-5.24).

CONCLUSION

AUD was independently associated with higher prevalence of SP and GP in individuals living in a rural area.

Alcoholic beverage consumption, smoking habits, and periodontitis: A cross-sectional investigation of the NutriNet-Santé study

BACKGROUND

Recent evidence suggests that dietary habits influence the development and severity of periodontitis. The present cross-sectional study evaluated the association between different types and quantity of alcoholic beverage consumption (alone and interacting with smoking) and the probability to suffer from severe periodontitis in the French e-cohort NutriNet-Santé.

METHODS

The study population consisted of 35,390 adults (mean age: 49.04 ± 13.94 years), who filled oral health questionnaires and completed at least three non-consecutive 24-hour dietary records. Data on type and frequency of alcoholic beverage consumption were obtained from a semi-quantitative self-reported alcohol frequency questionnaire; the daily quantity (g/day) was estimated from the 24-hour dietary records. The probability of severe periodontitis (main dependent variable) was assessed by calculating the modified periodontal screening score (mPESS) from selected questions.

RESULTS

A total of 7263 individuals (20.5%) presented a high probability of suffering from severe periodontitis (high-mPESS). After adjusting for confounding factors, the frequency of alcoholic beverage consumption was significantly higher among high-mPESS group than their low-mPESS counterparts, especially for hard liquor/spirits (1.9 ± 1.4 days/week for high-PESS versus 1.6 ± 1.1 days/week the low-PESS [P < 0.0001]). The mean daily quantity of ethanol was also higher in high-mPESS versus low-mPESS individuals (11.2 ± 15.6 versus 7.9 ± 12.3 g/day; P = 0.011). A stronger association with self-report severe periodontitis was noted when alcohol consumption exceeding > 20 g/day for women and > 30 g/day for men was combined with smoking habit (OR = 7.30 [95% CI: 6.1-8.73]).

CONCLUSION

The present results support an association between alcoholic beverage consumption and self-report severe periodontitis, particularly when it is associated with current smoking.

Intake of different alcoholic beverages and periodontal condition

Objective: The objective of this study is to study the association of alcoholic beverages and serum gamma-glutamyltransferase (GGT) level with periodontal condition. Material and methods: The study included 4294 dentate, non-diabetic Finnish adults aged 30-65 years who underwent periodontal examination during the Health 2000 Survey. The number of teeth with deepened (≥4 mm) periodontal pockets was the outcome. The exposures were self-reported beverage-specific alcohol intake (amount and frequency) and serum GGT level. The relative risks (RRs) and 95% confidence intervals (CI) were obtained by fitting zero-inflated negative binomial regression models. Results: We found no consistent association of either the intake of different alcoholic beverages or GGT level with the number of teeth with deepened periodontal pockets in the total study population or among the non-smokers. Among the highly educated non-smokers, spirit intake was associated with a low likelihood of having teeth with deepened periodontal pockets; RRs varied between 0.3 and 0.8. Among the non-smokers who had basic or intermediate education, spirit intake was associated with a higher likelihood of having teeth with deepened periodontal pockets; RRs varied between 1.2 and 1.8. Conclusion: In general, neither the intake of different alcoholic beverages nor the GGT level was consistently associated with the number of teeth with deepened periodontal pockets.