Alcohol abusers should be screened by dentists rather than doctors according to a new report but Greater Manchester's dental community are treating it with caution.
Cardiff University’s Jonathan Shepherd, the lead author of this report, says that dentists have ‘unique opportunities’ rarely shared by a general practitioner.
Dr Phil Wander, a retired cosmetic dentist for football and TV stars, said that he likes the report’s good intentions but stresses that it requires a team approach to succeed.
“The problem arises when you try to give patients an education as they’re not expecting this. I speak from personal knowledge here,” said Dr Wander.
“You can ask open questions to get patients talking about health issues. But once I did that while a junior nurse was having a smoke round the back and I asked her how she felt about smoking. She replied: ‘what the **** does that have to do with you?’ And we thought, if she is swearing at us, imagine how a patient would react to that question!”
Whereas GPs are visited with a particular health concern, Professor Shephard argues, most people tend to visit the dentist once a year for preventative check-ups. This allows dental health experts to offer treatment before they develop a potential oral cancer or gum disease.
And Dr Wander describes smoking and binge drinking as socio-economic problems, which are currently out of a dentist’s control. He cites the scenario of a patient without employment prospects can get depressed, be unable to stop drinking, and have financial difficulties, and be unmoved by up-close photographs of a mouth cancer victim.
When he was trained 40 years ago, Dr Wander says, the authorities never thought of addressing this sort of thing. If an initiative based on Professor Shepherd’s was implemented, it would require entirely new forms of training.
Dr Wander concluded: “I agree with the report but we have to look at the whole person, not just the hole.”
Writing in The Royal College of Surgeons’ Dental Journal, the researchers also say that the treatment offered to alcohol abusers would include motivational advice sessions delivered by hygienists or dental nurses.
A spokesman from the Griffin Dental Surgery in Salford agreed that hygienists and nurses can do this, but doubts the dentist himself would be as successful in deterring patients from alcohol. He also disagreed that dentists are in a privileged position since ‘patients fail with dental appointments all the time’.
He said: “I believe patients are very reticent about receiving advice off people with whom they’ve had a financial arrangement.
"If I was patient and I wanted to see a dentist who I’d previously spent a lot of money on, then the dentist starts moralising about my smoking habit or my drinking habit, I’d want to say to him: "But I’m paying you to look after my teeth." I mean, they pay doctors and dentists through taxation, but dentists seem to be held in lesser regard due to this financial implication.”
This holding of dentists in lesser regard became particularly overt, he added, when the Advertising Standards Authority (ASA) ordered a dentist to not refer to himself as ‘doctor’ in his advertisements, or else the title might confuse patients into thinking a dentist is medically qualified.
Dr Mike Pemberton, Consultant in Oral Medicine at the University Dental Hospital of Manchester, agrees with the report: “Dentists are trained to consider health issues beyond the treatment of teeth.
"They are able to spot cancers and potential cancers in the mouth and can advise their patients on risk factors such as smoking and alcohol.
"Dentists are able to give advice about alcohol consumption to their patients and this paper adds further thought on how this important topic maybe developed in the future.”