Feasibility of alcohol misuse screening and treatment in the dental setting

Abstract

BackgroundDental specialists treat conditions such as facial trauma and oral cancer that can result from alcohol misuse. Visits to primary dental care professionals are oriented towards prevention. Interventions coordinated by specialist services but delivered strategically in primary care could therefore potentially help to reduce burdens on secondary care services. The aim of this study was to determine the feasibility of screening for alcohol misuse and providing brief intervention in a primary dental care setting. MethodsIn this randomised controlled trial, patients aged 18–65 years were recruited from a local general dental practice. Patients were stratified according to appointment (with a dentist or hygienist). Reception staff administered envelope packs containing screening materials (the Modified Single Alcohol Screening Question [M-SASQ]), consent forms, and a short survey collecting contact details to patients who agreed to take part in the study. Packs were randomly pre-allocated to control and intervention groups by strata using block randomisation before the start of the study. Consenting patients scoring positively on the M-SASQ for drinking hazardously and allocated to the intervention group received a motivational intervention to reduce alcohol intake from either the hygienist or dentist. Patients in the control group received usual care. The outcome assessor and patients were masked to allocations. The outcome measure at 3 months was M-SASQ score. This trial is registered with the ISRCTN registry, number ISRCTN18745862. FindingsOne hygiene patient and 106 dental patients were recruited. The hygiene patient did not score positively on the M-SASQ for alcohol misuse. Of the 106 dental patients, 46 (43%) scored positively, with 26 allocated to the intervention group and 20 to the control group. Follow-up data were available for 22 (48%) of the 46 patients (12 intervention, 10 control). M-SASQ scores changed from positive to negative for two patients in the intervention and five in the control group. InterpretationAlcohol misuse screening and treatment was feasible in a primary dental care setting; this suggests a new approach involving the general dental team, which could potentially reduce burdens on specialist dental services. Overall, in this practice, the dentist was best placed to deliver the intervention rather than the hygienist since these health-care professionals saw most of the patients recruited into the trial. Contamination might have been a problem because more patients in the control group changed M-SASQ score. Building on these findings, a multicentre, cluster randomised controlled trial is planned. FundingRoyal College of Surgeons of England.