Sir, in the last decade, the emergence of independent breweries focusing on ales, stouts and flavoured beers, rather than lagers and bitters, has grown massively in the UK, as much as 65% in the last five years and 8% in 2016 alone. The UK now has well over 1,000 independent breweries.1 This trend is not isolated to the UK, but can also be seen in the USA, Scandinavia and Southeast Asia.

The increase seen in frequency of consumption of high Alcohol By Volume (ABV) drinks in recent years may be of interest to us as clinicians given the group it appears to be affecting. The craft beer craze appears to be being embraced by younger people of higher socio-economic and educational background, both male and female. These patients have previously been seen as unlikely to suffer much in the way of dental and oral disease and possibly deemed overall 'low risk' patients.

As we get to grips with the relatively newly revealed increased risk of oral cancers through HPV transmission, I would draw attention to the risks associated with a possibly increasing consumption of high ABV drinks amongst a similar cohort of the population. These drinks are higher in alcohol content, with many exceeding 6% and reaching as high as 15%. The effect of this skews our previously held conceptions of units in a pint, possibly leading to missed 'red flags' in our medical and social history taking. As we are aware, the new NHS recommended intake for both men and women is now less than 14 units per week, spread across three days in the week.2 In terms of an average 6% craft beer, this equates to only four pints per week, including weekends. This effect may also be seen, albeit to a lesser degree, in the increased consumption of often commercially cheaper 'New World' wines which are also higher in ABV. Furthermore, there is a well-documented, increased tendency towards consuming the weekly recommended allowance in one sitting.

The long-term effect of this pattern is obviously yet to be seen but as with all alcohol, there are definite immediate and cumulative risks in terms of trauma, oral cancer, non-carious tooth surface loss, and even periodontal disease.3 What is possibly new, however, are the groups of patients this may be having an effect upon, and the responsibility we have to discuss this with them.4 Finally, I would like to reinforce the risks to patients and our ourselves, of drinking alcohol the night before driving, working, or going into dental school.