1. The Mouth Alcohol Effect: 5, 10 15, 20 Minutes or More?

2. Mouth Alcohol Effect

3. Historic Historic Endogenous: Blood in mouth, GERD, belching, vomiting Endogenous: Blood in mouth, GERD, belching, vomiting Exogenous: alcoholic beverages, non beverage alcohol, non alcohol (gum, chewing tobacco etc) Exogenous: alcoholic beverages, non beverage alcohol, non alcohol (gum, chewing tobacco etc)

4. F.E. Anstie (1833-1874) BrAC determined by acid dichromate method BrAC determined by acid dichromate method First described mouth alcohol effect in 1867 First described mouth alcohol effect in 1867

5. Emil Bogen (1927) Used potassium dichromate visible color change, subjects blew into a football bladder, first described medicolegal use of breath alcohol testing Used potassium dichromate visible color change, subjects blew into a football bladder, first described medicolegal use of breath alcohol testing

6. Spectre of Spector N. Herbert Spector published in Science, 1971 N. Herbert Spector published in Science, 1971 Rinse mouth with alcohol of varying alcohol solutions, and blew into a Breathalyzer every 4-6 mins Rinse mouth with alcohol of varying alcohol solutions, and blew into a Breathalyzer every 4-6 mins 30s drop time 30s drop time 90s wait 90s wait change ampoules change ampoules

7. Spectre of Spector “highly inaccurate for at least first 20 minutes” “highly inaccurate for at least first 20 minutes” “merely sniffing 3X with the nose from flask containing 50%- resulted in offscale readings” “merely sniffing 3X with the nose from flask containing 50%- resulted in offscale readings” mouth washing and gargling with water only had slight effects mouth washing and gargling with water only had slight effects

8. Spectre of Spector J.A. Edwards (US DOT) responded J.A. Edwards (US DOT) responded This effect has been known for over 40 years, it is not new This effect has been known for over 40 years, it is not new “We appreciated Spector’s interest in our problem, but in this case, he raised a false alarm.” “We appreciated Spector’s interest in our problem, but in this case, he raised a false alarm.”

9. Blood in the Mouth Wigmore J.G. and Wilkie M.P., ‘A Simulation of the Effect of Blood in the Mouth on Breath Alcohol Concentrations of Drinking Subjects” Wigmore J.G. and Wilkie M.P., ‘A Simulation of the Effect of Blood in the Mouth on Breath Alcohol Concentrations of Drinking Subjects” Twenty-six male subjects consumed alcoholic beverages ad libitum over one hour Twenty-six male subjects consumed alcoholic beverages ad libitum over one hour Testing was conducted 1.5 hours later Testing was conducted 1.5 hours later The subjects provided a breath sample, then a blood sample was collected The subjects provided a breath sample, then a blood sample was collected The subjects then placed 3-10 mL of own blood into mouth and provided another breath sample The subjects then placed 3-10 mL of own blood into mouth and provided another breath sample

10. Blood in the Mouth The BACs ranged from 0.044 to 0.168 g/100mL (mean 0.095 g/100mL) The BACs ranged from 0.044 to 0.168 g/100mL (mean 0.095 g/100mL) BrAC (before) = 0.087 g/210L BrAC (before) = 0.087 g/210L BrAC (after)= 0.084 g/210L BrAC (after)= 0.084 g/210L No significant differences if truncated results used No significant differences if truncated results used Wigmore and Wilkie (2002)

11. Blood in the Mouth

12. Alcohol Solution Concentration Weight (g) of Alcohol in 5 mL Blood 0.08 g/100mL 0.004 Beer5%v/v0.198 Wine 12% v/v 0.474 Mouthwash 20% v/v 0.790 Liquor 40% v/v 1.580 Wigmore and Wilkie (2002)

13. Gastroesophageal Reflux Disease (GERD) Reflux of highly acidic stomach contents back into the esophagus –digestive disease affects up to 20% of population Reflux of highly acidic stomach contents back into the esophagus –digestive disease affects up to 20% of population

14. GERD-Kechagias et al 1999 5 male and 5 female GERD patients consumed 0.31-0.44 g/kg alcohol, frequent blood and breath samples were collected, subjects in supine position and GERD induced by compression belt 5 male and 5 female GERD patients consumed 0.31-0.44 g/kg alcohol, frequent blood and breath samples were collected, subjects in supine position and GERD induced by compression belt Coughing and hoarseness and incapacitating for short time Coughing and hoarseness and incapacitating for short time Mean BrAC was 0.042 g/100mL (GERD) and 0.044 g/100mL (no GERD) Mean BrAC was 0.042 g/100mL (GERD) and 0.044 g/100mL (no GERD)

15. GERD- Booker and Renfroe, 2015 10 GERD subjects, 5 controls, consumed 1.5-1.7 g/kg alcohol within 30 minutes after standard meal of rice, beans, corn chips and spiced salsa. (extreme conditions) BAC by indwelling catheter BrAC-Intoxilyzer 5000 on 2 occasions 10 GERD subjects, 5 controls, consumed 1.5-1.7 g/kg alcohol within 30 minutes after standard meal of rice, beans, corn chips and spiced salsa. (extreme conditions) BAC by indwelling catheter BrAC-Intoxilyzer 5000 on 2 occasions 3 of 10 subjects had elevated BrACs and only 1 showed elevated BrAC on both occasions shortly after drinking 3 of 10 subjects had elevated BrACs and only 1 showed elevated BrAC on both occasions shortly after drinking

16. GERD “GERD-related alcohol leakage from the stomach into a breath sample is therefore an essentially irrelevant source of potential error in forensic breath testing” “GERD-related alcohol leakage from the stomach into a breath sample is therefore an essentially irrelevant source of potential error in forensic breath testing”

17. Effect of Belching on BrAC

18. Dentures and Mouth Alcohol Harding et al (1992) No significant effect of dentures on MAE Harding et al (1992) No significant effect of dentures on MAE

19. Factors Which Decrease the Mouth Alcohol Effect Pre-existing BAC Pre-existing BAC Swallow rather than rinse Swallow rather than rinse Lower alcohol concentrations of beverage (e.g. beer) Lower alcohol concentrations of beverage (e.g. beer) Gum, chewing tobacco, food all increase salivary flow rate and thus decrease mouth alcohol effect Gum, chewing tobacco, food all increase salivary flow rate and thus decrease mouth alcohol effect Talking rather than closed mouth Talking rather than closed mouth Multiple breath samples Multiple breath samples

20. Pre-Existing BAC Gullberg, 1992 tested subjects at zero BAC and at approximately 0.100 Gullberg, 1992 tested subjects at zero BAC and at approximately 0.100

21. Rinsing vs Swallowing Wigmore and Leslie (2001), 30 subjects rinsed or swallowed 10 mL of 20% alcohol Wigmore and Leslie (2001), 30 subjects rinsed or swallowed 10 mL of 20% alcohol

22. Alcohol Concentration Caddy et al, (1978), beer (555 s), wine (735 s); vodka (915 s), alcohol (1,095 s) Caddy et al, (1978), beer (555 s), wine (735 s); vodka (915 s), alcohol (1,095 s)

23. Decrease Mouth Alcohol Effect by Increasing Salivary Flow Rate Wigmore and Bugyra, 2003 Wigmore and Bugyra, 2003 19 female and 11 male alcohol-free subjects 19 female and 11 male alcohol-free subjects Rinsed mouth with 20 mL of 20% v/v alcohol, expectorated Rinsed mouth with 20 mL of 20% v/v alcohol, expectorated No gum and chewed gum for five minutes No gum and chewed gum for five minutes BrACs determined at 5 and 10 minutes after expectorating BrACs determined at 5 and 10 minutes after expectorating

24. Wigmore and Bugyra, 2003 5 minutes 10 minutes No gum 0.155 g/210L (0.031-0.277) 0.035 g/210L (0.000-0.092) Gum 0.022 g/210L (0.00- 0.091) 0.002 g/210L (0.00- 0.010) Mean percent reduction 85%100%

25. Decreasing Mouth Alcohol Effect

26. Salivary flow rate is increased by gustatory and mechanical stimuli Salivary flow rate is increased by gustatory and mechanical stimuli Unstimulated salivary flow rate is 0.5 mL/min Unstimulated salivary flow rate is 0.5 mL/min Chewing flavored gum increases the salivary flow rate to 5.5 mL/min Chewing flavored gum increases the salivary flow rate to 5.5 mL/min

27. Multiple Breath Samples (Buczek and Wigmore, 2002)

28. Buczek and Wigmore, 2002

29. Classic Mouth Alcohol Experiment Subjects have zero BAC Subjects have zero BAC Rinse (not swallow) alcohol solution Rinse (not swallow) alcohol solution Keep mouth close, no talking Keep mouth close, no talking Multiple breath samples Multiple breath samples

30. Duration of Mouth Alcohol Effect? Beer swallowed in subject with pre- existing BAC, who talks and has mouth open (< 5 mins) Beer swallowed in subject with pre- existing BAC, who talks and has mouth open (< 5 mins) Zero BAC subject, rinses mouth with high concentration of alcohol, doesn’t talk, and keeps mouth close (20 min) Zero BAC subject, rinses mouth with high concentration of alcohol, doesn’t talk, and keeps mouth close (20 min)

31. Jim Wigmore www.wigmoreonalcohol.com www.wigmoreonalcohol.com www.wigmoreonalcohol.com LinkedIn -postings LinkedIn -postings www.researchgate.net www.researchgate.net www.researchgate.net

32. References Caddy, G.R., Sobell, M.B., and Sobell, L.C. “Alcohol Breath Tests: Criterion Times for Avoiding Contamination by Mouth Alcohol”, Behavior Research Methods and Instrumentation, 10: 814-818, 1978 Caddy, G.R., Sobell, M.B., and Sobell, L.C. “Alcohol Breath Tests: Criterion Times for Avoiding Contamination by Mouth Alcohol”, Behavior Research Methods and Instrumentation, 10: 814-818, 1978 Edwards, J.A., “Alcohol Breath Tests”, Science, 173: 8, 1971 Edwards, J.A., “Alcohol Breath Tests”, Science, 173: 8, 1971 Gullberg, R.G., “Breath Alcohol Analysis in One Subject with Gastroesophageal Reflux Disease”, JFS, 46: 1498-1503, 2001 Gullberg, R.G., “Breath Alcohol Analysis in One Subject with Gastroesophageal Reflux Disease”, JFS, 46: 1498-1503, 2001 Gullberg, R.G., “The Elimination Rate of Mouth Alcohol: Mathematical Modeling and Implications in Breath Alcohol Analysis”, JAT, 37: 1363-1372, 1992 Gullberg, R.G., “The Elimination Rate of Mouth Alcohol: Mathematical Modeling and Implications in Breath Alcohol Analysis”, JAT, 37: 1363-1372, 1992 Harding, P.M., McMurray, M.C., Laessig, R.H., Simley, D.O., Correll, P.J., and Tsunehiro, J.K., “The Effect of Dentures and Denture Adhesives on Mouth Alcohol Retention”, JFS, 37: 999-1007, 1992 Harding, P.M., McMurray, M.C., Laessig, R.H., Simley, D.O., Correll, P.J., and Tsunehiro, J.K., “The Effect of Dentures and Denture Adhesives on Mouth Alcohol Retention”, JFS, 37: 999-1007, 1992 Ignacio-Garcia, J.M., et al., “A Comparison of Standard Inhalers for Asthma witho and without Alcohol as a Propellant on the Measurement of Alcohol in Breath”, Journal of Aerosol Medicine and Pulmonary Drug Delivery, 18: 193-197, 2005 Ignacio-Garcia, J.M., et al., “A Comparison of Standard Inhalers for Asthma witho and without Alcohol as a Propellant on the Measurement of Alcohol in Breath”, Journal of Aerosol Medicine and Pulmonary Drug Delivery, 18: 193-197, 2005 Kechagias, S., Jonsson, K.A, Franzein, T, Andersson, L., and Jones, A.W., “reliability of Breath- Alcohol Analysis in Individuals with Gastroesophageal Reflux Disease”, JFS, 44: 814-818, 1999 Kechagias, S., Jonsson, K.A, Franzein, T, Andersson, L., and Jones, A.W., “reliability of Breath- Alcohol Analysis in Individuals with Gastroesophageal Reflux Disease”, JFS, 44: 814-818, 1999 Langille, R.M., and Wigmore, J.G., “The Mouth Alcohol Effect After a Mouthful of Beer Under Social Conditions”, CSFS Journal, 33: 193-198, 2000 Langille, R.M., and Wigmore, J.G., “The Mouth Alcohol Effect After a Mouthful of Beer Under Social Conditions”, CSFS Journal, 33: 193-198, 2000 Lutmer, B., Zurfluh, C., and Long, C., “Potential Effect of Alcohol Content in Energy Drinks on Breath Alcohol Testing”, JAT, 33: 167-169, 2009 Lutmer, B., Zurfluh, C., and Long, C., “Potential Effect of Alcohol Content in Energy Drinks on Breath Alcohol Testing”, JAT, 33: 167-169, 2009

33. References Spector, H.N., “Alcohol Breath Tests: Gross Errors in Current Methods of Measuring Alveolar Gas Concentrations”, Science, 172: 57-59, 1971 Spector, H.N., “Alcohol Breath Tests: Gross Errors in Current Methods of Measuring Alveolar Gas Concentrations”, Science, 172: 57-59, 1971 Wilkie, M.P., Wigmore, J.G., and Patrick, J.W., “The Performance of the Approved Screening Device, the Alcotest 7410 GLC in the Field: Low Incidence of False Positive Results in the Identification of Drinking Drivers”, CSFS Journal, 36: 165-171, 2003 Wilkie, M.P., Wigmore, J.G., and Patrick, J.W., “The Performance of the Approved Screening Device, the Alcotest 7410 GLC in the Field: Low Incidence of False Positive Results in the Identification of Drinking Drivers”, CSFS Journal, 36: 165-171, 2003 Wigmore, J.G., and Bugyra, I.M., “Decreasing the Mouth Alcohol Effect by Increasing the Salivary Flow Rate”, CSFS, 36: 211-216, 2003 Wigmore, J.G., and Bugyra, I.M., “Decreasing the Mouth Alcohol Effect by Increasing the Salivary Flow Rate”, CSFS, 36: 211-216, 2003 Wigmore, J.G., and Leslie, G.M., “The Effect of Swallowing or Rinsing Alcohol Solution on the Mouth Alcohol Effect and Slope Detection of the Intoxilyzer 5000”, JAT, 25: 112-114, 2001 Wigmore, J.G., and Leslie, G.M., “The Effect of Swallowing or Rinsing Alcohol Solution on the Mouth Alcohol Effect and Slope Detection of the Intoxilyzer 5000”, JAT, 25: 112-114, 2001 Wigmore, J.G., and Wilkie, M.P., “A Simulation of the Effect of Blood in the Mouth on Breath Alcohol Concentrations in Drinking Subjects”, CSFS Journal, 35: 9-16, 2002 Wigmore, J.G., and Wilkie, M.P., “A Simulation of the Effect of Blood in the Mouth on Breath Alcohol Concentrations in Drinking Subjects”, CSFS Journal, 35: 9-16, 2002