As potential "first responders," dental professionals must be able to identify the warning signs of eating disorders.
By Susan Richards
All dental professionals are accustomed to seeing a number of emotional or psychological issues arise with their patients, given the prevalence of anxiety surrounding a visit to the dentist. Studies show that approximately 36% of the population experiences dental fear, even though most know that oral health impacts their quality of life.
However, dentists may treat patients with more serious mental and physical health problems that present more clearly than white knuckles on the dental chair: eating disorders.
In Part I of this two-part series, we examined the different conditions and symptoms of eating disorders – or EDs – and why the dental professional may be uniquely positioned as a "first responder" to the affected patient. Now we'll examine the dental team's role in identifying the problem and providing the best care for those struggling with anorexia or bulimia, in the chair and beyond.
The Warning Signs
Eating disorders are estimated to affect approximately 9% of the population in their lifetime. It's an equal opportunity psychosomatic condition impacting all ages, races, sexual orientations, and genders, and the costs are exacted in health, dollars, and over 10,000 lives each year.
The most common types of ED are anorexia nervosa (AN) and bulimia nervosa (BN), and several oral health indicators are consistent with both of these conditions, including:
- Erosion of the dental enamel from stomach acids
- Lesions on the soft palate due to forced vomiting
- Tooth decay and caries due to poor nutrition
- Swelling of the salivatory glands resulting in a chipmunk-like appearance
- Osteoporosis in the alveolar bone from vitamin deficiencies
Knowing what to look for and which questions to ask, the dentist, assistant, and hygienist can identify an eating disorder and help patients get the care they need.
When and How to Address the Patient
Patients with an ED have likely gone to great lengths to keep their condition a secret from friends, family, and medical professionals. However, when regular visits to the dentist reveal the fallout of their illness, the dental team needs to proceed carefully and with sensitivity. Patients may react to pointed questions about their eating habits or symptoms with denial, embarrassment, or worse, avoiding all future dental care.
"All frontline practitioners, including dentists, should increase their competence related to eating disorders," writes Dr. Martha P. Levine, MD, in Communication Challenges Within Eating Disorders: What People Say and What Individuals Hear. Many ED sufferers may be unaware of the effect it has on their oral health.
Dr. Levine recommends guidelines for discreetly communicating with patients, including making observations about the clinical findings, listening to the patient's thoughts on the cause of the damage, and offering referrals if indicated.
Be sure to tread carefully when dealing with an adolescent patient you suspect of having an eating disorder. Regulations* surrounding parental permissions and confidentiality vary by state, so be aware of yours before proceeding.
The National Association of Anorexia Nervosa and Associated Disorders (ANAD) provides training for dental professionals on identifying physical symptoms of an ED and how to approach and care for the patient.
Treatment is a Team Effort
If the patient doesn't respond favorably or denies the problem, make a note in their file to follow up with them at future appointments, especially if the condition has worsened.
For the patient willing to address their eating disorder, it's important to have referrals and educational material on hand.
In an ideal collaboration, the dental team would work with the physician, nutritionist, and mental health professional; however, the dentist can help prevent further damage to the oral cavity.
While some ED sufferers neglect their oral hygiene, others – especially those with BN – may be hyper-conscious of their appearance and unwittingly accelerate the damage with their personal habits. To reduce the loss of enamel rods, experts recommend that patients delay brushing immediately following a purge and rinse with a mixture of water and baking soda.
Additional fluoride rinses or treatments can also aid in strengthening the enamel, and chewing sugar-free gum can help relieve dry mouth that comes with purging and taking anti-depressants.
Restorative dentistry for severe damage can be addressed when the time is right, but in the meantime, the dental team can provide a supportive, non-judgmental environment and work with the patient to improve their oral health as they traverse the often-uneven road to recovery.
If you'd like more information to help you and your practice identify and facilitate help for the dental patient with an eating disorder, here are just a few relevant and informative resources:
- National Eating Disorders Association (NEDA)
- Academy for Eating Disorders (AED)
- National Association of Anorexia Nervosa and Associated Disorders (ANAD)
- Eating Disorders in the Adolescent Patient
*DOCS Members have access to legal and regulatory support for questions about responsibility and limitations.
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Author: Susan Richards is a staff writer at DOCS Education. With over 20 years of experience in local journalism and business marketing, Susan's career includes award-winning feature writing, as well as creating content with context for a wide variety of industries.