Monday, 14 January 2019

Eating Disorders in Dentistry

Dentists need to be aware of common dental manifestations of eating disorders as we can be the first health professional who identifies a problem. Here is a summary of a talk I gave to undergraduates about dental management of eating disorders...

What are Eating Disorders?

Eating disorders are a group of related but with distinct disturbances in eating. Development is multi-factorial but can be stress, trauma, abuse even genetics. They are mental health conditions classified under the Diagnostic Statistical Manual of Mental Disorders (DSM).

What examples are there of Eating Disorders?

1. Bulimia Nervosa - a condition of binge eating then purging (typically by vomiting but also can be laxatives). The person is of normal weight.

2. Anorexia Nervosa - Type 1 is food restriction, Type 2 is where there are episodes of binging and purging. The person maintains a weight <85% of their expected weight.

3. Binge Eating Disorder - recurrent binging episodes without purging leading to obesity/becoming overweight

4. Pica - eating of non-nutritive substances e.g. chalk, tissues

5. Night Eating Syndrome - binge eating during the nighttime often with combined with insomnia

What Dental Manifestations are there?

There are lots of warning signs dentists can pick up from their patients if they have an eating disorder such as:

  • Palatal erosion of upper anterior teeth due to reflux or vomiting
  • Palatal haematoma/erythema from trauma from self-induced vomiting
  • Caries from high sugar binges
  • Toothwear associated with pica habits

How do we manage these patients?

When treating these patients we need to consider:

1. Dental management - including lots of preventative advice, high fluoride toothpaste, fluoride varnish and considering of composite to treat any wear. Dahl may have to be used if there is loss in vertical dimensions. 

2. Signposting - it's important to be able to signpost any patients who open up to you about having a problem onto their GP or other appropriate service (e.g. charities such as Beat). 

3. Safeguarding - if you suspect someone is suffering from an eating disorder this can be a difficult thing to discuss. Don't directly accuse a patient but explain what you are seeing clinically. If they don't open up ensure you document fully but in some circumstances you may need to consider safeguarding referrals e.g. if a patient is under 16. Always discuss with your safeguarding lead. Read more about safeguarding here

To see my full presentation click here.

Crisis at Christmas 2018

After two years of volunteering at Crisis at Christmas, this year I became a Shift Leader for the Service...

One of my amazing teams this year

What is shift leading?

The previous years I had volunteered with Crisis I spent my time seeing guests on the mobile vans, manning reception, (trying my best!) on decon, or going to other day centres  on triaging to bring guests back for treatment on our vans. 

This year as shift leader I did not personally see guests (although I recognised a fair few!) but instead I was in charge of co-ordinating the 3 shifts I leading on. This involved contacting volunteers to answer any queries they had, setting everything up for the day, assigning roles for volunteers, ensuring the smooth running of things throughout the day and clearing down at the end of the day. 

I was lucky to have some really supportive clinical dental supervisors on my shifts who looked after any clinical aspects of care for the guests (such as a particularly stubborn lower 6 that didn't want to budge for one patient) so I could focus on my duties and make sure all my volunteers were happy and supported. 

What did I learn?

Leading a team of up to 20 individuals can be tricky with varying experience and needs but I had fantastic teams all the days I lead who were eager to do their bit and work hard to ensure the service we providied to the homeless was first class. 

Something that I had to learn was when to delegate to others... I was so used to trying to do everything from clinical aspects to the running of reception, on the first day i was automatically doing too much. Quickly I realised I needed to use my team and a huge thank you to everyone who did their bit!!

On board one of the mobiles!

This year was a record year for the Crisis at Christmas Dental Service with 459 guests seen on the 4 mobiles over the week.

Many  thanks to all the volunteers, sponsors and donors which allowed the service to go ahead (especially CDS CIC, KCH and KCHFT who donated their vans), all the shift leaders and the organisers Nahush and Janine for all their hard work.

See you at Crisis 2019!

Did you volunteer your time for Crisis this year? What were your highlights? Let me know in the comments below. 

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