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.
