Body Dismorphic Disorder in Dentistry with Professor Tim Newton

A couple of weeks ago I attended an evening lecutre held by the BDA metropolitan branch with Professor Tim Newton who taught us about managing Body Dismorphic Disorder (BDD) in dentistry. 

I think this topic is only going to become more prominent within the field of medicine and dentistry, with social media like Snapchat and Instragram being the benchmark for attractiveness in many young person's lives. During the talk I kept thinking of cases I had experienced already in my short practising career so far and how I may have managed them better. Below is a summary of what I learnt from the lecture. 

What is BDD?

BDD is a somatoform disorder; this means it is a recognised mental disorder categorised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It includes:

1. Preoccupation with a perceived defect in appearance
2. This preoccupation causes clinically significant distress or impairment of socialising, occupation or other areas of function
3. This preoccupation is not better attributed for by another mental disease e.g. anorexia nervosa

Who is affected?

• Late adolescents
• People in their early 30s
• Equal ratio of men to women
• 38% of cases are preceded by a social phobia
• Obsessive Compulsive Disorder (OCD) is commonly related, as is alcohol dependence 
• Prevalence is reported at 0.7-3% in the general population and 7-15% in the cosmetic surgery world

How is the person affected?

• The person often has obsessive thoughts regarding a particular trait
• Their obsession can move from one body part to another 
• They often have compulsive behaviours e.g. checking mirrors, not leaving the house without make-up on, comparing their appearance to others
• This can interfere with their daily life as it can be time-consuming e.g. their working life can be affected
• Individuals suffer from higher levels of depression, anxiety and anger
• 27% are housebound
• 78% have suicidal ideations
• 17-33% have attempted suicide

How has the medical world encountered these patients?

Whilst research in the field of dentistry in this area is sparse, there have been studies mostly in the field of cosmetic surgery. According to these studies:

71-76% of BDD sufferers have sought cosmetic treatment

64-66% of BDD sufferers received some sort of cosmetic treatment

Only 35% of BDD sufferers were refused treatment

There is one study which focuses on orthodontic patients, which had around 7.5% of patients who sought orthodontic treatment suffered from BDD.

How can we assess and manage these patients in dentistry?

1. Setting

Establish a rapport with the patient and ensure you are in a private setting. Try to minimise the number of people present

2. Questions

Ask your usual questions but you may find it useful to ask:

• Why are they seeking a solution to their problem now?
• When did they become aware of the problem?
• What do they hope can be achieved from treatment?
• How much do their concerns interfere with their life?
• Do they have support from family/friends?
• Have they seen any other health professionals before seeing you?
• Do they have any diagnosed psychiatric disorder or have in the past e.g. OCD, depression, eating disorder?

3. Formal Assessment

I.e. refer onto a psychologist for a formal BDD assessment when you have a strong suspicion or if they disclose any suicidal ideations.

Management

1. Cosmetic treatment to address their concerns. This does not address their underlying BDD
2. Cognitive Behavioural Therapy (CBT)
3. Pharmacology e.g. Selective Serotonin Reuptake Inhibitors (SSRIs) although there is no evidence for these

Managing these patients and identifying them early can be really tricky! Prof Newton gave us a few example cases he had seen in the past and honestly with a few of them, on initial presentation it wasn't that obvious they were suffering from BDD. I think what I learnt was to ask in depth questions early on e.g. have they seen anyone else for their problem before, is there any pressure from family/friends/partners to improve their appearance? Breaking the news to them can also be a very awkward situation and the right wording can be hard to find. A good phrase Prof gave us was:

 'The solution to your problems is not further treatment.' 

To read more about BDD, a good resource is the Mind website.

Have you seen any patient who you suspect suffered from BDD? How did you manage them? Let me know in the comments below. 

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References:

Phillip, Grant et al 2001

Crerand et al 2005

De Jongh and Adain 2000

Max Cunningham et al 2004

Hepburn and Cunningham 2006

3M Rising Stars: Golden Ticket to Willy Wonka's

If you follow my Instagram, you may have seen my trip to Germany with 3M a few weeks ago....but what was I doing there?

The group invited to Seefelt

3M (no longer 3M ESPE) kindly invited me to their research and development site in Seefelt along with several other inspiring dentists. A chance to sample the Bavarian culture as well as see the insides of where the dental products I use are made!

It felt well and truly like being able to see the inside of Willy Wonka's chocolate factory and I was humbled to be invited alongside some pretty well known names in dentistry. I also learnt that 3M not only make dental and orthodontic products but post-it notes, adhesive tape and even the glue that holds planes together. 

After a rocky plane journey from London, we landed in Munich greeted by the the UKs 3M staff: John, Gavin and Amy. Although we only spent 2 days with each other, by the time it we had to journey back to the UK, I felt like I'd known the others for much longer and it was a fantastic way to get to know other dentists throughout the UK. 

Proudly showing off my visitor's pass

The first day we learnt about some of the post popular 3M dental products like Impregum, RelyX and Scotchbond and of course have a little play. One of my favourites was the new heavy VPS impression material Imprint which sets much quicker has it gives off heat during setting. All of us then of course had to take a blob in our hands and feel it get hot as it set. 

In the afternoon we had a fantastic time designing our ideal resin cement and the packaging along with it! Everyone gave it 120% and I think some of the groups came up with cutting edge innovations (see our box below where our cement is a universal shade that adapts to it's environment.....hence the name) and some impressive shelf lives (5, 10, 15+!!). 

My groups innovation new resin cement... and yes that is a chameleon not a fish. 

During the 2 days we also had the chance to have a guided tour around the labs which was very exciting. We weren't allowed to take any pictures of course but memorable bits including seeing the huge vats of impression materials being mixed (honestly the size of a smart car) and the conveyor belt of robots loading up the local anaesthetic cartridges. We also got to product test some of the new materials coming out soon from 3M and meet the inventors of some of their big-sellers (like Filtek Bulkfill). 

Not only were there educational activities, but we had a delicious traditional Bavarian meal (with Bavarian beer of course) alongside the lake Stamberger See where we had the most beautiful view of the sunset that I spammed all over my Instagram. 

The view of the lake while we were having dinner. 

I'd like to thank all of the 3M team for their hospitality and organising this fun and educational trip - it was great to meet everyone. I'd definitely recommend the trip if you get the chance!

Do you use any 3M products? Or been to Seefelt in person? Let me know in the comments below. 

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