Eating disorders, their signs and what the dental team can do to intervene

eating disordersThe first week of March marks Eating Disorder Awareness week. Natalie Bradley explores some examples of eating disorders and explains how dentists can spot the signs.

It is estimated that 1.25 million people in the UK have an eating disorder. Dental professionals can potentially be the first health professionals to spot some of the warning signs.

So not only do we all need to identify oral manifestations of these disorders and manage any dental problems these patients have, but also know where to signpost patients to help and support.

What are eating disorders?

Eating disorders are a group of related, but distinct, disturbances in eating.

Causes and development of these disorders are multifactorial with stress, trauma, abuse and even genetics implicated. 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 by using laxatives). The person is of normal weight
  2. Anorexia nervosa – there are two types. Type one is food restriction, type two is where there are episodes of binging and purging. The person maintains a weight less than 85% of their ideal weight, or a body mass index of less than 17.5
  3. Binge eating disorder – recurrent binging episodes without purging leading to obesity/becoming overweight
  4. Pica – eating of non-nutritive substances eg chalk, tissues. More common in pregnancy and also in patients who have learning disabilities
  5. Night eating syndrome – binge eating during the nighttime often 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
  • Tooth wear associated with pica habits
  • Signs of nutritional deficiencies eg glossitis, angular cheilitis, candidiasis
  • Other general health signs eg loss of weight, other mental health issues such as depression, calluses on hands as a result of chronic self-induced vomiting.

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 composite to treat any wear as well as managing any active caries. Dahl may have to be used if there is loss in vertical dimensions. Once their eating disorder is more stable, indirect restorations are appropriate
  2. Signposting – it’s important to signpost any patients who open up to you about having a problem onto their GP or other appropriate service. Beat is a charity that has excellent resources about eating disorders. As well as a confidential helpline and online peer support
  3. Safeguarding – if you suspect someone has an eating disorder this is often 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 eg if a patient is under 16. Always discuss with your safeguarding lead.

Here the experiences of one dentist who suffered with an eating disorder when they grew up.

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