Communicating the Dangers of Eating Disorders
Eating disorders like bulimia and anorexia affect far more than one’s weight. They can slow heart rates and cause cardiac arrest, they halt calcium intake and hurt your bones, they damage mental image and self-esteem, and negatively impact performance at school or work. While not as explored or talked about as much, these eating disorders have the potential to do irreparable damage to one’s oral health as well.
The National Eating Disorders Association estimates that over 11 million people in the United States suffer from serious eating disorders like bulimia and anorexia. These eating disorders are most common among teenagers and college-aged youths. This demographic is also most likely to outright not care about their oral health. An eating disorder compounded with ambivalence toward oral health is a recipe for disaster at a very young age. An untrained family member or friend may notice a sudden loss of weight, but as a dentist or RDH you’re able to notice telltale signs of anorexia or bulimia during a routine checkup or cleaning.
Most of these indicators are a product of a person’s “purging” in traditional bulimia and purge anorexia. People suffering from anorexia and bulimia are regularly purging, and this excess of vomit sends very strong stomach acids washing over one’s teeth again and again to the point of serious damage.
One of the prominent indicators of an eating disorder in a patient is intense tooth decay. The erosion caused by the stomach acid washing over the teeth rapidly wears down the protective enamel, making each tooth far more susceptible to cavities. Additionally, those suffering from anorexia are often drinking highly acidic and low-calorie sodas, sports drinks, and energy drinks to completely minimize caloric intake. This highly acidic combination is even more problematic, but the strength of the stomach acid alone is staggering in regards to keeping teeth healthy.
The effect of the stomach acid also wrecks the appearance of one’s teeth. Along with the traditional “yellowing” or “darkening,” you can see erosive lesions on the surface of the teeth as early six months after the first instance of purging. The shape and length of the teeth can also change as their edges decrease in size and become brittle and more likely to chip or break.
Severe halitosis is another negative effect of these eating disorders. Yes, there are many ways for someone to get a case of “bad breath” and halitosis may not be a substantial indicator of an eating disorder on its own. However, “severe” is the key word here. The drastically increased amount of bile and stomach acid in the mouth makes it impossible for someone with bulimia to alleviate halitosis through brushing or using mouthwash alone.
So, even if you see enough evidence to make you think a patient is suffering from an eating disorder, what can you do about it? As a dentist or an RDH you’re in a unique position to observe warning signs of an eating disorder, and can greatly improve the patient’s life if the situation is handled in a proper way. First and foremost, if you’re going to try and address the existence of an eating disorder with a patient it must be done gently and professionally.
Eating disorders are physical illnesses that stem from mental issues; it isn’t a matter of simply telling someone to stop purging. If you decide to address your patient be sure to phrase your question in a way that conveys your concern for them, and avoid using the words “anorexia” and “bulimia.” You should be saying something along the lines of “Have you ever made yourself throw up before?” not “Do you think you have an eating disorder?”
Depending on their reaction to your question, you have a few different ways to proceed. If the patient becomes very defensive the best course of action would be a referral to their primary care physician. Unless you have a particularly close relationship with the patient, it’s quite possible they won’t want to open up about the problem at all. If the patient is a teenager it might be wise to address your concerns with his or her parents as well.
If the patient says he or she has made themselves throw up before, but visibly becomes uncomfortable or quickly tries to steer the conversation towards something else it’s best to not continue to push for recovery. However, you can still express your concerns and help the situation by recommending ways to minimize the damage from an eating disorder. For example, telling the patient to rinse using a sugar-free mouthwash or seltzer after throwing up will alleviate some of the damage to the teeth caused by the stomach acid.
Of course, if the patient opens up and begins talking about the problem, it’s important to express your concern for not only their oral health, but their overall physical and mental health as well, and recommend that they seek treatment at an eating disorder facility or from a therapist. Expressing this can be a major force in helping your patient experience a true and long-lasting recovery.
Dental professionals cannot underestimate the importance of their position in identifying and helping patients with eating disorders. While it’s a very difficult conversation to have, a good bedside manner can make all the difference in changing a patient’s life for the better.
Very informative.Outstanding article.So many people need the help of others.
[…] Identifying and Communicating the Perils of Eating Disorders More than 11 million people suffer from eating disorders like bulimia and anorexia in the United States. The majority of this demographic are teenagers and college-aged youth. Coincidentally, this demographic is also the most likely to disregard their oral hygiene. When these two are combined, it is detrimental to one’s oral health. As a dentist, you can be one of the first to notice the signs of an eating disorder due to the extreme decay it causes. Read on for more signs to look for during an exam. […]
Solid article. I would agree that for the patient not willing to open up or seek further help for disorders involving induced vomiting it really is important that dentists and therapists provide information to reduce long term impact (like rinsing with water or mouthwash as you suggested).
It is a really tricky siutation that we all encounter in general practice.
Amazing article! I am always on the lookout for new dental information.
Hello Dylan, great article on a very sensitive, important topic. It’s good for dental professionals to be in tune with this.
Yes. Very touchy subject when I have had patients that are possibly subject to bulemia. Unfortunately educating teenagers about their problems seems almost in one ear and out the other. Until we find a way to address their real problem which is self image we won’t be speaking their language.
This article was very informative of the dangers. Some teens may listen and some may not but thats the how youth work. No teen would want nasty yellow or dark teeth so maybe this would help them understand that it is not healthy at all.
An eating disorder may cause lingering or even permanent damage to the teeth and mouth. Early detection of eating disorders may ensure a smoother and more successful recovery period for the body and the teeth. Damage to the teeth and mouth can be tempered by arming yourself with the right information and receiving appropriate guidance from your oral health professional.
If you or your loved one has struggled with an eating disorder, make sure you ask questions about your dental provider’s qualifications, their experience, the kinds of cases they have treated and their treatment philosophies. It is important that like all of your relationships with healthcare providers, your relationship with your oral healthcare provider be candid and honest. They can only provide as much help as you allow them to provide.