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.