Introduction: 

Welcome to the thirty-third edition of the NEDC e-Bulletin.

In this edition we're pleased to release the next resource in our series of specialised information packages for health care professionals: Dentistry and Eating Disorders. Dentists are among the best placed health care providers to be able to detect the potential presence of an eating disorder in their patients. Oral decay is one of the leading signs and side effects of an eating disorder, especially where purging behaviours are present. As such it is vital that this first opportunity for medical response is treated with the appropriate approach, evidence-based advice and with ongoing positive health outcomes at the fore.

We look forward to continuing our work with the Dentistry and other health care sectors to support efforts to assist in the early detection, treatment advice and support for people living with eating disorders.

Accompanying the release of this resource is a feature article on the nature of eating disorders and their effects on oral hygiene, an interview with leading expert in the treatment of eating disorders, Dr Sloane Madden and some useful links to additional online references and sources for dentists and our engaged membership.

If you are interested in getting more involved in the NEDC we encourage you to join the collaboration and become an NEDC member.

Contents

1. Feature Article: Enabling Early Identification

2. Dentistry and Eating Disorders: Get the resource here

3. An interview with Dr Sloane Madden

Dentists are recognised as being among the first health care professionals that patients with previously undiagnosed eating disorders may present to (Frydrych, Davies and McDermott, 2005). The physical signs of an eating disorder are by no means limited to changes in weight. Particularly where eating disorder behaviours include purging, (vomiting) signs of oral decay can be an early indicator of an eating disorder. Dentists are therefore in a unique position to detect and identify the presence of a possible eating disorder during oral check-ups.
The research suggests that the incidence of eating disorders is on the rise, with one in 20 Australians experiencing an eating disorder at some stage of their life. It would be expected that dentists who work with higher at-risk groups would come in to contact with a higher number of individuals presenting with early signs of an eating disorder (Frydrych, Davies and McDermott, 2005). Therefore dentists can play a key role in detecting the presence of an eating disorder, encouraging help seeking and assisting patients with referrals.

Oral signs and symptoms that can indicate an eating disorder is present include:

• Enamel erosion and erosive lesions
• Severe erosion on lingual surfaces of the maxillary anterior teeth
• Moderate erosion on lingual and occlusal surfaces on upper molars
• Erosion on lingual and occlusal surfaces on lower posterior teeth
• Mucosal lesions
• Weakening of incisal edges of incisor teeth
• Anterior open bite
• Loss of vertical dimension
• Bleeding gingiva
• Enlargement/swelling of salivary glands (especially parotid glands) or other swelling in cheeks/jaw
• Difficulty swallowing (i.e. lump in throat, globas sensation)
• Changes in colour, shape and length of teeth or teeth that are brittle, translucent and weak
• Moderate to high thermal sensitivity in teeth/gums
• Pulp exposure or pulp death
• Reports of frequent sore throats or dry mouth, burning tongue
• Dry, red or cracked lips

Some of the ways in which dentists can effectively engage with patients if they suspect an eating disorder or disorders behaviour are;

• Discuss the problem privately, without others around
• Raise the issue in a kind, non-judgemental way (e.g. “There are several problems with your teeth, including x, y, z. These problems can be associated with vomiting or a lack of nutrients in your diet. Do you make yourself vomit regularly or are you trying to diet or cut out foods?”)
• Be positive in your approach; it is essential that dentists use the appropriate language and create a positive first disclosure experience for patients if they are to engage successfully with future treatment
• Commend the patient if they are willing to talk about their problem (e.g. “I understand how difficult this is” or “I’m really glad you are talking to me”)
• Reassure the patient that they are not alone and that eating problems are common
• Avoid being critical, suggesting quick fixes or commenting on the patient’s weight, appearance or health in general
• If the patient denies they have an eating issue, accept their answer and focus on maintaining or restoring their oral health
• Provide the patient with information on how to improve or maintain their dental health overall

There is slow growth in the published literature output regarding the oral ramifications of eating disorders (Frydrych, Davies and McDermott, 2005). This potentially misses an opportunity for early intervention in eating disorders. It is a worthwhile area to explore as early intervention is critical for any patient with an eating disorder and early engagement in treatment greatly increases the chances of recovery.

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