Issue 56 I Dentistry and the Early Detection and Prevention of Eating Disorders
About this resource
Welcome to the fifty-sixth edition of the NEDC e-Bulletin. This edition will examine the role of the dentist in prevention and the early identification of eating disorders. We will also look at the launch of the new NEDC workforce learning E-tool for Dentists.
Early detection and intervention play an important role in eating disorder recovery. The oral and physical symptoms of an eating disorder are recognisable and present in a consistent pattern. Providing the dentist with the tools to create a safe and comfortable patient environment, promotes patient disclosure and an opportunity for the dentist to encourage the patient to seek help.
Included in this edition you will find a link to the newly revised NEDC resource for dentists. This resource was developed in collaboration with the Australian Dental Association (ADA).
We look forward to building on this and other significant partnerships as we work towards creating a workforce that is confident to assist in the early prevention and detection of eating disorders, and the support of people living with an eating disorder.
If you are interested in collaborating with the NEDC, we encourage you to join and become an NEDC member.
Dentists and oral health practitioners play an important role in the identification and treatment of eating disorders. As one of the first clinicians that a person with an eating disorder may come into contact with, a dentist can play a vital role as an Early Identifier and Initial Responder to a patient living with an eating disorder ((NEDC), 2018).
Early intervention is critical for any patient with an eating disorder. Research shows that the sooner treatment occurs, the better chance the individual has of recovery ((NEDC), 2018), putting those working within oral health in a unique position.
As outlined in the National Eating Disorders Collaboration (NEDC), National Practice Standards for Eating Disorders, Early identifiers and Initial Responders have a duty of care for the well-being of people at high risk; to proactively engage people at risk; to promote prevention and early help-seeking ((NEDC), 2018). Due to oral symptoms that result from disordered eating behaviors, the dentist is in a position to offer first level intervention, encourage the patient to seek treatment and provide guided self-help for people living with an eating disorder ((NEDC), 2018).
Central to identifying and responding to those at risk is the Dentist’s ability to recognise disordered eating behaviors; to assess common warning signs; to know of the appropriate referral pathways and own the skills to encourage and support help-seeking behavior.
Yet, the question for many practitioners’ is: What does this help look like from an oral health perspective and what are the barriers that exist to dental practitioners in providing this help?
General tooth erosion may take approximately two years to become clear, while intraoral manifestations of nutritional deficiency may present early in the clinical course of an eating disorder (Frydrych, Davies, & McDermott, 2005). Thus, the ability of the dentist to recognise the subtle changes in the mouth of a patient (Frydrych et al., 2005), is central to identifying the early indicators of an eating disorder. This critical ability results in more favourable treatment outcomes through early diagnosis.
It is difficult for an individual with an eating disorder to seek help. Hence, the relationship between a dentist or other oral health practitioner, and the patient is important. Research suggests, that while all dentists understand their ethical obligation as a health care provider and the importance of creating a rapport and level of trust with a patient (R.D. & L.A., 2006), it can be difficult for the dentist to engage with eating disorder-specific prevention behaviours (R.D. & L.A., 2006). Barriers to engaging in preventative behavior exist. The fear of offending the patient and a fear of misdiagnosis, and uneasiness with the patient approach (R.D. & L.A., 2006) are all aspects that may inhibit the dentist as an Early Identifier or Initial Responder.
Research (R.D. & L.A., 2006) indicates that this uneasiness in patient approach is common, and may result from a lack of training in identifying the oral manifestations of disordered eating behaviour, knowledge of best practice approach to treating patients living with an eating disorder and knowledge of the correct referral pathways for patients at risk or living with an eating disorder. Research also indicates that a lack of protocol and internal communications (R.D. & L.A., 2006) around best practice training to recognise the signs and symptoms of an eating disorder may also create an extra barrier for the dentist when treating a patient.
The diagram illustrated below outlines potential contingencies for dentists in the prevention of an eating disorder and has been adapted from the research of DeBate & Tedesco, 2006.
As Early Identifiers and Initial responders, it is important for the dentist and oral health professionals to understand the psychological characteristics of eating disorders and eating disordered behavior. The ability of the dentist to assess warning signs and key oral indicators*, have access to, and information about professional help and the right tools to support the patient is critical (R.D. & L.A., 2006).
How can we assist the dentist in the role of prevention and detection?
Gearing professional development towards improving practitioner skills around differentiating eating disorder-specific signs and symptoms from other types of oral health concerns is important. Additionally, providing tools for the assessment of physical cues of eating disorders, and the comparison of oral and physical cues with a patient’s health history and patient/provider communication is essential (DeBate, Tedesco, & Kerschbaum, 2005).
Well informed and equipped dentists and oral health practitioners are able to identify the oral indicators that result from disordered eating behavior and to provide the necessary proper pre-restorative care, restorative care, and referral for treatment (DeBate et al., 2005). This very important level of care that a dentist provides offers a pathway to improved quality of life, and a reduction in the potential further damage to the teeth and oral cavity (DeBate et al., 2005) of a patient living with an eating disorder.
A variety of eating disorder specific resources and support services are available to assist dentists and oral health practitioners in providing support to their patients, including:
These resources provide national information and guidance on treatment options as well as referral pathways.
* Further specific information about the warning signs and key oral indicators is outlined in further detail within the NEDC Dentistry and Eating Disorders resource.
(NEDC), N. E. D. C. (2018). National Practice Standards for eating disorders, 19.
DeBate, R. D., Tedesco, L. A., & Kerschbaum, W. E. (2005). Knowledge of oral and physical manifestations of anorexia and bulimia nervosa among dentists and dental hygienists. Journal of Dental Education, 69(3), 346–354.
Frydrych, A. M., Davies, G. R., & McDermott, B. M. (2005). Eating disorders and oral health: A review of the literature.Australian Dental Journal, 50(1), 6–15.
DeBate, R. D., & Tedesco, L. A. (2006). Increasing dentists’ capacity for secondary prevention of eating disorders: identification of training, network, and professional contingencies.Journal of Dental Education, 70(10), 1066–1075.
In September 2018, the NEDC launched a new E-Learning tool for oral practitioners. This tool targets the knowledge and confidence gaps often experienced by dentists and dental hygienists when treating a patient living with an eating disorder.
The NEDC, in collaboration with the Australian Dental Association (ADA), developed this professional E-learning resource, to support the dentist and other oral health practitioners in their role in the prevention, identification, medical management, and referral of patients with eating disorders.
The aim of the E-Learning tool is to guide oral health professionals in starting a conversation with patients about oral health and eating disorders. To provide clinical knowledge to establish that disordered eating behaviours exist, and secondary support through the correct referral pathways.
As part of this combined project, the ADA undertook a focus group of some of their members to understand their perspective on eating disorders, including how to approach a patient living with an eating disorder. This focus group was significant in identifying the gaps that exist in the knowledge and identification of eating disorders and practices for a standard approach to care for patients living with an eating disorder. The focus group provided important feedback that was used to directly target these gaps in the development of the E-Learning tool.
This month, on behalf of the NEDC, Professor Susan Paxton, Professor and Director of Postgraduate Teaching and Learning in the School of Psychological at La Trobe University, will present the E-Learning tool and updated Dentistry and Eating Disorders NEDC resource to a group of 350 oral health professionals and the University of Sydney, Dentistry Faculty teaching staff, at the Western Sydney LHD, Oral Health Network's professional development event.
With such an important role in the identification of eating disorders, oral practitioners can play a vital role in encouraging help-seeking behaviour and provide appropriate referrals to support the patient. This event presents a great opportunity to showcase this new learning tool as a support in guiding our oral practitioners in providing the best practice care for patients living with an eating disorder.
As we work towards establishing a workforce that is collaborative and engaged, we look to sector partners like the ADA for support. In working together, we are better able to identify gaps in the services and information available to health professionals and provide professional learning based on a national evidence-based framework in the prevention and management of eating disorders.
Dentistry and Eating Disorders: The Resource
Dentistry and Eating Disorders: The Video
This video, produced in partnership with the Australian Dental Association, outlines the key oral signs and symptoms of eating disorders that may be observed by oral health practitioners. The video gives tips on how to discuss concerns with patients, next steps in treatment and referral pathways.
We encourage you to share this link to our resource across your networks, to promote help-seeking behaviour, raise awareness about, and reduce the stigma associated with eating disordered behaviour.
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