Do dentists know how to recognise and treat patients with eating disorders?

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Eating disorders affect dental health in a number of ways that are visible to dentists, but most noticeable are acid reflux effects. The symptoms include swelling of the cheeks and jaw, tooth and gum sensitivity, tooth decay, tooth discolouration, and halitosis. Stomach acid increase due to bulimia erodes teeth and causes sensitivity to the teeth with staining, and irritated gums. Fizzy drinks often used by those with anorexia also contain acid that causes damage to tooth enamel, and the gums. Once dentin becomes exposed and gums irritated, the likelihood of bacterial infection and oral disease is higher.

These acidic reactions in people with eating disorders cause pungent bad breath that peppermints, chewing gum and mouth rinse do not conceal. Besides swelling of the cheeks and jaws, dentists may also notice wounds on the upper hand surface and knuckles caused by excessive purging as a result of bulimia. Dentists are usually the first to notice these warning signs and can act before the damage is irreversible not only to oral health but also to the physical and mental health of the patient.

Eating disorders like anorexia where patients starve themselves or bulimia where patients binge and purge are biological mental illnesses and have to be very sensitively handled for a positive outcome for the patient. Many do not easily acknowledge their illness or accept treatment for the disorder. Dr. Emmett R. Bishop Jr., MD, CEDS, of the Eating Recovery Centre in Colorado suggests direct non-labelling type questions said with concern, such as “Do you make yourself throw up?” Rather than questions like: “Do you have bulimia?” Engaging the patient in a gentle and caring discussion can open the door to a referral for psychological support, such as through the new 2010 NHS Psychological Therapies. Facilitating treatment for the underlying eating disorder is step towards holistically-improved dental health. 

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