Eating Disorders and Oral Health: A Dental Professional’s Role


by BREE ZHANG I


am a dental student who has struggled with an eating disorder. A reason I chose to enter dentistry was because dentists can play a huge role in working with pa- tients with eating disorders. Eating disorders are more common than we think, affecting nine percent of the world’s population and increasing in prevalence each year. They are not just a “phase,” and in fact, they can cause irreversible and even life-threatening health problems such as heart failure, permanent bone loss, stunted growth, infertility, kidney damage and more. Eating disorders have one of the highest mortality rates of all psychiat- ric illnesses, second only to opioid overdoses. About 26 percent of people with eating disor- ders attempt suicide.


Research shows early intervention means a greater chance of recovery. As dental professionals, we often see patients every six months, and we sit in a space where con- versations easily flow to topics about food, diet, nutrition and more. Furthermore, the mouth is a window to the body’s health and the first place to reflect signs of nutritional deficiencies and imbalances. It is also a place that hides signs of purging not easily visible to other medical providers—but in plain sight for dental providers.


We can serve as a point of early detection if we notice habits, mindsets or oral health manifestations that point toward eating dis- orders. Approximately 28 percent of patients suffering from bulimia are first diagnosed during a dental exam, according to the National Institute of Dental and Craniofacial Research.


BEING PROACTIVE AND PREPARED


Dental professionals are often the first health care providers to examine and recognize patients with eating disorders, but most den- tists do not take action due to fear of losing the patient, insufficient confidence in their


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Risk Factors Biological


Psychological social


or bullying, appearance ideal, internalization, limited social networks, historical trauma/ intergenerational trauma and acculturation. In particular, people from racial and ethnic minority groups, especially those who are undergoing rapid Westernization, may be at increased risk for developing an eating dis- order due to complex interactions between stress, acculturation and body image.


Establishing Protocol and Plan


suspicion, failure to initiate conversation due to uncertainty how to broach the issue, and lack of office protocol and practice policy.


Familiarizing Yourself the Risk Factors


There are many biological, psychological, and social risk factors at play. Biologically, having a history of dieting or negative energy balance can predispose one to an eating disorder. People with food allergies, gastro- intestinal conditions (IBS, celiac disease, etc.) or diabetes are more predisposed to eating disorders due to a required focus on food, labels, numbers (weight, blood glucose, A1c) and control. In fact, a quarter of people with diabetes develop an eating disorder.


Additionally, psychological risk factors of perfectionism, body image dissatisfaction, behavioral inflexibility and co-occurring psy- chological conditions like anxiety, depression, substance use, obsessive-compulsive disorder and PTSD can predispose one to an eating disorder. Two-thirds of those with anorexia showed signs of an anxiety disorder (includ- ing generalized anxiety, social phobia and obsessive-compulsive disorder) before the onset of their eating disorder.


Societal expectations and popular media also contribute to development of eating disorders, leading to weight stigma, teasing


How do we become prepared? As a dental team, we can establish in-office protocols for our dental team so we are prepared to know: • what to look for • what to do/say when encountering a patient with an eating disorder


• how to approach treatment planning


We can publicize familiarity with eating dis- orders on our website and office so patients know we can be a safe space and helpful resource to them. We also can improve early detection by adding ED screening question- naires with medical history to offer patients more options for disclosure if they do not feel comfortable with an up-front conversation.


KNOWING WHAT TO LOOK FOR Physical Signs


When appraising a patient, we should be observant of any recent changes in their general demeanor, gait and facial symmetry. Physically, patients with anorexia may pres- ent with fluctuations in weight, hair thin- ning/hair loss, lanugo (a layer of soft, downy hair over their body), edema (swelling in legs/ ankles), brittle nails and nail clubbing, and jaundice (yellowish skin and eyes). Patients with bulimia may look to have a more normal weight, but they may present with acute sialadenosis (“Chipmunk cheeks,” i.e., puffy, swollen cheeks), parotid gland swelling and Russell’s sign (abrasion on knuckles from self- induced vomiting).


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