Conversational Signs


Some warning signs in conversation can include: • if the patient talks about frequent diet- ing or engagement with fad diets (keto, no carbs, no dairy, vegetarianism/vegan- ism)


• if they show a preoccupation with weight, dieting, food, calories


• if they mention their refusal to eat cer- tain food categories


• if they have obsessive compulsive ten- dencies towards oral hygiene routine


• if they complain about being cold all the time


• if they make any mentions about loss of period (for female patients)


Oral Signs


There are many dental complications for both eating disorders, often resulting from nutritional deficiencies or acid regurgitation.


For patients with anorexia, they can develop: • canker sores • chronic dry mouth • angular cheilitis • candidiasis • Glossitis • enamel erosion • dry cracked lips • tooth decay from dry mouth and impaired saliva buffering.


For patients with bulimia, they may develop: • parotid gland swelling • cuts/ulcerations on the soft palate and oropharynx (from insertion of objects to induce vomiting) • globus sensation • dental erosion on the palatal surfaces of maxillary anterior teeth


• incisal fractures and chipping • perimylolysis in posterior teeth • hypersensitivity + temperature sensitivity


• loss of bone density (increasing the risk of jaw fracture during extractions).


In addition to these, patients with eating disorders may develop degenerative arthritis within the temporomandibular joint, creat- ing pain in the joint area, chronic headaches and problems chewing and opening/closing the mouth.


ESTABLISHING A SAFE NON- JUDGMENTAL SPACE


When you talk to patients, try to ask ques- tions using general terminology. • Instead of “do you purge” you can ask “do you ever feel guilty after you eat”


• Instead of “do you have an eating disor- der” you can ask “do you struggle with issues around food, eating and exercise?”


You also can ask patients about their current challenges, either health-wise or in general, to get to the root cause of any disordered eating patterns. If you suspect your patient does have an eating disorder, don’t let your hesitation of being wrong stop you from potentially helping such a patient. Always approach the conversation in a non-threat- ening, non-judgmental manner: • Use “I” statements (“I have noticed”) rather than “you statements” (“you may have XYZ”).


• Focus your language on your observa- tions, rather than the diagnosis. − For instance, if there is dental ero- sion, we can mention some possible causes (acid reflux or frequent vomiting) and give patients an op- portunity for disclosure.


• Give your patient dignity but stand firm with what you observe and what you know, such as “I could be wrong, but …”


• Reference the facts. Patients may not re- alize the severity of the health problems of their eating disorders (multi-organ failure). − As a dental provider, you are in a unique position to educate your patients about the potential dental complications of eating disorders and nutritional deficiencies (mouth sores, bad breath, cracked lips, swollen gums, receding gums) and complications of frequent vomit- ing/purging (erosion, brittle teeth, discoloration). Make sure your patients are informed about their oral health.


• Be prepared for resistance and denial. You should speak the truth of what you see and the facts you know. However, if your patient does not want to hear them, do not push them.


Here is a sample outline of what a conversa- tion could look like:


I wanted to check in with you. I have noticed you’ve mentioned _____ in our conversation. My inspection of your mouth shows _____. These are all signs pointing to _____. I could be wrong, but _____. I want you to know as your dentist, I am here for you. This is a safe space. You are totally welcome to say anything or noth- ing, but you can trust me with this knowl- edge that anything said here stays here.


You do not have to navigate any of this alone. I am connected to doctors and other professionals who will be of help to you. I can give you a referral, or we can work together to look for someone who fits you.


As a health professional, I also want to make sure you’re aware of the health com- plications of _____ such as _____. In par- ticular, there also are dental complications of _____ such as _____. We can develop a dental treatment plan together on how to best manage your oral health.


The most important thing to establish is you are here to help, and your dental office is a safe place to disclose ED struggles and prog- ress towards recovery. If your patient does disclose their eating disorder, they should be referred to their physician. If they decide not to, you can still be supportive and initiate prevention based on your clinical findings.


MANAGING DENTAL CARE


Patients need regular dental visits for continuing care and support, and they also should be regarded as medically compro- mised due to the risk of dangerous medical complications, which can include cardiac ar- rhythmias and cardiac arrest from electrolyte imbalances, risk for osteoporosis and jaw fracture during extractions and gastric bleed- ing. Blood pressure should be monitored. A comprehensive medical history should be taken and reconfirmed at every visit.


In-Office Dental Care


To remineralize enamel and reduce tooth sensitivity, you can introduce in-office fluoride varnish applications and fluoride mouthrinses.


CONTINUED NEXT PAGE ISSUE 1 | SPRING 2024 | focus 29


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