Eating Disorders CONTINUED FROM PREVIOUS PAGE


Essential restorative work should be done to limit tooth damage and relieve pain, but more permanent dental restorations such as crowns should not be completed while a patient is purging regularly (acid erosion will shorten the life of the restorations).


Home Care and Oral Hygiene Routine


The patient should be encouraged to brush three times daily with a soft brush and fluo- ridated toothpaste. They should be reminded to clean interproximally daily and also clean their tongue to remove biofilm and acid residue. To remineralize enamel, patients can use self-applied neutral fluoride and calcium plus phosphate products. To relieve dry mouth, patients can take saliva substitutes during the day. Xylitol products (toothpaste, gum, candies) are beneficial for salivary flow, reducing caries and reducing acidity.


It’s important to remember patients may still be purging throughout their recovery process. The patients can wear a mouthguard to protect teeth during purging episodes. Due to the high acidic content in the stom- ach, the patient should not brush directly after vomiting because it can scrub acids deeper into the tooth enamel and may cause more loss in tooth structure. After purging, patients can first neutralize their oral pH by adding a spoon of baking soda in a cup of water and rinsing their mouth, or a rinsing with a product with calcium and phosphate ions. They should wait at least one hour before brushing.


Throughout this process, you should keep in close communication with other medi- cal providers, as patients may be prescribed new medications (antidepressants) that could affect their oral health (xerostomia) and dental treatment plan. Patients may also undergo refeeding syndrome that should be monitored carefully, and they may need to see other specialists to address other health complications, especially as eating disorders often lead to multi-organ damage. Elective dental procedures should get medical clear- ance before you perform them.


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Working with a Support Team


You can remind your patient they are not alone and there are many people who can be in their support team, including:


• Primary care physician (PCP) • Psychiatrists for medication prescription and management


• Nutritionists/registered dieticians to provide education on nutrition and meal planning


• Psychologists/Counselors for psycho- logical therapy


• Partner, parents, other family members, friends


• School nurse/counselor (if attending school)


• Medical and dental specialists to treat other underlying health issues • Eating disorder support group


If patients are looking for an eating disorder support group, you can encourage them to ask their doctor or therapist for a referral, call local hospitals and universities, call local eat- ing disorder centers and clinics or visit their school’s counseling center.


Resources you can provide to your patients in the form of QR codes: • Screening Tool for ED nationaleatingdisorders.org/ screening-tool


• National Eating Disorders Support Helpline nationaleatingdisorders.org/ help-support/contact-helpline


• Free and Low Cost Support Groups natio- naleatingdisorders.org/free-low-cost- support


• Busting Myths about Eating Disorders nationaleatingdisorders.org/busting- myths-about-eating-disorders


CONTINUOUS LEARNING


While for this article, I mostly covered symp- toms of anorexia and bulimia nervosa, it is important to note there are various dimen- sions of eating disorders such as: • Anorexia Nervosa (AN): Persistent caloric restriction, low weight, fear of weight gain


• Bulimia Nervosa (BN): Binge eating and purging


• Binge Eating Disorder (BED): Uncon- trolled, binge eating and no purging


(most common eating disorder)


• Avoidant/Restrictive Food Intake Disorder (ARFID): restrictive food intake, but lacking the psychological consequences of AN


• Pica: Ingestion of non-nutritive, non-food substances (dirt, ice, soap, etc.; often related to pregnancy, iron deficiency)


• Rumination Disorder: Regurgitation of ingested food


• Orthorexia: Cutting out food groups/ concern in “purity” or “healthiness” of ingredients


• Diabulimia: Where individuals inten- tionally take insufficient insulin to lose weight


• Bigorexia: Muscle dysmorphia (most common in men)


• Anorexia athletica: Excessive exercising to the point where it becomes detrimen- tal to health


Reminder: eating disorders are not mutually exclusive. They often overlap (can manifest together or switch over time within a per- son). Your job is not to diagnose but to help support your patient and get them the proper help for recovery. Let us work together as a profession to support our patients through this journey.


Bree Zhang is a second year dental student at Columbia University College of Dental Medicine and serves as President for the Class of 2026. Passionate about dental advocacy and public health, Bree is a National Health Service Corps


Scholar, the Legislative Liaison of American Student Dental Association (ASDA) District 2, and the American Public Health Association (APHA) Oral Health Section Student Liaison. Bree graduated from Brown University with an ScB in Psychology and has given a TedXBrownU talk on tackling the interdisciplinary nature of dentistry through art, music, and psychology. She is currently exploring ways to implement music therapy into medical and dental settings to decrease patient fear and anxiety. Contact her at bree101zhang@gmail.com.


REFERENCES


1. Douglas, L. Caring for dental patients with eating disorders. BDJ Team 1, 15009 (2015). https://doi. org/10.1038/bdjteam.2015.9


2. Swinbourne J, Hunt C, Abbott M, Russell J, St Clare T, Touyz S . The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample. Aust N Z J Psy- chiatry 2012; 46: 118–131.


3. Westgarth D. What should the role of the dentist be in managing patients with eating disorders?. BDJ In Practice. 2021;34(10):12-15. doi:10.1038/s41404-021- 0916-z


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