Student Ambassador Blog
by Andrea Sauerwein
As rising dental professionals, it is crucial to remember that in addition to focusing on our patients’ oral health we may also be the first to identify and intercede with issues extending beyond their smile. Individuals tend to present to their dentist more regularly than their physician, emphasizing our role as advocates for patients’ overall health and wellbeing. These could involve eating disorders, substance-abuse disorders, obstructive sleep apnea, as well as domestic violence. Clinical signs and symptoms are apparent in some cases: erosion patterns of enamel due to acidic regurgitation, softened tooth structure and rampant caries due to “meth mouth,” fractured or avulsed teeth due to trauma. However, not all patients are forthcoming and willing to divulge the honest cause behind these oral problems. The question posed is how do we broach such a sensitive subject when patients are not forthcoming of their medical history or personal events, specifically the sensitive subject of eating disorders?
According to the National Eating Disorders Association, studies have found up to 89% of bulimic patients have signs of tooth erosion, due to the effects of stomach acid. Bad breath, sensitive teeth and eroded tooth enamel are just a few of the signs that dentists use to determine whether a patient suffers from an eating disorder. Other signs include teeth that are worn and appear almost translucent, mouth sores, dry mouth, cracked lips, bleeding gums, and tender mouth, throat and salivary glands.
Kristi Hatfield, RD, MS, provides some tips on communicating with such patients you may suspect of covering up a history of eating disorder:
- Start by asking if he or she has had a history with acid reflux. GERD typically affects the posterior (more so with maxillary) lingual aspects, whereas bulimia displays a pattern of mainly anterior lingual erosion. Trauma to the maxillary anterior may be evident (i.e. fractured incisal edges or mobility).
- Don’t be afraid to use the word “bulimia.” Ask the question with compassion, but also with confidence. The more uncomfortable you appear, the more timid and closed off the patient will be.
- It is essential to pose your discussion in a non-judgmental manner. Aim to build trust between you and the patient and avoid “coaching” him or her. Shame and denial are tightly linked to bulimia nervosa, and an individual may not be ready to open up to you at the initial exam.
It is critical to share your clinical findings with the patient and explain how their symptoms are linked. Make sure to:
- Discuss with the patient the reason his or her dentition is in such state is due to a problem that needs to be identified.
- Emphasize that no dental work can be performed to permanently remedy their dentition until such cause is recognized and treated.
Compliance may be difficult to achieve, as an eating disorder can span many years. Eating disorders often goes through quiet and active phases, and dental professionals must be supportive throughout. Ultimately, communication is key to achieving any level of success. The sooner you can form a trusting relationship with your patient, the better your chances of aiding them in tackling this destructive psychological problem, and the better the outcome.