National Eating Disorders Awareness Week 2022

Eating disorders affect all economic and educational groups. Which means, no matter what patient populations a dental provider serves, they could see adults or children who might be struggling with an eating disorder. The reality is, dentists and hygienists could be the first healthcare professional in that patient’s life to notice. Changes in the mouth are often the first physical sign of an eating disorder. These changes can start showing up as early as 6 months after consistent behaviors such as calorie restriction or purging.

According to the National Eating Disorders Association, “Early detection could ensure a smoother and more successful recovery period for the body and teeth.” If dental professionals have the knowledge needed to recognize signs of an eating disorder based on those changes, they’re better equipped to have a conversation around it, provide support, and a safe space for those struggling. This will mean approaching the subject in the most kind and delicate way possible, remembering that the patient might not necessarily be comfortable discussing something so sensitive and personal.

Signs and Symptoms

Signs of an eating disorder may include:

• Extraoral Signs
  • Enlarged parotid gland due to vomiting.
  • Russel’s Sign – A callous or bruising on the dorsal surface of fingers from inserting them against the teeth to induce vomiting.
• Intraoral Signs
  • Gingivitis
  • Tooth Decay
  • Periodontal Disease
  • Sores
  • Halitosis (bad breath)
  • Aphthous Ulcers
  • Swollen Salivary Glands
  • Sore Throat
  • Petechiae
  • Dry Mouth
  • Cracked Lips
  • Acid Erosion

It is important to evaluate all of the signs and symptoms together. This is especially true in the case of acid erosion as it may be caused by other factors. Gastrointestinal disorders and an acidic diet may also cause erosion. Other behaviors that may cause acid erosion that would appear clinically as similar to bulimia are drinking acidic drinks often (particularly holding acidic drinks in the mouth), sucking on lemons or other acidic fruit, bruxism, or drugs. Additionally, certain prescription medications may cause dry mouth. Even vitamin C deficiencies could cause lesions on the palate or the gums. Periodontal disease and chemotherapy may also be a cause for bleeding gums. For these reasons, it crucial to have a dialog and open communication with the patient to determine the cause.

Recommendations

Health Coach, Jan Lemoine recommends keeping recommendations and advice general as those with eating disorders are already sensitive and might feel shame around the subject. It’s important that dental professionals are careful not to share instruction that could lead the client to believe the recommendation is evidence of their failure or even worse have a patient to avoid dental care due to shame or feeling inadequate.

In the case that the dental provider is sure the patient is struggling with an eating disorder, recommendations may include:

• Rinsing with water after eating, drinking, or vomiting
• Avoid brushing after vomiting
• Using a mixture of baking soda and water to rinse after vomiting because it neutralizes acid
• Using a water-soluble tablet such as Alkalife that helps neutralize acid in the mouth
• Xylitol products to help with decay prevention and dry mouth
• Fluoride varnish and prescription fluoride toothpaste
• Regular dental visits so that the team may treat any dental issues early

Resources

• Jan Lemoine Disordered Eating Series
  • Part I: Core Issues https://youtu.be/1r2dBiv80QY
  • Part II: Common eating disorders and how they present themselves https://youtu.be/LEJF3EdiooQ
  • Part III: Treatment, effects, and how we can all help https://www.youtube.com/watch?v=mPXjx…
• National Eating Disorders Helpline for support, resources, and treatment options. Call or text 800-931-2237
• In CRISIS, text NEDA to 741741 and you will be connected with a trained crisis volunteer
• National Association of Anorexia Nervosa and Associated Disorders: https://anad.org/