Eating Disorder Referral and Information Center
International Eating Disorder Referral Organization
IS BULIMIA A DENTAL DISEASE?
By
Brian McKay, D.D.S.
I am a dentist. I’ve been in practice in the western Washington all my life. My practice is about changing someone’s life for the better. I’ve assembled a caring, sensitive team that supports me and works with me restoring the pride, self-esteem and confidence that comes when you flash a great smile at someone.
So what am I doing writing to the readers of an Eating Disorder organization?
It’s because dentists are in a unique position to detect bulimia and purging disorder. One of the classic signs is the loss of enamel and dentin, which usually occurs on the upper, front inside surfaces of the teeth. These signs generally appear after someone’s been purging for about two years – of course, this is dependent upon how many times the person is purging and whether or not the person has good oral hygiene habits.
There are other signs a dentist can see. Dry mouth, parotid gland swelling, gum inflammation or trauma. Behind the closed and hand-covered mouth is a person who is in severe stress: their gums, teeth, tongue, palate and throat are suffering the damaging consequences of chronic vomiting.
As a dentist, I have an obligation to be concerned not just about my patient’s oral health but their overall health as well. According to the Institute of Dental Research, 28% of bulimia cases are first diagnosed during a dental exam. There are two ways to look at this statistic. First, it’s a fairly high percentage for a health profession that is not specially poised to deal with eating disorders. On the other hand, when you consider that dental professionals are usually the first ones to have access to the part of the body that can most reveal the secret of this disease, then the percentage is probably low.
If there are clear signs that a patient has bulimia or purging disorder, dentists should confront that person in a gentle, firm and compassionate way. The recurring vomiting of bulimia produces a distinctive erosion pattern that is like a signature in a person’s mouth. There is no other erosion pattern quite like it. We can tell if the person is relatively new or a chromic purger. There’s no way to stop the hydrochloric acid from the stomach stripping the teeth of protective enamel. The result is a long list of symptoms and conditions that include:
-Cavities
-Enamel Erosion
-Gum pain
-Dry mouth
-Chronic sore throat
-Inflamed esophagus
-Hoarsened
-Palatal hemorrhages
-Decreased saliva production
-Enlarged Parotid glands
-Problems swallowing
-Jaw alignment abnormalities
Luckily, dental science and materials have progressed to the point where restoration can be successful. However, steps to restore a patient’s oral health can only begin in earnest once they’ve pursued treatment for their eating disorder and it is under control. Essentially, it’s a waste of time of money to do extensive restorative work if the person is still purging actively.
As a dentist I’ve reached out to individuals who sat in my office with the telltale signs of bulimia. Over the years, I’ve been fortunate to have able to assist most of them getting the treatment help they needed and then had the privilege or restoring their oral health and smiles when they were ready to take that step.
Our process has been perfected over the years. A critical element is the initial interview. The purpose is to allow patients to explain their hopes, desires and needs concerning their dental health. This interview is done in a non-threatening, non-clinical setting. We have no imposing front desk separating us from them. Our reception room looks like your living room.
If a patient has already admitted her bulimia to us it is easy to take the next steps. We discuss the help she needs or is getting already and we make arrangement to begin her dental restoration work. If she has not admitted to the problem our path is more challenging. Once I conduct the exam, I dismiss my assistant, sit the patient up, pull my chair around so I can be face-to-face with her and get honest. “I’ve found some teeth I have concerns about and I need more information. Is it OK if I ask you some questions? “ No one has ever answered no to that question. “The condition of your teeth is similar to the condition of others who have an eating disorder. Do you now or have you every had an eating disorder?” The odds are in my favor: more than 50% of the time the patient admits they are bulimic.
If she admits to being bulimic, she has placed a great deal of trust in me and I cannot break that trust by being judgmental in any way. I cannot assume she is ready to seek outside professional help for the bulimia. My mission is to be empathic and help the patient believe she can trust me and that I am concerned about her overall health. Once she admits an eating disorder, I can ask a series of questions: How long has she been dealing with her eating disorder? Does she have other symptoms? Has she sought help or guidance from other professionals? Does she need a referral to a physician or counselor? Is this the first time she has been bulimic or is she relapsed, a serial bulimic?
The key to success with a bulimic patient, regardless of where she is in her acceptance of or treatment for the disease is communication. Be clear about everything, portray empathy and care at every opportunity. Watch body language and look for trust before moving on.
The payoff is in the smile. I cannot emphasize enough the power of a beautiful, healthy smile. A positive self-image and self-esteem are critical for recovery from bulimia and a restored, healthy smile is evidence of those feelings. Does having a new smile help that process? Absolutely. It can be life changing.
Find Dr. McKay and other Dentists who specialize in working with patients who have eating disorders at our Dentist Finder click here
The views and opinions expressed in this article are strictly those of the author and are presented without editing. The opinions expressed herein do not necessarily reflect the position or the policy of EDReferral.com, and no official endorsement by EDReferral.com of the opinions expressed herein should be inferred.
