The dentist's role in eating disorder therapy

Posted by Dr. Edward Magida | Filed under , , , , , , , ,

Read any women's magazine these days and sooner or later you will encounter an article about eating disorders. Eating disorders are more widespread than ever and getting worse every year.

Often it is a dentist who is the first health professional to recognize the problem.

Dental complications of anorexia and bulimia vary in complexity depending upon the length and severity of the eating disorder and may include the following:

Enamel erosion, called "perimylolosis," is the most common problem and is caused by chronic exposure of enamel to hydrochloric acid of the purge cycle. The most common area involved are the back surfaces of the upper front teeth, but all teeth can be affected. The front teeth over time may appear shorter because the thin edges wear away first and eventually, even when a person closes their teeth together, the front teeth no longer touch.

Over time, the back teeth may become affected as their cusp tips, the pointy areas that grind the food, become rounded off.

Erosion can be accelerated by excessive toothbrushing, especially right after purging when the enamel has been softened and is more susceptible to mechanical wear.

Cavities, caused by the intake of the high caloric foods during the binge cycle and compounded by eroded and weakened enamel.

Hypersensitivity to hot, cold and sweets due to exposure of the dentin, which is the layer of tooth structure under the enamel that is in direct connection with the nerve of the tooth.

Apparent "eruption" of amalgam (silver) fillings, which happens as the enamel around the fillings erodes and makes the fillings seem to grow out of the tooth.

Salivary abnormalities, inducing enlarged parotid glands and reduced flow of salvia, causing "dry mouth" (xerostomia). If the patient is receiving treatment for depression, antidepressant drugs may exacerbate the problem.

Increased risk of gum disease related to reduced salivary flow, nutritional deficiencies, and trauma to the soft tissue in the mouth.

A patient with an eating disorder must be open and honest when it comes to answering questions about their problems. The dentist must be made aware of the person's medical history, nutritional status, previous dental treatment, extent of the binge/purge cycle and whether the person is currently in therapy, The dentist may request permission to consult with the therapist to discuss dental treatment objective, medications and issues of compliance and progress. As in any such situation, confidentiality is strictly adhered to.

Dental care for the eating disorder patient does not deviate markedly from any other patient, and includes:

Emergency treatment and pain management, thorough tooth cleaning and/or periodontal therapy, basic restorative care to restore tooth function, re-evaluation prior to cosmetic or complex treatment.

Extensive oral rehabilitation and elective cosmetic treatment should be delayed until the eating disorder had been controlled.

Cosmetic bonding, porcelain laminate veneers, porcelain crowns and bridges, as well as orthodontic treatment to correct color contour bite and spacing problems are often a powerful motivating factor in a patient's recovery.

By working closely with the psychotherapist and other members of the health professional team, the dentist can help in the intervention, treatment recovery and continued health of the eating disorder patient.