The Dentist talks to Beat about how mental health issues can manifest as eating disorders.
Mental health is a subject which historically failed to get the attention it deserved. This is something which seems to be changing and people are now more aware of some of the issues around mental health. What can healthcare professionals and dentists do more generally to raise awareness of conditions like eating disorders?
They can keep leaflets about eating disorders in waiting areas and display posters.
They can also educate staff on the symptoms of eating disorders and the warning signs. Talking openly about eating disorders is hugely important, as is encouraging others to share their experiences.
Practices can also help by getting involved in a team fundraising event for a charity like Beat.
What are the signs that dentists should look out for in patients (and potentially colleagues)?
There are many things to look out for.
For example:
- Significant changes in weight – loss or gain
- Extreme preoccupation with body, weight or shape
- Changes in behaviour such as low energy levels, low or anxious mood, irritability, difficulty concentrating, dizzy spells
- Wearing loose/baggy clothing in an attempt to hide their body
- Increased illness/infections due to compromised immune system
- Restrictive diet – dieting/calorie counting/omitting food that is believed to be high fat/calorific
- Not eating in front of others
- Becoming socially isolated
- Increased level of exercise to the point where it is considered excessive
- Feeling cold – swollen feet, hands or face
- Calluses on the back of the hands
Dentists are well placed to help in the fight against eating disorders, being perhaps the healthcare professionals who are seen most often by patients, and who are used to discussing diet and eating/drinking habits with patients. Eating disorders can also impact a sufferer’s oral health, what should dental professionals be on the lookout for in that regard?
Eating disorders can contribute to problems with dental/oral health in many different ways and significant changes in the mouth can indicate an eating disorder. Frequent self-induced vomiting, which is commonly a symptom of Bulimia Nervosa, can lead to erosion of the enamel due to strong stomach acid repeatedly flowing over the teeth. Self-induced vomiting can also lead to redness, scratches or cuts in the inside of the mouth due to frictional trauma (insertion of foreign objects in the mouth in order to help oneself vomit). Teeth can become discoloured, oral sensitivity – pain and swelling of gums, high number of fillings due to consumption of high sugary foods. The mouth can also become extremely dry due to dehydration. Lips may also become dry and cracked.
Restriction is a symptom commonly found in eating disorders which can lead to nutritional deficiency. Lack of proper nutrition can aid gums and other soft tissue in the mouth to bleed easily. Calcium deficiency in particular can promote tooth decay and gum disease.
If a dentist is concerned about a patient’s mental health and thinks they may be suffering from an eating disorder, what should be their initial course of action?
Dentists may be among the first healthcare professionals to observe the health complications of an eating disorder, however it is not the role of dentists to diagnose or treat the eating disorder. This is a sensitive topic and needs to be approached in a calm and non-judgemental manner. It is not appropriate for a dentist to comment directly on the eating disorder, however it is OK to present the oral findings of the examination to the patient. For example, if there is dental erosion or loss of tooth enamel the dentist could mention possible causes such as acidic drinks or frequent vomiting. This allows the patient an opportunity for disclosure. If no disclosure is made then the dentist should remain supportive and still devise an effective treatment plan.
If the patient is a child or teen then an attempt should be made to involve the parents if a disclosure is made. Perhaps the dentist may want to encourage them to bring someone with them to the appointment or if they were in the waiting room bring them in. If the patient is under 16 it is likely that their parents will be in the consulting room anyway and a discussion would be had in front of both of them.
Often an individual suffering with an eating disorder will find it difficult to be honest and open about their disordered eating behaviour and may go to great lengths to disguise or hide the problem, this is likely because talking about an eating disorder may feel terrifying or shameful to the individual. It may be that the patient initially denies an eating disorder and then returns and discloses an eating disorder, at which point the dentist should encourage the patient to seek support. The dentist could even make a referral to the GP with consent or signpost to support resources such as Beat.
The issue is a sensitive one and can be difficult for patients to discuss. Are there any particular words or phrases that one should steer clear of when communicating with patients or parents?
- Avoid comments on physical appearance, particularly with regards to weight
- Do not make any accusations and steer clear of any specific eating disorder terms such as ‘anorexia nervosa, bulimia nervosa or binge eating disorder’ until a proper diagnosis has been made
- Choose a time when you can speak to the person in private with no distractions
- Avoid commenting on someone’s eating habits
- Avoid lecturing or criticising – instead refer to behaviours you may have noticed
- Avoid ultimatums – you cannot force someone into treatment
- Avoid giving any kind of solutions – these should come from a trained professional only.