DentaltownUK April 2017 - 54

Research has shown that of the patients
who are suspected of having an eating disorder, about half (or their guardians) have given
confirmation when asked by their dentist.2 Hopefully
those who concealed their eating disorder accepted the
concerns expressed by their dental care professional as
a warning sign and sought help later.

Understanding eating disorders
Eating disorders are psychiatric illnesses characterized
by disturbed attitudes to eating and body image. They
are often accompanied by inappropriate, dangerous
methods of weight control. The three most common
eating disorders are bulimia nervosa (binge-purge),
anorexia nervosa (starvation), and binge-eating disorder
(bingeing without purging).3 There are also variations
of disordered eating, as well as eating disorders not
otherwise specified.4
Eating disorders often occur in individuals who
have suffered physical or psychological trauma5 and
are frequently accompanied by other psychiatric
illnesses6 such as depression,7 anxiety,8 self-harm
and chemical dependency.
Psychiatrist Dr. Wendy Spettigue
of the Canadian Academy of Child
and Adolescent Psychiatry described
the experience of some of her young
patients who have anorexia nervosa:
"Imagine a patient with severe
obsessive-compulsive disorder who
constantly thinks, 'There are germs
on my hands,' and the only thing that
makes it better is if they wash their
hands, which decreases the anxiety
temporarily; but the thoughts recur,
and the only thing that relieves the
agitation is washing their hands
again.
"Anorexia nervosa is the exact
same kind of illness where they can't
tolerate the severe anxiety and agitation
that go with the thoughts that have taken
over their minds that constantly say, 'You're
eating too much. You're gaining too much
weight.' They feel compelled to restrict or purge,
to get rid of that agitation." 9

Myths about eating disorders
*
*
*

Eating disorders are about food.
Eating disorders are a matter of choice or lifestyle.
Eating disorders are a matter of vanity or a way
to get attention.

APRIL 2017 // dentaltownuk.com

People at a normal body weight cannot have an
eating disorder.

Screening in the dental-office setting
Dental health professionals are in an ideal position
to participate in detection and secondary prevention of
eating disorders,10 which could improve prognoses11-and
even be a lifesaver, because eating disorders have the
highest mortality rate of all psychiatric illnesses.12
However, a 2015 Norwegian study13 found that 76
percent of dentists surveyed reported a need for more
education related to eating-disorder management.
Research findings from Finland14 suggested that many
dentists underestimated the number of patients they had
encountered with eating disorders.
In a recent informal survey, educators in several
North American dental hygiene schools have commented
about time constraints in the curriculum that preclude
covering eating disorders in much depth.
Clinical assessment includes the general appraisal,
which begins as soon as we greet a patient. A comprehensive medical history is also needed, along with
monitoring of vital signs.
Observe the following during the general appraisal:
* Gait and demeanor. Does the patient look alert,
or dazed? This could be a sign of electrolyte
imbalance, hypoglycemia, dehydration or
malnutrition.
* Facial symmetry. Individuals who purge by
vomiting often have swollen parotid glands,
giving a "chubby" look to the face, although they
might be underweight.
* Skin blemishes or a gray cast might occur due
to malnutrition, or carotenoderma-orange
skin from excessive intake of foods containing
carotene.15
* Sparse scalp hair.
* Bloodshot eyes and petechiae of the skin around
the eyes are related to forced vomiting.
* Lanugo hair, which is fine downy hair on the
face, arms and torso-related to excessive loss of
body fat.
* Clubbed fingers are a sign of malnutritionrelated myocardial atrophy or abuse of laxatives.
* Russell's sign: a callus or abrasion on the
knuckles from inserting fingers in the throat to
induce vomiting.
The following two questions are worth adding
to the medical history form, to assist in detecting the
possible presence of eating disorders:
* Do you eat in secret?
* Are you satisfied with your eating pattern?

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Table of Contents for the Digital Edition of DentaltownUK April 2017