Eating disorders and dental care

Your favorite patient climbs into your chair, and you are concerned. (I know, you aren’t supposed to have favorites, but face it, you do.) She doesn’t look so good. Weight has been dropping off her since her last visit four months ago. Her skin looks sallow, and the shine and luster in her eyes is gone. The enamel is wearing off of her teeth. You suspect that she might have an eating disorder. She might be throwing up with stomach acid damaging her teeth and esophagus. What do you do?

What if your patient is morbidly obese and has a large number of cavities? You’re concerned that he’s consuming large quantities of sweets and not practicing good oral hygiene. Do you say anything?

These are really tough issues that you, the dental professional, have to face. You’re a healthcare provider. We aren’t talking just about oral care but the whole person. Are you ignoring a situation that’s now the elephant in the room? If we don’t address it, the problem gets bigger and bigger. You’re now wondering, “What am I supposed to do about it?” We work so hard to be respectful and to protect our patients’ privacy, but at what cost? A medical doctor would address it. Is it because a doctor has more data such as weight, blood pressure, lab work and test results that are evidence of a problem? Maybe.

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But, these are your patients. Don’t you have an obligation to ask them how they’re doing and be open to the truth if it’s shared? I’m not suggesting that you approach anyone saying, “Why are you eating so much?” You surely would get fired for insulting a patient. The question is how can you communicate concern without offending them? Make sure to do this in a private office and not while the patient is in the chair. Privacy is important if you’re going to address a concern like this. And please, don’t discuss this with your staff in any open place where patients can overhear. This isn’t about gossiping about your patient; it’s about consulting with your superviser or the dentist so that you’re all on the same page. Trust your instincts. You’re a professional. If you suspect that there’s a mental health problem or a medical issue, someone needs to address it.

Consider asking the following questions:

• “When was the last time you saw your doctor?”

• “Is there anything major going on in your life that’s upsetting you?"

• “How can I help?”

• It sounds like you have a lot going on right now. Would you like to share anything with me?”

• “Are you having any medical issues that we should be aware of?”

• “Are you having any kind of emotional issues right now?”

• “How do you manage your stress level?"

Share concern for what you see:

• “That must be surprising to hear that you have three cavities.”

• “Can we speak openly about your oral care?”

• "Is there anything I can do to help you?”

• “Sugar is a prime suspect in a lot of cavities. I love my candy, but l learned that I’m keeping my teeth bathed in sugar, which causes decay. That leads to cavities and hurts my pocketbook big time. How about you?”

• “I’m worried about you. You look like you’ve lost a lot of weight in a short period of time.”

• “Would it be okay for me to talk to your primary care doctor about my concerns?”

If the door opens for a conversation, you don’t need to have all the answers. But, be aware of where you can refer someone for help. Make sure you stick your foot in the door and be that beacon of light. Life can depend on that. You’re on the frontline to identify problems and guide your patient to get help. Don’t be afraid.

Resources to consider:

• Education on what eating disorders do to teeth enamel

• Their internal medicine physician/pediatrician

• Parents (if the patient is a minor)

• Counselors

• Eating disorder facilities in your area

• Eating disorder hotlines and resources

• Weight Watchers

• Overeaters Anonymous

You’re not therapists or counselors. But, you have a special relationship with your patients. You’re another line of healthcare worker who can help to refer a patient to get help when he or she is in real trouble. Just like you’d refer someone to the oral surgeon or the endodontist, refer a patient to any of the resources I mentioned above.

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Please share this article with your staff. Trust your instincts. Don’t be afraid to ask nonjudgmental questions. This is why we came into this profession-to help patients take care of their health.

If you have had experiences like this in your practice, email me at diana2@discussdirectives.com. I’d like to hear your stories.