Dental Tribune United Kingdom Edition

United Kingdom Edition February 11-17, 2013 F igures from the National Institute of Health and Clinical Excellence sug- gest that 1.6 million people are affected by an eating disorder in the UK. With Eating Disor- ders Awareness Week taking place this week (11-17 Febru- ary), charity Beat are encour- aging people to ‘sock it to eat- ing disorders’, by organising ‘silly socks’ events and fund- raising to help support those with these illnesses. One of the biggest impacts eating disorders can have is on the teeth. Eating disor- ders cause tooth wear, which occurs when the outer tooth surface is lost as a result of chemical or mechanical activ- ity in the mouth. All sorts of dental problems can arise as a result, such as teeth becoming short and unattractive as well as rough or sensitive. Speak- ing or chewing can become a problem and some people will end up with numerous restora- tions or having teeth removed. Results from the Adult Psy- chiatric Morbidity Survey show that bulimia is the most preva- lent eating disorder, making up 40 per cent of those with an eating disorder, compared to 10 per cent of sufferers having anorexia. Bulimia causes tooth erosion due to repeated acid regurgitation, and diet choices among those who are bulimic may be acidic, with sugar free and carbonated soft drinks, sports drinks and alcohol be- ing frequently consumed, add- ing to erosion. Stress Stress is a common aspect in all eating disorders, which can also lead to other types of tooth wear. Emma Pacey, Clinical Coordinator at the London Tooth Wear Centre® says: “The associated psychologi- cal complications of an eating disorder mean the patient may be susceptible to other types of tooth wear often caused by grinding or clenching habits, whilst obsessive behaviour can translate to tooth brush- ing, resulting in abrasion.” Those with bulimia also become overly concerned with the prospect of bad breath, causing them to excessively brush their teeth. Terence, a bulimia sufferer for 11 years says bad breath took great im- portance for him during his illness. “After vomiting the first thing I did was clean my teeth, as I thought this would help keep my teeth strong and prevent bad breath. I was more bothered about bad breath [than oral health] and I didn’t realise what I was doing [to my teeth].” Unfortunately, oral care can often take a back seat when people are going through their illness. As with other psycho- logical disorders, judgement may be affected, and one of the concerns likely to be at the bot- tom of the list is the impact their lifestyle is taking on their teeth. Sam, who suffered from an- orexia and bulimia for 15 years, has had tooth decay, intensive root canal treatment, numerous fillings and three missing teeth as a result, says: “[Oral health] wasn’t high on my list of pri- orities, being thin was. When you have such a low opinion of yourself your teeth…is just one thing in a long list of things that you hate about yourself.” Causative factors Although a difficult and sensi- tive subject to broach, tooth wear which is deemed to be the result of an eating disor- der should be acknowledged. Emma says: “Denial and shame often feature and so discussion must be without judgement, with sympathy and time. Ac- knowledgment and rectification of the causative factors need to be realised, otherwise treat- ment will be compromised. “It is important to commu- nicate effectively and with con- sideration, and provide clear explanation in an open and sup- portive environment.” Sam agrees: “My dentist re- acted with what I perceive to be disgust and a total lack of sym- pathy. She was very dismissive and offered very little support and advice…it made me feel re- ally bad about myself and like I had no one to turn to. I saw the hygienist and broke down about my problems and told her how I felt about my teeth. She was very supportive and told me there are lots of things that can be done but I would need to be referred to a private clinic.” Advice It is also important to note that people with eating disorders may not want to listen to any advice given. Rhian, an eating disorder sufferer for 15 years, says: “I received very little ad- vice [from my dentist]. I didn’t seek any and I wouldn’t have been willing to accept any ei- ther.” Allison, who has suffered from both anorexia and bulim- ia, reiterates this. “Any advice you give may usually fall on deaf ears.” Nonetheless, dentists should not be disheartened when it comes to treating patients, and still need to look out for tooth wear as a result of eating disor- ders. Allison encourages “every dentist not to shy away from talking to their patients who present with high acid erosion on their teeth that could be at- tributed to an eating disorder.” Sam’s advice to dentists is: “Don’t be judgemental, eat- ing disorders are not a lifestyle choice, they are serious illness- es. Educate yourself about eat- ing disorders, the effects they can have on teeth and the signs to look out for.” Signs to look out for include increased levels of sensitiv- ity, and sharp or chipped front teeth. Acid erosion presents on the palatal and occlusal sur- faces of the teeth mostly, where acidic fluid pools in the mouth, and back teeth become round- ed and lose some of their sur- face characteristics, while front teeth may become translucent at the biting edges. If abrasion is also present, grooves may de- velop in the teeth near to where they meet the gums. Regret One of the biggest impacts that come with dental problems at- tributed to eating disorders is a lack of confidence and regret that oral health was neglected during their illness. Sara, an anorexia suffer- er, says: “Following recovery, the impact my eating disorder had upon my teeth has affect- ed my confidence. I was, and am, aware of the appearance of my dentition, my missing tooth, and am self-conscious at times when speaking.” Rhian says: “It upsets me that this is the lasting legacy of my eating disorder that I will have to live with for the rest of my life. I get annoyed at the amount I have and will contin- ue to have to pay out because of the damage years of an eating disorder has done to my teeth.” While dentists may not be able to stop an eating dis- order, they may be able to prevent severe tooth wear which has occurred as a result, and make a big difference to that pa- tient’s life. DT The lasting impact of eating disorders ‘Dentist should not shy away from talk- ing to their patients who present with high acid erosion on their teeth that could be attributed to an eating disorder.’ DT’s Angharad Jones looks at eating disorders and how dental professionals can help Contact information For more information regard- ing eating disorders and tooth wear, visit www.b-eat.co.uk and www.toothwear.co.uk 7News Feature ® www.scrub-up.comNext day delivery available. Limited time o er for Mainland England & Wales only. T & C apply full details on website. 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