14 DENTAL TRIBUNE Pakistan Edition May 2019 Eating disordersOral health professionals have role in early identification By Monique Mehler S YDNEY, AUSTRALIA - E a t i n g d i s o r d e r s a n d disordered eating together are estimated to affect over 16 per cent of the Australian population, according to the National Eating Disorders Collaboration (NEDC). The Australian Dental Association ( A D A ) a n d t h e N E D C h a v e collaborated in order to spread awareness about eating disorders and their identification and assessment and to encourage referral among oral health professionals. Early intervention is critical for a patient with an eating disorder. The sooner treatment occurs, the better chance the individual has of recovery. Consequently, the oral health practitioner is uniquely positioned as one of the first healthcare providers c o n s u l t e d b y a n i n d i v i d u a l demonstrating disordered eating behaviour. According to the National Practice Standards for Eating Disorders, a document drawn up by the NEDC, dental professionals fall into the group of early identifiers and initial responders. They are defined as follows: Early identifiers have a duty of care for the well-being of people in high-risk groups for eating disorders and who are most likely to act as the first point of contact for people with eating disorders and their families. The role of early identifiers is to proactively engage people at risk to promote prevention and early help seeking. Intra-oral manifestations of nutritional deficiency present early in the clinical course of an eating disorder, and general tooth erosion can take approximately two years to appear. Swelling around the cheeks or jaw or bad breath can be physical warning signs of frequent vomiting. The ability of the oral health practitioner to recognise the subtle changes in the mouth of a patient is central to identifying early indicators of an eating disorder as early as possible. The NEDC first partnered with the ADA New South Wales (NSW), as part of a combined project, where Eating disorders are serious mental health conditions which have a significant and underestimated impact on Australian society. (Photograph: NEDC and ADA/Shutterstock) ADA NSW undertook a focus group of some of their members to understand their perspective on eating disorders, including how to approach a patient living with an eating disorder. The feedback of this focus group resulted in the development of e- learning resources and provided significant progress in identifying the gaps that exist in the knowledge and identification of eating disorders and practices for a standard approach to care for patients with an eating disorder. When contacted by Dental Tribune International, the NEDC explained that working with the ADA in some way to create awareness of the oral health practitioners position in the i d e n t i f i c a t i o n , t r e a t m e n t a n d management of an eating disorder was important and was the perfect partner to promote this cause. The NEDC believes that as an organisation the ADA shares similar values to that of the NEDC. With a f o c u s o n c o l l a b o r a t i o n , professionalism, integrity and respect, the NEDC felt that these values aligned with their own. It is the goal of the NEDC to work collaboratively across the sector to provide better outcomes for all Australians living with an eating disorder, through the sharing and development of evidence-based, nationally consistent information and s t a n d a r d s . - D e n ta l Tr i b u n e International Anti-ageing medicine ... Continued from page 8 and lateral borders of the zygoma (Fig. 6). Results Post-treatment, the patients face appeared more youthful with better defined cheekbones and a firmer jaw line. The skin appeared smoother with fewer lines, wrinkles and depressions (Figs. 7a & b). Discussion Facial changes related to palatal expansion are clearly outlined in Singh: The maxillary complex shows a change in size (and/or mass) allied with an increase in structural complexity, in association with biological processes. Palatal expansion presumably, switches on osteoblastic genes associated with active boney deposition and concomitant remodeling of the spatial matrix ensues. In relation to the changes around the eyes, we must recall that the maxilla forms the floor of the orbit and skeletal changes may become apparent after expansion; specifically, changes in orbital morphology may be reflected on the skin of the face: as the lower eyelids become tighter, the lateral canthus becomes more horizontal; facial width increases, particularly at the zygomatico-maxillary sutures; and the craniofacial form, putatively, not only functions better, but looks more attractive. These changes have been documented in children, where palatal expansion is an everyday occurrence. The current article documents similar changes in a non- growing adult. Combining the results of palatal expansion and the placement of dermal fillers, we obtained a very satisfactory i m p r o v e m e n t i n f a c i a l aesthetics. - Dental Tribune International The complete digital ... Continued from page 9 plan the implant placement and surgical guide accurately and with just a few mouse clicks. Finally, digital technologies also enable visualising the treatment outcome for the patient. Clear visualisations of the end result facilitate communication with the patient, which, in turn, can increase case acceptance. Editorial note: A list of references is available from the publisher. This article was published in CAD/CAM - i n t e r n a t i o n a l m a g a z i n e o f d i g i t a l d e n t i s t r y N o . 01/2019. - Dental Tribune International Dentists discourage ... Continued from page 10 claimed to have tooth whitening properties; however, they did not contain enough free radical bleaching agent for this purpose. Furthermore, charcoal-based materials are often abrasive, which could damage the enamel and the gingivae. The popularity of charcoal toothpastes is believed to be increasing in many countries across the world, including the UK, the US, Japan, India, Thailand, Lithuania, Australia, Hong Kong, China, South Korea and Switzerland, where charcoal-based toothpastes have been reported to be produced. It is understood that many patients ask members of their dental team for advice on the use and benefits of charcoal toothpastes and powders, and that the advice given is often empirical. Therefore, dentists should make sure to inform their patients about the current trend and advise them to use other toothpastes. "When used too often in people with fillings, it can get into them and become difficult to get out," said co-author Dr Joseph Greenwall-Cohen from the University of Manchester Dental School in conversation with the BBC. "Charcoal particles can also get caught up in the gums and irritate them." Prof. Damien Walmsley, the British Dental Association's scientific adviser, told the BBC: "Charcoal-based toothpastes offer no silver bullets for anyone seeking a perfect smile, and come with real risks attached." He added, "So don't believe the hype. Anyone concerned about staining or discoloured teeth that can't be shifted by a change in diet, or improvements to their oral hygiene, should see their dentist." The study, titled "Charcoal- containing dentifrices", was published online on 10 May 2019 in the British Dental Journal. - Dental Tribune International Stress levels are ... Continued from page 12 AAAS meeting, the individual layers that build up the tooth enamel are thinner and less dense if exposed to stress, w h i c h i n c r e a s e s t h e vulnerability to dental cavities, he explained to Germanys international broadcaster Deutsche Welle. These changes can be measured by examining a primary tooth in a 3-D model based on a radiograph. Stress does not just come from excessive demands at school but also, for example, from problems with parental relationships, constant noise or even physical and/or mental abuse. The bodies of those who experience a great deal of stress produce a lot of the stress h o r m o n e c o r t i s o l . I t s concentration can be measured in the blood and saliva, said Boyce. But, of course, what we really want and what we are really after and what these snapshots fail to show is total cortisol exposure, added Boyce. Therefore, examining the actual teeth can reveal exactly this, as the stress hormone influences their development. The presentation, titled Social disparities in child oral health: Interactions between stress and pathogens, was presented on Feb. 15, 2019, in a scientific session at the Annual Meeting of the AAAS. - Dental Tribune International A dentist gets to the root of the problem. ~Anonymous