Recognition and management of eating disorders in the dental office

Assessment of the eating disorders and relationship with dental caries, age, gender, and body mass index in a sample of Turkish adolescents aged 9 through 15

Background and Aims

Eating disorders (ED) are an important public health problem for adolescents due to changing eating attitudes. Using the Eating Attitude Test (EAT-26) with a sample of Turkish adolescents aged 9-15 years, this study evaluated the behavioral risk of ED and its association with dental caries, age, body mass index (BMI), and gender.

Subjects and Methods

The EAT-26 scoring system was used, and variables examined included demographic, familial, sociocultural, social, and clinical features. Data were analyzed using SPSS® Statistics for Windows, version 20.0. (IBM, New York, NY, USA).

Results

A total of 112 adolescents, 46 (41.1%) boys, and 66 (58.9%) girls (mean age 11.46 ± 1.91 years), were evaluated. EAT-26 mean scores were 16.0 (10.0-21.0) for girls and 14.0 (12.0-23.0) for boys (Mann Whitney U test; P = 0.509). There was no statistically significant difference between the mean BMI scores and the mean EAT-26 scores for girls and boys (Mann Whitney U test) (P = 0.509) (P = 0.636). The mean DMFT decay-missing-filled and total) was higher in EAT-26 >20 than in EAT-26 <20, and the difference was statistically significant (Mann Whitney U test; P = 0.008). BMI was not correlated with EAT-26 (Spearman rank correlation test, r = -0.013, P = 0.156), but there was a statistically significant positive correlation between the development of caries and age (Spearman rank correlation test, r = 0.405, P < 0.05).

Conclusion

Early diagnosis of ED is crucial because it primarily starts during childhood and adolescence. It is responsible for the dft of the deciduous teeth. BMI is related to decay,missed,filled,total (DMFT), decay, filled, total (dft), and age in adolescents aged 9-15 years. Furthermore, we searched subgroups of EAT-26 for dental caries. Dieting score may be a significant factor for dental caries for ED. However, observing ability is an important factor for dentists because they can inform parents and provide information on preventing ED.

Is There an Association Between Fixed Orthodontic Treatment and Initiation of Eating Disorders? A Review of Currently Available Evidence

Objectives: The aim was to review the available literature regarding the potential association between fixed orthodontic treatment (OT) and the onset of eating disorders (EDs).

Method and Materials: Six indexed databases were searched until November 2020. The inclusion criteria were as follows: (a) patients undergoing fixed OT and (b) EDs in relation to fixed OT. Commentaries, letters to the Editor, reviews, and studies in patients with EDs not undergoing fixed OT were excluded. The pattern of the present review was customized to summarize the pertinent information.

Results: Four out of 10,076 initially-identified studies were included, and all of them were case reports. All patients were females, and the EDs reported were either anorexia nervosa (AN) or bulimia nervosa (BN). In three case reports, patients developed EDs after the initiation of OT. Fixed OT was performed in all the studies, and a variety of oral complications such as sore mouth, gingivitis, tooth surface demineralization, and others were reported.

Conclusion: Based upon the limited available evidence, the association between OT and the onset of EDs remains unclear. Further well-designed observational clinical studies are needed in this regard.

Dentists as Primary Care Providers: Expert Opinion on Predoctoral Competencies

Dentistry and medicine traditionally practice as separate professions despite sharing goals for optimal patient health. Many US residents experience both poor oral and general health, with difficulty accessing care. More efficient collaboration between these professions could enhance health. The COVID-19 pandemic disclosed further disparities while underscoring concerns that physician supply is inadequate for population needs. Hence, enhancing healthcare provider education to better meet the public's health needs is critical. The proposed titles “Oral Physician” or “Oral Health Primary Care Provider” (OP-PCP) acknowledge dentist's capacity to diagnose and manage diseases of the orofacial complex and provide some basic primary healthcare. The US Surgeon General's National Prevention Council and others recommend such models. Medical and dental education already overlap considerably, thus it is plausible that dental graduates could be trained as OP-PCPs to provide primary healthcare such as basic screening and preventive services within existing dental education standards. In 2018, 23 dental and medical educators participated in an expert-opinion elicitation process to review educational competencies for this model. They demonstrated consensus on educational expansion and agreed that the proposed OP-PCP model could work within existing US Commission on Dental Accreditation (CODA) standards for predoctoral education. However, there were broader opinions on scope of practice details. Existing CODA standards could allow interested dental programs to educate OP-PCPs as a highly-skilled workforce assisting with care of medically-complex patients and to helping to reduce health disparities. Next steps include broader stakeholder discussion of OC-PCP competencies and applied studies including patient outcome assessments.

Oral profile of eating disorders patients: Case series

Oral alterations in patients diagnosed with eating disorders (ED) are reported in the literature, but few articles demonstrate these changes in a specific population. This study aims to summarize the findings of 26 patients with ED in a Brazilian dental clinic, through analyzing the body mass index and oral conditions (decayed, missing and filled teeth-DMFT, dental wear, salivary flux, xerostomia, oral hygiene-OHI-S, oral lesions, and the prevalence of candidiasis), in order to facilitate recognition and enable accurate diagnosis for the general dentist. Probably, the premature diagnosis of ED resulted in lower DMFT and oral lesions.

Psychiatry in orthodontics. Part 1: Typical adolescent psychiatric disorders and their relevance to orthodontic practice

Adolescence is a time of rapid physical and mental development. It is also a time when many diagnosable psychiatric diseases are first noticed. A prior study showed that a high rate of suicidal behavior is seen in orthodontic practices. The orthodontist is in a unique position among medical practitioners because treatment occurs over several years with frequent appointments. This article is a current review of the etiology, diagnosis, and therapy for several pertinent mental disorders that occur in adolescents, including mood disorders, schizophrenia, attention-deficit hyperactivity disorder, personality disorders, and eating disorders. All have been associated with high rates of suicidal behavior and completed suicides. With a keen eye for the development of psychiatric issues, the orthodontist is in a position to make appropriate referrals, if needed.

Three cases illustrating the potential of dental treatment as a precipitant for weight loss leading to anorexia nervosa

OBJECTIVE

This is the first published report to illustrate the potential for dental treatment to precipitate weight loss leading to anorexia nervosa.

METHOD

Documentation of history and clinical findings on three adolescents referred to a specialist eating disorder service are presented.

RESULTS

These cases illustrate that dental treatment may be precipitants of weight loss leading to anorexia nervosa.

CONCLUSION

There is a need for increased awareness of this area amongst parents of children and adolescents vulnerable to eating disorders and also their dentists.

Dental fear, regularity of dental attendance and subjective evaluation of dental erosion in women with eating disorders

This questionnaire study, with a response rate of 53%, examined self-induced vomiting, erosions and dental attendance in women with eating disorders (EDs) as well as dental fear and its effect on attendance and communication with the dentist. A survey of 371 responding women with EDs, who were recruited from a self-help organization, revealed that dental fear was higher in women with EDs compared to the general population. Dental fear was present in 32.1% of women with EDs, and very high dental fear was present in 16.5% of women with EDs. Of those with very high dental fear, 32.3% had not visited a dental clinic at all in the preceding 2 yr, and 43.5% only initiated contact when they had symptoms. Self-induced vomiting was especially frequent in women with bulimia nervosa (87.9%) and in those with more than one ED (the 'mixed group') (80.6%). Among those with self-induced vomiting, 45.3% thought that they had erosions, although only 28.4% had erosions diagnosed by a dentist. Of women with EDs, 61.4% failed to disclose their condition. High dental fear did not affect willingness to disclose the ED. We conclude that dentists should examine ED patients carefully for dental erosions. Moreover, they should realize that most ED patients avoid disclosing their disorder and that dental fear further complicates dental treatment in these patients.

Communicating effectively with patients suspected of having bulimia nervosa

BACKGROUND

The dental team often is confronted with the clinical appearance of erosion affecting the hard and soft oral tissues. An investigative process often is needed to determine the cause of such erosion, because factors other than eating disorders may be involved. The authors present a protocol that should be considered in the assessment of dental erosion. Guidelines provide direction for the clinician toward opening a dialogue with a patient when the suspected cause of erosion is an eating disorder.

TYPES OF STUDIES REVIEWED

The authors review publications related to the causes of dental erosion and the patterns that are involved with both chemical and mechanical destruction of oral tissues. They also discuss the oral-tissue effects related to eating disorders. The authors stress the importance of assisting parents in obtaining adequate treatment for pediatric patients.

RESULTS

Cases of eating disorders among female college students, athletes, preadolescent children and men are well-documented. However, dental staff members often do not feel comfortable beginning a dialogue with patients who are suspected of having an eating disorder. This article focuses on the proper protocol for approaching such patients and beginning a dialogue. In addition, the authors provide suggestions for limiting further erosive damage to the tissues. They also discuss other causes of erosion that should be considered when assessing any type of oral erosion.

CLINICAL IMPLICATIONS

The dental team is in a prime position to assist patients who have eating disorders. Timely treatment by mental health and other medical professionals is crucial. The authors suggest a dialogue for approaching these patients and offer educational material to reduce further tissue destruction.