Pinpointing eating disorders

According to the National Institutes of Health, eating disorders affect approximately 30 million individuals in the United States each year. By comparison, Alzheimer's and autism affect 5 million and 3.6 million people respectively. Eating disorders are psychiatric disorders with psychological, behavioral, and physiological manifestations, and have the highest mortality rate of the psychiatric disorders (National Eating Disorders, National Eating Disorders Association).

BY ANN-MARIE C. DEPALMA, RDH, MEd, FADIA, FAADH

According to the National Institutes of Health, eating disorders affect approximately 30 million individuals in the United States each year. By comparison, Alzheimer's and autism affect 5 million and 3.6 million people respectively. Eating disorders are psychiatric disorders with psychological, behavioral, and physiological manifestations, and have the highest mortality rate of the psychiatric disorders (National Eating Disorders, National Eating Disorders Association).

Recent information from emergency department data represents a rise in serious outcomes due to eating disorders, such as excessive undereating or overeating. Patients range from elementary school-age children to the elderly. No one is immune. Intraorally, these patients manifest with enamel erosion, caries, xerostomia, periodontal and gingival disease, and traumatic lesions. As dental professionals, do you recognize patients with eating disorders?

Lisa Bennett Johnson, RDH, BSDH, MSDH, has developed a program called "Eating Disorders: Recognition through Recovery - The Oral Health Provider's Role" that enlightens dental teams on this pervading disorder. With 20 million women and 10 million men suffering from eating disorders, these patients often present to the dental practice with a potentially life-threatening disorder that affects their emotional and physical health. Often overlooked and undetected in the dental office, oral health-care providers can be instrumental in screening, identifying, and referring patients with an eating disorder to the appropriate health-care providers.

Lisa's program:

• Reviews current U.S. trends in eating disorders through statistics

• Describes the three classifications of eating disorders according to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition)

• Discusses eating disorder screening tools that can be used in dental offices

• Considers the best approach for dialogue with an individual who has (or is suspected of) an eating disorder

• Applies knowledge to develop an oral health treatment plan using risk development to prevent and/or manage oral health issues for patients with eating disorders

• Increases provider self-efficacy when eating disorders are encountered while providing dialogue and referral in the oral health setting

Lisa provides handouts for her program that include an array of evidence-based information including the ADA caries risk assessment information. She has found that many practices are unfamiliar with or resist incorporating caries risk assessments into their daily practice. However, caries risk assessment and management is essential when providers care for patients with eating disorders. Lisa focuses her program on the needs of her audiences. She has presented the program as a workshop, lecture, or a lunch and learn program.

Lisa's journey learning about eating disorders began in 2012 when she met with Massachusetts State Senator Harriette Chandler to talk about her concerns regarding the state of oral health in Massachusetts. During the conversation, Senator Chandler mentioned the Eating Disorders Coalition and that she was looking for oral health expertise for the Coalition, and Lisa fit the bill.

At this point, she had limited experience with eating disorders, but Lisa was confident in her ability to provide education to others. During her research, she learned that eating disorders occur in children as young as eight, the disorders peak in college, and they can recur in middle-aged individuals. Women are affected more than men. Lisa realized that eating disorders are rarely discussed in private practice; therefore she is focusing her energies on providing collaborative care with medical and behavioral health specialists to get the topic out into the open. From these efforts she has created the eating disorders program to educate dental teams.

Lisa is a graduate of the Forsyth School of Dental Hygiene at MCPHS University and recently received a master's degree with a focus on education and public health. She has been an ADHA member since she was an undergraduate, where the dean of Forsyth at the time, Linda Hanlon, and one of her professors, Kathy Eklund, instilled the importance of supporting the ADHA. Their experience and advice had a positive influence on Lisa's career choices and instilled dedication to best practices. She is concerned that many hygienists are forced to compromise their licenses and patient care for practice desires, and many feel they have little or no direct influence in their private practice settings.

Lisa's interests include education and contributing to alternative oral health-care delivery models. She believes organized dentistry remains overly focused on the treatment of disease, and that it has failed to adapt to current health models. She believes our nation is overdue for oral health providers who are committed to collaborative, preventive oral practice, who can take on a greater role in the health-care delivery system.

Lisa is a faculty member at Forsyth where she currently teaches Community Oral Health and Local Anesthesia. She has enjoyed providing direct patient care over the last 25 years and is thrilled to mentor dental hygiene students during an era when oral health is on the brink of great change. Practicing in offices that are less than desirable has opened her eyes to the challenges that many hygienists face. She feels that expanding the role of oral health professionals will require hygienists to think outside the box and obtain higher education levels that are equivalent to other allied health professionals, and this will lead to collaboration, employment opportunities, and fulfillment.

As oral health providers, we need to be aware of the signs of eating disorders and be open to noncritical evaluation and dialogue. While there is no fast or easy treatment, Lisa believes that hygienists should create a professional list of local eating disorder providers for referral. Networking with professionals you know and feel comfortable with will make referral easier and more likely, thus improving the lives for those who suffer from eating disorders.

For more information about eating disorders or Lisa's program, contact LisaBennett.Johnson@mcphs.edu.

Thought for the month:

If you are really thankful for the good in your life, what do you do? You share. - W. Clement Stone RDH


ANN-MARIE C. DEPALMA, RDH, MEd, FADIA, FAADH, is a Fellow of the American Academy of Dental Hygiene and the Association of Dental Implant Auxiliaries, as well as a continuous member of ADHA. She presents continuing education programs for dental team members on a variety of topics. Ann-Marie is collaborating with several authors on various books for dental hygiene and can be reached at amrdh@aol.com.

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