Eating disorders (EDs) are rapidly increasing in prevalence. Since COVID hit the US in 2020, ED diagnoses have increased by 15.3%.¹ An estimated 31 million Americans will develop an ED at some point during their lives, which is more than the population of Texas during the 2020 census.^2,3 EDs affect up to one out of every 20 people, so dental professionals may have multiple patients with EDs in their chairs during a workweek—often without patients disclosing that information on their health histories.⁴

What is an eating disorder?

Before delving into how to help patients struggling with EDs, we first need to understand what an ED is. According to psychology.org, an ED consists of “behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological and social function.”⁴

As a result, EDs can affect every part of people’s lives. The thoughts about weight and food are a never-ending reel constantly playing in their heads. It determines what they eat (or do not eat) … what they wear (or do not wear). They are constantly worrying about what those around them think of what they look like or how much they are eating. It is a draining condition both mentally and physically.

In the dental office

Dental offices can often be a challenging environment for people who are struggling with EDs. Part of our jobs as dental professionals is discussing oral esthetics and diet. Both of those topics can be triggering for people fighting EDs.

We cannot see erosion, significant demineralization, or rampant caries and turn a blind eye if we have patients with an ED or suspect patients have one. That goes against the beneficence portion of our code of ethics because it is not in our patients’ best interest. However, we also must be careful that we do not judge or shame our patients. We often do not know what they have experienced or what they are dealing with. EDs are usually a coping mechanism or response to bullying, trauma, or other mental health conditions. So, what can we do to balance our job with their struggles?

How to talk to patients about eating disorders

When we have patients who may have EDs but do not have one listed on their health histories, do not bring it up as an isolated topic. List it with multiple other conditions. We can also list the symptoms without mentioning an ED specifically. For example, we can talk to patients about generalized erosion by asking if they consume a very acidic diet, have acid reflux, or frequently vomit. This lists the potential symptoms of EDs without mentioning the issue by name.

If patients are actively in recovery, we need to obtain the contact information for their health-care team members, especially if they are working with nutritionists. Then, we can contact their providers about treatment options. If patients do have a recovery team, talk to the team about how to implement better nutrition prior to discussing it with your patients. Most of the time, nutritionists will be the providers who discuss dietary concerns with patients—not us.

When discussing nutrition with patients who are struggling with or may have EDs, give them the data with as little judgment as possible and allow them to make an informed decision on changes to diet or habits. Avoid referring to beverages and food as “bad” or “junk.” Speak about them as neutrally as possible while also discussing the consequences of highly acidic, sugary foods and beverages. Explain that anything consumed in high quantities can have health repercussions—even water.

Help them navigate the effects of EDs by discussing in-office fluoride treatment, prescribing high-fluoride toothpaste, and helping them improve their oral hygiene routines. Create treatment plans that prioritize managing any pain and discomfort that exists so that they can follow the eating recommendations from their recovery teams.

Boosting patients’ confidence

We can also play an important part in helping patients feel more confident in the way they look. However, be careful how you discuss this. Saying “How do you like your smile?” or “Is there anything you want to change about your smile?” puts the emphasis on what they think, which makes it clear that we are not judging them in any way. This opens the door for them to discuss any cosmetic concerns that they may have and allows us to help them feel more confident in the way they look. We can also bring up topics such as orthodontics from a functional aspect rather than a cosmetic one to keep patients from feeling like we are criticizing their appearance.

Dental professionals often underestimate their ability to help people struggling with EDs. The reality is that we can make a huge difference in the lives of our patients by helping them not only take care of their teeth to help maintain proper nutrition throughout the rest of their lives, but also by making them more confident with their smiles. As a dental professional, you can make a difference.

Additional reading:

• Oral manifestations and dental management of bulimic patients: 2 case studies
• When trauma affects the mouth: Oral health in domestic violence survivors

Editor’s note: This article first appeared in RDH eVillage newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

References

1. Zipfel S, Schmidt U, Giel KE. The hidden burden of eating disorders during the COVID-19 pandemic. Lancet Psychiatry. 2022;9(1):9-11. doi:10.1016/S2215-0366(21)00435-1
2. Bunnell D. Statistics. National Eating Disorders Association. https://www.nationaleating disorders.org/statistics/
3. 2020 population and housing state data. United States Census Bureau. August 12, 2021. https://www.census.gov/library/visualizations/interactive/2020-population-and-housing-state-data.html
4. Wu J, Guarda A. What are eating disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders