Whilst in the sun I once again have time to reflect on history as a dentist.
In 1993 I was sent to Temple University to visit the dental department by Manchester University.
I left with the feeling ‘Wow they deal with machete wounds here’ and of the memory of the Renfrew Centre – a centre 30 years ago established for eating disorders.
In 1993 eating disorders were rare or should I say very hidden. There was a ‘stigma’ attached to them and access to care was impossible in the UK. Over my practising life I have encountered many presentations of eating disorders. ‘Dentally’ it is still a very difficult subject to approach – certainly, if the young adult is accompanied by a parent and it still remains a ‘secret’.
The dental management of these patients takes time, review and prevention. From advice to high fluoride toothpaste, advice re from not cleaning after vomiting to the whole practice of boosting ‘self esteem’ – a dentist can and is in a position to help emotionally and physically with the team and other medical professionals.
The dental signs and symptoms of an eating disorder are the same:
- Loss of enamel
- Exposure of dentine
- Shortening of front teeth and chipping
- Grinding and enlargement of parotid glands
- Enlarged tongue
- Bad breath.
All signs and symptoms the dentist should look out for.
Management of loss of tooth substance by acid can be composite bonding or palatal/full coverage crowns, again assessing the age, presentation of the dentition and the long term prognosis.
As a dentist I have been fortunate to have fantastic mentors such as Trevor Burke, Narn Wilson and Val Clerehugh who even after I left university, continued to support, offer me advice and show me how to research.
Eating disorders, binging and anorexia is a condition that has grown exponentially since my article in 1996. Access to care is still an obvious problem, having access to dental, mental, psychological well being multifactorial, multidisciplinary and I’m afraid again something severely underfunded within our NHS system.
As a dentist, I will always try to help those that need it, be it a smile, be it a chat, be it a ‘point in the right direction’.
As dentists we have a duty of care to identify these presentations and as a health care professional support the person in any such way.
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