Bulimics can't hide symptoms from dentists
Bulimic patients can usually hide their eating disorders from family and friends, but not from their dentist, because the tell-tale oral symptoms are obvious to someone who knows how to "read a mouth."
Bulimia, an eating disorder that is characterized by episodes of binging and purging -- usually self-induced vomiting -- is often first discovered by the dentist, says the Academy of General Dentistry, an international organization of 35,000 general dentists from the United States, its territories and Canada dedicated to continuing dental education to ensure the best possible dental care for the patient.
"Dentists play an important role in the detection process," says Trey Petty, DDS, FAGD, spokedentist for the Academy of General Dentistry. "If you know what to look for, there are two symptoms in bulimics that never lie."
The first symptom is the erosion of the upper front teeth, which creates a pattern caused only by vomiting gastric acid, Dr. Petty said. This type of erosion can occur within days or weeks of the first vomiting episode. The second sign is a sore that appears in the corners of the mouth -- a red burn caused by the exposure to acid during vomiting.
Once he has recognized the symptoms, Dr. Petty says he asks the patient -- usually a woman -- a question that doesn't have a yes or no answer.
"I ask her how she makes herself throw up," he says. "It's not unusual for a patient to burst into tears."
Once the secret is out, Dr. Petty tells the patient he understands what a difficult problem she is going through, and explains the damage she is doing to her teeth and overall health. He also encourages her to seek counseling.
But treating the erosion is somewhat tricky, since there's no guarantee the patient will cease the binging and purging once the disorder is discovered. But if a patient doesn't cease the behavior, there's no point in restoring the erosion by doing composites, crowning or capping the teeth. He says those procedures aren't performed until the patient is no longer bulimic. Bulimic patients lose their teeth if they don't stop vomiting.
Until bulimics can come to terms with their illness, patients are given oral care instructions to prevent the erosion from worsening. Dr. Petty tells them to use a salt-based paste, such asa baking soda and water, and rub it on the teeth after vomiting to neutralize the acid on the teeth. After 30 seconds, rinse the paste off and proceed to brush, floss and use mouthwash to refresh the mouth. When that's not possible, he recommends they rinse their mouth with water after purging. Unfortunately, there's only so much a dentist can do since the decision to quit is ultimately the patient's.