Dentists Often First To Diagnose Bulimia

Bulimia is an insidious eating disorder whose binge-and-purge cycle can be difficult to detect. The women (and increasing numbers of men) who suffer from bulimia tend to be high achievers with normal body weights. They eat in public and vomit in private, with their friends and family members completely unaware of their condition. Even GPs will often miss a diagnosis of bulimia.

But dentists are another story completely. Dentists can often diagnose bulimia before anyone else. And just because you don’t treat patients for eating disorders doesn’t mean you don’t have a responsibility to diagnose the condition and refer the patient to someone who can treat them.

What are the dental signs of bulimia?

• Enamel erosion, particularly on the inside surface of the upper front teeth (in some patients, these signs will appear within months; in other patients, enamel erosion may take years to become visible)
• Tissue trauma from vomiting or inducing vomiting
• Increased caries
• Dental pain
• Damaged dental work
• Bleeding gums
• Enlarged salivary glands or reduced saliva

If you suspect bulimia, remember that sensitivity is essential; many people with eating disorders are not eager to be diagnosed. However, you have a responsibility to your patient not to ignore evidence of disease. You should first address your patient’s dental health, then give a referral to an eating disorder specialist.

A good place to start is, “You have erosion of your tooth enamel. This is often seen in people who vomit. Do you vomit frequently?” This question dodges the bulimia diagnosis. In fact, there are other conditions that can cause similar enamel erosion: acid reflux, morning sickness, etc.

Advise the patient that people who vomit have special dental needs. Patients should rinse with water but not brush after vomiting. Patients may also require extra dental care, artificial saliva, and additional calcium. Restorative dentistry should not begin until after the patient has been successfully treated and has stopped vomiting.

It’s important to also provide the patient with a referral to a professional qualified to handle eating disorders, not just the patient’s general practitioner. Your local eating disorder clinic can help you find the right person for these referrals.

How do you handle patients who show signs of bulimia? Share your stories.

Read more