I read an article this morning on dentists diagnosing eating disorders. It’s actually something that I’ve always wondered about… mainly because I was always scared that my dentist would call me out on the ED. It’s funny how having a doctor say something about my eating disorder felt oddly validating (maybe because I needed someone to say that I wasn’t okay for my feeling crappy to count), but having the dentist make a comment was mortifying.
I have never gone to the dentist and wanted anything to be wrong. In fact, I’d pray, “Please please please let everything be okay. PLEASE.” During my worst ED points, I’d avoid the dentist completely. I was sure that purging and restricting and whatever else was not good for my teeth (or gums). I did not want to have to explain anything to my dentist. Having seen a few not-nice dentists in my past, I also did not want to be told “how bad what I was doing was for my teeth.” (No kidding, I know that.)
When it came to teeth, I was embarrassed about the ED. It’s hard to explain why I wasn’t so ashamed when it came to other medical issues… but I think it’s because:
- Dentists probably aren’t trained to deal with EDs
- Everyone wants nice teeth
- I felt totally irresponsible not taking care of my teeth. Cavities and whatnot just did not mesh with my perfectionistic drive.
Finally I decided that maybe if I paid a dentist enough they would have to be nice. Isn’t that how things sometimes work? Maybe if I just found an expensive dentist, then he wouldn’t want to offend me by suggesting I had an eating disorder. In hindsight, I don’t know how much sense this actually makes, but it seemed pretty logical at the time.
Anyway, I was lucky enough to find a dentist who didn’t say a thing to me (I saw a cosmetic dentist–which I highly recommend. My insurance covered him, too). I’m sure he knew — I had 4 cavities — but he just fixed what he needed to fixed and I moved on with my life. It was such a relief.
I’m sure that dentists do see evidence of eating disorders months before anyone else (especially if you do go the recommended two times a year)… but there is a difference between your doctor confronting you about your eating disorder from your dentist doing the same. I’m okay talking about it with my PCP (and even my neurologist — hey, why not), but definitely not about to have a conversation about it with my dentist. I don’t know why there is such a big difference between “you’re hurting your body” and “you’re ruining your teeth,” but the former seems like no big deal and the later feels so shameful.
But if they are the first professional to notice, don’t they owe it to their patient to ask them about it and see that they get proper care. i.e. notifying their PCP or something? It seems to me ignoring it would be like parents or friends ignoring it, letting the person stay in their illness and possibly die.
My cosmetic dentist has called me out on it… I think the fact that my whole family sees him may be part of it too…
Standing in the Rain – I agree that just ignoring the problem would probably be irresponsible… and maybe it is good that this is one more professional who can recognize the problem and push the patient towards getting help. I guess I’ve just had previous dentists who I don’t think would be very sensitive about the issue and would have said something like “you know you’re ruining your teeth by doing this,” rather than sitting me down and saying he was concerned and that he thinks I should see someone about it.
Jess – what did you say when you cosmetic dentist brought it up?
My dentist figured it out, but not by looking at my teeth. I went to see him when I was at my lowest weight and he asked my dad what was up (the dentist is a family friend) when I said “fine.” I didn’t have any problems then, but he gave me a sample of high-fluoride toothpaste to protect my teeth.
After my last appointment with a new dentist, I’m thinking I should have gotten more tubes of that stuff. Not pretty. The damage to my teeth is more from osteoporosis than purging, since vomiting wasn’t my preferred method.
I’ve been in and out of the dentists’ chair more times than I can count and spent a fortune on my teeth. I’m positive my dentists knew something was wrong. I mean how many times can a crown fall out in less than six months? Or bridges be chipped and eroded less than five years later? However, not one ever said anything about it to me at all. If one has asked, I’d be ashamed but relieved too.
I think in general, dentistry is coming around a bit. My current dentist was quite sensitive to my issues, but I was also at a stage of being up front and honest with her. I know in recent news, some dentists are trying to collaborate better with other professionals in regards to Ed patients. I’m still curious about the Bulimia is a Dental Disease book. Anyone read it yet?
” I don’t know why there is such a big difference between “you’re hurting your body” and “you’re ruining your teeth,” but the former seems like no big deal and the later feels so shameful. ”
this is so true. although i bit the bullet a while back and decided to be honest. i got extreeeeemely lucky– 5+ years of on and off anorexia & bulimia and no permanent tooth damage besides a few cavities– but i’m glad i shared my secret. now when i go back i can be reassured that my teeth are truly ok and that they aren’t just doing what they need to do while noticing that my teeth are actually falling apart. because if they were, i’d want to know that so that i could figure out what to do (if at very least to minimize further damage).
sending courage your way… the dentist is actually an important part of your team….
I have had experiences at opposite ends of the spectrum with this. Back in high school, I had a dentist essentially accuse me of being bulimic (I have/had anorexia, in 9+ years of eating disorderdom I have purged maybe twice?), and blew off my insistence that I didn’t throw up regularly. So this dentist was aware of warning signs, but not of the fact that anorexia causes low bone density and also tooth decalcification.
My current dentist is treating me for decalcification, sensitivity, gum recession, stress-related tooth grinding, etc and has never shown any indication that he suspects an ED.
A periodontist that I saw last year took one look in my mouth, one look at me, and said “Are you in treatment for your anorexia?” Unfortunately since I didn’t need gum surgery, that was a one-time visit, he can’t do much for me. He did hand-write a very nice follow-up letter, encouraging me in my treatment efforts.
I wish there were some database of dentists that treat eating disorder patients, similar to the different treatment finder search engines for therapists!
I don’t know why there is such a big difference between “you’re hurting your body” and “you’re ruining your teeth,” but the former seems like no big deal and the later feels so shameful. ”
I feel the same way and I think it’s because the latter is something about your looks. They’d might as well tell me that I’m getting fat- it becomes another outward cosmetic issue. Like if you have a ton of cavities and gross teeth, you could just as well be eating too much candy and drinking too much soda. And it could be ugly, just like being fat could be ugly. Hurting your body is such an internal thing that nobody can see so it doesn’t matter as much when it comes to embarassment and shame.
My dentist didn’t figure it out- or at least he didn’t tell me that he knew if he did. I was scared shitless though when I first went- enough that he actually asked me why I was so nervous about xrays. haha. The only thing that he did notice was that my teeth weren’t as white as they should be but he asked me if I drank a lot of coffee and I just went with that. I actually asked about my enamel and he said that it’s totally fine. And then proceeded to tell me how it takes years and years to ruin enamel- how its sooo strong and I have nothing to worry about
He did slightly allude to not knowing what on earth I was doing with my teeth to cause so many cavities (six of them) but I think it was just a passing thought.
i agree it would be irresponsible for the dentist to ignore the eating disorder, especially because you are probably right that they are probably the first to see it because of the acid erosion on your teeth