Teeth hold the key to early diagnosis of eating disorders

Dentists can play a key role in the detection of health conditions including anorexia nervosa, bulimia and Gastro-Oesophageal Reflux Disease (GORD), according to research from King's College London.

The data, published in the British Dental Journal, found that many of the medical conditions that result in the erosion of tooth enamel, known as erosive tooth wear, can have serious and even possibly fatal consequences if left undiagnosed or untreated.

Researchers recommend that dentists be aware of the very specific oral signs of eating disorders, which include the erosion of the insides of the upper front teeth facing towards the roof of the mouth, but also of the physical and psychological indicators of the conditions.

Eating disorders affect an estimated 725,000 people in the UK - at a cost of around £15 billion per annum. The report authors believe that the early identification of the subtle signs of the developing condition, coupled with referrals to GPs, may lead to both better health outcomes and savings for the NHS.

In addition to eating disorders, the research also looked at the role dentists can play in the early identification of Gastro-Oesophageal Reflux Disease (GORD), a condition which develops when the reflux of stomach contents causes troublesome symptoms, such as two or more heartburn episodes per week. Regurgitated or vomited stomach contents are highly acidic and repeated contact with tooth enamel and dentine results in erosive tooth wear.

The impact of chronic alcoholism on oral health was also investigated by the study. Many alcoholics present with erosive tooth wear related to regurgitated or refluxed stomach juice.

This is due to the fact that alcohol can result in gastritis and provoke gastroesophageal reflux, and that alcoholics are less likely to have a healthy balanced diet and tend to eat more acidic foods and drinks.

Lead author Dr Rebecca Moazzez, Reader and Consultant in Restorative Dentistry says, "There is a clear benefit to patients of the dental team being able to pick up on the early signs of conditions such as eating disorders or acid reflux, which may appear very subtle and difficult to detect.

"Dental examinations should include the possibility of detecting signs of GORD and eating disorders, and if detected, appropriate referral and liaison with medical professionals instigated, leading to better outcomes for the patient.'

The 2017 NICE guidelines provided dental recommendations on how to mitigate the impact of vomiting on oral health, including avoiding brushing teeth after vomiting, instead rinsing with a non-acid mouthwash, having regular dental and medical reviews and avoiding highly acidic foods and drinks.

As the NICE guidelines recommend that dietary counselling should only be offered as part of a multi-disciplinary approach, researchers suggest that it is most important for dentists to focus advice on the timings of oral care routings.

The role of dentists to spot the subtle signs of an eating disorder in its initial stages may be helpful in early identification, which has a better outlook for successful management.