In the United States, disordered eating is considered an epidemic due to societal pressures to be thin, especially in young women and adolescents. When it comes to the diagnosis of life-threatening eating disorders, dentists and their staff members are on the frontlines.
According to a recently published article in the Journal of the American Dental Association (June issue), a brief patient assessment can be used by dentists to screen patients at risk during routine preventive dental care appointments.
Disordered eating behaviors occur on a continuum, the JADA research by registered dental hygienist Anne L. Hague, notes—ranging from chaotic or irregular eating to dieting, fasting, bingeing or meal-skipping. All are worthy of discussion in a health care setting, because they can progress to full-syndrome eating disorders. A routine dental appointment provides an ideal opportunity for oral health care practitioners to screen patients, Ms. Hague added.
Many of the initial signs of eating disorders are found in or around the mouth. The American Dental Association names several, including: salivary glands that may be enlarged, with individuals experiencing xerostomia; red, dry and cracked lips; lesions that appear on oral soft tissues which may also bleed easily; changes in the color, shape and length of teeth; restorations that appear elevated when erosion occurs on the surrounding enamel; or hot and cold sensitive teeth.
A simple questionnaire has been developed for health care practitioners in screening for eating disorders. Known as a "SCOFF questionnaire," it consists of five questions with yes or no answers: Do you make yourself vomit because you feel uncomfortably full? Do you worry you have lost control over how much you eat? Have you recently lost more than 15 pounds in a three-month period? Do you believe that you are fat when others say you are too thin? Would you say that food dominates your life?
Ms. Hague encourages oral health practitioners to administer the questionnaire to at-risk patients during dental appointments as part of the process of obtaining patients' medical history. A yes answer can lead to further discussion about eating behaviors and a determination of whether the patient should be referred to a mental health specialist.
Eating disorders, particularly in adolescents, are associated with the highest rates of morbidity and mortality of any mental health diagnosis, adds Ms. Hague in the article "Eating Disorders: Screening in the Dental Office." Early detection is critical given that treatment efficacy for disorders is poor and the rate of complete recovery is low. The dental team has an important role in detection and making use of referral systems that may reduce the oral health risks of eating disorders and improve the likelihood that the patient will achieve long-term recovery.© American Dental Association. All rights reserved. Reproduction or republication is strictly prohibited without the prior written permission from the American Dental Association.