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Dentists Asked to Watch for Eating Disorders

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WEST PALM BEACH, Fla. - The battle against eating disorders is being fought in the dentist's chair.

Dentists are being encouraged to recognize the signs of these sometimes fatal illnesses _ anorexia nervosa and bulimia _ when they show up in the mouths of patients, and to try to guide patients to doctors who can help make a diagnosis.

Anorexia and bulimia are both psychiatric disorders. Anorexia is usually suspected when underweight people _ 15 percent or more under the recommended body weight _ intentionally starve themselves. They are often unable to see their bodies as they really are.

A bulimic will try to prevent weight gain after an episode of binge eating by vomiting, using laxatives or exercising aggressively.

Both conditions may develop in teenage girls, and it is estimated that 5 percent to 18 percent of women in their first year of college already have bulimia.

Dentists do not treat either condition, of course, so why should they become involved?

Because up to 10 percent of these sufferers will die of their disorders, and dentists might be the first medical professionals to notice signs.

One of the most common? Tooth erosion. Constant throwing up results in severe erosion of tooth enamel, because acids from chronic vomiting wear away the enamel.

"Since Karen Carpenter (the singer who died of anorexia 20 years ago) broke it into the public attention, everyone is more aware of it. There's no question that everyone from the average dentist to the average family practitioner has to be more aware," says Dr. Michael Siegel, professor and chairman of diagnostic sciences at Nova Southeastern University in Fort Lauderdale, and author of a recent dental textbook chapter on eating disorders and oral health.

Siegel, who is also chairman of the American Dental Association's Council on Scientific Affairs, says dentists should proceed with a "diagnosis of exclusion" if they suspect that a patient is suffering from one of these conditions and isn't being treated.

"Don't jump to the wrong conclusion. The single most common cause of teeth erosion is sipping on a Coke all day long, constantly bathing the teeth in it," he said.

The key is not to insult the patient, once other options are ruled out, because angry patients won't get the treatment they need.

Siegel says he's seen primarily women with these disorders over the past 20 years, although his medical text chapter refers to a minute percentage of men _ less than a half percent _ with histories of bulimia found during college studies.

The good news is that there is restorative treatment for teeth injured by constant vomiting, and even interim measures that bingers and anorexics can practice before they're totally cured, such as rinsing the mouth out with water and a mild baking soda solution, or having the dentist prescribe fluoride, which can help replace minerals and decrease tooth sensitivity to heat and cold.

"The mouth is attached to the body. Most of the time, dentists are giving good oral health, but if we find something more important, our job is to refer it appropriately," Siegel said.

"A perfect smile, if you're dead, won't accomplish much."

On Health is a weekly column on health issues. If you have questions or comments, write Carolyn Susman at The Palm Beach Post, P.O. Box 24700, West Palm Beach, Fla. 33416, call 561-820-4433 or e-mail

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