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Dental Hygienist, Aviva Spiro, shares her insights on the significant connection between oral health and Eating Disorders.

Hello everyone,

Did you know Oral Health Month and Dental Hygienists Week are both celebrated in April?

There is a significant connection between oral health and Eating Disorders.

According to the Oral Health Foundation, Eating Disorders can cause the following: enamel erosion, dry mouth, mouth sores, dry/cracked lips, sensitive teeth, tooth decay, etc. – all warning signs of “vomiting, excessive sugar intake or nutritional deficiencies”. Dentists and Dental Hygienists can, therefore, be the first to recognize signs of an Eating Disorder.

Today, I had the pleasure to speak with Aviva Spiro, a Dental Hygienist, who has been in practice for over 40 years.

There are many studies which state that Dental Hygienists and Dentists may be the first to detect signs of an Eating Disorder? Was there any training related to this when you were studying?

There are studies available about Eating Disorder and oral health. I have over the years attended seminars on Eating Disorders. These seminars are not mandatory.

Do the Canadian Dental Hygienists Association or the Ontario Dental Hygienists Association offer webinars or training on Eating Disorders?

Yes – There are also webinars available through the RCDS (Royal College of Dental Surgeons of Ontario)  Some courses/webinars to consider:

What do you see in patients that would indicate signs of an Eating Disorder?

As you mentioned before, one of the most apparent signs is the wearing away of the enamel on the upper front teeth, especially on the inside. There may also be signs of nutritional deficiencies such as bleeding gums, more cavities in the mouth due to the acid buildup after vomiting (which would indicate the patient has been struggling with bulimia).

What is the range of age that you have seen possible cases of Eating Disorders?

The age range is predominantly between 16-30.  However, I know there are women in their 70’s and 80’s who have been suffering for decades with bulimia.

When you see this – how is it handled within the practice?

There are many things to consider: If I felt that a patient had an Eating Disorder, I would gently try to speak to them about it as so many patients struggle with shame and stigma. If they refuse to speak about it, I will then speak to the Dentist about my concerns before the Dentist enters the room. If the patient still does not want to speak about it, the Dentist and I would then discuss what the best route would be for them after the appointment. It depends on the patient’s age, i.e., a child, adolescent, youth, or adult.  Each presents different issues that would need to be addressed including confidentiality.

Do you feel that you and others in your practice are well prepared to have a conversation with a patient who may be showing signs of an ED?

As we see patients for years and have established relationships with them, I do feel that I have enough knowledge to have a preliminary discussion. It would, however, be beneficial for the staff to attend an information session. about Eating Disorders and then discuss steps.

What interventions do you think would be most helpful for a patient with an Eating Disorder? Are there resources or anything you can offer that would not be triggering to them?

If the patient is amenable to have a preliminary discussion, I would do that with them. I would determine the next steps by discussing their situation with both the patient and the Dentist. If the patient discusses it, I will do all I can to find the proper path for them providing resources like:

Thank you so much for your time, Aviva! So glad we could honour Oral Health Month and Dental Hygienists Week with you!

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