Should dentists screen patients for eating disorders?

Should Dentists Screen for Eating Disorders?

Yes, dentists should actively screen patients for eating disorders, as they are often the first healthcare professionals to encounter undiagnosed cases and early detection significantly improves prognosis and reduces both dental and systemic complications. 1

Rationale for Dental Screening

Dentists occupy a uniquely advantageous position in the healthcare system for eating disorder detection:

• Oral manifestations appear early in the disease course, often before patients seek psychiatric or medical care, making dentists the first-line identifiers of these conditions 1, 2
• Regular patient contact during routine preventive care appointments provides repeated opportunities for assessment that other healthcare providers may not have 3
• Patients may feel more comfortable discussing eating concerns with their dentist than with other healthcare professionals, creating a therapeutic window for intervention 3
• Early detection through dental screening is directly associated with fewer dental and systemic adverse effects and a more favorable overall prognosis 1

Key Oral Warning Signs to Identify

Dentists should be alert to these pathognomonic physical findings during examination:

• Parotid gland enlargement presenting as swollen cheeks or jawline, caused by repeated self-induced vomiting stimulating salivary gland hypertrophy 4
• Dental enamel erosion particularly on lingual surfaces of maxillary anterior teeth, resulting from repeated acid exposure from gastric contents 4, 2
• Russell's sign (calluses or scarring on the dorsum of the hand from self-induced vomiting) 4
• Xerostomia (dry mouth) which increases caries risk 2
• Dental caries and poor gum health secondary to acid exposure and nutritional deficiencies 4
• Hair thinning or lanugo-like facial hair indicating malnutrition 4

Screening Implementation

Validated Screening Tools

• Use brief, validated questionnaires during routine preventive care appointments to systematically identify at-risk patients 1
• The American Psychiatric Association recommends screening for eating disorders as part of initial evaluations, a principle that extends to dental settings 5, 6

Patient Assessment Components

When eating disorder is suspected, dentists should assess:

• Weight history patterns including recent weight changes, maximum and minimum weights 5
• Eating behavior patterns including restrictive eating, food avoidance, or binge eating 5
• Compensatory behaviors such as purging, excessive exercise, or laxative use 5
• Preoccupation with food, weight, and body shape as a percentage of daily thoughts 5
• Psychosocial impairment secondary to eating or body image concerns 5

Referral and Multidisciplinary Management

Once screening identifies a potential eating disorder:

• Immediate referral to appropriate mental health professionals (psychiatrists, psychologists) and nutritionists is essential, as eating disorders require multidisciplinary treatment 7, 2
• Coordinate care with the patient's medical team rather than attempting to manage the psychiatric condition independently 2
• Continue dental management of secondary oral conditions while the underlying psychiatric disorder is being treated 7
• Failure to recognize and refer may lead to serious systemic problems in addition to progressive and irreversible damage to dental hard tissues 2

Common Pitfalls to Avoid

• Do not dismiss oral findings as simple erosion or caries without considering eating disorders in the differential diagnosis, particularly in adolescent and young adult females 3
• Do not delay referral waiting for the patient to volunteer information about eating behaviors, as denial is a hallmark feature of these disorders 2
• Do not attempt solo management of the psychiatric condition—eating disorders require specialized psychiatric and psychological intervention 7, 2
• Do not overlook male patients, as eating disorders, while more common in females, also occur in males 3

Special Populations Requiring Enhanced Vigilance

• Adolescents aged 12 and above should receive routine screening at initial visits and periodic intervals 5
• Patients with Type 1 diabetes require particularly careful screening, as eating disorders in this population carry substantially higher mortality risk 5
• Female athletes presenting with the female athlete triad (disordered eating, amenorrhea, osteoporosis) 3
• Patients with unexplained poor glycemic control or recurrent hospitalizations (in diabetic patients) 5