Three Cases Illustrating the
Potential of Dental Treatment as
a Precipitant for Weight Loss
Leading to Anorexia Nervosa
Works Cited:
References
Jaffa, T. (2007). Three cases illustrating the potential of dental treatment as a precipitant for weight loss leading to anorexia nervosa. European Eating Disorders Review, 15(1), 42-44. doi:10.1002/erv.760
Summary of Journal Article:
This article discusses the link between dental treatment and the onset of anorexia nervosa. Discussion of the precipitants of anorexia nervosa
tends to focus on dieting driven by the cultural pressure to be thin (Fallon, Katzman, & Willie,1994). After assessing large numbers of eating disordered
teenagers over a period of years it is was found that while these factors are important, there appear to be other routes into anorexia nervosa. This article discusses three separate cases that appear to have started from dental procedures. These three cases were followed for two years and are three patients out of one hundred that have an eating disorder.
In the first case a twelve year old girl presented with a 9-month history of weight loss following a visit to the dentist where she required a filling and her first dental local anesthetic, an experience which she strongly disliked. She was advised to stop eating sweets between meals to avoid further
similar problems. She did so, but then progressed to not snacking between meals and reducing her meal portions. Shortly before the onset of her eating disorder she had experienced some bullying at school and her pet dog had died, so it is not solely linked to her dental experience.
In the second case a sixteen year old girl presented with a 2-year history of food related difficulties. The difficulties were linked to a dental surgery and fitting of a dental brace to re-align her teeth. Her mouth had been sore following this making eating painful and in addition she remembered being advised to avoid sweet foods. She had already tended to avoid unhealthy foods and responded to this advice by doing this more. She probably never resumed a
normal diet from this point. Although, her weight didn't become a major concern until the added stress of school exams was added to the equation.
In the third case a fourteen year old girl was showing signs of weight loss after having braces put on. The braces were initially tight and made it difficult to chew resulting in her eating mostly soups and soft food. A friend told her that wearing braces might result in her losing weight. She reduced what she ate and increased her exercise level. She complained of feeling fat, and she used the discomfort of the braces as an excuse to not eat.
There is very little on the relevance of dental intervention to the onset of anorexia nervosa. The three cases described illustrate that dental
intervention can precipitate the dietary restraint and consequent weight loss that may lead to anorexia nervosa. All three began losing weight after dental interventions (Jaffe, 2006). All three patients progressed from weight loss due to factors associated with teeth to a more typical anorexic picture, although the time scale varied.
I think it is very important for dental professionals to be aware of how sensitive young people are about their appearance and weight. I think it is also very important to be extremely clear with the patient about what limitations are given about their diet. I think diet and nutritional counseling would be an v important thing to incorporate in all adolescent dental visits. It is also important to discuss with the parents that there may be some discomfort after dental treatment, but to give them a realistic idea of how much pain their child will be in and to watch for signs of them avoiding food.
Personal Reflection:
I chose to use this topic because I had a very close friend in high school that had an eating disorder and I watched her struggle to overcome it. It is a constant battle for her and when she is under large amounts of stress she still has to pay very close attention to her weight to make sure she continues to eat. If eating disorders are caught early then people are able to get the counseling and help they need and tend to have an easier time overcoming the issues. I think it is important for dental professionals to be able to recognize signs of eating disorders because we have the power to be the change agent that could save a life.
Additional Information:
Below are a few websites that have a lot of good information about eating disorders and how to care for your teeth if you have an eating disorder. There is also information on how to find help if you have an eating disorder.
http://www.ada.org/3104.aspx?currentTab=1
http://www.ncbi.nlm.nih.gov/pubmed/18997921
References
Jaffa, T. (2007). Three cases illustrating the potential of dental treatment as a precipitant for weight loss leading to anorexia nervosa. European Eating Disorders Review, 15(1), 42-44. doi:10.1002/erv.760
Summary of Journal Article:
This article discusses the link between dental treatment and the onset of anorexia nervosa. Discussion of the precipitants of anorexia nervosa
tends to focus on dieting driven by the cultural pressure to be thin (Fallon, Katzman, & Willie,1994). After assessing large numbers of eating disordered
teenagers over a period of years it is was found that while these factors are important, there appear to be other routes into anorexia nervosa. This article discusses three separate cases that appear to have started from dental procedures. These three cases were followed for two years and are three patients out of one hundred that have an eating disorder.
In the first case a twelve year old girl presented with a 9-month history of weight loss following a visit to the dentist where she required a filling and her first dental local anesthetic, an experience which she strongly disliked. She was advised to stop eating sweets between meals to avoid further
similar problems. She did so, but then progressed to not snacking between meals and reducing her meal portions. Shortly before the onset of her eating disorder she had experienced some bullying at school and her pet dog had died, so it is not solely linked to her dental experience.
In the second case a sixteen year old girl presented with a 2-year history of food related difficulties. The difficulties were linked to a dental surgery and fitting of a dental brace to re-align her teeth. Her mouth had been sore following this making eating painful and in addition she remembered being advised to avoid sweet foods. She had already tended to avoid unhealthy foods and responded to this advice by doing this more. She probably never resumed a
normal diet from this point. Although, her weight didn't become a major concern until the added stress of school exams was added to the equation.
In the third case a fourteen year old girl was showing signs of weight loss after having braces put on. The braces were initially tight and made it difficult to chew resulting in her eating mostly soups and soft food. A friend told her that wearing braces might result in her losing weight. She reduced what she ate and increased her exercise level. She complained of feeling fat, and she used the discomfort of the braces as an excuse to not eat.
There is very little on the relevance of dental intervention to the onset of anorexia nervosa. The three cases described illustrate that dental
intervention can precipitate the dietary restraint and consequent weight loss that may lead to anorexia nervosa. All three began losing weight after dental interventions (Jaffe, 2006). All three patients progressed from weight loss due to factors associated with teeth to a more typical anorexic picture, although the time scale varied.
I think it is very important for dental professionals to be aware of how sensitive young people are about their appearance and weight. I think it is also very important to be extremely clear with the patient about what limitations are given about their diet. I think diet and nutritional counseling would be an v important thing to incorporate in all adolescent dental visits. It is also important to discuss with the parents that there may be some discomfort after dental treatment, but to give them a realistic idea of how much pain their child will be in and to watch for signs of them avoiding food.
Personal Reflection:
I chose to use this topic because I had a very close friend in high school that had an eating disorder and I watched her struggle to overcome it. It is a constant battle for her and when she is under large amounts of stress she still has to pay very close attention to her weight to make sure she continues to eat. If eating disorders are caught early then people are able to get the counseling and help they need and tend to have an easier time overcoming the issues. I think it is important for dental professionals to be able to recognize signs of eating disorders because we have the power to be the change agent that could save a life.
Additional Information:
Below are a few websites that have a lot of good information about eating disorders and how to care for your teeth if you have an eating disorder. There is also information on how to find help if you have an eating disorder.
http://www.ada.org/3104.aspx?currentTab=1
http://www.ncbi.nlm.nih.gov/pubmed/18997921