Dental fear, regularity of dental attendance and subjective evaluation of dental erosion in women with eating disorders

Abstract

This questionnaire study, with a response rate of 53%, examined self-induced vomiting, erosions and dental attendance in women with eating disorders (EDs) as well as dental fear and its effect on attendance and communication with the dentist. A survey of 371 responding women with EDs, who were recruited from a self-help organization, revealed that dental fear was higher in women with EDs compared to the general population. Dental fear was present in 32.1% of women with EDs, and very high dental fear was present in 16.5% of women with EDs. Of those with very high dental fear, 32.3% had not visited a dental clinic at all in the preceding 2 yr, and 43.5% only initiated contact when they had symptoms. Self-induced vomiting was especially frequent in women with bulimia nervosa (87.9%) and in those with more than one ED (the 'mixed group') (80.6%). Among those with self-induced vomiting, 45.3% thought that they had erosions, although only 28.4% had erosions diagnosed by a dentist. Of women with EDs, 61.4% failed to disclose their condition. High dental fear did not affect willingness to disclose the ED. We conclude that dentists should examine ED patients carefully for dental erosions. Moreover, they should realize that most ED patients avoid disclosing their disorder and that dental fear further complicates dental treatment in these patients.

Access to special care dentistry, part 6. Special care dentistry services for young people

“…83 Willumsen reported that 75% of women who have reported abuse that included oral penetration had high levels of dental fear. 22,83 The ability of these individuals to accept minor or major discomfort associated with instru ments in the mouth was reduced and feeling unable to breathe and/or severe gagging or choking interfering with treatment delivery were increased. 71 It is also important to note that men who have experienced CSA are more likely than women to have experienced abuse involving oral sex.…”

“…82 It is well reported that, although often suffering from poor self-esteem and confi dence, they need total control in stressful situ ations to be able to cope. 22,71,83 Dealing with dental treatment is difficult for all the reasons mentioned, plus the fact that the experience may provoke symptoms of post-traumatic stress, fl ashbacks and dissociation. 81 Interestingly, women who report dental fear and sexual abuse are often unaware that their dental fear may be related to the CSA.…”

“…Self-induced vomiting is common, with 88% of women with BN and 81% of women with more than one eating disorder practising this behav iour. 22 The pattern of erosion has been classically described as affecting the palatal and labial surfaces of the upper teeth secondary to vomiting, refl ux and regurgitation (Fig. 2).…”

“…22,71,[80][81][82][83] As yet, most of the studies are relatively small, no doubt diminished by rare disclosure to dentists and repres sion of CSA experiences, 83 but clearly women with a high degree of dental fear are more likely to have been victims of trauma (childhood neglect, sexual molestation or rape), 80 with up to 34% of them reporting a history of childhood molestation, attempted rape or incest. 81 Parallels have been drawn between the long-term effects of CSA and the spe cifi c factors that lead to increased stress being in a horizontal position, feeling claustrophobic, being alone with some one more powerful, loss of control and anticipating or experiencing pain.…”

“…Co-operation is essential, as patients with eating disorders have greater levels of dental anxiety than the general population and a high propor tion only attend the dentist when they have symptoms. 22 The primary goal of dental care is to preserve the remaining teeth and to prevent further erosive loss of dental hard tissue.…”