By Marianne Lincoln

This is the third in a series of stories from the Pierce County Oral Health Summit.

Dr. Dave Hansen DDS along with many attendees learned a new word, cariology. As defined: car·i·ol·o·gy (kâr’ē-ŏl’ə-jē) n. The study of dental caries and cariogenesis.

He began his discussion with the observation, “If you stick around long enough, everything you know becomes wrong.” With the advancement in techniques, treatments and scientific knowledge, this may appear to be true in dentistry as well as other career fields.

His presentation and photos were about the detection and treatment of (mostly) girls and women with eating disorders involving purging. Gastric juice, as compared to acidic consumables like soda pop, produces differing manifestations on tooth enamel. GERD (Gastro esophageal reflux disease) & Bulimia are very harsh on teeth, but affect different locations within the mouth. All cause forms of enamel erosion.

His recommendation, if you drink sodas, have GERD, Bulimia or other purging diseases, rinse your mouth out with water afterward. Do not brush your teeth until about 30 minutes after rinsing. The acid in your mouth rubbed around with the toothbrush speeds up the abrasion. Many people brush their teeth right after vomiting; they need to change this habit. He noted that pH is part of the equation. Gastric fluid and battery acid have about the same pH, but gastric fluid is more concentrated and erosive to tooth enamel.

There is a long list of eating disorders and the list appears to be growing. Here are a few he mentioned: Bullimia Nervosa, Anexoria Nervosa, Orthorexia (obsession with eating healthy food,  isolation, usually have OCD), Binge (compulsive eating, obesity), Purging disorder (no bingeing), Muscle Dysmorphia (Bixorexia, BDD) and Diabulimia (insulin deprevation). Here is a link to an organization in Seattle called National Eating Disorders Association (NEDA) that helps people with these conditions.

Dr. Hansen said, “Marilyn Monroe could not get a job today, she’d be asked to lose weight.” Body hatred starts early, often in girls just as they reach puberty and their bodies begin to develop curves. There are even websites that help them maintain their eating disorders and give tips for fooling doctors. Early intervention is very important and dentists, if they know what to look for, have the opportunity to catch this condition and forewarn unsuspecting parents.

Dr, Hansen was asked how to approach parents on this topic as dissemination of this condition is a delicate matter. He noted that early intervention was very important. He recommends having a discussion with the patient or parents (if the patient is under 18). Explaining the reasons for enamel loss, referring them to appropriate specialists and being cautious not to alienate patient are important. Help the patients understand how to protect their teeth. If the patients are in a moderate to severe stage of the disease, their condition is quite serious. Dispense written information and suggest they get help.

As his presentation continued, he had photos of a patient’s mouth from beginning stages to advanced stages of decay from bulimia. He had several discussions with this patient and suggested she get treatment for her condition. Once she provided evidence that she was significantly improving with her disease, he agreed to replace all her teeth with implants of pretty white teeth. But over time, erosion began to show up again.

At this point Dr. Hansen showed a bit of emotion. The audience of dentists, hygienists, nurses and health administrators was touched by his concern. As it turned out, this patient was a friend of the family, which is why he had access to extensive information on the condition and treatment. Like Karen Carpenter and several famous people with this condition, it is eventually fatal. He showed a photo of this lovely young lady. It is amazing how such a beautiful girl can have such a problem with her appearance. After hearing earlier from another dentist about the problems with obesity, the audience realized that criticism toward overweight and obese people can backfire. There is no perfect body type and being sensitive not to be derogatory about a person’s appearance can be beneficial to their health. The quest toward the perfect skinny shape is not necessarily healthy either.

Of particular note, Dr. Hansen showed some photos of professional models with serious underweight problems. As health professionals, he noted, it is important to encourage a healthy lifestyle, not a particular body shape.  As he wrapped up his remarks, he pointed out the treatment for bulimia has about a 50% failure rate.