Discovering signs of eating disorders

NICK EICHER, HOST: It’s The World and Everything in It from member-supported WORLD Radio. Today is Thursday, April 5th. Good morning, I’m Nick Eicher.

MARY REICHARD, HOST: And I’m Mary Reichard. The acronym ANRED stands for Anorexia Nervosa and Related Eating Disorders. It’s a group that estimates that 8 million Americans suffer from an eating disorder. Seven million of those are female. And about 95 percent are between the ages of 12 and 25.

EICHER: People who suffer from anorexia or bulimia are often secretive. Even their parents may be unsuspecting. But there’s one profession that uncovers the truth in one out of four bulimia cases—and it’s not one you’d expect.

REICHARD: WORLD Radio’s Laura Finch brings us the story.

LAURA FINCH, REPORTER:

AUDIO: If it’s going to overwhelm you, don’t worry about it…. But good news is, no cavities, so there’s good news there.

Erica Kight has been a dentist in the western suburbs of Chicago for six years. She practices what she calls “non-judgmental” dentistry.

AUDIO: People are not themselves in the dental chair. They’re scared. And they don’t know what’s going on. So if you can take away that unknown feeling, and come in and be warm, and friendly and welcoming the whole experience is going to be way more enjoyable for them.

Like any dentist, she takes care of patients with cavities and receding gums. She even mills crowns using the latest technology.

AUDIO: Rhythmic milling sounds

It involves a 3-D model and two tiny drills that carve away on a block of porcelain about the size of a tooth.

AUDIO: This is the opposite of printing, its reduction. So there’s this block, and it’s taking away anything it doesn’t need. And in the end, there will be the crown.

And sometimes she sees troubling symptoms on the backside of the patient’s top teeth. She explains.

AUDIO: When in a normal situation, people swallow their food, and they keep it down. That’s the ideal situation. When it comes to eating disorders, particularly in bulimia, a lot of the acid comes up as well and that will really start to damage the teeth. We are going to see as dentists, specific spots on the teeth. 

A patient with bulimia binges on high sugar foods like ice cream. And then throws up. It may be a few times a week… or up to 5 or 6 times a day. And all that vomit takes its toll on teeth.

AUDIO: Teeth are coated in enamel, which is white. The next layer under enamel is called denton. And it’s yellow.

Stomach acid eats away the white enamel–even though enamel is the hardest substance in the body.

AUDIO: So what we see is when that enamel wears away, you wear away to the next layer, which is the denton, which is yellow. So when I see yellow, it’s a red flag, or a yellow flag. I’m scared. 

It’s especially scary when the patient is young because the denton is softer than enamel and erodes about 7 times faster.

AUDIO: They have a whole lifetime they’re going to be wearing away denton, more of that denton. So even regular foods will eat through that a lot faster. So it’s scary, when you see that in young patients.

When Kight sees those suspicious spots, she doesn’t want the patient to become defensive. So that’s where the non-judgmental philosophy comes in.

That initial conversation is actually easier when teens come in for a cleaning without their parents.

AUDIO: So that’s when you actually have a chance. If the parents are there—forget it, you’re not getting anything out of them.

But when a patient is younger than 18, dentists are ethically required to inform parents. Kight recalls one clear case of bulimia in a young patient.

AUDIO: It was a 17 year old, and so you know, I talked with them, and very—I tried to be as warm and friendly and nonjudgmental as possible, but I mean clearly shutting down. Wanting nothing to do with me. 

So Dr. Kight brought the mom back and told her what she was seeing.

AUDIO: It was the first time the mom had any idea this was going on. I said to the patient I’m sorry, but I care too much about you to let this go. And the mom, you could see the light bulb go off, and she was seeing it, and she was like yes, this is an issue.

Once the enamel has eroded away it can’t be restored. And regular fillings won’t adhere to denton.

AUDIO: So a lot of times you’re looking at full coverage crowns. It’s always tough as a dentist when you have to do a major crown on a tooth that has no decay. But it’s still a damaged tooth, so you have to treat it in that manner.

When Kight sees evidence of an eating disorder, she recommends counseling… because her diagnosis is only the beginning.

In extreme cases, a patient may need a full set of either crowns or dentures—one for every. Single. Tooth. That’s rare, but it does happen.

Kight is passionate about spotting danger signs, partially because of her two daughters. The oldest just turned 4.

AUDIO: When you have those hard conversations, you just think, ok, if this was Addison, if this was Sadie, I would absolutely want to know. But it’s hard. It’s really hard.

AUDIO: Air sounds

For WORLD Radio, I’m Laura Finch reporting from Geneva, Illinois.

(Photo/Laura Finch)

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