A smile: the untold cost of an eating disorder

A smile: the untold cost of an eating disorder

I’ve been self conscious of my smile all my life. During most of my childhood this feeling had nothing to do with my teeth – I was convinced there was something wrong with my face and that I looked stupid when I smiled. There isn’t anything wrong – it’s simply that my mouth is a shape that means I can’t give a toothy grin, no matter how hard I try. Not a ‘nice’ looking one, anyway. I used to get yelled at constantly to ‘smile’ when dancing, to ‘show my teeth’ and that made me super aware of my ‘flaw’ to the point that I spent countless hours practising in the mirror and trying to stretch my mouth so that it would SMILE.

-“F”

Dentists want to help people who have eating disorders. We have a chance to tell them what it feels like when our eating disorder starts to ‘eat’ and destroy our teeth. On April 5, I will co-present with Prof. Susan Paxton at the 35th Australian Dental Congress in Melbourne. Our presentation is listed on the main scientific program.  Our topic is: Reflux and related diseases. I invite you to share your dental experience to help dentists know how to help others. Your details will remain confidential.  Email: june@junealexander.com

Today, ‘F’ generously and candidly opens up her heart to share her experience:

These days as an adult, I smile differently. On reflection I can see that, from a very young age, most of my smiles were acting – they were not spontaneous, they did not emanate from my heart or from happiness. Whereas now, when I smile, it’s because I am smiling on the inside too. And somehow, not being able to smile ‘properly’ doesn’t matter any more. A smile is more than just your teeth, it’s your whole face, your eyes; the sparkle. It’s how I connect with a stranger or a friend – a smile says a thousand words and breaks down many barriers.

I never had a single filling growing up. My teeth were always ‘perfect’. They were small, and not to my liking aesthetically, but perfect teeth for which to be thankful. Towards my later teen years, years before I made myself sick for the first time, my teeth had already started to crumble. I can only surmise that perhaps it was for the same reasons my bones deteriorated – malnutrition plus years of a very protein-heavy diet regime. I’ve since heard that such a regime makes you excrete calcium. And then there was my massive consumption of diet drinks. My front teeth became very weak and started to crumble like chalk. The first chip started a landslide of other breaking bits while the rest of my teeth became extremely sensitive and painful.

My first trip to a free community dentist was panicked. I was sure I was going to lose my teeth, and I felt guilty, even though I wasn’t vomiting, because deep down I knew it was my fault. Thankfully the dentist said I had no cavities and a good set of teeth, although some were rather transparent and had some chips off. I celebrated by promptly forgetting my fears, telling myself I was being silly to worry so much; after all, it was only people who vomited who had teeth problems. I’d been terrified that my eating disorder would be ‘discovered’ too, and was relieved that it wasn’t. My GP knew, my ED treatment team knew, but I didn’t want other people to know, so deep was my shame.

Over the next couple of years I started vomiting and my teeth went to hell. I also spent a lot of time in hospital constantly drinking supplement drinks like resource plus, ensure plus, Sustagen and similar, mainly containing large amounts of sugar – and I tended to sip them through a straw but keep the drink in my mouth, often not having the courage to actually swallow the liquid right away.  I ended up with several broken or crumbled top front teeth, of which I was extremely self-conscious and broken hearted about. I also regretted that I’d ever complained about my good teeth before. I wished I’d been thankful for them and taken better care of them. Being unwell meant I didn’t go to the dentist because I was always in hospital or between admissions, too fatigued or weak, and far too ashamed. I’d been self-conscious of my smile before, but now I constantly covered my mouth, and avoided smiling or laughing, even covering it when I spoke.

I also had problems with my wisdom teeth – all four were impacted and I was in a constant cycle of them breaking the skin, becoming infected, healing up, and starting again I was told that the infection went to the jawbone and there was no way to clear it up without actually removing the teeth and infected area. There was a LOT of pain from every other tooth in my mouth too, and constant sores and infections. My use of over-the-counter pain medication became ridiculous. I adapted to eating differently – chewing with my back teeth or on the least sore side, and avoiding very cold or very hot foods and drinks.

I actually did end up venturing to the dentist for help with the wisdom teeth but was told I was too underweight to safely have them out. Also I couldn’t be managed at the dentist facility but would have to have them out in hospital under a general anaesthetic for my own safety. I was referred to the maxofacillal (of or relating to the jaws of face) unit of the hospital and put on their waiting list. I kept coming up for consultation, being told I was too underweight and put back to the bottom of the list over the next at least five painful years. I remember one consultant always saying when I turned up there that he could still blow me off the chair with one puff, so I couldn’t have the operation yet.

Finally I gained just enough weight to have them taken out, and in a single surgery had all four wisdom teeth out plus four stubs of my former front teeth. Recovery was hard and quite painful, especially as I found myself purging even when I had stitches still in my mouth, not even 24 hours later. I was lucky to not do any damage or cause infection.

I returned to the dental hospital and was assigned a lovely female dentist, who I have kept seeing for four or five years now. She knows about my eating disorder and is matter-of-fact about it. I think her knowledge from working with cancer patients and other patients who have problems with vomiting for other reasons, and with dry mouth/lack of saliva (can also lead to problems) meant she was less likely to be shocked by my teeth and more able to accept the damage as being a result of having a serious illness and not something I was easily able to just stop. Luck is part of it too – she just happens to be an unusually gentle and compassionate lady. Over many sessions she has filled in countless cavities, and constantly refilled them as the fillings constantly come loose and fall out. She’s never frustrated or judgemental and she has always had good advice for me as well as encouragement to keep fighting and not let it get me down too much. Dentures were made to replace my four top teeth and, while I find very awkward to eat with these, they do wonders for my feelings of self consciousness about my mouth and have allowed me to talk, smile, and laugh without having to hide it. Some day I hope to be able to save up and have implants but that’s a long way off and impossible until I’m over the ED.

I’ve been fortunate to be eligible for free dental care at a university dental school in Queensland, which can be accessed by those with health care cards or pension cards, but I hate to think of what this would have cost otherwise.

I also have severe reflux and have had a stomach ulcer identified in the past, so that is also something I identify with, but that’s another story.

Dentists – what to say

People with eating disorders will find it easier to approach dentists who are compassionate and non-judgemental. If the patient is upfront about having an eating disorder, reassuring them that they are not alone, and that they are not ‘disgusting’ might help. Offer strategies to help, for example, my dentist recommended a very high fluoride toothpaste only available over the counter, gave me some samples of other toothpastes that might help in my situation, recommended rinsing every time I purged and using bicarbonate of soda in water to rinse. Approaching the patient’s dental health like a joint project will be helpful – avoid telling them off or telling them to ‘just stop’ what they are doing, because that’s not helpful and if they could just stop, they wouldn’t be there with these problems. And they already probably beat themselves up about it more than enough without other people joining in.

Scheduling regular appointments – every couple of weeks – to both clear a backlog of work to be done if their teeth are in poor shape, and to continuously be monitoring and patching them – is a good idea. Unfortunately dental work is undone far too easily and regular appointments might be necessary to try and keep on top of that deterioration – also if they know the dentist is on their side and they won’t be reprimanded for damage to dental work, the patient is more likely to seek help when they need it rather than wait and have it deteriorate more.

If the patient isn’t been upfront about having an eating disorder, I think that asking them kindly if they are sick a lot is probably all that’s needed, and then telling them why, the effects it is having on their teeth, and following much the same sort of strategies as above. My dentist asked me the first time I had an appointment with her if I vomited a lot, and I didn’t feel judged.

She simply stated that she sees a lot of people who throw up for whatever reasons (e.g. chemotherapy) and went on to talk about the effects of throwing up a lot and the strategies I could use to help myself. When the eating disorder sufferer realises they will not be condemned by their dentist, they will feel greatly relieved and may feel confident enough to confide more about it. Asking if they are under the care of a doctor for the eating disorder and, if they are not, referring them to one is very important.