title: Communicating effectively with patients suspected of having bulimia nervosa.
abstract: BACKGROUND
  The dental team often is confronted with the clinical appearance of erosion affecting the hard and soft oral tissues. An investigative process often is needed to determine the cause of such erosion, because factors other than eating disorders may be involved. The authors present a protocol that should be considered in the assessment of dental erosion. Guidelines provide direction for the clinician toward opening a dialogue with a patient when the suspected cause of erosion is an eating disorder.
  
  
  METHODS
  The authors review publications related to the causes of dental erosion and the patterns that are involved with both chemical and mechanical destruction of oral tissues. They also discuss the oral-tissue effects related to eating disorders. The authors stress the importance of assisting parents in obtaining adequate treatment for pediatric patients.
  
  
  RESULTS
  Cases of eating disorders among female college students, athletes, preadolescent children and men are well-documented. However, dental staff members often do not feel comfortable beginning a dialogue with patients who are suspected of having an eating disorder. This article focuses on the proper protocol for approaching such patients and beginning a dialogue. In addition, the authors provide suggestions for limiting further erosive damage to the tissues. They also discuss other causes of erosion that should be considered when assessing any type of oral erosion.
  
  
  CONCLUSIONS
  The dental team is in a prime position to assist patients who have eating disorders. Timely treatment by mental health and other medical professionals is crucial. The authors suggest a dialogue for approaching these patients and offer educational material to reduce further tissue destruction.
authors.affiliation: Baylor College of Dentistry, Department of Periodontics and the Stomatology Center, Dallas, USA. nburkhart@bcd.tamhsc.edu
authors.forename: Nancy
authors.initials: N
authors.lastname: Burkhart
authors.forename: Michael
authors.initials: M
authors.lastname: Roberts
authors.forename: Matthew
authors.initials: M
authors.lastname: Alexander
authors.forename: Anne
authors.initials: A
authors.lastname: Dodds
mesh_terms: D000293:Adolescent; D000328:Adult; D001828:Body Image; D002032:Bulimia / Q000150:complications* / Q000523:psychology*; D002648:Child; D003142:Communication; D003812:Dentist-Patient Relations; D005260:Female; D006801:Humans; D008297:Male; D014077:Tooth Erosion / Q000209:etiology* / Q000517:prevention & control