The aforementioned objectives may be achieved by (a) holding warm eye contact with the patient, (b) maintaining relaxed facial muscles, (c) smiling, and (d) occasional nodding to indicate that you are listening or empathizing with the patient’s difficulties.

The dentist must also consider the patient’s feelings about, as well as the motivation to rectify, the dental erosion problems. This consideration is particularly important for patients with eating disorders. A “pushy” dentist would provoke resistance. In particular, the eating disordered patients may have mixed feelings and ambivalence in disclosing or seeking help. A strategy opens to the dentist is make explicit a dilemma in the patient’s mind. The dilemma being whether (a) to live a healthy life/good teeth and cope with body image or (b) to self-inflict harm as a result of restraining her/his diets. At the same time, the dentist suggests a means to resolve the dilemma.

Every patient has his or her own pace of processing information. DiClementi and Prochaska [20] put forward the Stages of Change model (see below). The model is a very effective way of conceptualizing a patient’s motivation. The model is, moreover, particularly appropriate for dental patients with addictive behaviors (e.g., substance abuse, excessive gambling, excessive intake of alcohol, obsessive rituals, eating problems).

Patient A, in the first, precontemplation, stage has no insight, but denial of any problems. Patient A would be resistant to any treatment by a dentist because she/he does not realize (a) that there is any underlying psychological problem and (b) how dental health may be affected by psychological difficulties.

In the second, contemplation, stage, Patient A has a feeling of ambivalence about seeking help. The second issue is the onset of severe pain due to dentin hypersensitivity. A knowledgeable and friendly dentist may prompt Patient A to explore the possible causal link between (a) maladaptive behaviors (like eating disorders or addictive behaviors) and (b) serious dental problems. Patient A begins to consider how the tooth erosion problem can be helped by dealing with the underlying causes of his or her maladaptive behavior.

Patient A is now prepared to “face the challenge,” and Patient A becomes more receptive to the dentist’s suggestions. Preparation is the stage in which patient is convinced of the necessity of receiving both dental and psychological treatments. The success of preparation depends on the support and reassurance offered by the dentist (as well as cognate health professionals).

The next step for those with eating disorders and alcoholism is (i) to discuss the problems and (ii) to set targets for change with full commitment from the patient to be referred to the clinical psychologist or psychiatrist. These patients need constant support and empathy from other people in addition to a lot of courage from themselves.

Whether or not a patient is having some general symptom of depression may be ascertained with the questions tabulated in Table 11.1. If they answer “yes” to more than seven questions, it is appropriate to suggest that the patient may have some depressive symptoms which may contribute to the dental problem. After getting a fuller history, the dentist may suggest referrals to her/his doctor.

Whether or not a patient is having some eating disorders may be ascertained with the questions tabulated in Table 11.2. At the end of the assessment, the dentist is in a better position to identify and draw an approximate profile of the patient’s eating problem behaviors and elicit some of the full story.