What society holds up as beautiful in men and women is often unrealistic, and in the modern age of computer-altered images and airbrushing, those ideals seem virtually unattainable for most people.

The pressure to be perfect is especially difficult for people with body dysmorphic disorder (BDD). While most people focus to some degree on their appearance, those with BDD are obsessed with their perceived flaws.

With the number of elective cosmetic dentistry procedures being performed on the rise, dentists may be the first health care provider to notice BDD and intervene, according to a study in the March/April 2003 issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).

Chris Herren, DMD, co-author of the study, became interested in the disorder after dealing with a patient who displayed symptoms of BDD. The patient wanted whiter teeth and insisted that the teeth were too dark, regardless of the number of bleaching procedures performed.

For reasons unknown to Dr. Herren, the patient broke down and admitted that teeth whitening had become an all-consuming obsession. "The floodgates opened," he said. "The patient broke down and started crying."

A dentist who suspects a patient is suffering from BDD will recommend a physician to properly diagnose the problem, since symptoms are similar to personality traits of a person unusually meticulous about their appearance.

Signs of BDD:

•  Distress over a minor physical flaw
•  Difficulty functioning because of obsession with flaw
•  Excessive behavior related to flaw
•  Believes others treat him or her differently because of flaw
•  Requests unneeded or excessive treatment of the flaw
•  Unrealistically dissatisfied with results of treatments and procedures or unable to verbalize expectations