For many people, eating disorders are part of every day life. These abnormal eating habits may involve either insufficient or excessive food intake to the detriment of an individual’s physical and psychological health. The resulting effects of the dietary issues involved directly and indirectly relate to oral health problems.
Common Types Of Eating Disorders
-Anorexia Nervosa (commonly called, ”anorexia”) - This eating disorder is characterized by a refusal to maintain a healthy body weight, an obsessive fear of weight gain, and an unrealistic perception of current body weight. Anorexia can cause menstruation to stop, and often leads to bone loss, loss of skin integrity. It is a big stressor on the heart, there is an increase in the risk of heart attacks and related heart problems. This disorder also presents with an increased risk of death. Peer pressures play a role in an individuals’ obsession with their outer appearances. Recent research suggests it is not only about a person’s outward perception but genetics may play a role in the disease process.
-Bulimia Nervosa (commonly called, “bulimia”) – This eating disorder is characterized by recurrent binge eating followed by purging. The purging can include self induced vomiting, excessive use of laxatives/diuretics, or excessive exercise. Fasting may also be used as a method of purging (self inflicted vomiting) following a binge.
-Compulsive over-eating- This eating disorder is characterized by eating large quantities of food even when not feeling hunger. The food is generally consumed quickly and often with little to no regard for proper nutrition.
Dental Issues That Arise From An Eating Disorder
Tooth Enamel Erosion and Tooth Decay – It is quite common to see an increased incidence of tooth decay in all forms of eating disorder. It is also not unusual to see very extensive decay that leads to tooth loss. For bulimic and over-eaters, high calorie, high carbohydrate foods put the enamel at risk due to increased sugar levels in the mouth. Vomiting (either self inflicted or from eating an enormous amount of food) exacerbates the problem by incorporating stomach acid into the oral environment. Anorexics are also prone to regurgitation of stomach acid due to lack of food in the stomach.
It is quite common in patients with an eating disorder to need extensive dental work over and over again. This is especially true to the backs of the teeth, (facing the tongue) since these surfaces would be exposed the most to the stomach acids released from vomiting. The gum lines of teeth are also prone to decay when habits of snacking through the night and not brushing occur frequently.
Soft Tissue Damage – The force of repeated vomiting also takes a toll on the soft tissues in the mouth. This can result in swelling of the tonsils and the uvula in the back of the throat. Another indicator of an eating disorder may be a red and swollen tongue or a lacerated palate caused by vomiting induced by placing a finger into the back of your throat (fingernails and other implements will damage the palate).
Other Eating Disorder Dental Issues Include:
-Gum pain
-Chronic sore throat
-Inflamed esophagus
-Palatal hemorrhages
-Decreased saliva production - leading to dry mouth (xerostomia)
-Enlarged Parotid glands
-Problems swallowing
-Jaw alignment abnormalities
Dental Treatment Options
An eating disorder is a major health issue and create all kinds of problems both to our dental health and systemic health. Communication is important to not only get help to overcome the disease but also to get proper dental treatment.
Dental hygiene becomes extra important in patients with an eating disorder because some of the damage from stomach acids in the mouth can be minimized if patients brush, floss, and rinse following vomiting. This can lessen the effect of the acids on the teeth. Damage will still be done if the habits remain for long or short periods of time.
Standard dental treatment for an eating disorder can include:
-Dental Fillings
-Root Canal Therapy
-Tooth Extractions
-Periodontal Surgery
Eating Disorder Conclusion
An eating disorder is a very difficult disease to diagnose and treat. Dentists need to know the warning signs to be able to get patients in need to seek proper help. Eating disorders can ultimately kill and should not be taken lightly. The dentist should be able to speak openly about oral symptoms of eating disorders if signs are present. This is a difficult topic to discuss for most but is nevertheless important. The patient must feel comfortable enough with their dentist to tell them they think they have an eating disorder. The dentist should be clear about everything, portray empathy and care at every opportunity. Body language is very important. Trust between the dentist and patient is very important to establish before moving on.
Once habits are addressed, treatment and restoration of healthy teeth and smile go hand in hand.. The power of a beautiful, healthy smile can do wonders do our emotional well being. A positive self-image and self-esteem are critical for recovery from bulimia and a restored, healthy smile is evidence of those feelings. Does having a new smile help that process? Absolutely. It has been shown time and again to be life changing. Even more important is restoration of the teeth to a healthy state so that the patient can eat without pain and regain health.