“There is no sincere love than the love for food.”

                                                                   -George Bernard Shaw

How true! But when this love turns into obsession it becomes a disorder! Eating disorders are considered by many as lifestyle choices. But it is much more than that. In fact, eating disorders are described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) as a psychological condition. Eating disorders are actually a reflection of various psychological conditions which leads an individual to indulge in unhealthy and obsessive eating habits. 

How do eating disorders reflect in the mouth?

A person with an eating disorder may portray a happy picture and try to escape from everyone including the doctor, family, friends due to his or her extreme emotional upheaval. But such people cannot hide anything from their Dentists. Their teeth speak much more than they eat! According to National Eating Disorder Association, 2002, 89% of people with bulimia nervosa, a type of eating disorder show signs of oral health deterioration. Another important finding from the Institute of Dental Research states that almost 28-30% of cases of bulimia nervosa are recognized first during the dental examination. Youngsters, teenagers, and women are the common victims of eating disorders and hence present with a host of dental problems too!

Let’s look at different types of eating disorders and their influence on oral health

Anorexia nervosa and it’s ill effects on oral health

Anorexia nervosa is a complex psychological condition involving emotional challenges, unrealistic body shape and image issues, and an exaggerated fear of gaining or losing weight. Individuals suffering from anorexia nervosa have a tendency to maintain extremely low weight under pressure to maintain body image which is far from reality. As a result, these individuals devoid themselves of high nutritional food and required calorie intake. They literally starve themselves to maintain the perfect body weight or even exercise vigorously. At times, such individuals eat uncontrollably and then attempt to get rid of the food by vomiting. Thus, due to extreme starvation and vomiting they suffer from extreme nutritional deficiencies.

Dental problems that arise with anorexia nervosa

• People with anorexia starve themselves to the extent that they have nutritional deficiencies which leads to an array of oral problems. Deficiencies of calcium, iron and vitamin-B can have a damaging effect on oral health. Poor oral health can manifest into gum problems like bleeding gums, swelling, and repeated infections of the gums.
• Iron deficiencies can lead to burning or painful mouth, cracked lips, frequent oral ulcers, dry mouth and fungal infections.
• Such deficiencies hamper the self-repair and regenerative potential of mouth.
• Erosive tooth wear or loss of tooth structure due to forceful vomiting is the most common oral sign of an eating disorder.
• Loss of jaw bone or osteoporosis is a major finding in patients with anorexia nervosa due to lack of adequate nutrition. Such patients have weak jaw bone and can be easily prone to infections or fractures.
• Research has shown that the occurrence of periodontal diseases or chronic gum problems is at a much higher rate in such patients as compared to normal individuals.
• Dry mouth, reduced salivary flow, poor oral hygiene, and denial of dental treatment by such individuals can lead to multiple dental caries.
• According to statistics, 43% of patients suffering from anorexia nervosa reported bleeding gums typically after tooth brushing as their chief complaint.
• Another study reported that almost 37% of patients reported extreme teeth hypersensitivity due to loss of tooth structure caused due to forceful vomiting.
• Most of these oral problems cause pain, discomfort, loss of function, and unpleasant appearance of teeth which can severely hamper an individual’s self-esteem.

Struggle with Bulimia nervosa shows in the mouth too!

Bulimia nervosa is a serious and potentially life-threatening eating disorder characterized by intermittent periods of binge eating and self-induced or forceful vomiting called purging. Individuals suffering from bulimia often times binge to eat in less than 2 hours. Young adults and women are more susceptible to bulimia. How does Bulimia nervosa manifest in the mouth?

Acidic wearing off the enamel layer of the tooth ( tooth erosion) is the common oral feature seen due to purging. Frequent vomiting leads to the continuous flow of acidic gastric contents over the teeth. As a result, the outer layer of teeth i.e., enamel gets dissolved due to the mechanical and chemical effect of the highly acidic vomit of the person.

The upper and lower front teeth are usually affected the most. The thinning of tooth structure is more visible on the inner and biting surfaces of upper and lower teeth. The excessive erosion of the enamel layer of the tooth leads to a change in size, shape, and structure. As a result, the teeth look more uneven and crooked. Frequent eating and vomiting cycle can cause enlargement of the major salivary glands. Statistics reported 27 out of 41 patients with bulimia nervosa with a visible swelling on both sides of the face.

Few patients with bulimia also presented with a condition called ‘sialadenosis’, which is swelling of the salivary glands. Salivary gland swelling leads to a considerably decreased flow of saliva in the mouth. At times, the salivary flow is reduced to an extent where a person can experience dryness of mouth, a condition called as ‘dry mouth’.

People suffering from bulimia tend to eat a lot of unhealthy and junk food. In addition to that due to reduced salivary flow, such people are more susceptible to ‘dental caries’. Natural hydration and hygiene of the mouth is maintained by saliva, but due to decreased saliva, the chances of dental cavities increase in people suffering from bulimia.

Advanced gum problems are commonly seen in such patients due to poor oral hygiene practices.

Trauma to the soft palate, pharynx and other parts of oral cavity is almost a universally recognized feature because such patients tend to put external objects in their mouth to induce forceful vomiting.

Cracked corners of lips coupled with fungal infections like ‘oral candidiasis’ is an early marker of poor oral health of bulimia patients.

How can your dentist help you

• The Dentist is usually the first clinician to recognize if the patient is suffering -from any eating disorder. Your dentist cannot deal with the underlying psychological problem but can definitely provide a comfortable and friendly atmosphere for you to feel more relaxed. 
• Patients with eating disorder generally are very hesitant to talk about their problem and try to avoid giving a proper medical history. In such case, your dentist will encourage and motivate the you to speak and help address the real issue along with the other dental problems.
• A dentist can also help you get out of the denial mindset regarding seeking oral care and can provide optimum guidance and care related to oral health issues.
• They also help dealing with certain coping mechanisms and useful tips to practice home remedies for maintaining a good oral health.

A good oral care is a must

• It is essential to rinse the mouth thoroughly after vomiting episode with simple tap water to wash off any excess acidic content of the vomit.
• Daily use of fluoridated mouthwash under a Dentist’s recommendation can be very helpful.
• Erosion cavities developed due to loss of tooth structure should be closely monitored and if required can be treated with restorative procedures.
• Dentinal hypersensitivity can be minimized by use of appropriate Dentist-recommended desensitizing pastes.
• Fluoride varnish applications can be considered to remineralizer the lost tooth structure due to frequent vomiting episodes.

Highlights

• Eating disorders like anorexia nervosa and bulimia nervosa are complex health conditions developed due to multiple factors majorly due to emotional imbalance in a person.
• People suffering from eating disorders have an array of unattended dental problems.
• Typical dental problems seen in patients with eating disorders are teeth erosion, dental caries, chronic gum problems, salivary gland swelling, dryness of mouth, cracked lips, oral fungal infections, ulcers etc.
• Oral cavity is often times the first site to display clinical signs of eating disorders.
• The role of a Dentist is very pivotal in the recognition and proper treatment of oral diseases occurred due to eating disorders.