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Posts for tag: eating disorders

By John G. Fisher, DMD
March 10, 2015
Category: Oral Health
EatingDisordersMayContributetoDamagedTeethandGums

While most dental problems are caused by disease or trauma, sometimes the root problem is psychological. Such is the case with bulimia nervosa, an eating disorder that could contribute to dental erosion.

Dental erosion is the loss of mineral structure from tooth enamel caused by elevated levels of acid in the mouth, which can increase the risk for decay and eventual tooth loss. While elevated acid levels are usually related to inadequate oral hygiene or over-consumption of acidic foods and beverages, the practice of self-induced vomiting after food binging by bulimic patients may also cause it. Some of the strong stomach acid brought up by vomiting may remain in the mouth afterward, which can be particularly damaging to tooth enamel.

It’s often possible to detect bulimia-related erosion during dental exams. The bottom teeth are often shielded by the tongue during vomiting, so erosion may be more pronounced on the unshielded upper front teeth. The salivary glands may become enlarged, giving a puffy appearance to the sides of the face below the ears. The back of the mouth can also appear red and swollen from the use of fingers or objects to induce vomiting.

Self-induced vomiting may not be the only cause for dental erosion for bulimics. Because the disorder causes an unhealthy focus on body image, bulimics may become obsessed with oral hygiene and go overboard with brushing and flossing. Aggressive brushing (especially just after throwing up when the tooth enamel may be softened) can also damage enamel and gum tissue.

Treatment must involve both a short — and long-term approach. Besides immediate treatment for dental erosion, a bulimic patient can minimize the effect of acid after vomiting by not brushing immediately but rinsing instead with water, mixed possibly with a little baking soda to help neutralize the acid. In the long-term, though, the eating disorder itself must be addressed. Your family doctor is an excellent starting point; you can also gain a great deal of information, both about eating disorders and treatment referrals, from the National Eating Disorders Association at their website, www.nationaleatingdisorders.org.

The effects of bulimia are devastating to mental and physical well-being, and no less to dental health. The sooner the disorder can be treated the better the person’s chance of restoring health to their mind, body — and mouth.

If you would like more information on the effect of eating disorders on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”

EatingDisordersCanCauseProblemsWiththeTeethandMouth

Sometimes what’s going on in the mouth may point to a deeper issue. Although unpleasant to address, a dental examination could reveal signs of an eating disorder.

There are two disorders in particular that can adversely affect oral health: bulimia nervosa, characterized by food binging followed by purging through self-induced vomiting; and anorexia nervosa, characterized by self-starvation behavior. Occasionally, patients with one disorder may display behavior associated with another disorder.

“Binge-purge” behavior patterns are especially damaging to tooth enamel. When teeth are exposed to high levels of acid, the minerals in tooth enamel soften and erode. This is common with patients who overuse sodas, sports drinks and juices with high levels of citric acid. But bulimic patients also experience it because of stomach acid residue in the mouth after purging.

Patients with eating disorders also encounter other problems in the mouth. The salivary glands may become enlarged, giving the sides of the face a puffy appearance. The throat, palate and back of the tongue may appear red and damaged caused by fingers or other objects used to induce gagging.

There are also some differences between the two disorders in their effect on dental health. Anorexics tend to neglect grooming habits, including daily oral hygiene, which can lead to tooth decay and gum disease. Bulimic patients, on the other hand, are very mindful of body image and practice excellent grooming habits — but to a fault. In fact, aggressive brushing (especially after purging when high acid has caused enamel softening) can actually cause more erosion.

In the short-term, it’s important to treat dental problems caused by eating disorder behaviors, as well as encouraging better hygiene practices like waiting a few minutes to brush after purging or by rinsing with a little baking soda and water to help neutralize the acid. Ultimately, though, the eating disorder itself needs to be addressed and treated. In addition to your personal healthcare providers, the National Eating Disorders Association (nationaleatingdisorders.org) is a good online source for information and referrals.

Although a sensitive issue, an eating disorder can’t be ignored. Because of its effect on all aspects of health, including the teeth and mouth, the sooner it’s addressed, the better the outcome for patients and their families.

If you would like more information on the effect of eating disorders on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”