The research is clear. Oral health problems frequently affect patients with eating disorders, and the first line of defense sometimes is your dentist. In a study published by the European Journal of Oral Science, patients with vomiting/binge eating behaviors reported worse perceived oral health and had more dental erosion than their ED-free counterparts. In ED patients with longer duration of the disease, dental erosion was significantly more common.
Effective, non-judgmental communication is critical, dental and mental health professionals say. So what follows is a rundown of what types of oral health issues arise across eating disorder types.
Anorexia nervosa is a syndrome characterized by an excessive fear of becoming overweight, which leads to significant weight loss. This disorder occurs most frequently in adolescent females by a ratio of 3:1 compared to males.
Malnutrition and vitamin deficiencies are common with this eating disorder. That means bone loss can occur, especially in long-term anorexia cases. Teeth are bones, so it’s a matter of time before dental carie (cavity) risk increases.
Increased sensitivity of teeth to temperature is also common. In addition, changes in the color, shape, and length of teeth can occur over time. Teeth can also become brittle, translucent, and weak. And there is increased risk of periodontal disease, gingival bleeding, and delayed healing.
As for the non-bone issues, patients with anorexia can experience xerostomia dry mouth and low resting-salivary flow. This decreases the capacity of saliva to help provide protection against bacteria. In addition, patients battling anorexia have an increased risk of altered taste sensation and infection of the salivary glands (sialadenitis).
Bulimia nervosa is an eating disorder that involves eating large quantities of food (binge eating)
and then eliminating food self-induced vomiting or by taking laxatives. An individual with bulimia engages in a cycle of binge eating and vomiting. That produces an abnormal amount of stomach acids into the mouth which over time erodes tooth enamel. This erosion can lead to cavities, discoloration of the teeth and tooth loss.
Since teeth appear worn and yellow, a dentist may be the first to notice signs of this eating disorder. And cosmetic dentistry can help correct deteriorated tooth enamel. However, a dentist cannot diagnose or treat the underlying disease.
Prescription medication is a common treatment of both anorexia and bulimia. And with most meds, there are side effects. One side effect impacting the teeth is bruxism—the excessive grinding of one’s teeth. Typically, bruxism doesn’t cause serious problems and can be resolved with mouthguards. But severe bruxism may damage teeth, tooth restorations, and crowns.
Other Eating Disorders
Avoidant/restrictive food intake disorder (ARFID) is a condition characterized by eating very little and/or avoiding certain foods. It usually begins in childhood. People with ARFID may avoid certain foods because of their texture or odor. It would have to be the right combination of refused foods to cause dental issues, but it is possible.
Binge eating disorder (BED) is characterized by regular episodes of extreme overeating and feelings of loss of control about eating. Unlike bulimia, people with this disorder rarely vomit after binging, if ever. So the dental health impacts are less. However, overweight and obesity are common symptoms of BED, and those conditions sometimes trigger things like acid reflux issues or sleep apnea. Neither of those conditions make life easy on your gums and teeth.
What You Can Do
If you or a loved one is struggling with an eating disorder, there is help. The National Eating Disorder Association (NEDA) operates a helpline that offers support, resources, and treatment options. Helpline volunteers are trained to help you find the information and support you are looking for.
For crisis situations, text “NEDA” to 741741 to be connected with a trained volunteer at Crisis Text Line. Visit nationaleatingdisorders.org/ or call the hotline at (800) 931-2237 for more information.