Eating Disorders Affect Oral Health

By Catherine M. Fascilla, D.D.S.

Anorexia Nervosa is an eating disorder characterized by an intense fear of weight gain and the desire to be thinner. It is a self-induced starvation. People with this disorder appear emaciated and do not have the ability to maintain a minimally normal weight for their height or age.

Bulimia is an eating disorder characterized by episodes of binging (eating large quantities of food in a short period of time) followed by purging. Purging is accomplished by self-induced vomiting, using laxatives or diuretics, fasting or engaging in vigorous exercise to counteract the binging.

Each of these disorders robs the body of adequate minerals, vitamins, proteins and other nutrients needed for good health causing potential damage to the teeth muscles and major organs. Some of the medical complications from bulimia results from stomach acid brought up while vomiting, causing ulcers or ruptures in the esophagus. Abuse of laxatives and diuretics can cause dependency for normal elimination as well as life-threatening electrolyte imbalances.

Because bulimia can be extremely damaging to teeth, the dentist may be the first to detect an eating disorder. The stomach acid causes the outer surface of the enamel to erode especially on the inside or “ tongue-side” of the front teeth.

The loss of protective enamel can make the teeth very sensitive to temperature, and highly susceptible to decay and more serious infections of the nerves within the teeth. Severe erosion can lead to changes in the bite, or the way the upper and lower teeth come together and eventual tooth loss. Stomach acid also causes dry mouth, sore bleeding gums, chronic sore throat, burning tongue and swollen salivary glands.

A very important step toward curing a patient with these disorders is the patient’s acknowledgement of the problem. Then with the aid of medical, nutritional and psychological counseling or support groups, patients can recover.

Recovery takes time. While the patient is trying to control the episodes of induced vomiting, it is important to know that teeth should not be brushed immediately after vomiting . This would increase the amount of enamel erosion because the patient would be scrubbing with an acidic solution. Teeth should be rinsed first with water or with a solution of baking soda and water so that the acid is neutralized.

Fluoride gels should also be used to try to make the enamel more acid resistant. Once the bulimia is controlled or cured, teeth can be restored and maintained to last a lifetime.

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