Eating disorders affect the whole body, and impact oral health as a part of overall health. In addition to negative overall health effects, eating disorders have specific, direct impacts on teeth, gums, and the mouth.
From the dentist’s point of view, it’s not always evident that a patient has an eating disorder. If your dentist is without that information, they should be informed.
While young women with anorexia nervosa and bulimia nervosa are the most common category of people with eating disorders, problems can also appear among the elderly, children, or anyone else. Eating disorders affect all ages and genders.
What are eating disorders?
Eating disorders are more than one thing, and can comprise greatly irregular eating patterns, severely restricted eating, unhealthy diet, regurgitation of ingested foods, and so on. These various disorders are mostly psychological, involving problematic attitudes to food, weight, and body image, and for that reason can be particularly hard to treat. At other times the eating disorder is purely physiological. Either way, the eating disorder will have negative implications for oral health.
Types of eating disorders
Greatly restricted food intake, driven by distorted body image and manifesting in extreme weight loss. Anorexia nervosa can be accompanied by other eating disorders.
Avoidant/restrictive food intake
Overly selective food choices. When certain essential foods are excluded from the diet, nutrition is compromised. Often beginning in childhood, avoidant behaviour can lead to other eating disorders in adulthood.
Loss of control of when, what, and how much to eat. When consumption is unmatched to nutritional needs, large variations in weight can result.
Binge eating paired with purging behaviors such as self-induced vomiting, laxative and diuretic abuse, and excessive exercising.
Night eating syndrome
Night eating syndrome combines overeating with sleep disorder. Those affected will eat perhaps 25% of their daily intake after dinner and before sleep, then wake in the night and feel that they must eat again to return to sleep.
Problems arising from eating disorders
Disrupted or disordered eating cause deficiencies in vitamins, minerals, and nutrients, leading to improper body functioning. Specific dental problems include tooth erosion, increased risk of cavities and decay, and gum disease.
Dental patients with eating disorders have an increased risk of tooth erosion, linked to acidity either in vomit or in foods and drinks, or caused by excessive brushing, especially after purging or vomiting.
Erosion can lead to sensitive teeth, loss of the bone structure makes that teeth secure, and degraded appearance of teeth.
Tooth erosion is common in patients with anorexia and bulimia (where vomiting has detrimental effects on tooth enamel). Eating disorders can also weaken the immune system, leading to complications arising from dental surgery.
Cavities and tooth decay
Risks of cavities and tooth decay vary depending on the eating disorder. However, eating disorders accompanied by a dry mouth, or infections or medications used to treat eating disorders, can all reduce the production of saliva.
Reduced saliva production leads in turn to increased formation of cavities and other forms of tooth decay. An abnormally dry mouth also increases the risk of oral bacterial infections and yeast infections, such as thrush (caused by the Candida Albicans fungus).
Poor oral hygiene, especially in cases where the eating disorder leads to greatly restricted food intake, can lead to increased gingivitis.
In its turn, gingivitis can lead to problems of its own. It can cause micronutrient deficiencies such as shortages of B vitamins, calcium, and vitamin C.
Treating eating disorders
Eating disorders require a variety of treatment approaches, of which dentistry is just a part. Many eating disorders lead to visible effects in the mouths of patients, making dentists often the first to detect eating problems.
From the point of view of dental treatment, regular appointments become particularly important. Patients with eating disorders will benefit from both active treatment for dental problems, and education to learn the best approach to take in their case.
Dental treatments appropriate for the problems caused by eating disorders include active measures to combat dental caries, measures to relieve dry mouth, restorative measures for repairing damage to gums and enamel, approaches to reduce tooth sensitivity, and a generally increased regimen of dental checkups.
Other tactics include dietary advice, psychological support, medical oversight, and family support. Unlike with most dental problems, dealing with the dental complications of eating disorders requires a multi-pronged campaign.