Oral Health Topics
Anorexia Nervosa (Eating Disorders)
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It has been estimated that more than 10 million Americans currently are affected by serious eating disorders such as anorexia, bulimia and binge eating. While anyone can suffer from an eating disorder, they are most common in teen and young adult women. Eating disorders can have a large negative impact on an individual's quality of life. Self-image, relationships with families and friends as well as performance in school or on the job can be damaged. It is critical for anyone with symptoms of an eating disorder to seek professional help. People with eating disorders also can suffer from numerous physical health complications, such as heart conditions or kidney failure, which can lead to death.
It is often the pain and discomfort related to dental complications that first causes patients to consult with a health professional. Dentists are often the first health professionals to observe signs and symptoms of eating disorders.
Types of Eating Disorders
Anorexia typically involves an extreme fear of weight gain or a dread of becoming “fat” even though these individuals are markedly underweight. Individuals attempt to maintain a low body weight by restricting food intake. They may also exercise excessively and binge-eat followed by purging behaviors such as self-induced vomiting or misuse of laxatives, diuretics or enemas. Anorexia has the highest premature mortality rate of any psychiatric disorder. The majority of deaths are due to physiological complications.
Bulimia involves discrete periods of overeating (binge eating) which may occur several times a week or at its most severe, several times a day. During the binge, sufferers may feel completely out of control. They may gulp down thousands of calories often high in carbohydrates and fat. The amount of food consumed would be considered excessive in normal circumstances. After the binge comes purging designed to compensate for overeating and avoid weight gain. Those behaviors may include self-induced vomiting, misuse of laxatives, enemas, and diuretics. Studies have found that up to 89% of bulimic patients show signs of tooth erosion.
Binge Eating or Compulsive Overeating may affect almost as many men as women. In the past, these individuals were sometimes described as "food addicts." Since 1992, "binge eating disorder" has been used to describe individuals who binge eat but do not regularly us inappropriate weight control behaviors such as fasting or purging to lose weight. Binge eating may involve rapid consumption of large amounts of food with a sense of loss of control. Feelings of guilt and shame may lead to repeated episodes of binge eating.
Each of these eating disorders can rob the body of adequate minerals, vitamins, proteins and other nutrients needed for good health. Individuals with eating disorders can display a number of symptoms including dramatic loss of weight, secretive eating patterns, hair loss, feeling cold, constipation and, for women, the loss of their monthly menstrual period. Eating disorders may also cause numerous other physical health complications, such as heart conditions or kidney failure, which can lead to death.
Eating disorders that may include frequent vomiting and may result in nutritional deficiencies can also affect oral health. Salivary glands may become enlarged and individuals may experience xerostomia. Lips are often red, dry and cracked. Lesions may appear on oral soft tissues which may also bleed easily. There may be changes in the color (translucency), shape and length of teeth. (See photographs below.) Restorations may appear elevated when erosion occurs on the surrounding enamel. Teeth may become sensitive to hot and cold.
Photos courtesy of Craig Mabrito, D.D.S.
The frequent vomiting and nutritional deficiencies often associated with eating disorders can severely affect oral health. According to the National Eating Disorders Association, studies find up to 89 percent of bulimic patients have signs of tooth erosion, due to the effects of powerful stomach acid.
Over time, this loss of tooth enamel can be considerable, and the teeth change in color, shape and length. They can also become brittle, translucent and sensitive to temperature. The salivary glands may swell, causing the jaw to widen and appear squarish. Lips may become reddened, dry and cracked, and the patient may also experience chronic dry mouth.
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Eating disorders arise from a variety of physical, emotional and social issues all of which need to be addressed to help prevent and treat these disorders. Family and friends can help by setting good examples about eating and offering positive comments about healthy eating practices. While eating disorders appear to focus on body image, food and weight, they are often related to many other issues. Referral to health professionals and encouragement to seek treatment is critical as early diagnosis and intervention greatly improve the opportunities for recovery.
- Patients should be counseled on the need for meticulous daily personal oral health care.
- Patients who purge by vomiting should be advised NOT brush immediately after vomiting, but rinse with baking soda to help neutralize the effects of the stomach acid.
- An oral health risk assessment will aid in identification of treatment needs including the need for the use of additional fluoride modalities.
- Recall interval should be established based on the risk assessment.
- ADA Dental Minute—Diet/Nutrition and Dental Health
- National Eating Disorders Association
- Dental Complications of Eating Disorders—Information for Dental Practitioners
This assessment tool lists the most common oral signs and symptoms of frequent vomiting and nutritional deficiencies and provides tips on talking with patients who present with signs of an eating disorder.
- American Dietetic Association—Eating Disorders
Discusses many of the physical and psychological symptoms of eating disorders.
- National Institute of Mental Health—Eating Disorders
A booklet that describes the different types of eating disorders, symptoms, and treatments.