How Eating Disorders Affect Oral Health

Dental health reflects the body’s overall wellbeing
Up to 3% of Canadians (over a million) are impacted by eating disorders, according to a 2016 survey by Statistics Canada. Some people consider them a lifestyle choice or coping mechanism; in reality, they are serious health concerns that can lead to severe or potentially fatal physical and psychological illnesses.

One underappreciated complication of eating disorders is the impact that they can have on your dental health. Anorexia nervosa, bulimia nervosa, and binge-eating are the three most recognized eating disorders, according to the Canadian Mental Health Association (CMHA). While they do share some dental health impacts, each one brings its own particular concerns for maintaining good oral health.

Anorexia nervosa

Anorexia stems from a distorted body image that makes someone believe they are overweight despite contradictory evidence, to the point that they may still see themselves as fat when they are emaciated. This intense fear of gaining weight makes the sufferer follow a severely limited diet. As a result, those with anorexia nervosa become emaciated, causing physical and mental health complications. The mortality rate of anorexia nervosa is quite high; as many as 10% of sufferers may die as a result of suicide or starvation-caused illnesses.

Anorexia Nervosa’s Effects on Oral Health

Nutritional deficiencies – People with anorexia nervosa do not consume sufficient calories to fuel their bodies’ daily functions, nor do they receive the proper nutrition to allow for healthy living. This leads to various complications including:
Halitosis – Bad breath is a result of a vitamin B3 (or niacin) deficiency.
Sores and cracks – The lack of vitamin B3 can also cause canker sores. Iron deficiency can result in mouth ulcers and fissures found in the corners of the mouth.
Dryness – Dehydration causes the mouth and lips to dry, leading to reddened and cracked lips.
Bone loss – Without the proper intake of calcium and vitamin D, anorexia nervosa can lead to osteopenia or osteoporosis. This weakens the teeth and bones, making them brittle and prone to breaking.
Tooth discolouration – Without proper nutrition, the body cannot remineralize tooth enamel. Teeth can lose their natural shape and colour, becoming translucent or discoloured.
Tooth decay – Iron, calcium deficiency and Vitamin D deficiencies can promote tooth decay by weakening the body’s defences.
Gum disease – Gum diseases, like gingivitis and periodontitis, are other potential health concerns that can be caused by insufficient nutrition.
Tooth sensitivity – People with anorexia nervosa often develop an increased reactivity to temperatures, especially to cold. Their teeth can also become very temperature-sensitive, due to enamel loss.
Issues with the salivary glands – The nutritional deficiencies that accompany this disorder can cause the salivary glands to become enlarged, impacted, or infected, potentially causing pain. This could result in chronic dry mouth, reducing the saliva’s ability to buffer the acids and resulting in cavities.
Stomach acids harm teeth and gums, causing sensitivity

Bulimia nervosa
Bulimia is characterized by recurring cycles of bingeing (compulsively eating excessive amounts of food) and purging (forced elimination of food). Purging can take various forms, including forced vomiting, fasting, taking extreme quantities of diuretics and laxatives, and prolonged or excessive exercise.

The precise factors leading to bulimia nervosa have not yet been fully identified. It is believed to be influenced by a combination of genetics, hormones, an unhealthy body image, transitional stress, and emotional issues stemming from trauma.

Unlike anorexia nervosa, there are no obvious visible indicators of this condition, as sufferers often maintain a normal body weight.

Bulimia Nervosa’s Effects on Oral Health

Nutritional deficiencies – Similar to anorexia nervosa, insufficient nutrition due to purging can lead to a dry mouth, cracked lips, bad breath, tooth discolouration, and bone loss.
Sore throat – Stomach acids eat away at the soft tissue in the digestive tract. A sore throat caused by frequent purging can become persistent and chronic.
Tooth decay and wear– Vomiting introduces stomach acids into the mouth. The corrosive nature of stomach acids wears away at the surface of teeth, the enamel, resulting in tissue loss, surface lesions, and frequent cavities. This can be exacerbated by brushing teeth after vomiting.
Tooth sensitivity – The weakening of tooth enamel and gum deterioration can make teeth sensitive to extreme temperatures. Hot or cold food or beverages may cause pain.
Soft palate damage – The soft palate is the soft tissue at the back of the roof of your mouth. This area is especially prone to injury caused by stomach acids.
Inflamed salivary glands – Purging can inflame and infect the salivary glands located in the jaw and neck. Enlarged glands can be painful and may be perceptible to others, aggravating negative body image and stress.
Binge-eating can be fuelled by feelings of guilt or shame

Binge-Eating Disorder
Similar to bulimia nervosa, binge-eating involves the compulsive eating of large amounts of food in a short period, but without subsequent purging. Periods of excess intake of food instead trigger feelings of shame, guilt, and depression which, in turn, can lead to further binge-eating.

Without actively seeking methods to rid themselves of the excess calories eaten during a binge-eating episode, sufferers commonly gain weight despite frequent dieting and may become clinically obese.

Effects on Oral Health:

Tooth decay – Binge-eating (especially with an increased intake of sugary foods or carbonated beverages) exposes teeth and gums to increased plaque and acid, resulting in cavities and tooth decay.
Tooth sensitivity – As a result of higher acidity in the mouth, gums and tooth enamel can be worn away, making teeth more sensitive when exposed to hot or cold food or drinks.
Begin your recovery with a dentist visit

How to Treat Dental Issues Caused by Eating Disorders
Having an eating disorder is difficult to overcome on your own. Fortunately, you don’t have to do it alone. There are many who can help you break the destructive cycle of these disorders and many strategies you can use to regain control of your emotional and physical health. Here are some useful approaches:

Treat the disorder and receive dental care
Enlisting professional help to combat the disorder is, by far, the most effective means of reclaiming your health. Your treatment plan should include professional dental care. A dentist can assess the extent of any damage and restore as much of your oral health as is possible.

If you have dealt with your condition for an extended period, some of its adverse effects may not be easily reversible. Depending on the problem, solutions may include placing crowns, caps, or veneers, a root canal, or cosmetic dentistry.

Dental care alone
You may not yet be ready to seek psychological treatment for your problem. Even so, it is recommended that you stay on top of your oral health. Consult your dentist and ask for advice on oral health care. Visit regularly, every four to six months, to monitor issues and prevent them from worsening.

If your dentist raises concerns about a possible eating disorder, be as honest with them as you can. This allows them to provide you with a thorough assessment and offer you more relevant advice.

Your dentist can also offer you the support you need to get started on your journey to recovery. Naming the problem is the first step, and it can help to open up to a professional in a safe, non-judgemental environment. Your dentist has only your wellbeing in mind and will keep all discussions private and confidential.

Observe stringent dental hygiene
Ask your dentist what you can do at home to maintain healthy teeth and gums. Follow this advice to the letter to protect your oral health and to mitigate existing problems.

Brush and floss your teeth regularly. Do not brush immediately after vomiting. Stomach acid weakens teeth and makes it more susceptible to damage.
Rinse or swish mouthwash instead of brushing after a purge. Use either water, baking soda, or a sugar-free rinse to offset the acid in your mouth.
Moisturize your mouth often. Dry mouth can be caused by frequent vomiting and a lack of proper nutrition. Keeping your mouth moist can help prevent tooth decay. Ask your dentist what type of liquid to use (whether plain water or specialized products).
Use products prescribed by your dentist. They may recommend fluoride mouthwash, desensitizing toothpaste, or remineralizing substances.
Good dental habits can keep complications in check

Your dental health is essential. Having an eating disorder should not stop you from getting the care you need. Your dentist’s office can be a safe place to discuss your issues. You do not have to open up completely, but letting your dentist know that you are struggling with an eating disorder can help alleviate symptoms, address complications, and help you take that first step to regaining control of your physical and mental health.