Millions of people in the United States, particularly teenage and young, suffer
from health-threatening eating disorders, and dentists are often the first to spot
the signs. Why? The repeated, self-induced vomiting that characterizes bulimia nervosa
has a pronounced effect on teeth. Anorexia nervosa (self-starvation) can also have
some noticeable effects on oral health.
More than 90% of those with bulimia experience tooth erosion. This is caused by
acid from the stomach, which can dissolve the enamel when it comes in contact with
teeth during vomiting. Teeth that have lost enamel can appear worn, chip easily,
and become sensitive to hot and/or cold. Of course, acid erosion can also affect
people who drink a lot of soda, sports drinks and energy drinks - even the diet
varieties. But acid erosion in bulimics has a particular pattern: It is evident
on the upper front teeth, particularly on the tongue side and biting edges. The
bottom teeth, on the other hand, tend to be protected by the tongue when a person
throws up.
Once enamel is lost, it can't grow back. But the damage can be repaired with various
restorative techniques including veneers and/or crowns. The best treatment will
be determined by how extensive the damage is, which in turn depends on how frequently
the person has engaged in binge-purge behavior.
To protect the teeth it is important not to brush them immediately after vomiting
as this can scrape off more of the softened enamel. It is better to rinse with water
to which a little baking soda has been added, which neutralizes the acid. Even a
plain water rinse is helpful. Sometimes a sodium fluoride mouthrinse is recommended
to strengthen the enamel and reduce its loss.
Erosion is not the only sign of an eating disorder that a dentist or hygienist may
notice. In severe cases the salivary glands can become enlarged, causing the sides
of the face under the ears to look puffy. Also, the throat, back of the tongue and
roof of the mouth can appear reddened or otherwise traumatized from the use of fingers
or other objects to induce gagging. Soft tissues of the mouth can also be damaged
by acid.
Only about 20% of anorexics experience tooth erosion, but there are other signs
that may become apparent in the dental office. Nutrition and hygiene suffer in general,
which in turn can mean more tooth decay and gum disease. There is also considerable
overlap between anorexia and bulimia.
If you are struggling with an eating disorder or believe that a loved one is, please
let your healthcare professionals know. We will make sure you get the help you need
for healthy teeth and a healthy life. You can also visit the National Eating Disorders
Association for some helpful information.