Medical editing by MaryAnne Lynch Small, BDS, MPH and Chloe Stacks, DDS Candidate.
Eating disorders are illnesses that sit at the crossroads of physical and mental health. Simply put, these problems take an undeniable toll on the body. From the brain and bones to the heart and hormones, no system or body area is spared.
Here, we focus on the consequences of eating disorders on oral health.
Eating disorder symptoms such as purging by inducing vomiting, eating restrictively to the point of malnourishment, and binge eating have negative implications on oral health. Compared to those without eating disorders, affected individuals have higher rates of:
- Tooth erosion,
- Cavities,
- Dry mouth, and
- Enlarged salivary glands.
Erosion
Dental erosion is when teeth are gradually dissolved over time. This occurs when a tooth is repeatedly exposed to acid. With each exposure to acid, another thin layer of tooth enamel is dissolved and lost. Frequent vomiting over time introduces enough acid into the mouth to potentially result in progressive and irreversible loss of tooth enamel.
Erosion is the most common consequence of eating disorders on oral health. People who routinely purge by inducing vomiting are seven times more likely to experience dental erosion than those without eating disorders.
Alongside frequent vomiting, purging-related behaviors sometimes reported by people with eating disorders are of added concern. For example, vigorous tooth brushing immediately after vomiting can cause abrasion and compound the loss of tooth structure. Consumption of a high volume of carbonated beverages may contribute to the onset and worsening of erosion. Erosion can also be caused by eating too much highly acidic food, such as citrus fruit and sour candies.
Even when erosion is not visibly apparent to the individual, hypersensitivity can be a sign of it. Hypersensitivity is a short, sharp dental pain that occurs in response to stimuli like cold temperature or touch.
Cavities
An eating disorder does not cause cavities directly, but the presence of an eating disorder is associated with increased rates of cavities. Several factors common among people with eating disorders play a role in the accelerated progression of cavities in this group:
- Changes in the composition of saliva,
- Relative lack of saliva,
- Loss of tooth enamel, and
- Frequent, high sugar binge eating episodes.
Deprioritizing at-home oral health care routines like regular tooth brushing with fluoride toothpaste and flossing, during acute phases of an eating disorder may worsen cavity progression. Similarly, avoiding or delaying semi-annual visits to a dentist can also have a negative impact.
Dry Mouth
Dry mouth describes a lack of adequate salivary flow. This can be due to sustained dehydration and/or nutritional deficiencies. Therefore, this may be seen in restrictive-type eating disorders. Having a dry mouth can increase the risk of dental erosion, dental cavities, halitosis (bad breath), and oral infections. Lips can also appear dry, cracked, and reddened due to dehydration.
Enlarged Salivary Glands
This can occur in eating disorders that involve chronic purging. Frequent vomiting causes the salivary glands to be overstimulated and overworked. All salivary glands can be affected. However, swelling of the parotid glands is the most common.
The parotid glands are located on each side of the face, just in front of and slightly below the ears. Swelling in the parotid glands can make the cheeks appear puffy and can be quite uncomfortable.
Swelling resolves gradually once purging behaviors stop. It takes a little time for the glands to recognize that they do not need to “work overtime” anymore.
Gum Recession
Aggressive tooth brushing – to freshen breath after purging, or due to other body image concerns related to how teeth appear – can lead to the gum line receding over time.
Other Oral Effects of Eating Disorders
Fungal or bacterial infections at the angles of the mouth, called Angular Cheilitis, are caused by a combination of dryness and nutrient deficiencies. These factors essentially increase susceptibility to common pathogens.
Tips from the Professionals
There are several preventative measures people with eating disorders can take that may protect or reduce future damage to dental health.
Dental professionals, including the medical editors of this post, offer the following suggestions and suggest speaking about them with your dentist:
- Avoid toothbrushing immediately after vomiting to reduce damage to the tooth surface. Wait about 30 minutes prior to brushing.
- Rinse with baking soda and water to neutralize acid in the mouth after vomiting (1 teaspoon of baking soda in 8 oz of water).
- When toothbrushing, brush gently and use a fluoride toothpaste to strengthen enamel.
- Floss daily to clean between teeth. If vomiting regularly, also clean your tongue to remove acid residue.
- Use home-based fluoride products, like a fluoride rinse or mouthwash, or products containing calcium and phosphate to further enhance enamel remineralization.
Seeking Help
Visiting a dentist is key to developing a personalized plan to reduce damage to oral health. Regular dentist visits are especially important to monitor changes in oral health. They can also evaluate when it is appropriate to start any recommended restorative treatment.
Secrecy and shame around symptoms, or worries about what dental intervention might be required, can sometimes interfere with getting in to see the dentist. Remember that oral healthcare providers are accustomed to helping people with the very dental issues you may be experiencing!
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