With eating disorders like anorexia and bulimia affecting millions of Americans, the dental professional may be the first to see the warning signs. In Part I of a two-part series on this health issue, we look at the different conditions and their impact on oral health.
By Susan Richards
The link between a person's overall physical well-being and oral health has long been established, and studies continue to strengthen that association. However, the dots aren't always as obviously connected between mental health issues and the oral cavity. Most notable was the increase in bruxism cases due to the stress and anxiety of the pandemic in 2020 and beyond.
But there is one psychosomatic condition that has been shown to have a significant effect on the state of one's oral health: eating disorders.
The American Psychological Association defines eating disorders – or EDs – as "a pathological disturbance of attitudes and behaviors related to food." Those suffering from an ED are often preoccupied with their body weight and image to varying degrees. There are many different diagnoses of eating disorders which include:
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
- Binge Eating Disorder (BED)
- Avoidant/Restrictive Food Intake Disorder (ARFID)
- Body Dysmorphic Disorder (BDD)
- Other Specified Feeding or Eating Disorder (OSFED)
A comprehensive 2020 report compiled by several industry groups estimates that 9% – almost 30 million Americans – will be affected by an ED in their lifetime. The disorder's impact is experienced by all ages, races, sexual orientations, and genders – although they are twice as prevalent for females.
The study calculated the economic cost of eating disorders to be a staggering $64.7 billion annually, which included productivity losses, healthcare costs, and decreases in efficiency. However, the more meaningful losses are the 10,200 deaths per year due to an eating disorder and the high percentage of those who attempt or die by suicide.
In part one of this two-part series, we'll review the two most common types of EDs, their symptoms, and how they may present in a patient's oral health.
Anorexia Nervosa
According to the diagnostic and statistical manual of mental disorders (DSM-5), anorexia nervosa (AN) is mainly identified by an extreme aversion to gaining weight, often with a distorted perception of one's size or shape, which might be addressed by restricting their intake of food, excessive exercise, and purging.
Bulimia Nervosa
The criteria for diagnosing bulimia nervosa (BN) includes episodes of binge eating in a set time and a perceived lack of control over the need. Then to avoid weight gain, recurrent actions are taken to offset the binge, including self-induced vomiting, fasting, or abuse of laxatives and other medications.
While the physiological repercussions from eating disorders are many – ranging from dry skin to cognitive damage – a 2020 article published in the NIH National Center for Biotechnology Information highlighted the specific consequences of eating disorders on the oral cavity. The main oro-dental pathologies cited by the authors include but are not limited to dental erosion, caries, and salivary production.
Eating Disorder Effects on the Oral Cavity
People depriving themselves of proper sustenance can exhibit signs of nutritional and vitamin deficiency resulting in poor oral health. This can manifest in several ways, including candidiasis, cracked lips, advanced periodontitis, mouth sores, and even osteoporosis in the alveolar bone leading to temporomandibular joint dysfunction (TMD).
Purging and forced vomiting can result in lesions or other trauma to the soft palate. In addition, there may be correlating scratches and bruising on the knuckles. Chronic vomiting can also contribute to sialadenosis or a noticeable, non-inflammatory swelling of the salivary glands. It may be painful and compound the patient's poor emotional state surrounding appearance.
The most common oral feature in ED patients is dental erosion due to the strong gastric acids bombarding the teeth, in addition to poor nutrition and improper oral hygiene. According to the Oral Health Foundation, approximately 90% of BN patients suffer from tooth enamel erosion. This can result in changes in the color, shape, length, and strength of the teeth and even cause infection or pulp death in extreme cases.
Any or all of these contributing factors, such as poor nutrition and dehydration, may also culminate in tooth decay and dental caries. Ancillary sources of oral health problems in ED patients may include the use of antidepressants which can cause dry mouth, plus over-aggressive brushing, which can further damage the dentin.
Other eating disorders like BED and ARFID also include behaviors that can lead to the same conditions described above.
In the Dental Chair
Dentists, hygienists, and dental assistants are uniquely positioned for patients with eating disorders. While they may hide their condition from friends, family, and medical professionals, there is likely to be more consistency and frequency with their dental visits.
In the next issue of Incisor, we'll continue in Part II of "The True Impact of Eating Disorders on Oral Health" by discussing the role and capacity of the dental professional to make a difference.
If you're not yet subscribed to receive the Incisor newsletter, filled with cutting-edge dental news sent directly to your inbox bi-weekly, you can do so here.
Author: Susan Richards is a staff writer at DOCS Education. With over 20 years of experience in local journalism and business marketing, Susan's career includes award-winning feature writing, as well as creating content with context for a wide variety of industries.
