This week marks Eating Disorder Awareness Week, and we must recognise that patients’ dietary habits often play a vital role in their oral health.
An eating disorder is a mental health condition where disordered eating behaviour is adopted to cope with difficult situations or emotions. This often leads to nutritional deficiencies and harmful habits that have severe consequences on one’s dental health.
"Around 1.25 million people in the UK have an eating disorder."
While teenagers and young people between the ages of 12 and 20 years old are the most affected, anyone can develop an eating disorder regardless of age, gender, ethnicity or cultural background. Whilst young women are more likely to develop them, around 25% of those with an eating disorder are believed to be male.
According to estimates from the eating disorder charity Beat
, around 1.25 million people in the UK have an eating disorder. The most common disorders are anorexia nervosa, bulimia, and binge eating disorder, which can cause lingering or even permanent damage to the teeth and mouth.
Eating disorders are complex and there is no single cause. Factors like genetics, biology and psychology can make it more likely for an individual to develop an eating disorder. Early detection and intervention can ensure a smoother and more successful recovery period for the body and teeth.
Individuals with an eating disorder are more at risk of developing poor oral health. Disorders characterised by food restriction or frequent vomiting, like anorexia nervosa and bulimia, can have negative effects on the mouth.
How eating disorders influence oral health
"Food restriction and frequent vomiting often leads to deficiency in nutrients that promote good oral health, such as calcium, iron and B vitamins."
Food restriction and frequent vomiting often leads to deficiency in nutrients that promote good oral health, such as calcium, iron and B vitamins. Insufficient nutrient intake can lead to tooth decay and gum disease. Frequent vomiting can also cause strong stomach acid to repeatedly flow over teeth and can cause enamel erosion and tooth sensitivity. It may also cause tissue loss and erosive lesions on the surface of the mouth, and, in extreme cases, the pulp can be exposed and cause infection, discoloration or even pulp death. To avoid aggravating these consequences, NICE recommends avoiding tooth brushing after vomiting and to rinse with a non-acid mouthwash.
In addition, other disorders, like binge eating, can lead to excessive consumption of foods high in sugar, which can lead to tooth decay. A frequent binge-and-purge cycle can also lead to redness, scratches, and cuts inside the mouth, especially on the upper surface commonly referred to as the ‘soft palate’ and cause an enlargement of the salivary glands. Enlarged glands can be painful and are often visible to others, which can lead to further emotional distress.
A further dental complication often associated with eating disorders is degenerative arthritis within the temporomandibular joint. When arthritis begins in this joint it may create pain in the joint area, chronic headaches and problems chewing and opening/closing the mouth.
Depending on the eating disorder changes in the mouth can often be some of the first physical signs, which puts dental professionals in a great position to recognise potential early warning signs of eating disorders.
Supporting your patient
While it’s not the role of the dentist to treat an eating disorder, you can guide the patient to the appropriate help, describe the clinical signs you are seeing in the mouth, and where necessary treat the oral condition.