Eating disorders are sometimes perceived as not very serious conditions. They are a group of serious conditions in which individuals are very preoccupied with food and weight and cannot focus on anything else. Food and weight becomes paramount in the individual’s world.

There are many types and subtypes of eating disorders, but the main types are anorexia nervosa, bulimia nervosa and binge-eating disorder. Eating disorders can cause serious body and mouth problems and can even be life-threatening. These disorders predominantly affect women, but their prevalence and magnitude are growing in men.

Anorexia nervosa is characterized by an inability to maintain a normal body weight for one’s age and height. The individual usually has an intense fear of gaining weight or becoming fat and has a distorted body image. It is because of this reason that the individual refrains from eating.

Bulimia nervosa, unlike anorexia nervosa, is identified by recurrent episodes of binge eating (rapid eating of large quantities of food in a short time), followed by vomiting; the use of laxatives and diuretics; fasting or exercise to prevent weight gain.

When a person has a binge-eating disorder, the individual may eat when they are not hungry and continues eating long after they are uncomfortably full. The individual may try to diet or eat normal meals after a binge and this triggers a new episode of binging. It is worth noting that a binge eater can be of a normal weight, overweight or obese.

One dramatic mouth problem seen in eating disorders is tooth erosion stemming from self-induced vomiting. The chronic regurgitation of gastric contents causes smooth erosion of the inside surfaces of the upper teeth and of the grinding surfaces of the back teeth. It usually takes at least two years for the effects of the self-induced vomiting on the teeth to appear. The amount of stomach acid reaching the mouth and how often it reaches the mouth, will determine how much of the enamel is worn away. However, good mouth hygiene habits can slow the effects.

It is important though, to be aware that brushing immediately after vomiting would accelerate tooth erosion, instead of preventing it.

When the teeth are worn away, patients commonly complain of severe sensitivity to hot and cold. They also complain that the edges of fillings on back teeth appear higher than the nearby tooth structure. How the individual’s teeth come together is also often affected.

Another mouth effect of eating disorders is the enlargement of the salivary (spit) glands by the ear, under the angle of the jaw and under the chin. These enlargements can occur in about half of the persons affected by eating disorders.

The onset of the swellings may follow a binge-purge episode by several days. Initially the enlargements are often intermittent and may appear and disappear before becoming persistent. Unfortunately, there is no recommended treatment to reduce the size of the glands. The glands will usually return to their normal size when the binge-purge behaviour stops.

Dry mouth is yet another phenomenon in persons suffering from an eating disorder. Saliva flow rates are reduced by repeated induced vomiting; the overuse of laxatives and diuretics; and chronic dehydration resulting from fasting and vomiting. A dry mouth in combination with inevitable nutritional deficiencies usually causes varying degrees of gum disease and infections in the corner of the mouth.

It is also very common for individuals to experience bruising in the back of the throat due to the induction of vomiting by foreign objects. Foreign objects include fingers, combs and pens.

When a dentist learns that a patient has an eating disorder, he/she will ask many thorough questions in order to get a grasp of the habits of the patient and to establish trust. When young patients are afflicted with the disorder, their parents are encouraged to be involved. Dental treatment begins with rigorous hygiene and home care to prevent further destruction of tooth structure. These measures may include:

Topical fluoride application in the dental office to prevent further erosion and reduce hypersensitivity.

The daily home application of sodium fluoride gel in trays or applied with a toothbrush. This will promote hardening of enamel.

The daily application of a prescription fluoride dental paste.

The management of dry mouth.

Rinsing the mouth with water immediately after vomiting and following that rinse with a rinse of sodium fluoride to neutralize acids and protect tooth surfaces.

Definitive restorative dental treatment outside of palliative and preventative options, are usually delayed until the patient suffering from the eating disorder is stabilized psychologically. The rationale is that an acceptable prognosis for dental treatment depends on the patient ending the binge eating and vomiting habit.

Of particular significance, is that the past use of the appetite suppressant phentermine and fenfluramine or Phen-fen, may place the individual at risk for cardiac valvular disease. Those with a history of Phen-fen use for at least four months should have an echocardiogram and cardiac evaluation by a physician to determine the need for antibiotic prophylaxis prior to dental procedures that induce bleeding.

If you or someone you know is afflicted with an eating disorder, please consider the mouth impact of the disorder and visit your oral healthcare professional for a comprehensive assessment.

Keep your mouth alive.

• This article is for informational purposes only. It is not intended and may not be treated as, a substitute for professional medical/dental advice, diagnosis, or treatment. Always seek the advice of a physician or dental professional with any questions you may have regarding a medical/dental condition. Never disregard professional medical/dental advice or delay in seeking it because of a purely informational publication.

If you have questions, please send email to dr_andreclarke@hotmail.com.