Unique to You

About eating disorders

Eating disorders such as anorexia nervosa, bulimia, and binge eating are serious but treatable mental and physical illnesses. Among mental health disorders, the mortality rate from eating disorders is second only to opioid addiction.¹

While most commonly diagnosed in adolescent and young adult females, eating disorders can affect people of any gender, age, religion, size, or body shape. An estimated 20 million women and 10 million men in America will have an eating disorder at some point in their lives.²

Eating disorders can be difficult to identify since many behaviors are often done in secret. Worse, initial weight loss can be met with compliments, which reinforces abusive behavior.

Elevated risk factors for eating disorders include:

• Weight stigma (also called weight-based discrimination)
• Bullying (particularly those with weight control issues)
• Type 1 diabetes, especially in women
• Anxiety disorders
• Relatives with eating disorders
• Perfectionism
• A history of dieting and unsuccessful weight loss
• Athletic activities involving weight targeting or weight-related performance. These are not uncommon in sports such as wrestling, boxing, cheerleading, and running.

Eating disorders and your oral health

While people with eating disorders may appear healthy, they can't avoid the impact on their mouths. Oral symptoms of eating disorders are often evident in as few as six months.³ If you suspect someone you love is facing an eating disorder, it is important to encourage them to visit the dentist regularly. Your dentist may be the key to early detection and intervention. Unfortunately, studies show that individuals with eating disorders tend to visit their dentist less often than recommended.⁴

Depending on the type of eating disorder, there are many possible impacts on your mouth. Bulimia, or binge eating that is often followed by forced vomiting to avoid weight gain, is the hardest on the teeth due to poor nutrition and the presence of a highly acidic oral environment.

• Enamel erosion: Frequent vomiting causes stomach acid to repeatedly flow over the teeth. Over time, this strong acid breaks down the tooth's enamel, leading to tooth sensitivity, discoloration, chipped or cracked teeth, and tooth loss. If enough enamel has eroded, the tooth pulp can be exposed, leading to an infection that requires invasive treatment like root canal therapy. More commonly, the teeth become thin, weak, and brittle. Often, the erosion of the teeth is most significant on the non-visible side of the front upper teeth. Teeth can easily chip and fracture and, in some cases, may need to be removed. As a result, the bite and positional relationships between the teeth can change, leading to unwanted tooth movement.⁵
• Tooth decay: Also related to common side-effects of eating disorders, stomach acid, enamel erosion, and heavy use of low calorie, acidic beverages can accelerate your risk for tooth decay.⁵
• Periodontal disease: Periodontal disease is typically caused by poor oral hygiene, which leads to the accumulation of plaque and bacteria on your teeth and gums. Poor nutrition, especially deficiencies in vitamins C and D, iron, and calcium, can lead to bleeding and inflammation of your gums. This can open a pathway for "bad" bacteria to enter your bloodstream. People with eating disorders generally suffer from poor nutrition.⁵
• Dry mouth: Poor nutrition can lead to dehydration, which can prevent your normal saliva levels from washing away bacteria and stomach acid. Dry mouth can lead to cracked or chapped lips and tooth decay.⁵
• Mouth sores: Purging can lead to redness, scratches, and cuts inside the mouth. Vitamin deficiencies – specifically Vitamin B3 (niacin) – can help cause mouth sores, a potential warning sign of anorexia or bulimia.⁵
• Swollen salivary glands: Frequent binging and purging can cause your salivary glands to enlarge. This can restrict your body's normal saliva levels. They can also be painful and visible to others.⁵
• TMJ disorders: Arthritis and other disorders of the temporomandibular joint (TMJ) often result from eating disorders, particularly those that involve binge eating and vomiting behaviors. Symptoms such as headaches, facial pain, tongue thrusting, fullness in the throat, and jaw fatigue are significantly more prevalent in people with eating disorders. Higher incidences of dizziness, difficulty concentrating, and poor sleep are also common.⁶
• Osteoporosis: Eating disorders can lead to poor nutrition, which can contribute to low bone mineral density. Osteoporosis has been connected to periodontal disease, tooth loss, and TMJ disorders.
• Bad breath: Persistent bad breath (halitosis) is a common symptom of an eating disorder. Stomach acid, frequent vomiting without proper cleaning afterward, and vitamin B3 deficiencies are all associated with bad breath.

Inform your dentist:

• If you or a loved one has an eating disorder, be sure to mention this when your dentist or hygienist conducts a health history and current health status. Keep in mind that they are there to help you, not make judgments on your condition.
• Provide your dentist and physician with each other's contact information. This is important if they need to discuss your condition, oral health status, or medications.

Make oral health a priority:

• Eating disorders are often very difficult to detect until the impact is severe. However, their impact on the mouth can be quite visible from an early stage, especially to dental health professionals. Parents should make their pre-teen and teenage children's dental visits a priority.
• Make sure you are brushing at least twice a day with a soft-bristled brush and fluoride toothpaste. If your gums bleed, don't stop brushing your teeth. Bleeding gums may be a sign of inflammation or plaque build-up below your gum line, which requires more attention, not less.
• If you have dry mouth, special toothpaste is available to reduce the symptoms. Some types may require a prescription.
• If your enamel is eroding, your dentist may suggest desensitizing and/or remineralizing toothpaste or prescriptions.
• Flossing at least once a day helps remove plaque from between teeth where brushes do not reach.
• If your dentist feels that you are not getting enough fluoride, they may suggest fluoride supplements.
• Use mouthwash frequently to kill germs and reduce bad breath.
• If you or a loved one is frequently vomiting, rinse with clean water as soon as possible to wash away stomach acid and bacteria. It's also recommended not to brush for at least an hour after vomiting to avoid embedding stomach acid deeper into the tooth enamel.⁵
• Drink plenty of water to keep your mouth moist, increase your saliva flow, and keep you hydrated.
• Avoid sugary or acidic drinks and snacks.

Eating disorder symptoms and behaviors have connections to issues that affect your oral health as well.

• Individuals with diabetes have been known to intentionally restrict their insulin to lose weight. In fact, it is estimated that women with Type 1 diabetes are up to twice as likely to develop an eating disorder than women who do not have diabetes.⁷ This is known as diabulimia, and it can be life-threatening. Diabetes is also strongly correlated to your oral health.

• New moms may be at risk for eating disorders. This can lead to a host of health problems that can impact both mother and baby. Regular dental visits can help prompt early identification and intervention.

• Tobacco and drug use as means to lose weight is common in people with eating disorders. Both also have significant effects on your systemic and oral health.