According to the National Eating Disorders Association, more than 10 million Americans currently are affected by serious eating disorders such as anorexia, bulimia and binge eating. Anyone can suffer from an eating disorder, but they are most common in teenagers and young adult women. Most eating disorders are often diagnosed and treated by doctors, psychiatrists and psychologists. Dental professionals identify over one quarter of all incidences of diagnosed bulimia and anorexia. The dental team at Frisco Kids Dentistry may be the first to recognize signs of an eating disorder due to the various oral complications that are associated with the condition. Since many children and teenagers affected by eating disorders often avoid medical treatment, the roles of dentists and hygienists in the lives of such individuals can be critical.
Types of Eating Disorders
Eating disorders can develop from a variety of physical, emotional and social issues all of which need to be addressed to treat these disorders. Family can help by setting examples about healthy eating habits and offering positive comments. While eating disorders appear to focus on body image, food and weight, they are often related to many other issues. Treatment is critical as early diagnosis and intervention greatly improve the opportunities for recovery.
Anorexia is an extreme fear of gaining weight or a dread of becoming fat. Even though these children and teens may be very thin or even extremely underweight, they see themselves as “fat.” They may attempt to reach or maintain what they think is their perfect body weight by literally starving themselves or limiting food intake. They may also exercise excessively or eat excessive amounts of food in one sitting and then attempt to get rid of the food and calories from their bodies by forcing themselves to “throw up” or by the misuse of laxatives or enemas.
Bulimia is also the fear of being overweight. Children and teens that suffer from bulimia have discrete periods of overeating (binge eating), which may occur several times a week or even several times a day. The amount of food consumed would be considered excessive in normal circumstances. After they overeat, the individuals try to “undo” the fact that they ate too much as quickly as possible by forcing themselves to “throw up” or by the misuse of laxatives or enemas. This is often referred to as “binging and purging.” Studies have found that up to 89% of bulimic patients show signs of tooth erosion.
Binge Eating or Compulsive Overeating can affect both boys and girls. Sometimes these children and teens are described as “food addicts.” They overeat (binge eat) like bulimia, but do not regularly try to get rid of the food immediately by throwing up or by misusing laxatives or enemas. Feelings of guilt or shame may make it easier for the teen to overeat again and repeat the cycle.
Dental and Oral Complications of Eating Disorders
Any eating disorders that may have frequent vomiting can result in nutritional deficiencies can also affect oral health. Some of the conditions to be aware of include the following.
Erosion of tooth enamel
The most commonly seen problem related to recurrent vomiting is the erosion, or breaking down, of tooth enamel. The tooth enamel is the protective outer layer of the teeth. Vomit contains gastric (stomach) acid and repeated purging eventually wears away an individual’s tooth enamel. This usually occurs on the inner surface of the front teeth within the first six months of regular vomiting. Over time the erosion on the front of the teeth may become noticeable, and teeth will often appear thin, yellow, shiny and even transparent near the tips. Tooth erosion is experienced by nearly 89% of individuals with bulimia; it may also be evident in individuals with anorexia. Erosion of the tooth enamel is commonly detected by dentist and dental hygienists because the inside and outside surface of the teeth is closely inspected during a routine examination.
Children and teenagers with eating disorders sometimes complain of tooth sensitivity. Hypersensitivity to hot and cold temperatures is often a result of the erosion of tooth enamel. With the protective barrier of enamel wearing away, the inner layer of the tooth can become exposed. In extreme cases the pulp can be exposed and cause infection, discoloration, or even pulp death. The results of enamel erosion can cause brushing the teeth, drinking a glass of water, or even taking a deep breath through the mouth can become extremely painful.
Soft Palate Damage and Salivary Gland Enlargement
Teenagers with bulimia will often stick fingers or foreign objects down their throats to induce vomiting following a binge episode. As a result, redness, scratches and cuts often appear inside the mouth, especially on the upper surface commonly referred to as the ‘soft palate’. This type of damage is a warning sign for Dr. Rubin and his staff, because healthy daily behaviors rarely cause harm to this area. Also, soft palate damage along with cuts or bruises on the knuckles is often seen together. This is a result of the teenager’s teeth placing pressure on the skin while attempting to purge. Finally, a frequent binge and purge cycle can cause an enlargement of the salivary glands, a symptom that can be particularly bothersome for individuals with bulimia. The salivary glands may swell, causing the jaw to widen and appear squarer. Lips can become reddened, dry and cracked, and the teen may also experience chronic dry mouth.
Treatment of Oral Health Consequences from Eating Disorders
Eating disorders arise from a variety of physical, emotional and social issues all of which need to be addressed to help prevent and treat these disorders. Teenagers should be instructed on the need for daily personal oral health care.
If you suffer from an eating disorder these practices can reduce oral health problems associated with it:
- Brushing daily with desensitizing toothpaste that also contains fluoride will not only treat and prevent hypersensitivity, but will also help keep enamel strong thereby preventing decay.
- Daily flossing will prevent build up of food and bacteria between teeth, thereby preventing decay, while choosing water, milk or tea instead of highly acidic fruit juices or sugary sodas will help to keep teeth stronger and healthier.
- A fluoride rinse can be used immediately following brushing to provide greater protection to the teeth for teens that vomit frequently.
- Immediately after throwing up, do not brush, but rinse with baking soda to help neutralize the effects of the stomach acid.
- Schedule 6-month dental examination with Frisco Kids Dentistry.
- Consult with Dr. Rubin and his staff about your specific treatment needs.
A receptive and understanding dental staff may be the first step on the road to treatment and recovery. Frisco Kids Dentistry is here providing their patients with nonjudgmental support, which can be instrumental in encouraging the individual to seek help to recover from the eating disorder.
Please contact Frisco Kids DDS at 214-618-5200 if you would like to schedule an appointment.