Eating disorders, including anorexia, bulimia and binge eating involve by definition, disordered eating; providing a surplus or deficiency in essential body nutrients, which can cause short and long term affects to dental health.
Bulimia, a type of eating disorder in which an individual ‘purges’ food (self-induced vomiting to rid their bodies of food) can be the most detrimental to oral hygiene and health, causing irreversible acid erosion of tooth enamel. Recovery from an eating disorder is incredibly hard, with on an average six to ten years until full recovery according to UK charity Beat.
With the right treatment from worldwide experts, early intervention and dental treatment to prevent dental destruction is possible. For suffering patients, world class treatment can result in a sustainable and restorative recovery.
What Is an Eating Disorder?
Eating disorders are psycho-social illnesses that affect many adolescents and adults. Despite affecting millions worldwide, there is limited research studies into eating disorders and the studies completed often have unrepresentative cohort sizes and inconclusive results.
This can make diagnosis and treatment complicated and far from straightforward, requiring multiple, cross-industry professionals and much time, often at the detriment to the patient and their health.
There are many types of eating disorder, most commonly Anorexia Nervosa, Bulimia and Binge eating Disorder. These disorders each have complicated genetic, neuroscientific, environmental, and biological causality for which much is still unknown.
They can result in complex metabolic, morphological and functional alterations of multiple organs and systems, exhibiting varying degrees of morbidity and sometimes resulting in life-threatening outcomes. One of the complications of eating disorders however, can be worsened dental health and a significant impact on the teeth of sufferers. With regards to medical cover, often, eating disorders can be judged by insurers to be a pre-existing condition and may fall outside of the scope of the cover offered by the health insurance provider in question.
How Does Anorexia Affect Your Teeth?
There are two types of Anorexia Nervosa; Anorexia ‘restrict’ or ‘binge-restrict’ (with some episodes of binge eating) and Anorexia ‘binge-purge’ subtype.
Anorexia is defined as simply ‘a loss of appetite.’ There are genes for the disorder, but the condition is often triggered by stress, anxiety, and depression which neurochemically (via the flight-or-fight mechanism), decrease gastric motility and decreased appetite. In both types of Anorexia Nervosa, despite being very underweight, a patient presents with a disturbed body image and a morbid fear of weight gain.
Patients can deprive themselves of essential dietary nutrients out of fear of increasing their weight. This lack of nutrients, often for high-fat foods such as dairy products which contain the essential Calcium needed to maintain tooth structure, can cause irreversible structural damage to teeth.
Dietary choices in Anorexia can also worsen dental health and hygiene, with a preference for more-low calorie, low-carbohydrate and low-fat, and often perceived ‘healthy’ foods such as fruit and vegetables like oranges, lemons, and tomatoes, which are very acidic.
These food choices help maintain a low body weight, but strip the tooth enamel, causing irreversible damage. This type of erosion is usually found on the labial surface of the tooth. Episodes of binge eating are common in Anorexia, as when a patient denies themselves highly palatable foods for a sustained period, they are vulnerable to binge eating episodes of the foods they denied themselves.
This is often followed by anxiety, shame and guilt and sustained periods of highly controlled calorie restriction again. This results in loops and cycles of bingeing and restriction.
Anorexia ‘binge-purge’ subtype is very similar to Bulimia as instead of restricting food post binge, patients purge the food from their bodies. One of the ways to ‘purge’ or ‘remove’ calories from the body can be with exercise, laxatives, or self-induced vomiting. This vomiting can cause dental erosion.
How Does Bulimia Affect Your Teeth?
In cases of Bulimia, a patient undertakes a sustained, rapid and uncontrolled binge eating episode, followed by the ‘purging’ of consumed calories, often with diuretics, laxatives or self-induced vomiting use.
It is both the binge consumption of highly sugary foods and the vomiting and reflux of gastric acid from the stomach onto the teeth, that damages dental health. This reflux damages tooth dentin (especially in the molars) and tooth enamel and can also cause mucosal lesions, periodontal lesions and increased dental sensitivity.
Diuretics and laxatives can cause fluid imbalances, resulting in decreased salivary concentrations, exacerbating further the detriments to dental health of bulimia. Patients with bulimia should not undertake treatment until the ‘gorging and vomiting cycle has been broken.’
‘Vomiting induced erosion’ is often found on the lingual surfaces of maxillary anterior teeth in patients suffering from Bulimia, contributing to deteriorating dental health.
Binge Eating and Teeth
Binge eating is when an individual eats in a ‘rapid, uncontrolled manner on a regular basis, to the point where they are uncomfortably full.’
Unlike in cases of Anorexia, where binge episodes are more impulsive, episodes of binge eating are mainly planned in advance, often at night, with special highly palatable ‘binge foods.’ It often involves eating when not hungry, in secret, in a fast and negative way. The patient is often depressed but feels a temporary dopamine (the brain pleasure neurotransmitter) ‘high’ from the episode.
After the binge patients feel depressed, guilty, ashamed, or disgusted with themselves. Binge eating often causes weight gain and the sugars from the episode and sustained saliva production, are detrimental to teeth.
Can Eating Disorders Be Treated?
All patients suffering from eating disorders need help from multi-disciplinary, inter-connected teams including dieticians, psychologists, dentists, physiotherapists, general practitioners, and mental health nurses.
The dental complications they may experience need to be assessed on a case-by-case basis, tailored to their condition, the state of their teeth, and the best long-term solutions to dental problems found. Often this can involve veneers, cosmetic dental rehabilitation, resin rebuilds, onlays, fillings and crowns.
How Can GlobMed Help with Eating Disorders?
At GlobMed we understand the importance of highly specialised teams in health and wellbeing. We work with the best professionals worldwide to tailor our services to an individual’s needs and health and care requirements. We can help eating disorder patients access the best dental teams to improve and repair the damage they may have as a complication of their diagnosis. We can give eating disorder patients back their smiles and help them overcome their challenges.