Oral Health Issues in Eating Disorder Recovery
Disordered eating patterns are restrictive or compulsive behaviors that revolve around food and drink. These patterns often develop due to preoccupation with food or persistent anxiety about one’s body image.
According to the American Psychiatric Association, up to 5% of the population is affected by some type of eating disorder. Disordered eating patterns commonly begin during adolescence or young adulthood, but they can develop in people of any age.
Eating disorders frequently co-occur with other conditions such as obsessive-compulsive disorder (OCD), anxiety disorder, and alcohol/substance abuse disorders. In many cases, the behavior patterns associated with eating disorders can resemble those caused by addictions.
Anorexia Nervosa, Bulimia Nervosa, and Binge-eating Disorder are among the most common types of eating disorders. These conditions may have different signs, symptoms, and long-term health impacts:
- Anorexia Nervosa: A disorder characterized by low body weight, extreme and persistent fear of weight gain, and a distorted perception of one’s own weight. Individuals with this condition may resort to extreme measures to prevent weight gain; such as purging or abuse of laxatives and dietary aids.
Symptoms of anorexia nervosa include extreme weight loss, thin appearance, dehydration, fatigue, anemia, thinning hair, dry or yellowish skin, sensitivity to cold, and a layer of soft, downy hair that covers the body. - Bulimia Nervosa: A disorder characterized by frequent bouts of binge eating, followed by extreme compensatory behaviors designed to prevent weight gain, which can include self-induced vomiting or ‘purging’, intense exercise, or fasting.
Individuals with this condition may frequently express dissatisfaction about their body image, and display peculiar eating habits such as visiting the bathroom immediately after every meal. Other symptoms include severe tooth erosion, chronic throat inflammation, and fatigue. - Binge-eating Disorder: A disorder characterized by recurring episodes of compulsive overeating. These episodes may last about 1-2 hours, and occur at least once per week over the span of several months. Unlike bulimia, people with this condition do not engage in purging behaviors after they eat, though they may try to compensate for the calories in other ways.
Common symptoms of binge-eating disorder include weight fluctuation, unwillingness to eat around others, eating as a reaction to emotional distress, eating large amounts despite not being hungry, hiding secret ‘stashes’ of food around the home or workplace, and frequent sporadic dieting.
Living with an unmanaged eating disorder of any kind can severely harm your oral health in a variety of ways, sometimes causing complications that lead to serious chronic issues. In fact, dentists can often detect the early signs of eating disorders before other types of care providers because of their impacts on oral health.
For individuals recovering from eating disorders, being aware of the risks and maintaining good oral health can help significantly reduce the chance of many serious illnesses. There are several important considerations for oral health care in eating disorder recovery.
How eating disorders affect oral health
Even if they don’t involve purging behaviors, untreated eating disorders can cause and contribute to a wide range of serious oral health issues. The specific effects will vary on a case-by-case basis, but there are several common indicators of eating disorders that dentists may be able to notice.
Keeping an eye out for these symptoms can help ensure that you and your dentist can address any issues early and minimize the chance of long-term damage to your teeth and gums.
Bad breath
Eating disorders can cause bad breath (halitosis) in several ways. The frequent presence of stomach acid and bile in the mouth caused by purging behaviors can directly contribute to foul odor regardless of your hygiene practices. Regular purging can also lead to dehydration, which is another potential cause of bad breath.
Additionally, the poor dietary habits associated with eating disorders can lead to a variety of nutritional deficiencies that can cause bad breath, including inadequate levels of iron, zinc, vitamin B12, vitamin C, and vitamin D.
Dry mouth and mouth sores
While it may not seem especially dangerous, dry mouth (xerostomia) can cause a number of serious oral health complications including mouth sores, tooth decay, gum disease, and infections. Over time, disordered eating patterns may lead to nutritional deficiencies that can increase the risk of xerostomia, including potassium, iron, calcium, and vitamin B6 deficiencies.
Other types of nutritional deficiencies that may stem from disordered eating, such as vitamin B12 deficiency, can directly contribute to recurrent aphthous stomatitis, a condition where painful sores form in the mouth and at the base of the gums.
Regular purging can also directly contribute to dry mouth by causing fluid loss and dehydration. Additionally, the frequent passing of acid and bile through the mouth associated with purging behaviors can lead to ulcers forming in the mouth and throat.
Tooth erosion
Research has shown that eating disorders and purging practices are directly associated with tooth erosion. This is because continued exposure to stomach acid can cause tooth enamel to break down and wear away over time. One study found that about 70% of patients who practiced self-induced vomiting displayed visible indicators of dental erosion.
Erosion caused by regular purging can lead to issues like discoloration of the teeth and increased sensitivity to hot and cold food or drinks. It may also cause teeth to become shorter and/or misshapen. In some cases, it can lead to more serious complications like infections, tooth fractures, and pulp death. Tooth loss caused by these complications can become irreversible if erosion is allowed to progress unchecked.
Tooth decay
Individuals with eating disorders have a much greater risk of dental caries (cavities) than those without. Binging behaviors can contribute to this risk significantly, especially if you binge eat foods with high levels of sugar and acid, such as chocolate. Regular purging can increase the risk even further, as exposure to stomach acid can gradually wear down the tooth’s protective enamel, allowing cavities to form more easily.
Additionally, the restrictive dietary habits associated with anorexia nervosa can lead to several nutritional deficiencies that increase the risk of cavities; including calcium deficiencies and vitamin K deficiencies that cause low bone density, as well as vitamin D deficiencies, which can make teeth more susceptible to fracture and decay.
Gum disease
In addition to tooth problems, disordered eating is also commonly associated with periodontal (gum) disease, a serious infection that can lead to bone loss and increase your risk for a variety of other health issues.
Binge eating and purging behaviors can increase this risk by irritating the gums and causing the gum tissue to separate from the teeth. This creates small spaces or ‘pockets’ between the teeth and gums where bacteria can accumulate undetected.
Overly restrictive eating behaviors can also make you more susceptible to gum disease, as they can deprive you of nutrients that are vital for periodontal health, including vitamin A, vitamin B, vitamin C, vitamin D, and vitamin E.
Oral health treatment options for eating disorder recovery
Maintaining oral health while recovering from an eating disorder is a multifaceted process that involves self-care, lifestyle modifications, and other preventative measures. Taking the right steps and making the right considerations can help you reduce your risk of serious complications during this process.
At-home treatment options for eating disorder recovery
While some oral health issues may inevitably require professional care, there are a variety of at-home treatments and self-care best practices that can help you minimize discomfort and protect your teeth and gums.
Maintaining a healthy brushing and flossing routine is essential for preventing or recovering from any type of oral health issue. According to the American Dental Association, you should brush your teeth twice a day for two minutes at a time using fluoride toothpaste, and floss once per day.
Fluoride is highly beneficial for strengthening tooth enamel, which can help prevent erosion and other oral health issues associated with disordered eating. It’s also important to be gentle when brushing, as brushing too aggressively can cause irritation, and contribute to erosion and gum recession.
If you engage in purging behaviors, you should avoid brushing your teeth immediately after vomiting. While this may be tempting, it can compound the effects of stomach acid and cause the enamel to erode even faster. To avoid this, you should always wait to brush for about an hour after purging.
Understanding the role of dentists and patients in eating disorder recovery
While protecting your oral health is largely a personal responsibility, your dentist should also have a major role in your treatment and recovery. To optimize your outcome, it’s important to find a dentist who understands the oral health considerations for eating disorder recovery, and work together to develop a plan that suits your needs.
There are several important tools and methods that dentists can use to help you support your oral health while recovering from an eating disorder. Their role will likely involve a combination of preventative care, restorative care, and patient education.
Preventative Care
While many oral health issues like erosion and tooth decay can be irreversible, taking the right proactive steps can help you minimize their impact, and possibly avoid them altogether.
The early detection and treatment of issues is a key aspect of oral health care, and regular dental checkups can help you and your dentist identify potential problems early and stop them from progressing. In general, you should visit your dentist for checkups at least once per year, though this can vary, and people with recurring issues may be advised to go more frequently.
In addition to checkups, your dentist may utilize other prophylactic treatments to help diagnose and stop issues in their early stages. Some common examples of prophylactic dental care include cleanings, scalings, fluoride treatments, sealant application, and X-rays.
Restorative Care
In many cases, the oral health damage done by an eating disorder cannot be reversed through home treatments and lifestyle changes. Because of this, seeking restorative oral health care is often an important next step after recovering from an eating disorder.
Some commonly-used types of restorative dental care include fillings, crowns, and root canals, which can help repair teeth that have been damaged by decay, as well as bonding, which can be used to replace enamel that has been damaged or stripped away by erosion.
In more severe cases, implants may be used to replace teeth that are too decayed for fillings or crowns. When planning restorative dental care, it’s important to discuss your condition with your dentist to identify the best course of treatment.
Education and Awareness
In addition to administering treatments, dentists also have the important job of educating patients about oral health risks and best practices for care during eating disorder recovery. Research has shown that giving patients oral health education can lead to improved care practices and reduce the risk of issues like cavities and gingivitis.
Proper oral health education should cover topics such as hygiene best practices, injury prevention, and the importance of regular prophylactic treatments like cleanings. It should also cover the oral health risks of smoking and alcohol consumption, and the best/worst foods for supporting oral health.
For individuals with chronic conditions that may impact oral health in specific ways, dentists can provide personalized advice for minimizing risks and avoiding complications. They can also directly address patients’ questions/concerns about any issues they may be experiencing.
Other Resources for Eating Disorder Recovery
Addressing your oral health needs is a crucial part of the eating disorder treatment process, but it’s important to do so in the right way. In some cases, it may be more prudent to address other issues related to your eating disorder before focusing on oral health.
Coordinating a plan with your entire care team, which may include your dentist, your eating disorder therapist, your physician, and your dietician, can help you stay on track and make sure you’re fully supported throughout the treatment and recovery process.
In addition to your personal care team, you can also find a variety of online resources that offer valuable information about eating disorder recovery. Some examples of helpful eating disorder resources include:
- National Eating Disorders Association Helpline
- National Association of Anorexia Nervosa and Associated Disorders Helpline
- Academy for Eating Disorders
- Bulimia Nervosa Resource Guide
- Eating Disorder Referral and Information Center
Here, you can find resources such as articles, videos, interactive helplines, care provider directories, discussion forums, screening tools, and information about free and reduced-cost care.
By arming yourself with the right information and surrounding yourself with the right healthcare professionals, you can recover from eating disorders and their associated oral health issues more completely and avoid lasting damage.