Eating Disorders and Bad Teeth

We all know that oral health is related to the foods that we eat, or in the case of eating disorders (EDs) the foods we do not eat and/or the polluted food we use for a binge. But what is not apparent to most people is the devastating impact that an ED can have on one’s oral health.  Over the years I have seen examples of the impact of anorexia, bulimia and bulimarexia on dental hygiene, and it isn’t pretty. There was the schoolteacher, who was Bulimic, whose teeth all turned black.  She was asked to take a leave because she was scaring her students. There are the dozens of patients who have come to me with an entire mouth full of cavities that seemed to have appeared out of nowhere but are a result of their eating disorders. In most cases these were people who had never had cavities before the ED.

In 6 of the cases I have seen in treatment, the individuals lost all of their teeth. Fortunately, I have an orthodontist friend here in Cincinnati that is a genius when it comes to implanting teeth. In one case, however, not only did my patient lose all her teeth, but she also lost the jawbone necessary for the implant. In other words, she will spend the rest of her life with the receded jaw of an 80-year old and no teeth with which to chew her food. This is perhaps the saddest case I have ever seen. She had struggled valiantly for years with the ED, Lost her teeth, and at that point realized the toll the disorder was having on her. It motivated her to recover and she sought me out for treatment. She eventually recovered completely but not in time to save her teeth or her bones. She was a trooper, however, and has a very successful home-based business. She also reaches out and offers support to others with EDs. Hands down, my best referral source.

Impact of EDs on Oral Health

Believe it or not, changes in the mouth are often the first physical signs of an eating disorder, although they are generally overlooked. For example, individuals with EDs often have chronic dry mouth because they do not hydrate, or because they purge, which also results in dehydration. 

Dry mouth, also known as xerostomia, causes the salivary glands to produce insufficient amounts of saliva. Saliva is an important component of oral health. It provides a natural defense against acid erosion by neutralizing acids within the mouth, washing away food debris, and restoring minerals to the teeth. When an insufficient amount of saliva is produced and dry mouth regularly occurs, it can cause serious oral health issues, including:

  • Gum disease: Gum disease is a common complication of dry mouth. Caused by a bacterial infection from plaque and tartar buildup at the gums, gum disease is dangerous to oral health because it increases the risk of tooth decay, allowing decay to reach the tooth roots. Gum disease may even spread to the structures supporting the teeth, resulting in loose teeth, tooth loss and destruction of the bones supporting the teeth.
  • Tooth decay: Dry mouth allows harmful acids, plaque, and food remnants to stay on the teeth, also frequently resulting in tooth decay.
  • Enamel erosion: Acids left on the teeth as a result of dry mouth can lead to enamel erosion, which is the protective layer of the teeth. As the enamel erodes, the teeth are left vulnerable to tooth decay and root canal infection.
  • Dental staining: Finally, dry mouth increases the risk of dental staining and discoloration as a result of the enamel erosion and increased levels of plaque and food debris on the teeth.

Food restriction is another major contributor to poor oral health. Food restriction leads to deficiencies in calcium, iron and the B vitamins. Insufficient calcium promotes tooth decay and gum disease; even if an anorexia patient does consume enough calcium, because they also need enough vitamin D to help the body absorb it. Insufficient iron can foster the development of sores inside the mouth. Insufficient amounts of vitamin B3 (also known as niacin) can contribute to bad breath and the development of canker sores on the lips or inside the mouth. Gums can also become red and swollen—almost glossy-looking—when food is restricted. This is most often a sign of gingivitis.

For the Bulimic, the frequent vomiting leads to strong stomach acid repeatedly flowing over the teeth. Over time the tooth’s enamel is eroded causing the teeth to change in color, shape and length as well as becoming brittle, translucent and weak. When this happens, eating hot or cold food or drink may become uncomfortable. In addition, tissue loss and erosive lesions on the surface of the mouth may occur. The edges of teeth often become thin and break off easily leaving the pulp exposed.  This often leads to infection, discoloration or even the death of the tooth. 

Did you know that excessive tooth brushing or rinsing after vomiting can actually lead to tooth decay? Another ironic kick in the ED butt.

Other complications may also occur as a result of the purging by vomiting. Degenerative arthritis within the temporomandibular joint in the jaw is a dental complication often associated with purging by vomiting. This joint is found where the lower jaw hinges to the skull. When arthritis begins in this joint it may create pain in the joint area, chronic headaches and problems chewing and opening/closing the mouth. Again, we see the ED leading to a condition which makes eating painful and possibly less likely, which means that it exacerbates the ED.

Purging by inserting the knuckles into the mouth can also lead to redness, scratches and cuts inside the mouth, especially on the upper surface commonly referred to as the ‘soft palate.’ Such damage is a warning sign for dental professionals, because healthy daily behaviors rarely cause harm to this area. Soft palate damage is often accompanied by cuts or bruises on the knuckles as a result of an individual’s teeth placing pressure on the skin while attempting to purge. 

Alleviating Dry Mouth and Treating Dental Damage

Fortunately, there are a variety of treatments available to restore the health and appearance of teeth damaged by some of these conditions. In the case of dry mouth:

-Drink plenty of water
-Using an over-the -counter saliva production
-Chewing sugar-free gum to encourage saliva production
-Adding moisture to dry air with a humidifier
-Brush/floss multiple times a day to prevent damage from plaque and acid exposure

The Thyroid and Teeth

I believe that the thyroid gland is particularly sensitive to food restriction. Under normal circumstances, it produces hormones needed for a vast range of bodily functions.  For example, it instills homeostasis across various systems in the body. If damaged, it either goes into override or a hiatus and shuts down.  When either of these things happen, they wreak havoc across various parts of the body, including your mouth.

Thyroid problems are heavily linked to a wide range of dental ailments like gum disease and tooth decay. Likewise, EDs have been shown to be particularly hard on the thyroid. Those with hyperthyroidism or overactive thyroid are more susceptible to dental problems like cavities, osteoporosis in the jaws, and rapid tooth growth in children. 

Thyroid patients in general are prone to oral problems like dry mouth. Besides dehydration, dry mouth is usually accompanied by other debilitating symptoms like sore mouth, difficulties with swallowing, and even tooth decay as described above. The trick is to restore normal eating as soon as possible, while treating your thyroid imbalance. That said, treating the dental problems separately can prevent the more serious damage to the teeth and also promote recovery. 

If you or a loved one is struggling with disordered eating please reach out to me. I am the Eating Disorder Pro and I can help. 

Does someone you love suffer from an eating disorder?

Dr. Renae Norton specializes in the treatment of eating disorders. Located in Cincinnati, Ohio. Call 513-205-6543 to schedule an appointment or fill out our online contact form for someone to call you to discuss your concerns. Tele-therapy sessions available. Individual and family sessions also available.

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