DENTAL NEWS: Dental problems could be a sign of an eating disorder

People with eating disorders often mask their disease, making it hard for a primary physician to detect. But the dentist can see telltale signs, such as redness and ulcers, that patients can't hide. 

Dr. Gigi Meinecke, a practicing dentist and president of the Maryland Academy of General Dentistry, discusses how dentists can help treat people with eating disorders.

Why are dentists able to detect eating disorders?

It might surprise some people that a large number of diseases and conditions of the body have symptoms that can appear in the mouth. Some of these manifestations are disease-specific and help to raise a degree of suspicion in the alert practitioner. Eating disorders are among those conditions which present with very classic appearances on the teeth as well as the soft tissues inside the mouth.

Patients suffering from these disorders often attempt to keep their food-related problems a secret and will avoid their medical practitioner. It's not uncommon for the dentist to be the first practitioner to diagnose these disorders. According to the National Institute of Dental and Craniofacial Research, 28 percent of patients with bulimia are first diagnosed during a dental exam.

What are some of the oral health symptoms for someone who might have an eating disorder?

The dentist will often identify one or more of the following in patients with eating disorders: specific wear-patterns on the teeth in characteristic locations, redness and/or ulcerations in the mouth, lesions on the soft palate, irritations in the corners of the mouth, decreased saliva production and enlarged parotid glands, the large salivary glands located between the ear and jaw. Additionally, the patient may present or complain about dry mouth, burning tongue and sensitive teeth, or they may notice that their teeth appear shorter.

Which eating disorders cause these problems?

Eating disorders are commonly classified in two groups: anorexia nervosa and bulimia nervosa. Both have subtypes, and many patients often present with a combination of symptoms which may blur the distinction between anorexia or bulimia. Generally speaking, these disorders may involve the following: severe calorie restriction, binge eating, purging and self-induced vomiting. Each of these behaviors will produce harmful or destructive effects in the mouth which become detectable to the dentist.

How can malnourishment caused by eating disorders contribute to dental problems?

Nutritional deficiencies will typically manifest themselves first as the soft tissue complications that I've described. Here are a few that come to mind: chronic ulcerations in the corners of the mouth (angular cheilitis), painful inflammation of the tongue (glossitis), fungal infections of the mouth (candidiasis), burning sensation in the mouth or tongue (glossodynia), poor healing of oral injuries, loss or distortion of taste and predisposition to gum disease. Nutritional deficiencies may also contribute to dry mouth (xerostomia). Unfortunately, most people are not aware that persistent dry mouth encourages tooth decay.

How are dental problems caused by eating disorders treated?

Identification of the problem with a proper medical referral is a dentist's first priority. Then, patient education regarding the oral effects of their disorder with a compassionate, nonjudgmental approach is often key to enlisting the patient as a partner in their treatment. I've personally watched patients become highly motivated in preventing further damage to their teeth once they understand the link between their eating disorder and their dental problems. Sadly, many of the effects on teeth may require placement of caps (crowns) or other filling materials, with some advanced cases needing root canals or even removal of the tooth.

Is there a way to prevent these dental problems while treating the eating disorder?

Simple strategies, such as rinsing with plain water and not brushing your teeth for an hour after vomiting — which contradicts what most people are inclined to do — will decrease the damage caused by stomach acids. Additionally, using a fluoride containing toothpaste and home fluoride treatments prescribed by the dentist can decrease decay as well as decrease tooth sensitivity. Regular dental visits to check for problems before they become large and expensive is also something everyone should do.