Nick Coller and Alison Dooley explore the link between eating disorders and the oral cavity, and how dental professionals can assist in diagnosis.
Definition
Eating disorders are psychosomatic disorders with a multifaceted aetiology, characterised by abnormal eating patterns.
They result as a complex mix of psychological and personality traits, environmental factors (like peer and parental pressure), child maltreatment, social isolation, and cultural differences.
Whilst there are several forms of eating disorder, there are three main types: anorexia nervosa, bulimia nervosa and binge eating disorder:
- Anorexia is characterised by an aversion to food leading to severe weight loss
- Bulimia is characterised by bouts of extreme overeating, followed by fasting or self-induced vomiting or purging
- Binge eating disorder is characterised by eating a lot of food in a short period of time on a regular basis often without being hungry or already being full.
Affected groups
The Priory Group highlights that: ‘Between 1.25 and 3.4 million people in the UK are affected by an eating disorder.’
Whilst it is young, affluent caucasian females who are traditionally thought to suffer from an eating disorder, evidence points to the fact that the situation is more complex.
The Priory Group also highlights that: ‘25% of those affected by an eating disorder are male.’
Further, minority groups are also disproportionately affected (especially the BAME and LGBTQ+ communities). Such minority communities are less likely to seek professional help and treatment, due to previous negative experiences.
Signs and symptoms of eating disorders in the oral cavity
Whilst eating disorders affect all the body’s systems (including the cardiovascular, gastrointestinal, neurological and endocrine systems), the oral cavity may be the only site of manifestation.
Furthermore, oral signs might be some of the first present in an undiagnosed patient.
Dental professionals therefore have a key role to play in helping to identify those with an eating disorder and potentially help undiagnosed patients access services that might help them avoid more serious complications.
The following signs and symptoms of an eating disorder might be evident in the oral cavity:
- Dental erosion or pathological tooth loss (with associated dental hypersensitivity)
- Reduced salivary flow and salivary gland enlargement (sialadenosis)
- Dental caries
- Gingivitis and periodontitis.
Dental erosion and hypersensitivity
Erosion is common in patients with eating disorders due to self-inflicted vomiting.
Dental erosion is the gradual, irreversible destruction of the calcified tooth framework. Non-bacterial chemical action causes this. Initially, it appears as glossy tooth surfaces; gradually progressing to flat indentations, coronal to the cementoenamel junction.
Not surprisingly, tooth erosion comes hand in hand with dentinal sensitivity.
Saliva flow and salivary gland enlargement
Xerostomia is common in patients with eating disorders due to self-inflicted vomiting, excessive intake of the laxatives, diuretics, and/or appetite suppressors, and strenuous workouts.
Further, antidepressants prescribed for the eating disorder can also have a xerostomia effect.
Lastly, sialadenosis is a common condition principally affecting those with bulimia.
You can define sialadenosis as a relapsing, bilateral, asymptomatic, non-inflammatory, non- neoplastic salivary gland enlargement, which does not affect the gland functioning.
Dental caries
DeBate et al pointed out that patients with eating disorders are more likely to have certain types of carious lesion; namely:
- Cervical caries
- Leathery dentinal lesions with large areas of undermined enamel.
Gingivitis and periodontitis
Patients suffering from eating disorders often lack meticulous oral hygiene; hence, they are more vulnerable to periodontal issues.
Additionally, they tend to suffer from vitamin and micronutrient deficiencies, which can further contribute to poor periodontal health.
Dental management
Dental professionals should adopt a non-judgmental approach when treating patients with a disclosed or undisclosed eating disorder.
Some patients are secretive about eating disorders and will not always readily admit there is a problem.
Oral hygiene instruction and oral self-care form an important part of any treatment plan, along with fluoride therapy for those with erosion linked hypersensitivity.
Active treatment by means of debridement or provision of restorations depends on the needs of the individual patient.
Whilst there is no definite contra-indication to restoring eroded surfaces, you might lose further tooth substance around restorations if the patients still purges through vomiting.
While a patient is purging regularly, this may delay definitive dental restorations such as crowns.
Conclusion
Signs of eating disorders often first present in the oral cavity before other more serious systemic complications are evident.
Dental professionals are therefore in a prime position to assist in making the initial diagnosis and attempt to encourage the patient to access appropriate treatment services.
Helpful numbers
BEAT
- 0808 801 0677
- Offers information and advice on eating disorders, and runs a supportive online community.
Samaritans
- 116 123
- Nationwide helpline offering non-judgmental support to anyone in need.
Anorexia and Bulimia Care (ABC)
- 03000 11 12 13
- Advice and support for anyone affected by eating problems.
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