Eating Disorders

Bulimia nervosa and anorexia nervosa are two conditions that are prevalent primarily among older adolescents and young adult women. Both are characterized by a distortion of body image and an over concern with body shape and/or weight.

Bulimia nervosa is characterized by recurrent episodes of binge eating, followed by self-induced vomiting, the use of laxatives, diuretics, fasting or excessive exercise. The vomiting results in prolonged acid exposure to the teeth. The protective enamel covering of the teeth literally dissolves away, leaving the dentin of the teeth exposed. The dentin is a much more porous material that when exposed can result in extreme sensitivity to changes in temperature. These changes are most apparent on the inside of the upper teeth which are most affected by the acid from repeated vomiting.

Repeated vomiting can also result in enlargement of the salivary glands, especially the parotid glands on the side of the cheeks. Not only can this reduce the flow of saliva and create a dry mouth, but also this enlargement may give a ‘chipmunk’ appearance to the bulimia sufferer.

Anorexia nervosa patients have an intense fear of becoming fat and a distorted body image. Although not all do, anorexia patients that vomit repeatedly after eating may suffer from the same oral changes as bulimia nervosa patients. If anorexia patients have poor oral hygiene, and more plaque accumulation, they may also have increased rates of cavities and periodontal disease.

Other changes common to both conditions relate to poor nutrition and general systemic dehydration. In the mouth, the color and texture of the gums may change, becoming pale pink and weak. Also, the corner of the mouths can become severely chapped in a condition called angular chelitis. Low water intake can also lead to dry mouth with a reduction in the saliva’s ability to neutralize the plaque that can cause cavities and periodontal disease.

Treatment:

Bulimia and anorexia nervosa are complex problems that need to be treated in conjunction with a physician and a mental health provider. A dental care provider should treat the oral problems associated with these conditions. Frequent professional cleanings are very helpful to aid in the prevention of cavities and periodontal disease. Topical fluoride treatment can be beneficial in preventing acid erosion and reducing dentin sensitivity. It is important to rinse with water after vomiting and to follow this with a fluoride rinse to neutralize the acid and protect the tooth surfaces. Brushing immediately after regurgitation and before rinsing with water and fluoride may actually accelerate the tooth erosion. If the teeth are severely eroded, they may require restorations to improve function and cosmetics. Simple restorations may involve bonding of the teeth, but more advanced tooth erosion may require porcelain laminates or even full mouth capping. Daily home application of a fluoride gel may also be indicated, and people that have dry mouth may benefit from artificial saliva.