DISCLAIMER: If you or someone you know may be suffering from an eating disorder, seeking help can be a life-saving decision. The National Association of Anorexia Nervosa and Associated Disorders provides an eating disorder hotline from 9:00 AM to 9:00 PM central time from Monday through Friday at 1-888-375-7767. If you are experiencing suicidal thoughts, call or text the crisis hotline by dialing 988. Additionally, the National Eating Disorders Association provides a treatment directory to find mental health professionals near you.
The most lethal mental health disorder is anorexia nervosa, a type of eating disorder that impacts millions of people worldwide. Patients with anorexia have a risk of suicide that is eighteen times greater than those without an eating disorder, making early intervention and mental health care critical. While most dental visits are focused on treating patients’ oral health concerns, regular dental cleanings can also play an important role in detecting early signs of many types of disordered eating. By treating eating disorders as an oral health issue, dentists help protect their patients from a growing mental health crisis.
- Common Types of Eating Disorders
Anorexia Nervosa is primarily characterized by extreme and unhealthy weightloss, oftentimes accompanied by a distorted body image. Anorexia nervosa patients consume less calories than are needed for healthy bodily functions, leading to slowed digestion, muscle cramps, hypothermia, hair loss, and menstrual irregularities, amongst many other symptoms associated with the body’s experience of extreme nutritional deprivation. While some patients may restrict their calorie intake or limit their consumption of entire food groups, others may engage in forced over-exercising or self-induced vomiting.
Bulimia Nervosa is an eating disorder in which patients repeatedly binge eat before self-inducing vomiting or taking laxatives to compensate for binge eating episodes. Binge eating is defined as a period of time in which an individual consumes a much larger amount of food than most people would eat in the same amount of time and under the same circumstances, while experiencing feelings of a lack of control over their eating. Symptoms include noticeable fluctuations in weight, menstrual irregularities, difficulty falling and staying asleep, and a fear of eating in public.
Binge Eating Disorder is diagnosed by recurrent binge eating episodes during which a patient may eat very rapidly, reach an uncomfortable level of fullness, purposefully eat alone, or uncontrollably eat even when not experiencing feelings of hunger. For a patient to be characterized with binge eating disorder and not anorexia or bulimia, the episodes occur on average at least once a week for three months and cannot be associated with compensatory behaviors. Patients may also experience weight fluctuations, stomach cramping, hypertension, and difficulty concentrating.
Avoidant Restrictive Food Intake Disorder (ARFID) is most commonly characterized in children who limit the amount and type of foods they consume out of a lack of interest in food, sensitivities to texture/smell, or fear of choking/vomiting. While ARFID is most common in children and young adolescents, individuals of all ages can be affected. Patients with ARFID fail to meet their nutritional needs without facing a lack of food or suffering from body image disturbances. Those with autism spectrum disorder or who experience severe picky eating from a young age are more likely to develop ARFID. Patients commonly lack an appetite, have a limited range of accepted foods, have an intense fear of choking/vomiting, and experience abdominal pain or constipation. Physical effects range from nutrient deficiencies to the extreme effects of starvation that are commonly associated with anorexia.
- Oral Manifestations of Eating Disorders
Those who suffer from eating disorders are at risk for permanent physiological damage. While oral symptoms may seem unexpected, they are often some of the first manifestations of eating disorders, meaning that dentistry can play a much larger role in mental health than some may think.
Nutrient deficiencies associated with an insufficient consumption of food can lead to xerostomia, or dry mouth, in which patients lack enough saliva to chew, swallow, and talk. Swollen gums caused by gingivitis and bad breath due to a lack of niacin in one’s diet are also common oral symptoms of anorexia and ARFID. Limited intake of calcium and vitamin D also greatly increase a patient’s risk of tooth decay.
Patients with bulimia can present with a variety of indications depending on their form of self-induced compensation. Manually induced vomiting can cause bruising in the mouth, swollen salivary glands, lesions, and sores. The acidity of repeated instances of vomiting can also cause extensive damage to tooth enamel causing translucency, chipping, and an increased risk of tooth decay.
The most common sign of binge eating disorders is increased tooth decay due excessive consumption of sugary and acidic foods that have little nutritional value. Cavities can further cause tooth discoloration, sensitivity to temperature, infection, and tooth loss. If there is severe wear on a patient’s teeth, they may even develop degenerative arthritis of the temporomandibular joint, causing pain and discomfort.
- Conclusion
The adverse physiological effects of eating disorders are extensive, and without treatment, patients are at risk of permanent damage and even death. While many don’t consider the dentist at all when facing the challenges of an eating disorder, one’s oral health can reveal crucial clues relating to their mental health, helping individuals get the help they need as early as possible. In one study, 92.4% of women with bulimia reported suffering from oral problems, yet only 29.2% of these women reported discussing their eating disorder with their dentist. By spreading awareness of the dental implications of eating disorders, more patients will be comfortable discussing eating disorders with their dentists, and more practitioners will be able to effectively help direct their patients to the mental health resources they need.
