Women only: Cramps, bloating and now, tooth erosion?
With more intense menstruation, regular vomiting also is a symptom.
Monthly menstrual cycles produce many uncomfortable, and sometimes painful, symptoms, which can include cramps, headaches and bloating. With more intense, painful menstruation, a condition otherwise known as dysmenorrhea, regular vomiting also is a symptom. This monthly recurrence can cause severe tooth erosion, according to a study in the November/December 2008 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal.
This condition often masquerades as an eating disorder, since both dysmenorrhea and bulimia nervosa cause noticeable erosion on the back of the front teeth of the top jaw as a result of the exposure to stomach acid. However, it is imperative that patients understand the main distinguishing factor between the two conditions.
"Whereas bulimia nervosa is a voluntary act - the woman induces vomiting herself — dysmenorrhea is involuntary," says Mohamed Bassiouny, DMD, MSc, PhD, author of the study. "Contractions in the uterus or the abdominal wall force the patient to vomit without any cause."
Due to its uncontrollable force, dysmenorrhea also creates a different erosion pattern on the teeth. "A dentist can tell when a patient suffers from bulimia or dysmenorrhea, due to the distinct erosion patterns," says Dr. Bassiouny. "When vomiting is voluntary, the individual controls the direction and force," he says. "The tongue creates a tunnel which protects, in most instances the back teeth. When a patient has dysmenorrhea, the erosion affects almost all surfaces of the dentition to varying extents."
Dr. Bassiouny also notes that many women are affected by dysmenorrhea without knowing that the condition exists. "Roughly 52 percent of the population suffers from the condition," he says, "and women who are affected by dysmenorrhea usually do not detect the damage to their teeth until later in life." In his research, women become aware of dysmenorrhea's effects on teeth in their 50s or 60s, whereas women who suffer from bulimia do so most commonly in their 20s or 30s due to the fast rate of destruction by the frequent voluntary vomiting. The symptoms of dysmenorrhea, he says, can occur every three to four weeks and even outside of the traditional cycle, and last between 10-12 days.
When severe erosion occurs, "the tooth enamel is worn down, exposing the nerve endings of the teeth, which results in tooth sensitivity," says Connie White, DDS, FAGD, spokesperson for the AGD. Although erosion is not reversible, Dr. White says, dentists can help reduce the effects of the acid on the teeth by advising them on proper care. Patients should "rinse the mouth thoroughly during episodes of vomiting and avoid immediate brushing of the area. Brushing right after vomiting actually worsens the effects of the acid because it rubs the acid into the teeth."
According to Dr. Bassiouny, to treat the condition it is imperative that women inform all health professionals of the symptoms. "The condition and associated dental fallout are not purely medical or purely dental," he says. "Women who suffer from dysmenorrhea need to be treated by a gynecologist for internal causes and by the dentist to restore and prevent further damage to the dentition. This coordinated effort of management is the best course of action."
Dental effects of dysmenorrhea:
• Teeth may show loss of enamel
• Exposed dentin of affected teeth may appear brownish
• Sensitivity due to dental erosion
• Teeth appear shorter
• Disfigurement of facial esthetics