Changes in Mouth Often First Signs of Eating Disorders

Binge/purge cycle can severly affect oral health.

The physical signs of an eating disorder may first show up in the mouth. That is why it is important for members of the dental team to be alert for the oral signs of eating disorders, so they can provide referrals to health care professionals trained in dealing with such disorders, says Barbara J. Steinberg, D.D.S., clinical professor of surgery at Drexel University College of Medicine in Philadelphia. Dr. Steinberg is presenting here at the American Dental Association's 144th Annual Session with her colleague Shirley Brown, D.M.D, Ph.D., a practicing dentist and clinical psychologist specializing in eating disorders.

Experts say more than 5 million people in the United States suffer from eating disorders. "The mouth reflects the rest of the body," Dr. Steinberg states. "A patient's oral status may be indicative of an eating disorder, particularly bulimia, when it involves chronic bingeing and vomiting."

The frequent vomiting and nutritional deficiencies often associated with eating disorders can severely affect oral health. According to the National Eating Disorders Association, studies find up to 89 percent of bulimic patients have signs of tooth erosion, due to the effects of powerful stomach acid. Over time, this loss of tooth enamel can be considerable, and the teeth change in color, shape and length. They can also become brittle, translucent and sensitive to temperature. The salivary glands may swell, causing the jaw to widen and appear squarish. Lips may become reddened, dry and cracked, and the patient may also experience chronic dry mouth.

Drs. Steinberg and Brown tell members of the dental team to advise their patients who experience these behaviors to rinse with plain water immediately followed by an over-the- counter fluoride rinse to help the teeth re-mineralize.

Left untreated, extreme cases of eating disorders may expose the innermost layer of the teeth, the pulp, which can result in infection, discoloration or even pulp death. If pulp death occurs, the patient may need a root canal or to have the tooth extracted.

"Dentists can treat the oral effects of eating disorders, but they need to keep the patient's overall physical and mental health in mind, too," Dr. Brown says, "particularly since anorexia and bulimia are associated with a fairly high rate of suicide. By referring patients with suspected eating disorders to appropriate health care professionals, dentists and the dental team may play a crucial role in helping to save their patients' lives."

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