Dental Treatment For Patients With Eating Disorders

Basic Information About Eating Disorders

Serious disturbances in eating behavior, often in the form of unhealthy intake or severe overeating, are signs of an eating disorder. Eating disorders are treatable medical illnesses. Anorexia nervosa, bulimia nervosa and binge eating are the main types of eating disorders.[1] People with eating disorders have a distorted body image and unrealistic perception of weight. Eating disorders are most prevalent among young, middle- to upper-middle-class, well educated Caucasian women, but also can affect men, older women and African Americans.[2]

Anorexia Nervosa

Anorexia nervosa is a chronic debilitating illness in which a person demonstrates an altered eating pattern and subsequent weight loss.[4] Anorexia nervosa is characterized by a distorted body image. People with anorexia nervosa view themselves as fat even when they are underweight. [3] The condition affects an estimated 0.5% to 3.7% of females at some time during their lifetime.[1] Teenage girls and young women account for 90 percent of cases. Left untreated, anorexia nervosa may result in serious medical complications or death.[3]

Symptoms: [5]

  • Most individuals with anorexia nervosa refuse to recognize (deny) that they have an eating disorder.
  • Weight loss of 15% or greater below the expected weight
  • Inappropriate use of laxatives, enemas, or diuretics (water pills) in an effort to lose weight
  • Self-imposed food intake restrictions, often hidden
  • No menstruation
  • Skeletal muscle atrophy
  • Loss of fatty tissue
  • Low blood pressure
  • Dental cavities due to self-induced vomiting
  • Blotchy or yellow skin

Bulimia Nervosa

Bulimia is an illness defined by food binges, or recurrent episodes of significant overeating, that are accompanied by a sense of loss of control. The affected person then uses various methods — such as vomiting or laxative abuse — to prevent weight gain. Many, but not all, people with bulimia may also suffer from anorexia nervosa, an eating disorder involving severe, chronic weight loss that proceeds to starvation. [5] Bulimia nervosa affects an estimated 1.1% to 4.2% of females.[1]

Symptoms: [5]

  • Binge eating
  • Self-induced vomiting
  • Inappropriate use of diuretics or laxatives
  • Overachieving behavior

How Eating Disorders Affect Teeth

Anorexia nervosa is an eating disorder that, in addition to damaging overall health, can harm teeth and reduce bone in the mouth. This can cause teeth to loosen and fall out. This deterioration of the patient’s dental condition can cause further anxiety for the anorexic patient and make eating and mascitatory function more difficult. A healthy dentition is a critical component in the overall perception of one’s self-image.

Bulimia nervosa harms overall health and is particularly destructive to teeth. It involves secret repeated binge eating followed by purging—self-induced vomiting, use of laxatives, fasting, diuretics or diet pills. The digestive system contains strong acids that break down food. When vomiting is used to purge food from the body, these acids attack tooth enamel. Repeated vomiting can severely erode tooth enamel and over time, teeth will become worn and translucent. The mouth, throat and salivary glands may become swollen and tender and bad breath may result.

Bulimia can cause: [6]

  • Erosion of dental enamel
  • Increased sensitivity to temperature. In extreme cases the pulp can be exposed and cause infection, discoloration, or even pulp death.
  • Enlargement of the salivary glands, dry mouth, and reddened, dry, cracked lips.
  • Dryness of the mouth and decreased salivary flow
  • Redness of the throat and palate
  • Changes in the color, shape, and length of teeth. Teeth can become brittle, translucent, and weak.

Tooth enamel, the hard protective covering of the tooth, is eroded by gastric acids when a bulimic individual repeatedly vomits. This causes the teeth to weaken and become susceptible to breakdown. Over time, teeth can decay, crumble, fracture, and fall out.

Widespread cavities over a short period of time are a significant problem for anorexic/bulimic patients. The problem is two-fold: those patients that binge on high-calorie, high-carbohydrate foods and then purge run the greatest risk of decay. The sugar in the foods set up an acid-attack on the enamel, while the act of purging bathes the teeth in hydrochloric acid from the stomach. This acid not only contributes to decay, but can also erode the teeth and fillings. The chronic bulimic patient will need numerous fillings over and over again, and have eroded enamel on the tongue-side of the teeth. [7]

Dental Treatment for Patients With Eating Disorders

With the intervention of eating disorder specialists and our professional dental team, individuals can be helped to prevent further damage to their teeth and to have damaged and worn teeth replaced. It is essential that the patient is physically able to consume a proper diet. An appropriate means of restorative management is necessary to help meet this goal.

In bulimic patients, a durable, restorative technique that minimizes the corrosive effects of acidic materials is needed to address immediate, esthetic, psychological and functional demands. The Teeth In A Day® protocol is a predictable treatment to consider.

It is very important that the patient cooperate fully throughout the maintenance phase of treatment. Patients must also continue their psychological treatment. We would be happy to evaluate your mouth and discuss your dental needs at Pi Dental Center.

Video: Leslie’s interview prior to dental implant treatment.

LINKS: is launching a new awareness campaign in support of student mental health education. 

Where to get help and links to eating disorder web sites:

[1] The New Encyclopaedia Britannica — Volume 1, Micropaedia, Ready Reference. 15th Edition. Chicago,IL 2005.
[2] Magill’s Encyclopedia of Social Science — Psychology — Volume 2, Editor, Nancy A. Piotrowski, Ph.D., Salem Press, Inc. Pasadena, CA 2003.
[3] Mayo Clinic Family Health Book, Mayou Foundation for Medical Education and Research, New York, NY 2003.
[4] Eating Disorders, Everything You Need To Know, Jim Kirkpatrick MD and Paul Caldwell MD, Firefly Book, Buffalo, NY 2001.
[5] Medline Plus Medical Encyclopedia. Bethesda, MD 2008.
[6] Eating Concerns and Oral Health. 2006.
[7] Eating Disorders and Teeth. Tracey Ryan.

Pi Dental Center, Fort Washington, PA