STORY BYPart III of a Series
on Eating Disorders
At first glance, the mouth of a person with an eating disorder appears normal, but a closer look inside may reveal serious problems: erosion on the surfaces of the teeth, abscesses on the gums, glandular enlargement of the cheeks and a chemical change in the saliva.
Frequently, it is the dentist who is the first doctor to diagnose a patient with an eating disorder. All these changes are caused by the lack of proper nutrition and the acid from self-induced vomiting.
"These changes are most obvious on the back surfaces of the upper teeth, as well as those along the gum line and the chewing surfaces. The loss of tooth structure in these areas frequently causes sensitivity to hot and cold and can even result in the development of abscesses," explains Dr. Catherine M. Flaitz, dean of the University of Texas Dental Branch at Houston. "When there is significant destruction, the pulp or nerve of the tooth can become damaged and require root canal treatment and crown restorations."
Self-induced vomiting can cause trauma in the mouth, depending on what the person puts in her mouth to induce regurgitation.
With loss of enamel from erosion, the teeth become thinner, smooth and glassy in appearance. These changes are usually seen after two years of binge eating and purging. With time, significant tooth erosion can develop, causing the teeth to yellow and become brittle. This deterioration of the enamel, which is the outer layer of the tooth, cannot be regenerated—once lost, it is gone forever. As the enamel wears off, the teeth appear yellow or amber in color.
"These conditions are caused by acid in the mouth from self-induced vomiting, carbonated drinks and increased amounts of fruits that are consumed to cause diarrhea," Flaitz says. It is the citrus fruits—oranges, lemons, grapefruit—that do the most damage if eaten in large amounts. Tomatoes are highly acidic, also. Hard candies that are artificially fruit flavored can also cause significant damage because the flavoring is acidic and the candy slowly dissolves in the mouth.
If young people with eating disorders notice that their teeth are turning darker, they may try to whiten their smiles with over-the-counter bleaching agents. These products not only won't improve the color of eroding teeth, but might further wear away enamel. Bleaching products will cause eroding teeth to be more sensitive and darker in color because the second layer of the tooth, dentin, becomes exposed.
Another change is in the saliva. For some, there is a decreased amount, but for everyone the consistency thickens and cannot dilute, cleanse and neutralize the inside of the mouth as it did before. "To neutralize the inside of the mouth, we recommend the patient rinse with water either alone or containing a fourth teaspoon of baking soda. Another option is to rinse with an antacid," she explains.
Chewing sugarless gum helps stimulate saliva and promote the natural re-mineralization or re-hardening of teeth. The use of topical fluorides helps to decrease sensitivity and prevent cavities from forming.
To correct the damage done inside the mouth, the dentist can cover the teeth with restorations or crowns to help prevent further damage.
Even more changes take place inside the mouth:
Other possible head and neck problems from eating disorders are hair loss from nutritional deprivation, chapped lips and very dry skin from dehydration, and very fine fuzzy hair growth on the face.
"These changes are very disconcerting for a young person obsessed with their body image," Flaitz observes.
UPDATED: 12-15-2003
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Dr. Catherine M. Flaitz is Dean of the UT Dental Branch.
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Make an appointment
with your stress—
and keep it!
Set aside a specified time of day, say 3:00 to 3:20 P.M. Keep this appointment with yourself—make it as important as a client or a child’s reading time.
Now, let the stress pour out of you, all the worry, guilt, what-ifs, if-onlys. Hold nothing back. Imagine every possible scenario that intrudes on you, day and night. Funnel it into that 20-minute period.
When the bell goes off, you are done, finished, until your next appointment with yourself.
When you’re tempted to let stressful thoughts crawl across your mind, remind yourself that you have 20 minutes to address them—tomorrow.
