What are the effects of anorexia on teeth and oral health?

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Anorexia nervosa (AN) is a mental health disorder that can lead to physical complications, including effects on the teeth.

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What are the effects of anorexia on teeth?

People with anorexia nervosa restrict food, which often means their body is not receiving the proper nutrients it needs for robust oral health. One of the primary elements necessary for strong teeth is calcium. Without enough calcium, teeth are at risk of decay. However, to absorb calcium, a person needs to get enough vitamin D. Those with anorexia nervosa also tend to have low levels of iron, which can promote mouth sores, and insufficient vitamin B, making it easier to develop bad breath.

Side effects of anorexia nervosa on teeth and gum health

Many side effects and complications on teeth and gum health are associated with anorexia. 

  • Dry mouth: People with anorexia typically don’t fuel their body with the nutrition it needs to keep the mouth salivating properly. The glands in the mouth that produce saliva may swell, leading to chronic dry mouth. If the mouth becomes too dry, the inside of the mouth and the lips may get red and cracked. 
  • Tooth decay: Besides a lack of calcium, frequent purging can cause teeth to become brittle, making them sensitive to temperature. The acid caused by self-induced vomiting can wear away at the tooth’s enamel, leading to tooth decay. (2)
  • Gum disease: Gum disease, also called periodontitis is an infection that affects the mouth’s soft tissue. If left untreated, gum disease can eat away at the bones supporting the teeth, leading to tooth loss. The signs of gum disease are swollen, red, or bleeding gums. Dry mouth, common among those with anorexia, can also promote gum disease. 
  • Gingivitis: Gingivitis is a common type of mild gum disease. It tends to cause tender gums that bleed easily, often when brushing or flossing. In those with an eating disorder, gingivitis tends to develop due to dry mouth. 
  • Bad breath: Chronic dry mouth and infections in the mouth, such as gum disease or gingivitis, can lead to bad breath. 
  • Degenerative arthritis within the jaw: Degenerative arthritis, also called osteoarthritis, is when the cartilage and tissues surrounding a joint wear down. People with anorexia can develop degenerative arthritis in the temporomandibular joint, also known as temporomandibular joint dysfunction (TMJ) where the lower jaw attaches to the skull. (1) Signs and symptoms of this arthritis include pain, swelling, and stiffness of the jaw.

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How to treat oral problems associated with anorexia nervosa

Individuals with anorexia who are experiencing mouth discomfort or noticing changes in their teeth and gums should consult with their dentist for treatment. It’s essential for people to be honest with dentists if they struggle with an eating disorder. Anything discussed with a dentist should remain confidential, and the dental office should feel like a safe resource during the healing process. 

Treatments for anorexia teeth will vary depending on the individual. The first step will often address long-term damage, such as tooth decay or gum disease. In the early stages of tooth decay, a dentist may suggest a fluoride treatment to prevent further loss of the tooth’s enamel. If the teeth have more decay, the individual may need a filling or crown to replace the missing enamel and stop further damage. If the tooth pulp is damaged, the dentist could perform a root canal to remove it and clear any infections. Sometimes when a tooth is severely decayed, in rare situations it may require a tooth extraction. If the dentist needs to remove a tooth, dental implants can replace the missing tooth. (3) Dentists will typically do a deep cleaning using special instruments to clean under the gum line to treat gum disease. (4)

Dentists may suggest using a fluoride rinse to use at home to help prevent further decay and strengthen enamel. They may also prescribe a desensitizing agent to relieve gum and mouth pain. It’s also essential to maintain proper oral hygiene practices, such as brushing and flossing daily. 

Brushing the teeth and gums directly after purging can further damage the mouth. Instead, an individual should gently rinse with water and a sugar-free mouthwash to clean the mouth and reduce the risk of tooth decay and infection. 

Seeking help for an eating disorder takes courage. The experts at Within Health understand the complexity of eating disorders such as anorexia and are available to guide all individuals through the healing process. Contact the Within Health admissions team to start the healing journey.

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Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Dental complications of eating disorders. National Eating Disorders Association. (2018, February 22). Retrieved January 31, 2022, from https://www.nationaleatingdisorders.org/dental-complications-eating-disorders
  2. Uhlen, M.-M., Tveit, A. B., Refsholt Stenhagen, K., & Mulic, A. (2014). Self-induced vomiting and dental erosion – a clinical study. BMC Oral Health, 14(1). https://doi.org/10.1186/1472-6831-14-92
  3. Mayo Foundation for Medical Education and Research. (2017, July 19). Cavities/Tooth Decay. Mayo Clinic. Retrieved January 31, 2022, from https://www.mayoclinic.org/diseases-conditions/cavities/diagnosis-treatment/drc-20352898
  4. Reiff Ellis, R. (n.d.). How to know if you have gum disease and what to do about it. WebMD. Retrieved January 31, 2022, from https://www.webmd.com/oral-health/features/gums-problems-gingivitis

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