What are the effects of anorexia on teeth?
One of the biggest reasons anorexia nervosa and other eating disorders affect oral health is the lack of proper nutrients being received by the body. People with AN commonly restrict food, which can lead to a lack of key vitamins and minerals needed to promote oral health.
Calcium is often the most impactful of these minerals, as it plays a big role in building strong teeth. Without enough calcium, teeth are at risk of decay. However, to absorb calcium, the body also needs sufficient levels of vitamin D.
Those with anorexia nervosa also tend to have low levels of iron and vitamin B, which can lead to additional issues.
And those who struggle with purging-type anorexia nervosa, which involves purging behaviors such as self-induced vomiting, may encounter even more risks to their oral health, since this frequently introduces corrosive stomach acid into the oral cavity.2
Side effects of anorexia nervosa on teeth and gum health
Anorexia nervosa can promote poor oral hygiene, and is associated with many side effects and complications on teeth and gum health, including:
- Chronic dry mouth (xerostomia): Anorexia nervosa has been connected to xerostomia, or dry mouth. This could lead to issues with chewing and swallowing, as well as tooth decay and fungal infection in extreme cases.5,6
- Tooth decay: Food restriction is also generally tied to nutrient deficiencies, including a lack of calcium, iron, and B vitamins. This can promote tooth decay. If someone struggles with purging-type anorexia nervosa, frequent vomiting, or brushing of teeth thereafter, can also contribute to this issue.1
- Gum disease: The same type of nutritional deficiencies that lead to tooth decay can also contribute to gum disease in patients with anorexia nervosa.1
- Gingivitis: Gingivitis is a common type of mild gum disease which can cause tender gums that bleed easily, often when brushing or flossing. It’s also been linked to disordered eating behaviors.1
- Angular cheilitis/exfoliative cheilitis: The continuous peeling of the lips, also known as exfoliative cheilitis, and the inflammation of the small cracks in the corners of the mouth, known as angular cheilitis, have both been connected to disordered eating behaviors.7
- 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.Signs and symptoms of this arthritis include pain, swelling, and stiffness of the jaw.1
How to treat oral problems associated with anorexia nervosa
Dental treatment for anorexia teeth will vary depending on the individual and the specific problem at hand.
The first step is often addressing the potential for any 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. In rare situations, when a tooth is severely decayed, 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
Tips to avoid further damage during eating disorder recovery
For someone struggling with AN or bulimia nervosa (BN), brushing the teeth and gums directly after purging can further damage the mouth. Instead, an individual can:8
- Gently rinse with water and a sugar-free, alcohol-free mouthwash
- Wash the mouth with water or fluoride solution
- Gargle with basic solutions, such as baking soda
If teeth must be brushed, it’s better to wait at least an hour before doing so, to avoid causing more damage. Using basic, alkaline toothpaste and avoiding sugary foods and drinks can also help cut down on potential damage.8
Dentists may also generally suggest using a fluoride rinse to use at home to help prevent further decay and strengthen enamel. And maintaining proper oral hygiene practices, such as brushing and flossing daily, is essential.
Finding help for anorexia nervosa
Often, dental professionals are among the first people to notice signs of anorexia nervosa and other eating disorders. Individuals with AN 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 remains confidential, and the dental office should feel like a safe resource during the healing process.
But there are many other options for those looking for help, including comprehensive treatment plans that fold in different aspects of therapy, nutritional education, and medical support.