Sometimes what’s going on in the mouth may point to a deeper issue. Although unpleasant to address, a dental examination could reveal signs of an eating disorder.

There are two disorders in particular that can adversely affect oral health: bulimia nervosa, characterized by food binging followed by purging through self-induced vomiting; and anorexia nervosa, characterized by self-starvation behavior. Occasionally, patients with one disorder may display behavior associated with another disorder.

“Binge-purge” behavior patterns are especially damaging to tooth enamel. When teeth are exposed to high levels of acid, the minerals in tooth enamel soften and erode. This is common with patients who overuse sodas, sports drinks and juices with high levels of citric acid. But bulimic patients also experience it because of stomach acid residue in the mouth after purging.

Patients with eating disorders also encounter other problems in the mouth. The salivary glands may become enlarged, giving the sides of the face a puffy appearance. The throat, palate and back of the tongue may appear red and damaged caused by fingers or other objects used to induce gagging.

There are also some differences between the two disorders in their effect on dental health. Anorexics tend to neglect grooming habits, including daily oral hygiene, which can lead to tooth decay and gum disease. Bulimic patients, on the other hand, are very mindful of body image and practice excellent grooming habits — but to a fault. In fact, aggressive brushing (especially after purging when high acid has caused enamel softening) can actually cause more erosion.

In the short-term, it’s important to treat dental problems caused by eating disorder behaviors, as well as encouraging better hygiene practices like waiting a few minutes to brush after purging or by rinsing with a little baking soda and water to help neutralize the acid. Ultimately, though, the eating disorder itself needs to be addressed and treated. In addition to your personal healthcare providers, the National Eating Disorders Association (nationaleatingdisorders.org) is a good online source for information and referrals.

Although a sensitive issue, an eating disorder can’t be ignored. Because of its effect on all aspects of health, including the teeth and mouth, the sooner it’s addressed, the better the outcome for patients and their families.

If you would like more information on the effect of eating disorders on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”