­­How eating disorders can affect your mouth: and how your dental team can help spot early signs

Eating disorders such as anorexia, bulimia and binge eating disorder all have negative effects on the mouth, their symptoms can range from slight to severe and dental professionals are often the among the first to identify possible red flags.

Multiple studies have shown eating disorders can have an effect on oral health. That’s why the Oral Health Foundation is supporting Eating Disorders Awareness Week.

In this blog post we will look at what the main symptoms of each condition are, how they can affect the health of your mouth and how your dental team can help you.

What is anorexia?

People with anorexia nervosa limit their intake of food and drink and have a fear of gaining weight. Many people with anorexia attribute their self worth to their caloric intake and punish themselves for eating too much or eating the “wrong types” of foods.

As well as restricting calorie intake some people with anorexia will try to get rid of excess calories and weight through exercise, vomiting, taking laxatives or using enemas.

“I thought about food and calories all the time. I tried to avoid foods containing lots of fat or carbohydrates and only had ‘safe’ foods which I felt were okay to eat.”

Anonymous; B-eat

What is bulimia?

Bulimia nervosa is a binge eating disorder and is diagnosed based on binge-purge patterns of suffers. To meet the criteria for a diagnosis of bulimia you must be binging (taking in an excessive amount of calories in one sitting) and purging (expelling food/calories through excessive exercise, taking laxatives or forcing yourself to vomit) for a prolonged period of time on a regular basis.

Specific binge-purge patterns vary between sufferers, but as many people with bulimia are considered to be a healthy weight signs can often go unnoticed. People with bulimia may also experience symptoms such as tiredness, bloating and/or constipation, abdominal pain and irregular menstrual cycles.

“I used to go to the food cupboard, fridge or freezer and eat as much as I could, as quickly as possible, to try to make myself feel happier and fill the hole I felt inside. Afterwards I felt physically and emotionally upset and guilty about all the food I had eaten, so I would make myself sick.”

Anonymous; B-eat

What is binge eating disorder?

Binge eaters have previously been classified as food addicts although we now have a greater understanding of the condition. Binge eaters will often take in large quantities of food and/or drink without feeling like they are in control of what they are doing, these binges can be planned ahead of time with the sufferer buying “special” foods to binge on, or they could be spontaneous.

Binge eaters are not “overindulging” on foods or simply just having large portions, these are not enjoyable experiences and often cause a lot of distress and embarrassment for sufferers.

Characteristics of a binge eating episode include eating faster than normal, eating until feeling uncomfortably full, eating large amounts of food when you don’t feel hungry, eating alone through embarrassment at the amount being eaten, and feelings of disgust, shame or guilt during/after the binge.

Unlike bulimia sufferers, those with binge eating disorder will not purge after a binge.

“It’s like a switch is turned on in your mind and the only thing you can do is eat until you physically cannot anymore. It’s terrifying because it’s like the real you is still in your head but has no power over what you are doing and you’ve suddenly become something else.”

Anonymous; B-eat

How can eating disorders affect the health of your mouth?

All of these eating disorders affect your health, have negative effects on sufferers’ bodies and should be treated as serious health conditions.

Potential negative effects of vitamin and nutrient deficiencies can cause the body to shut down and not function properly and that will also be reflected in the mouth. Revealing oral signs of eating disorders include:

  • Enamel erosion
  • Dry mouth
  • Enlarged salivary glands
  • Cracked/dry lips
  • Mouth sores
  • Tooth decay
  • Sensitive teeth
  • Bruising and/or injury to the mouth

Those who purge through vomiting can also erode tooth enamel through excessive contact with stomach acid.

image of severe tooth erosion and red gums 

Source: ResearchGate.net

How can the dental team help detect eating disorders?

Dentists, dental hygienists, therapists and dental nurses are in a good position to recognise the early warning signs of eating disorders.

During your dental check-up they carry out checks on the hard and soft tissues of the mouth and look for signs of tooth erosion and possible injuries to the mouth which could have been induced by forcing objects into the mouth to make yourself vomit.

As well as erosion through stomach acid they will also be able to detect things such as tooth decay from excessive sugar consumption and signs of nutrient deficiencies.

If they suspect that you might be suffering from an eating disorder they will talk you calmly through the clinical signs they are seeing in your mouth and if needed talk to you about prescribing a high fluoride toothpaste or varnish to protect your teeth from decay.

The more open and honest you can be with your dental team, the better they will be able to help you.  Your dental team can be trusted to help you and will not judge you over any symptoms you are having.

Have you suffered from an eating disorder which has led to oral health complications? If so we’d like to hear from you. Please email [email protected]. for more information and help us provide better oral healthcare to all.

Disclaimer: this blog post is in no way intended to treat or diagnose an eating disorder and is not a substitute for a professional diagnosis. If you or someone you know is struggling with an eating disorder, please visit B-eat at www.beateatingdisorders.org.uk