Why the oral health of those living with eating disorders should not be ignored
I wish that I had been told about how to protect my mouth. I have had to have so much dental treatment as a result of my illness.
Anonymous – lived with an eating disorder in her teens.
Eating disorders are a group of complicated mental illnesses that are associated with numerous risks to medical, social and psychological health and wellbeing. Eating disorders impact a significant number of Australians. The National Eating Disorder Collaboration estimates that 9% of the population are affected, and that number is increasing. Approximately 15% of women will experience an eating disorder during their lifetime.
An aspect of physical health that is often overlooked is the oral health changes that may occur for some people living with an eating disorder. Poor oral health, although often given low priority due to more pressing medical risks, can affect appearance, self-esteem and the ability to eat and can severely impact a person’s quality of life. The sooner these issues and risks are considered, the greater the opportunity exists to prevent unwanted outcomes.
There are four types of eating disorders, and oral health risks will vary depending on a number of factors associated with each of these illnesses:
• Anorexia Nervosa – the persistent restriction of energy intake, intense fear of gaining weight and disturbance in self-perceived weight or shape.
• Bulimia Nervosa – repeated episodes of binge eating followed by compensatory behaviours – actions aimed at making-up for the perceived over-consumption of calories. This can include (but are not limited to) vomiting, use of diuretics or compulsive exercise.
• Binge Eating Disorder – regular episodes of binge eating accompanied by feelings of loss of control, and in many cases, guilt, embarrassment and disgust.
• Other Specified Feeding and Eating Disorders – present with many of the symptoms of other eating disorders such as anorexia nervosa, bulimia nervosa or binge eating disorder but will not meet the full criteria for diagnosis of these disorders.
Oral Health Risks and Eating Disorders
A person who has an eating disorder might be at increased risk of tooth erosion, tooth decay, dry mouth, infection, inflammation and sensitivity, and oral pain. All of these can be a deterrent to eating. These issues can get worse over time, adding a distressing and complicated health burden which, if identified early, could be avoided.
In some instances, an oral health professional might be the first person to recognise the signs of an eating disorder. Ideally, a patient will disclose their eating disorder to their oral health professional. However, whether the patient is willing to talk about their illness or not, the oral health professional will discuss with the patient, in a non-judgemental way, approaches to managing and restoring damage, both in the clinic and at home.
As an example, those who purge by vomiting will be advised not to brush their teeth for about 30 minutes after, as brushing before then will increase the damaging effects of the stomach acids on teeth. A neutralising product may also be recommended along with a toothpaste with a higher concentration of fluoride to protect the teeth from demineralisation.
Other recommendations for those who purge might include:
• Rinsing the mouth with a solution of 1 teaspoon of bicarb soda in water after vomiting
• Chewing sugar free gum to promote saliva flow which helps to restore the pH balance of the mouth
• Limiting or avoiding acidic products like citrus fruit, fruit drinks, energy drinks and soft drinks.
Of course, regular appointments with an oral health professional are essential to maintaining oral health, especially while living with an eating disorder. A dental professional will advise how often these should occur, depending on the individual’s situation.
If you or someone you know is living with an eating disorder, seeking urgent medical and psychological care is critical. At an appropriate time in the treatment process, oral health intervention should also be addressed.
The future of eating disorders and oral health
The role of the oral health professional in recognising an eating disorder, and managing its effects is critical. However, a barrier to this occurring is that it can be difficult for an individual living with an eating disorder to seek help from one health professional, let alone two or three. With this in mind, the potential for other health practitioners to be involved in basic oral health reviews could help to not only increase the understanding of the serious consequences of an eating disorder on oral health, but perhaps also increase the number of individuals willing to seek professional oral health treatment.
Tiffany Patterson Norrie is a dietetic graduate who is currently conducting a PhD research study that explores oral health, eating disorders and role of dietitians. Tiffany says, “Although current recommendations by the Dietitians Association of Australia encourage the incorporation of oral health assessment and referrals into clinical practice, especially for people with eating disorders, this aspect of dietetic practice has not been fully explored in Australia.
“I hope that this study will inform the development of a screening tool and formalised training program to support dietitians in performing basic oral health assessments and referrals. If this occurs, it will eventually improve the oral health and nutritional outcomes of those living with eating disorders,” says Tiffany.
With early detection from health professionals, including dietitians, and ongoing advice and treatment from oral health professionals, those living with an eating disorder are less likely to experience serious and ongoing oral health issues throughout their life. That is definitely something to smile about.
Lindy Sank has worked as a dietitian in medical facilities in South Africa and Sydney. She is a
member of the local Oral Health Promotion Committee and makes many contributions to promoting
oral health in community, educational and professional settings. Lindy is a founding member of the
Oral Health Advisory Panel.
Tiffany Patterson Norrie is undertaking her PhD at the Centre for Oral Health Outcomes and
Research Translation (COHORT), Western Sydney University.
The Oral Health Advisory Panel (OHAP), is a group of independent healthcare professionals with the aim of raising awareness of the importance of good oral health and its impact on general wellness. The Panel aims to take oral health beyond the dental clinic.
Follow the Oral Health Advisory Panel via twitter @OHAPanel to stay up to date with practical advice on good oral health habits.
 www.eatingdisorders.org.au – Eating disorders and looking after your teeth