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Caring for Eating Disorders: Merging Dental and Mental Health

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Merging Dental and Mental Health

Caring for Eating Disorders: Merging Dental and Mental Health

April 30, 2008
By: Danae Roumis for Dental1

Sure, teeth help us speak – but they also do a great deal of talking on their own. We acknowledge our teeth as a merger of form and function, both at the forefront of our appearance and as an important part of eating and communicating, but perhaps they deserve even more credit. Many underlying health conditions have consequences for oral health, and can be detected by dental professionals during routine check-ups. One of these conditions is bulimia.


Bulimia nervosa is an eating disorder that affects mostly females within or around adolescent age, although a small percentage of males are also affected. Bulimia involves an alternating routine of binging and purging – that is, eating large amounts of food followed by purging through induced vomiting, or taking laxatives or diuretics. Those who suffer from bulimia and other eating disorders are typically preoccupied with their body weight and image. In recent years, the ubiquitous pressure to be thin has increased the number of young people with eating disorders.











Take Action

  • Good nutrition and dietary habits are absolutely essential to good dental health.

  • Eating disorders have serious consequences for dental and overall health, and need to be addressed in regards to both their physical and psychological expressions.

  • Bulimia in specific has damaging effects on tooth strength, periodontal health, and other sensitivities.

  • Dental treatment and treatment for your bulimia can be coordinated and complementary. Addressing concerns with your dentist will allow him/her to help you coordinate the two.

  • Your dentist can describe the fluoride options available to you (toothpaste, mouthwash, rinses, gel). To help dry mouth, drink water to keep your mouth moist. There are also saliva replacements your dentist can prescribe.

  • If you have your bulimia under control and are seeking tooth restoration, ask your dentist about composite resin or amalgam replacements.

  • Dentists and other health professionals are there to help – don’t hesitate to take advantage of their knowledge and support.


  • So, what’s all the chatter about teeth? According to the National Eating Disorders Association (NEDA), up to 89 percent of bulimic patients show signs of tooth erosion, which is the most prominent indicator of chronic vomiting. Stomach acids brought up during vomiting can dry oral tissues, which become red and sore, corrode tooth enamel, and cause swelling in the salivary glands. Reliance on diet pills or laxatives can also cause damage, as they decrease the salivary flow essential for neutralizing acids in the mouth to prevent decay and re-mineralize enamel. Dental erosion can lead to a reduction in tooth size and changes in bite. Hormonal imbalances associated with bulimia also affect the strength of teeth, which become discolored and weak. Bulimic patients often experience chronic sore throats, hemorrhages behind the palate, and an increased risk for temperature sensitivity and tooth loss. Anemia is relatively common in bulimic individuals as a result of nutritional deficiencies, and impairs healing processes, increasing the risk for periodontal infections.


    Twenty-eight percent of bulimia cases are first diagnosed during dental exams, according to Colgate Oral Pharmaceuticals and the Institute of Dental Research. This confers a great responsibility on dental professionals to understand the signs and symptoms of bulimia and be able to address them properly with their patient. It also presents the opportunity for a larger group of healthcare professionals to address eating disorders, casting a wider support net.


    Dental professionals should be willing to introduce the issue, and be ready to make recommendations regarding dental health. For example, while bulimic patients usually brush their teeth more frequently than average, brushing can further the erosion caused by stomach acids, and the recommendation is to rinse with baking soda or fluoride mouthwash instead, which can minimize the damage done to the mouth and teeth. Toothpaste containing fluoride is recommended for brushing, as it strengthens enamel and teeth. Dentists should also be willing to offer suggestions for seeking more thorough overall care for the disorder.


    The consequences of bulimia do, indeed, stretch beyond the dental manifestations. Kidney or gastrointestinal problems can also result from abuse of laxatives or diuretics. Muscle cramps, heartburn and abdominal pain are also common. Many sources say that those who suffer from bulimia may experience elevated levels of anxiety or depression, and are more likely to develop dependencies on alcohol or drugs. All healthcare professionals need to be aware of these things when counseling a bulimic patient.


    Some of the signs of bulimia are more habitual, and might be more likely to be detected by friends and family of the individual. Those suffering from bulimia fluctuate on a scale of 5 to 20 pounds per week, and may show signs of dry lips and mouth, and red eyes from the strain of vomiting. They often present with a callus on the index finger, due to pushing against the upper teeth when inducing vomiting. Bulimic patients may also take up compulsive gum chewing or use of mouthwash, ice chewing, or nail biting. They may complain of dizziness and thirst, or faint as a result of dehydration from the purging of fluids.


    Our teeth are talking, and we should listen. In this case, their message is clear: the physical and psychological aspects of eating disorders are inseparable, and treatment must be a joint venture. It is of the utmost importance to the patients’ wellbeing to acknowledge this connection.

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