HJAR Jul/Aug 2023

52 JUL / AUG 2023 I  HEALTHCARE JOURNAL OF ARKANSAS ORAL HEALTH WHAT does oral health have in common with eating disorders? Turns out, there are sev- eral things. Linking eating disorders to oral health has a direct implication and associa- tion in that the early onset of these disorders is often manifested in the oral cavity. In fact, the oral cavity may be the only site of mani- festation where these eating disorders first appear, even including weight change. 1 It is easily surmised that the dentist is often the first to recognize and identify an eating dis- order, as these signs and symptoms appear in the anorexic or bulimic patient intraorally. 2 Eating disorders such as anorexia nervosa and bulimia nervosa are types of psychiatric disorders. 3 These two eating disorders can have great consequences in a person’s overall health, yet the exact cause remains unknown. However, biologic, genetic, cultural, social, and psychological factors seem to play a role in the etiology of these disorders. 4 Understanding oral health’s association to these types of disorders necessitates un- derstanding more about anorexia nervosa and bulimia nervosa. Since dentists see their patients on a recall frequency, this group of healthcare providers has an advantage in identifying any changes that occur in their patients, both intraorally and extraorally. Anorexia involves an unhealthy low body weight, an unnatural fear of gaining weight, DIALOGUE COLUMN ORAL HEALTH dentist can clearly see the erosion of the teeth and identify this issue. In the early stages, the dental erosion occurs on the palatal surfaces of the maxillary anterior teeth. As this habit continues, the erosion appears on the lingual surfaces and cusps of the posterior teeth. When the patient is eating and drinking a high acidic diet, the teeth are further dam- aged and become sensitive, resulting in poor hygiene since toothbrushing and cold liquid contact are painful. 9 Erosion of the contacts between teeth can lead to vertical dimension loss, which can lead to loss of bone density, resulting in weakening of the jaw bone. The dental healthcare professional can also identify traumatic injuries in the soft palate. Ulcerations or scarring are evident, as these patients often use objects other than their fingers — such as a pen, utensil, or comb — to stimulate vomiting. 10 Many times, the bu- limic patient loses their gag reflex since they vomit so frequently. This increases the risk of choking since the gag reflex serves as natural protection for swallowing. 11 Bulimia is characterized by binge eating followed by purging, by either self-induced vomiting or the use of laxatives. In general, this is a harder diagnosis due to the difficulty in recognizing it since the majority of patients maintain a normal body weight. 12 Only one- third of bulimic patients have a history of and a self-view of weight and shape that is unrealistic. 5 These patients often look in the mirror and see an overweight person instead of the true self-image. Rigorous exercise, self- induced vomiting, starvation, and eating low calorie food only to sustain energy are the most common characterizations this disor- der displays. Because this disorder usually manifests in adolescence and progresses into the teenage years, the outward signs can of- ten be overlooked since these are viewed as the growing years and the body is constantly changing. When weight loss is concealed, other be- haviors can surface such as depression, ob- sessive behavior, or amenorrhea. 6 Anorexia has an extremely high death rate. Patients suffering from this disorder are at risk of dy- ing from medical complications. Suicide is the second leading cause of death for these patients. 7 Because dentists see patients every six months, they have the advantage of this fre- quent visit and can detect changes. In self- induced vomiting that has gone on for many months, this acidic substance erodes the lin- gual surfaces of teeth. Risk factors include consuming large amounts of citrus fruit, soft drinks, and sports drinks. 8 Sugary drinks and frequent vomiting give the perfect formula to result in dental erosion. On examination, the EATING DISORDERS and Their Impact on Oral Health