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HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2023 53 Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas “Oral manifestations of eating disorders in ado- lescent patients. A review.” European Journal of Paediatric Dentistry 22, no. 2 (June 2021): 155-158. doi: 10.23804/ejpd.2021.22.02.13 4 Rai, R.; Anand, V.; Prakash, C. “Eating Disorders and Its Dental Impact.” International Journal of Innovative Science and Research Technology 5, issue 10 (October 2020). https://ijisrt.com/eat- ing-disorders-and-its-dental-impact 5 Mayo Clinic. “Eating Disorders.” March 28, 2023. https://www.mayoclinic.org/diseases- conditions/eating-disorders/symptoms-causes/ syc-20353603 6 Morris, J.; Twaddle, S. “Anorexia nervosa.” The BMJ 334, 7599 (April 28, 2007): 894-8. doi: 10.1136 /bmj.39171.616840.BE 7 National Institute of Mental Health. “Eating Dis- orders: About More Than Food.” Revised 2021. https://www.nimh.nih.gov/health/publications/ eating-disorders 8 Kisely, S.; Baghaie, H.; Lalloo, R.; Johnson, N.W. “Association between poor oral health and eating disorders: systematic review and meta-analysis.” British Journal of Psychiatry 207, issue 4 (Octo- ber 2015): 299-305. doi: 10.1192/bjp.bp.114.156323 9 Otsu, M.; Hamura, A.; Ishikawa, Y.; et al. “Factors affecting the dental erosion severity of patients with eating disorders.” BioPsychoSocial Medicine 8 (Nov. 19, 2014): 25. doi: 10.1186/1751-0759-8-25 10 Steinberg, B.J. “Medical and Dental Implica- tions of Eating Disorders.” The Journal of Dental Hygeine 88, no. 3 (June 2014): 156-9. https://jdh. adha.org/content/jdenthyg/88/3/156.full.pdf 11 Sivakumar, S.; Prabhu, A. “Physiology, Gag Re- flex.” StatPearls [Internet], January 2023 (Up- dated March 12, 2023). https://www.ncbi.nlm.nih . gov/books/NBK554502/ 12 Aranha, A.C.C.; Eduardo, C. de P.; Cordás TA. “Eating disorders. 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Erratum in: BMC Psy- chiatry 14 (2014): 62. complex psychiatric diseases with medical complications that can be life-threatening. 16 It is key that the disorder is caught sooner rather than later, and as the first sign of- ten appears in the mouth, the dentist is the prime healthcare provider in identifying it. Dentists are in a principal position not only to diagnose, but to discuss and in- form their patients about oral healthcare and overall health consequences. Limiting the consumption of acidic food and drink, as well as advising of proper oral hygiene post-vomiting is important. 2 Avoiding tooth- brushing immediately after vomiting is vital since these acids do so much harm to the enamel, and the pressure of brushing can damage teeth. Rinsing immediately after vomiting with water, milk, or 0.05% sodi- um fluoride, which neutralizes the acidity in the oral cavity and protects teeth, is rec- ommended. 10 Xylitol products are beneficial, as they stimulate salivary flow, reduce oral cariogenic bacteria, and reduce acidity in the oral cavity. 17 Eating disorder patients can be highly re- sistant to treatment and are often in denial that they even have an illness. 18 It is crucial that a multidisciplinary approach be taken when treating this group of patients. The fact that the dental healthcare provider is able to detect, diagnose, and alert the pa- tient in the early stages before their oral health and overall health are affected is of utmost importance. This is another impor- tant example of the fact that a person cannot achieve good overall health without good oral health. n REFERENCES 1 Hasan, S.; Ahmed, S.; Panigrahi, R.; et al. “Oral cavity and eating disorders: An insight to holis- tic health.” Journal of Family Medicine & Primary Care 9, no. 8 (Aug. 25, 2020): 3890-3897. doi: 10.4103/jfmpc.jfmpc_608_20 2 Rosten, A.; Newton, T. “The impact of bulimia nervosa on oral health: A review of the litera- ture.” British Dental Journal 223 (2017): 533–539. https://doi.org/10.1038/sj.bdj.2017.837 3 Monda, M.; Costacurta, M.; Maffei, L.; Docimo, R. anorexia or obesity. Large amounts of food are consumed and followed by an episode of depression, guilt, and shame, which leads to purging behavior. Dental caries is prevalent among these patients with eating disorders. The recur- rent vomiting promotes xerostomia. With- out normal salivary flow to assist in com- bating the harmful bacteria present in the oral cavity, people with chronic dry mouth have an increased incidence of caries. Xe- rostomia promotes an altered taste sensa- tion, thus making food bland and unappe- tizing. 13 These patients tend to crave sweets and select sugary liquids and foods. 14 This craving of sweets, coupled with xerostomia and tooth erosion, results in dental caries. Sialadenosis occurs more commonly in patients that vomit often, although it is not a hallmark of an eating disorder. When it does present clinically, the enlarged parotid gland is easily detected by the dentist. The patient often reports difficulty in chewing and swallowing since the natural flow of sa- liva is obstructed by these swollen glands. 15 When the face swells due to this condition, this can also evoke an unfavorable self-view by the patient, making the disorder even more dangerous. The dental healthcare professional is prime to diagnose oral complications and identify if the eating disorder is, in fact, the underlying cause. Because adequate food is not eaten and retained in the body, nutrients are not absorbed, and medical complica- tions ensue. If the disorder can be caught early and treated, better outcomes are pos- sible. If this disturbing psychological dis- order isn’t caught, medical complications range from sore throat; esophageal tears; dehydration; electrolyte imbalance; damage to liver, bowels, and kidneys; and finally, ir- regular heartbeat and cardiac arrest. Skilled healthcare professionals treating these eat- ing disorders are mandatory, as these are