Oral implication of eating disorders

People with eating disorders can suffer from
oral health problems in addition to their
disorders.
The behaviours associated with anorexia
nervosa and bulimia nervosa, both eating
disorders, include binge eating, induced
vomiting, abuse of laxatives and diuretic
drugs which increase the passing out of water
from the body. These behavioural changes
also have effects on the mouth and peri-oral
structures.
People affected by bulimia have characteristic
repeated episodes of vomiting. The stomach
contains acids which aid in digestion which
are released during vomiting. Acids naturally
eat up the organic substances and similarly
the teeth.
It therefore makes nonsense the thought of
brushing the teeth when there is vomiting as
these acids are further rubbed into the teeth
and cause more tooth wear. This does more
harm than the intent. The best action in such
circumstances is to rinse the mouth with
clean water or a neutral solution or a basic
one like caustic soda and water reducing the
potential harmful effect of the acid.
Bulimia nervosa is an eating disorder , the
term bulimia is coming from a Greek term
which means to be ravenous or ox- hunger ,
the percentage of bulimics are not really
ascertained by statistics. It is however safe to
assume that with the increasing trend or the
societal fashion that is complimentary on the
thin figure and ostracising the large figure, it
is likely to be silently appreciable.
This societal trend of suggesting a beautiful
body is achieved mainly by being tall and
slim has a sub-luminal effect of fuelling
eating disorders.
Bulimics have a tendency to binge eat, eating
just about everything in large volumes over a
short time followed by purging, an attempt to
rid oneself of the consumed food. Purging is
achieved mostly by self induction of the
vomiting. So bulimia nervosa is a disease in
which hunger is a factor and the effect on the
nervous system is another.
The disease was naturally first highlighted by
a psychiatrist, a British gentleman Gerald
Russell in 1979. The disease may mean
individuals alternating between a condition
known as anorexia nervosa another eating
disorder and obesity.
In anorexia nervosa there is a characteristic
weight loss from self starvation in previously
but not restricted to young healthy teenage
girls. The incidence in the developed
countries are considerable , figures for
developing countries are not readily
available , the general trend leans towards a
likelihood of an increase incidence.
Bulimia nervosa on the other hand can be
accompanied by long fasting periods, use and
abuse of diuretics, laxatives, stimulants or
excessive exercise. Sufferers are concerned
about their body weight; they therefore set
an incompatible weight limit or threshold.
Bulimia nervosa is stress related. There is a
loss of ions like potassium from the body,
deterioration of general health and
depression is usually seen.
The symptoms seen in the oral, dental and
associated tissues and organs can be
highlighted below.
The acid vomited by the sufferers causes an
erosion of the tooth as the enamel is worn
away. This is most visible on the inside
surface of the teeth the side facing the throat
as this side is the first side that contacts the
vomited fluids.
The salivary glands, especially the parotids –
the ones at the side of the jaws which open to
give saliva near the upper teeth, may be
slightly swollen. These swellings subside
when the person returns to the normal diet.
Oral ulcers and abrasions at the soft tissue of
the mouth, the soft palate and the posterior
regions of the roof of the mouth. These ulcers
may be as a result of the fingers traumatising
the soft tissue in trying to induce vomiting ,
the finger often the index finger or the ring
finger is inserted to initiate a vomiting reflex
in the throat.
In such cases the dentist is able to assist by
fabricating a plastic splint to cover the teeth
so they do not get decayed or suffer from
erosion. There is an added advantage
whereby the splints may be filled with
neutralising basic solutions like Magnesium
hydroxide.
Sodium fluoride mouthwashes and sodium
bicarbonate similarly neutralise the effect of
the stomach acids contained in the vomit.
In saying the obvious, eating disorders are
more common in women than men. There are
associated disorders like anxiety, impulse
control substance abuse with bulimia
nervosa. There is surprising sexual
association behaviour with bulimia nervosa,
alcohol abuse and family history.
Adolescent women are in this case most at
risk. The reason for the overall weight
increase seen over the years could be traced
to a better sense of nutrition and availability
of more or less junk food and protein. The
media can be pronounced guilty due to a
trend projected that thin is healthier, as one
can see in the girlie and feminine magazines,
and the mass media television, movies and
fashion trends as the best fashioned clothes
are made in the size 8 or less. This has a
negative effect on young ladies who therefore
go to extreme lengths even purging and
consuming all sorts of herbal weight loss
tablets etc. The author is not averse to
healthy life style, just highlighting the
negativity in such thin is best message.
To summarise , cycles of rapid out of control
eating which may stop only due to the
interruption from a third party or when the
stomach hurts from over extension as it is
being over filled by food consumed, whilst the
stomach is a receptacle for ingested food it is
actually limited in size. This being followed by
self induced vomiting, leads to a cycle that
goes on and on like a rolling wheel down a
slippery slope.
Apart from the oral effects there is chronic
gastric reflux after eating , dehydration of the
body due to excessive vomiting , lack and
loss of potassium ion from the body, the body
ion balance necessary for normal body
function is disrupted , cardiac arrests may
occur, irritation to the oesophagus and it may
even rupture , the oesophagus is a muscular
organ/ structure , oral problems of decay etc
as earlier highlighted , delayed emptying of
the stomach , constipation and infertility,
weight loss.
Parents should try to observe their children
and observe their weight and any other
habits like hiding in the toilet for so long
avoiding food. Sometimes bulimics may or
may not indulge in purging. Any excessive
fasting in children should be monitored for
any untoward consequence. The use of
laxatives and diuretics
The treatment of the general effects needs to
always include psychotherapy. The dentists
will try and relieve the oral and dental effects.

Posted By David Aniemeka