*Content of this blog some readers may find triggering* 

An eating disorder is a mental disorder defined by abnormal eating behaviours that adversely affect a person’s physical or mental health. 

They can present as a wide range of issues from not eating at all, to binging food and then vomiting it back up (also known as purging). 

Eating disorders aren’t the most talked about topic. 

As dental professionals we tend to focus on ‘just the teeth’ but I think it’s vitally important to help support the patient by signposting them to other services which may with other aspects of their disorder. 

At the Dental Hygiene Studio, we work closely with patients who suffer with eating disorders. It is interesting to learn, however, that the clinical effects are often only a small part of the problem. 

Often, alongside eating disorders, patients are also suffering with other mental health issues including depression, anxiety, self-harm, substance abuse, effects from trauma, obsessive compulsive disorder, and suicidal thoughts/behaviours. 

How is a patient supposed to control their impulses and have their dental health as a high priority when they struggle to simply get through each day? 

Eating disorders tend to be a hidden problem because they are also dealing with crippling anxiety and depression. They feel ashamed, fear they will be judged, misunderstood, ignored, or worse, simply want to end their life. They struggle to have relationships, so are isolated, and feel unloved, unsupported, and alone. 

Here is a simple outline of the most common disorders and their complications:

Anorexia

Anorexics limit their food and drink intake due to a fear of gaining weight. They may also engage in behaviours like vomiting, using laxatives, or excessive exercise to get rid of ‘excess’ calories. 

Symptoms can include:  

  • Constantly thinking about food and calories. 
  • Restricting certain food types. 

Oral Health Effects can include:  

  • Chronic dry mouth: reduced saliva production due to dehydration and no food present in the mouth. 
  • Tooth wear: Enamel erosion from acidic vomit. 
  • Gum disease and cavities: due to poor nutrition.  

 

Bulimia:  

Bulimia involves binge eating followed by purging (vomiting, laxatives, or excessive exercise). 

Symptoms can include:  

  • Binge-purge patterns. 
  • Tiredness, bloating, and irregular menstrual cycles in females. 

Oral Health Effects can include:  

  • Severe acid erosion: Frequent vomiting damages tooth enamel resulting in sensitivity and dental pain 
  • Gum disease and cavities: acidic conditions are detrimental for the mouth 
  • Tooth wear

 

Binge Eating Disorder:  

 Binge eaters consume enormous quantities of food being unable to have any feeling of control. 

Symptoms mostly include:  

  • Unplanned binges. 
  • Distress and embarrassment. 

 

Oral Health Effects often include: 

  • Tooth wear 
  • Pain and sensitivity 
  • Redness/swelling of the gums 

 

 

At the dental appointment we try and help and support the patient by: 

  • Monitoring oral health at every visit. 
  • Providing guidance on oral care. 
  • Addressing any dental concerns. 
  • Encouraging proper nutrition. 
  • Addressing and educating about dry mouth and enamel erosion depending on its severity. 
  • Encouraging regular dental check-ups, not just with a dental hygienist but a dentist too. 
  • Encouraging patients to rinse their mouth with water after purging. 
  • Encouraging patients to delay brushing teeth after purging to protect enamel and reduce irreversible damage which results in sensitivity and pain. 

  

I asked a patient to try and explain from their viewpoint what are the biggest obstacles and problems they suffer from simply attending an appointment.  

The range of emotions a dental visit presents can be so overwhelming.  

Here they explain in their own words what it’s like: 

I’ve suffered with an eating disorder for several years now…bulimia to be specific.

Visiting the dentist has always been a huge difficulty. But after purging for so long, the idea of visiting a dentist turned to another level of daunting. This is not only due to the pain inflicted from the damage of the stomach acid but also the visible effects.

What will the dentist think? Will I be able to hide from the dentist that I have an eating disorder? How would I cope visiting a dentist when they see the effects of the stomach acid on my teeth and gums and realise I have bulimia?

These are all questions that swirled around my mind endlessly for months and months. Before falling victim to bulimia, I had no dental issues whatsoever. Maybe a little sensitivity here and there but nothing noteworthy.

But this changed quite drastically. After nights upon nights, years upon years of purging..my teeth became so sensitive. Even the slightest trickle of cold water or hot coffee touching my teeth and the pain would be intense. My gums also felt like they would burst open at the slightest little touch of my toothbrush.

It was a dental nightmare. This is why visiting the dentist seemed like such a scare.

I’m happy to say I was very very surprised.

Upon arrival, I made it known that my level of anxiety was way above the average person. Once I was back in the chair, I focused on my breathing and closed my eyes. This is my main coping mechanism, as simple as it sounds.

Before even opening my mouth, I told the dentist I suffered with an eating disorder but didn’t go into any specifics. From purging, my gums were much more red/purple around the edge of each tooth so this was something that made me so self conscious. If the dentist saw this, they’d surely know I purged. That said, I always feel a huge amount of shame when telling someone of my eating disorder but I felt little to none here.

The dentist was very understanding and didn’t ask me to elaborate or anything. Just that they understood and would help me in any way possible.

After the appointment, I felt a great sense of relief. Going to a dentist is an especially daunting task with an eating disorder, but through the simple way of communication and honesty, I can rest easy knowing that all they want to do is help me.

My advice for any patient with an eating disorder who is anxious about the idea of visiting a dentist: be honest. The dentists are not there to judge you, they’re simply there to help.

At the end of the appointment, I was given some very useful information about what foods to eat, avoid and drinks too. It was very welcomed. They recommended I avoided anything acidic like cola, lemonade, energy drinks and also limited my consumption of coffee and hot drinks. Not just because of the pain they can cause from the sensitivity issues posed by purging but also the potential of staining my teeth.

I had no idea about this so it was very welcomed!

Finally, I was showed how to brush my teeth correctly and carefully to prevent me from causing too much discomfort. It had turned out I was brushing my teeth far too roughly which would’ve just damaged my gums over and over had I not made the leap to make the dental appointment.

To conclude, I would’ve never imagined finding the courage to visit a dentist for a long time, but I did it and it’s a huge achievement. For anyone going through the suffering living with an eating disorder inflicts,

I highly recommend digging deep and making an appointment. You will not regret it. Dentists are there to help and it’s really no where near as scary and I’d anticipated.

– Anonymous patient

An eating disorder is usually accompanied by other physical complications too which can vary in severity but include: 

  • Heart failure and other heart problems 
  • Acid reflux. 
  • Gastrointestinal problems. 
  • Low blood pressure. 
  • Organ failure and brain damage 
  • Osteoporosis and tooth damage 
  • Severe dehydration and constipation 
  • Stopped menstrual cycles.  
  • Infertility 
  • Stroke. 

As you can see, being ‘Bulimic’ is not as simple as purging after food. There is a myriad of other problems that the patient is dealing with daily.  

Our role as dental professionals should be looking at our patients as human beings and remembering empathy, care, dignity, and respect are what underpins our professional relationship. Trust, sharing knowledge and signposting to other services are also what we should be doing. 

Listening to what patients tell us can only empower us as professionals to do better, be better and help them to be better too. 

If you need more information about eating disorders, you may find these links helpful: 

Advice for parents – Eating disorders – NHS (www.nhs.uk) 

Eating problems – Mind 

The UK’s Eating Disorder Charity – Beat (beateatingdisorders.org.uk) 

17 Best Eating Disorder Recovery Blogs (choosingtherapy.com)