Although our primary remit as dental professionals is to help patients improve their oral health, there are many caveats to this. Each person in our chair will have different needs, have been through different experiences and have different priorities when it comes to their physical and mental wellbeing. We have to work with these and adapt our approach accordingly. With Eating Disorder Awareness promoted at the end of February, I felt this was a good time to consider how we might change our care for patients who have been affected by one of these terrible conditions.
In numbers
An estimated 1.25 million people have an eating disorder in the UK.[i] Sadly, a huge proportion of children and young adults are affected by problematic eating. NHS statistics[ii] suggest that almost 60% of people aged 17-19 years experienced eating problems in 2023, with 57% of those aged 20-25 also affected. Prevalence of eating problems in most child and young adult age groups almost doubled between 2017 and 2023.
Among adults, the number of hospital admissions for eating disorders rose by 84% between 2015/16 and 2020/21.[iii] Approximately 75% of those with an eating disorder are female, demonstrating a higher risk for women. In fact, records of hospital episodes involving an eating disorder diagnosis in England for 2022-23[iv] show that 13,758 women and 837 men were treated for anorexia nervosa in the year. Around 6,453 women and nearly 598 men were treated for bulimia nervosa, while 13,672 females and 1,253 males were admitted for an unspecified eating disorder during the same time.
Increased systemic health risks
Eating disorders have a detrimental impact on the body and the mouth. Systemic conditions associated with low weight and eating disorders include hypokalemia (imbalanced potassium in the body); hyponatremia (imbalance of water to sodium); hypophosphasteia (reduces cardiac output, and causes muscle dysfunction and pain, acute renal tubular necrosis and impaired neurological function); and bone marrow suppression.[v]
Excessive weight loss is also associated with psychological conditions like depression and anxiety, as well as contributing further to an unhealthy relationship with food.[vi] This creates a difficult cycle that makes overcoming an eating disorder even more difficult for sufferers. It’s important to remember that not all eating disorders will result in noticeable weight loss.
Oral presentation
Oral presentationEating disorders will commonly present with oral symptoms. Depending on what condition a patient has, frequent vomiting, binge eating and regular tooth brushing will all leave signs in the mouth.
Erosive tooth wear is a typical oral symptom of an eating disorder,[vii] often caused by regular vomiting. The lesions often feature from the cingulum across the entire lingual surface of the anterior teeth, becoming more severe over time to also affect the dentine and palatal tooth surfaces. Where sufferers often brush their teeth after vomiting, this can cause abrasion and accelerate tooth surface loss. In addition, the loss of significant surface height can cause occlusal instability, consequently increasing the risk of temporomandibular disorders.
The soft tissues of the mouth are also likely to be affected by an eating disorder. A disordered diet can lead to vitamin deficiencies (including vitamin C), and is often high in carbohydrates and sugar, which has been linked to a higher risk of gingival inflammation.[viii]
Traumatic habits, hyposalivation and poor oral hygiene will further negatively affect periodontal health. Those with eating disorders are also more likely to experience dry lips, labial erythema, exfoliative cheilitis, palatal tissue discolouration, haemorrhagic lesions, lip-cheek biting, burning tongue, periodontal disease and gingival recession.vii [ix] [x]
Supporting patients
Eating disorders are, first and foremost, mental health conditions. Their management is complex and will be tailored specifically to the individual. For the dental team, our role is to help those with a diagnosis to improve their oral health and reduce negative symptoms for a better quality of life. We may also assist in identifying eating disorders by having sensitive conversations with patients or their parents/guardians where potential oral health signs have been detected.
The Eating Disorder Awareness campaign is a great opportunity to start displaying information in the practice and to communicate key messages to patients during appointments. The theme for 2025 is that anyone can be affected by an eating disorder, regardless of age, gender or background. This is a good reminder for us all to avoid stereotypes and to be ready to help any patients who may be suffering. You can find out more about the campaign or download resources at edaw.beateatingdisorders.org.uk.
For further information about the endodontic referral services available from EndoCare, please call 020 7224 0999 or visit www.endocare.co.uk
Author: Dr.Michael Sultan
EndoCare, led by Dr Michael Sultan, is one of the UK’s most trusted Specialist Endodontist practices. Through the use of the latest technologies and techniques, the highly-trained team can offer exceptional standards of care – always putting the patient first. What’s more, EndoCare is a dependable referral centre, to which dentists from across the country send their patients for the best in specialist endodontic treatment.
[i] Beat Eating Disorders. Statistics for journalists. https://www.beateatingdisorders.org.uk/media-centre/eating-disorder-statistics/ [Accessed November 2024]
[ii] Mental health of children and young people in England, 2023 – wave 4 follow up to the 2017 survey. Publication, part of mental health of children and young people surveys. November 2023. https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2023-wave-4-follow-up/part-5-eating-problems-and-disorders [Accessed November 2024]
[iii] Hospital admissions for eating disorders increased by 84% in the last five years. May 2022. Royal College of Psychiatrists. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2022/05/18/hospital-admissions-for-eating-disorders-increased-by-84-in-the-last-five-years [Accessed November 2024]
[iv] Statista. Hospital episodes involving a primary diagnosis of an eating disorder in England in 2022/23, by tope and gender. https://www.statista.com/statistics/987218/england-eating-disorders-by-type-and-gender/ [Accessed November 2024]
[v] Cuntz U, Quadflieg N, Voderholzer U. Health Risk and Underweight. Nutrients. 2023 Jul 24;15(14):3262. doi: 10.3390/nu15143262. PMID: 37513680; PMCID: PMC10383423.
[vi] Miller-Kovach K, Hermann M, Winick M. The psychological ramifications of weight management. J Womens Health Gend Based Med. 1999 May;8(4):477-82. doi: 10.1089/jwh.1.1999.8.477. PMID: 10839702.
[vii] Rangé H, Colon P, Godart N, Kapila Y, Bouchard P. Eating disorders through the periodontal lens. Periodontol 2000. 2021 Oct;87(1):17-31. doi: 10.1111/prd.12391. PMID: 34463986; PMCID: PMC8637500.
[viii] Woelber, J. P., Gebhardt, D., & Hujoel, P. P. (2023). Free sugars and gingival inflammation: A systematic review and meta-analysis. Journal of Clinical Periodontology, 50(9), 1188–1201. https://doi.org/10.1111/jcpe.13831
[ix] Romanos GE, Javed F, Romanos EB, Williams RC. Oro-facial manifestations in patients with eating disorders. Appetite. 2012 Oct;59(2):499-504. doi: 10.1016/j.appet.2012.06.016. Epub 2012 Jun 29. PMID: 22750232.
[x] Schlosser BJ, Pirigyi M, Mirowski GW. Oral manifestations of hematologic and nutritional diseases. Otolaryngol Clin North Am. 2011 Feb;44(1):183-203, vii. doi: 10.1016/j.otc.2010.09.007. PMID: 21093629.
