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The dental damage of eating disorders

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  Posted by: The Probe      6th March 2020

Despite being prevalent, serious psychological illnesses that can debilitate and even kill, eating disorders (EDs) remain widely misunderstood. Stereotypes surrounding EDs can delay people realising they have a problem and seeking help for their condition. Many people believe that EDs primarily or even exclusively affect white women. In reality, anyone can develop an ED no matter their ethnicity, socioeconomic background, orientation or sex.

The belief that EDs only affect particular individuals or groups of people can contribute to feelings of denial or embarrassment, thus presenting an obstacle to treatment.[i] Late detection of an ED will generally result in greater harm to the patient. Last year, systemic failures of early detection and intervention were blamed for the highest number of hospitalisations in eight years due to EDs. This was not an anomaly either, as the NHS has seen year-on-year rises in hospital admissions due to EDs, with the number of patients doubling since 2010.[ii]

Only a minority of those with an ED seek treatment, so the true scope of the problem is difficult to determine and likely underreported. EDs are often comorbid with other psychological disorders such as anxiety and depression. The risk of suicide for people with an ED is elevated even when comorbidities are accounted for.[iii]

Recognising ED

EDs can cause extensive damage to teeth, so much so that sometimes the first indicator of an ED is the appearance of the patient’s teeth. Consequently, dental professionals can play an important role in helping patients with an ED get help. There are numerous EDs and their manifestations can be diverse and difficult to detect.[iv]

Anorexia & Bulimia Nervosa

These are the most well-known EDs, although still frequently misunderstood. Anorexia is characterised by distorted body image and excessive efforts to control body weight, typically through caloric restriction. Bulimia involves a pattern of binge eating followed by inappropriate compensatory behaviour to avoid weight gain (e.g. excessive exercise, fasting or self-induced regurgitation).[v], [vi]

Binge eating disorder (BED)

Now recognised as an eating disorder, BED is chronic and distinct from simply overeating. Sufferers typically consume large amounts of food when they are not physically hungry, and can feel ashamed, guilty, depressed or disgusted following binges. BED does not involve purging behaviour. In addition to the psychological toll, this ED can lead to obesity, diabetes, caries and related health consequences in the long-term.[vii]

 Pica

Pica is an eating disorder where the patient eats non-food substances. The object eaten can be virtually anything, which can result in the ingestion of toxic or otherwise harmful material. One man was discovered to have consumed 40 knives![viii] The substance can also be substantially harder or coarser than food generally is, which can potentially irritate and damage the mouth, teeth and digestive system (paper, bricks, gravel, metals, etc.). Pica has been linked to other mental health disorders including obsessive-compulsive disorder. It has been hypothesised that some cases of Pica are triggered by nutritional deficiency.[ix]                                     

Rumination disorder

This is the regular regurgitation of food, which may then be re-consumed or spit out (diagnosis requires at least one month of this behaviour).[x]

Other specified feeding or eating disorder (OSFED)

This is a catch-all diagnosis for patients that exhibit an ED but do not meet the DSM-5 criteria for listed EDs.

In addition to disorders listed in the DSM-5, other harmful behaviours have been identified that are broadly related. Among these are compulsive exercise, orthorexia (an obsessive fixation with eating healthily), diabulimia, and laxative abuse.[xi]

Symptoms

Acid erosion of teeth

Exposure to stomach acid can rapidly destroy tooth enamel. Patients who induce vomiting should be advised to rinse with a non-acidic mouthwash after regurgitating and avoid immediately brushing their teeth afterwards.[xii] If the patient has induced vomiting by using their hands, irritation or a callus may be present on their fingers.[xiii] Regular vomiting may also result in chronic sore throat and swelling of the salivary gland in the neck and below the jaw.[xiv]

Dehydration

Some ED behaviours can cause dehydration, either deliberately or as a side-effect. Dehydration can have serious consequences for the body, including within the oral cavity where it can reduce salivary flow and increase the risk of caries.[xv] Chronic dehydration is linked to urolithiasis (kidney stones), constipation, colorectal cancer, deep vein thrombosis, orthostatic hypotension and other conditions.[xvi]

 Malnutrition/starvation

Starvation may be indicated by: abnormally dry or yellowing skin, lanugo-like body hair, brittle hair/nails, osteoporosis, anaemia, reduction in muscle mass, severe constipation, internal body temperature drops, lethargy, discolouration of the extremities, purpura, cessation/disruption of menstrual cycle, and a variety of other symptoms.[xvii], [xviii]

EDs can have devastating effects on general and oral health, leaving some patients vulnerable to multiple complications. In this case, consider referring patients to the multi award-winning Ten Dental+Facial team. They offer a range of both general and specialist treatments, and are highly experienced in treating patients with complex oral health needs, including those who suffer from an ED.  

ED is a psychiatric disorder, and patients are unlikely to be forthcoming about their condition. Detection and encouragement of the patient to seek further treatment require awareness and sensitivity. It is important to remember that ED can affect any demographic and that BMI is not a reliable indicator of a disorder.

 

For more information visit www.tendental.com or call on 020 33932623

  

[i] New research shows eating disorder stereotypes prevent people finding help. Beat Eating Disorders. 2019. https://www.beateatingdisorders.org.uk/news/beat-news/eating-disorder-stereotypes-prevent-help November 15, 2019.

[ii] Marsh S. Hospital admissions for eating disorders surge to highest in eight years. The Guardian. 2019. https://www.theguardian.com/society/2019/feb/15/hospital-admissions-for-eating-disorders-surge-to-highest-in-eight-years November 22, 2019.

[iii] Keski-Rahkonen A., Mustelin L. Epidemiology of eating disorders in Europe: prevalence, incidence, comorbidity, course, consequences, and risk factors. Current Opinion in Psychiatry. 2016; 29(6): 340-345. https://www.ncbi.nlm.nih.gov/pubmed/27662598 November 22, 2019.

[iv] National Institute for Health and Care Excellence. Eating disorders: recognition and treatment NICE guideline [NG69]. NICE. 2017. https://www.nice.org.uk/guidance/ng69/chapter/Recommendations November 22, 2019.

[v] Parekh R. What are eating disorders? American Psychiatric Association. 2017. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders November 22, 2019.

[vi] Douglas L. Caring for dental patients with eating disorders. BDJ Team. 2015; 1: 15009. https://doi.org/10.1038/bdjteam.2015.9 November 22, 2019.

[vii] Parekh R. What are eating disorders? American Psychiatric Association. 2017. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders November 22, 2019.

[viii] Pokharel S., Berlinger J. Doctors remove 40 knives from man’s stomach in India. CNN. 2016. https://edition.cnn.com/2016/08/22/health/india-man-with-knives-stomach/ November 15, 2019.

[ix] Advani S., Kochhar G., Chachra S., Dhawan P. Eating everything except food (PICA): a rare case report and review. Journal of International Society of Preventive & Community Dentistry. 2014; 4(1): 1-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015153/ November 15, 2019.

[x] Rumination disorder. National Eating Disorders Association. 2019. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/rumination-disorder November 15, 2019.

[xi] National Institute for Health and Care Excellence. Eating disorders: recognition and treatment NICE guideline [NG69]. NICE. 2017. https://www.nice.org.uk/guidance/ng69/chapter/Recommendations November 22, 2019.

[xii] National Institute for Health and Care Excellence. Eating disorders: recognition and treatment NICE guideline [NG69]. NICE. 2017. https://www.nice.org.uk/guidance/ng69/chapter/Recommendations November 22, 2019.

[xiii] Askounes S., Williams K. Eating disorders with the dental practice: a literature review. Global Journal of Medical Research: J Dentistry & Otolaryngology. 2016; 16(3). https://medicalresearchjournal.org/index.php/GJMR/article/view/1236 November 22, 2019.

[xiv] Parekh R. What are eating disorders? American Psychiatric Association. 2017. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders November 22, 2019.

[xv] Guo L., Shi W. Salivary biomarkers for caries risk assessment. Journal of the California Dental Association. 2013; 41(2): 107-118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825179/ November 22, 2019.

[xvi] El-Sharkawy A., Sahota O., Lobo D. Acute and chronic effects of hydration status on health. Nutrition Reviews. 2015; 73(S2): 97-109. https://doi.org/10.1093/nutrit/nuv038 November 15, 2019.

[xvii] Askounes S., Williams K. Eating disorders with the dental practice: a literature review. Global Journal of Medical Research: J Dentistry & Otolaryngology. 2016; 16(3). https://medicalresearchjournal.org/index.php/GJMR/article/view/1236 November 22, 2019.

[xviii] Parekh R. What are eating disorders? American Psychiatric Association. 2017. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders November 22, 2019.


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