Eating disorders are mental health conditions that significantly impair physical health and psychosocial functioning. Eating disorders have severe consequences on mental well-being and physical health, including oral health. The three most frequent eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder.
- Anorexia nervosa is characterized by self-starvation and low weight and/or significant weight loss. It can be subdivided into a restricting type (in which weight loss is accomplished by reduced food intake, excessive physical exercise, or fasting) and a binge eating/purging type. Purging behaviours include self-induced vomiting or misuse of laxatives, diuretics, appetite suppressants, or enemas.
- Bulimia nervosa is characterized by recurrent episodes of binge eating with compensatory purgative behaviours to control weight gain. Weight is generally normal.
- Binge eating disorder is characterized by recurrent episodes of binge eating without compensatory behaviours characteristic of bulimia nervosa. For this reason, individuals with binge eating disorder are generally overweight or obese.
Eating disorders can have severe sequelae with high mortality rates. Recovery from eating disorders can vary from several months to years. Treatment programs are more efficient if initiated soon after eating disorder onset. Consequently, early detection of an eating disorder is vitally important. Oral health clinicians are frequently the first professionals to suspect an eating disorder because of the unique clinical oral features associated with eating disorders.
This narrative review summarized the oral health impact of eating disorders. Oral manifestations of eating disorders include:
- Dental erosion from self-induced vomiting.
- Dental abrasion from traumatic toothbrushing following vomiting episodes.
- Higher incidence of caries from high carbohydrate consumption and multiple episodes of food intake.
- Temporomandibular disorders from loss of interarch contacts and vertical dimension from vomiting and/or binge eating behaviours.
- Dry lips, labial erythema, exfoliative cheilitis, palatal tissue discoloration, hemorrhagic lesions, lip-cheek biting, burning tongue, ulcerative lesions, and periodontal diseases. Resultant factors may include an unbalanced diet, traumatic habits, hyposalivation, and poor oral hygiene, which may negatively affect oral mucosa and periodontal tissue health.
- Swelling of parotid salivary glands from chronic vomiting.
- Hyposalivation, which increases the risk of halitosis, plaque accumulation, gingival inflammation, dental caries, and erosion.
Oral health professionals play a vital role in the early recognition and subsequent diagnosis of eating disorders because of the impact eating disorders have on the oral cavity. Improving the level of oral care in individuals with eating disorders may contribute to better overall outcomes in nutritional and psychotherapeutic approaches.
