STORY BYPart III of a Series
on Eating Disorders
At first glance, the mouth of a person with an eating disorder appears normal, but a closer look inside may reveal serious problems: erosion on the surfaces of the teeth, abscesses on the gums, glandular enlargement of the cheeks and a chemical change in the saliva.
Frequently, it is the dentist who is the first doctor to diagnose a patient with an eating disorder. All these changes are caused by the lack of proper nutrition and the acid from self-induced vomiting.
"These changes are most obvious on the back surfaces of the upper teeth, as well as those along the gum line and the chewing surfaces. The loss of tooth structure in these areas frequently causes sensitivity to hot and cold and can even result in the development of abscesses," explains Dr. Catherine M. Flaitz, dean of the University of Texas Dental Branch at Houston. "When there is significant destruction, the pulp or nerve of the tooth can become damaged and require root canal treatment and crown restorations."
Self-induced vomiting can cause trauma in the mouth, depending on what the person puts in her mouth to induce regurgitation.
With loss of enamel from erosion, the teeth become thinner, smooth and glassy in appearance. These changes are usually seen after two years of binge eating and purging. With time, significant tooth erosion can develop, causing the teeth to yellow and become brittle. This deterioration of the enamel, which is the outer layer of the tooth, cannot be regenerated—once lost, it is gone forever. As the enamel wears off, the teeth appear yellow or amber in color.
"These conditions are caused by acid in the mouth from self-induced vomiting, carbonated drinks and increased amounts of fruits that are consumed to cause diarrhea," Flaitz says. It is the citrus fruits—oranges, lemons, grapefruit—that do the most damage if eaten in large amounts. Tomatoes are highly acidic, also. Hard candies that are artificially fruit flavored can also cause significant damage because the flavoring is acidic and the candy slowly dissolves in the mouth.
If young people with eating disorders notice that their teeth are turning darker, they may try to whiten their smiles with over-the-counter bleaching agents. These products not only won't improve the color of eroding teeth, but might further wear away enamel. Bleaching products will cause eroding teeth to be more sensitive and darker in color because the second layer of the tooth, dentin, becomes exposed.
Another change is in the saliva. For some, there is a decreased amount, but for everyone the consistency thickens and cannot dilute, cleanse and neutralize the inside of the mouth as it did before. "To neutralize the inside of the mouth, we recommend the patient rinse with water either alone or containing a fourth teaspoon of baking soda. Another option is to rinse with an antacid," she explains.
Chewing sugarless gum helps stimulate saliva and promote the natural re-mineralization or re-hardening of teeth. The use of topical fluorides helps to decrease sensitivity and prevent cavities from forming.
To correct the damage done inside the mouth, the dentist can cover the teeth with restorations or crowns to help prevent further damage.
Even more changes take place inside the mouth:
Other possible head and neck problems from eating disorders are hair loss from nutritional deprivation, chapped lips and very dry skin from dehydration, and very fine fuzzy hair growth on the face.
"These changes are very disconcerting for a young person obsessed with their body image," Flaitz observes.
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Dr. Catherine M. Flaitz is a professor of diagnostic sciences at UT Dental Branch and an oral pathologist.
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Eating healthy
reverses metabolic syndrome
Dr. Tasnime Akbaraly of University College London and her colleagues were interested if healthy eating could actually turn-the-tide and reverse metabolic syndrome, which is having 3 or more of the following risk factors: excess abdominal fat; high triglycerides, hypertension, low levels of HDL the “good” cholesterol, or type 2 diabetes. Having metabolic syndrome doubles a persons’ risk of heart disease and greatly increases the odds of developing type 2 diabetes.
The researchers studied 339 British civil servants with metabolic syndrome, and how closely the adhered to the Alternative Healthy Eating Index (AHEI) to see if it could help reverse metabolic syndrome. The AHEI is a set of published nutritional guidelines by the Harvard School of Public Health in 2002 that emphasizes whole grains, fruits, vegetables and decreased red meat consumption.
Five years into the study, nearly 50% no longer had metabolic syndrome. People who followed the AHEI guidelines the closest were nearly twice as likely to have reversed their metabolic syndrome. The results of the study were published in Diabetes Care, online July 29, 2010.
Dr. Alice Lichtenstein, an expert on diet and heart health from Tufts University in Boston who was not involved in the study said, "It's not about focusing on individual components of the diet, it's really the whole package, and that becomes important because it means that if one of the components of a healthy diet is to eat more fruits and vegetables, just buying a pill saying that there's a concentrated extract of fruits and vegetables is probably not what's going to help you."
Call and make an appointment with Wellness Coach Sam Hester, CWC, CPT, LWMC, at 713-500-3327. It's confidential and free. For more information on the wellness services provided, visit UT Counseling and WorkLife Services.
