One of the biggest impacts eating disorders can have is on the teeth. Eating disorders cause tooth wear, which occurs when the outer tooth surface is lost as a result of chemical or mechanical activity in the mouth. All sorts of dental problems can arise as a result, such as teeth becoming short and unattractive as well as rough or sensitive. Speaking or chewing can become a problem and some people will end up with numerous restorations or having teeth removed.

Results from the Adult Psychiatric Morbidity Survey show that bulimia is the most prevalent eating disorder, making up 40 per cent of those with an eating disorder, compared to 10 per cent of sufferers having anorexia. Bulimia causes tooth erosion due to repeated acid regurgitation, and diet choices among those who are bulimic may be acidic, with sugar free and carbonated soft drinks, sports drinks and alcohol being frequently consumed, adding to erosion.

Stress is a common aspect in all eating disorders, which can also lead to other types of tooth wear.  Emma Pacey, Clinical Coordinator at the London Tooth Wear Centre® says: “The associated psychological complications of an eating disorder mean the patient may be susceptible to other types of tooth wear often caused by grinding or clenching habits, whilst obsessive behaviour can translate to tooth brushing, resulting in abrasion.”

Those with bulimia also become overly concerned with the prospect of bad breath, causing them to excessively brush their teeth. Terence, a bulimia sufferer for 11 years, says bad breath took great importance for him during his illness. “After vomiting the first thing I did was clean my teeth, as I thought this would help keep my teeth strong and prevent bad breath. I was more bothered about bad breath [than oral health] and I didn’t realise what I was doing [to my teeth].”

Unfortunately, oral care can often take a back seat when people are going through their illness. As with other psychological disorders, judgement may be affected, and one of the concerns likely to be at the bottom of the list is the impact their lifestyle is taking on their teeth.

Sam, who suffered from anorexia and bulimia for 15 years, has had tooth decay, intensive root canal treatment, numerous fillings and three missing teeth as a result, says: “[Oral health] wasn’t high on my list of priorities, being thin was. When you have such a low opinion of yourself your teeth…is just one thing in a long list of things that you hate about yourself.”

Although a difficult and sensitive subject to broach, tooth wear which is deemed to be the result of an eating disorder should be acknowledged. Emma says: “Denial and shame often feature and so discussion must be without judgement, with sympathy and time.  Acknowledgment and rectification of the causative factors need to be realised, otherwise treatment will be compromised.

“It is important to communicate effectively and with consideration, and provide clear explanation in an open and supportive environment.”

Sam agrees: “My dentist reacted with what I perceive to be disgust and a total lack of sympathy. She was very dismissive and offered very little support and advice…it made me feel really bad about myself and like I had no one to turn to. I saw the hygienist and broke down about my problems and told her how I felt about my teeth. She was very supportive and told me there are lots of things that can be done but I would need to be referred to a private clinic.”

It is also important to note that people with eating disorders may not want to listen to any advice given. Rhian, an eating disorder sufferer for 15 years, says: “I received very little advice [from my dentist]. I didn’t seek any and I wouldn’t have been willing to accept any either.”

Allison, who has suffered from both anorexia and bulimia, reiterates this. “Any advice you give may usually fall on deaf ears.”

Nonetheless, dentists should not be disheartened when it comes to treating patients, and still need to look out for tooth wear as a result of eating disorders.  Allison encourages “every dentist not to shy away from talking to their patients who present with high acid erosion on their teeth that could be attributed to an eating disorder.”

Sam’s advice to dentists is: “Don’t be judgemental, eating disorders are not a lifestyle choice, they are serious illnesses. Educate yourself about eating disorders, the effects they can have on teeth and the signs to look out for.”

Signs to look out for include increased levels of sensitivity, and sharp or chipped front teeth. Acid erosion presents on the palatal and occlusal surfaces of the teeth mostly, where acidic fluid pools in the mouth, and back teeth become rounded and lose some of their surface characteristics, while front teeth may become translucent at the biting edges. If abrasion is also present, grooves may develop in the teeth near to where they meet the gums.  

One of the biggest impacts that come with dental problems attributed to eating disorders is a lack of confidence and regret that oral health was neglected during their illness.

Sara, an anorexia sufferer, says: “Following recovery, the impact my eating disorder had upon my teeth has affected my confidence. I was, and am, aware of the appearance of my dentition, my missing tooth, and am self-conscious at times when speaking.”

Rhian says: “It upsets me that this is the lasting legacy of my eating disorder that I will have to live with for the rest of my life. I get annoyed at the amount I have and will continue to have to pay out because of the damage years of an eating disorder has done to my teeth.”

While dentists may not be able to stop an eating disorder, they may be able to prevent severe tooth wear which has occurred as a result, and make a big difference to that patient’s life.

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Materials provided by University of Basel. Note: Content may be edited for style and length.