Anorexia and bulimia are eating behavior disorders (EDs) that can have very negative consequences on oral health.
The main factors are malnutrition and the dehydration they cause, the effects of which can have a very negative impact on teeth, gums, and other structures of the oral cavity.
Malnutrition, dehydration, and vomiting are the main causes of oral changes in anorexia and bulimia.
However, the consequences of anorexia and bulimia in the mouth are especially significant when they are of the purgative type. That is when they are accompanied by provoked vomiting and the abusive use of laxatives and diuretics.
The damage caused by these eating behavior disorders is more serious the longer they last. Hence the importance of early diagnosis and treatment.
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In this sense, dental professionals have a key role. Sometimes oral lesions are the first warning signs that lead to suspicion of a possible eating disorder.
This is especially relevant since anorexia and bulimia are serious disorders that can trigger significant physical illnesses and, in extreme cases, lead to death (the most frequent causes being suicide or malnutrition).
In addition, some of the oral manifestations they cause cannot be reversed. Thus, it is essential to recognize them early and treat them promptly.
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Table of Contents
Main oral alterations in anorexia and bulimia
The main oral manifestations that cause anorexia and bulimia are dental erosion, caries, alterations in the tongue, periodontal tissues and in salivary glands, bruxism, and dysfunctions of the temporomandibular joint.
Tooth erosion. The reflux of fluids from the stomach through vomiting damages dental tissue causing tooth erosion.
The most affected teeth are usually the upper ones, especially the inner faces. This is because the tongue directs gastric contents forward during vomiting and, at the same time, protects the lower teeth.
At the same time, the chemical insult caused by the acid of vomiting is aggravated by the mechanical insult caused by frequent brushing to remove the bad taste and scratchy feeling in the mouth after vomiting.
This abrasion can also drag away the prisms of weakened enamel, contributing to the formation of cavities.
Tooth decay. The higher incidence of caries in patients with anorexia and bulimia is a factor discussed due to the multifactorial nature of the disease.
Even so, different studies do refer to a higher risk of caries in eating behavior disorders.
The main triggering factors would be a high-carbohydrate diet associated with poor oral hygiene, increased acidity in the oral cavity due to changes in the bacterial flora and vomiting, decreased salivary flow and xerostomia due to fluid loss by vomiting, the use of diuretics and laxatives or the consumption of certain drugs.
In this sense, it is worth mentioning that people with anorexia and bulimia may be under antidepressant treatment, which can contribute to the appearance of dry mouth.
Xerostomia. People with anorexia and bulimics of the purging type may present variable degrees of xerostomia as a consequence of dehydration, malnutrition, poor absorption, anxiety, hormonal disorders, and the use of antispasmodics, diuretics and laxatives, and the consumption of depressants medication. Of the nervous system.
Alterations in the salivary glands
It has been observed that hypertrophy of the parotid gland, located below the ear and behind the lower jaw, usually occurs between 2 to 6 days after an episode of binge eating and purging. This disturbance may persist even after anorexia and bulimia have been reversed or have resolved spontaneously.
At the same time, the dehydration caused by chronic vomiting can cause a viral or bacterial infection in the said gland (sialadenitis). If so, salivary flow is reduced and saliva becomes thicker and more viscous.
Malnutrition and the growth of the salivary glands have also been linked. This enlargement may come and go, or be persistent if the eating disorder progresses. When this occurs, a bilateral or unilateral facial deformity is seen.
Mucosal and tongue lesions
Nutritional deficiencies (especially vitamin C and vitamins B1, B6, and B12) and xerostomia cause an alteration of the mucous membranes of the oral cavity.
All this, together with the acid content of the vomit, makes them more susceptible to ulcers, infection, redness, pain, angular cheilitis (small wounds in the corner of the mouth), and cleft lips.
The alterations in the tongue are of a sensory nature and may present an appearance of atrophic glossitis. That is, the tongue becomes inflamed and takes on a smooth appearance.
Lacerations may also occur from inducing vomiting, rapid food intake, or the force of regurgitation.
Oral candidiasis is another symptom that can occur in people with anorexia and bulimia as it can be associated with nutritional deficiencies.
Periodontal alterations. Periodontal disorders are common in anorexia and bulimia.
The main causes are dehydration of the oral tissues, deficiencies in saliva production, hormonal and metabolic problems, poor oral hygiene, and nutritional deficiencies.
Regarding the latter, the lack of vitamin C is especially harmful by causing defects in collagen synthesis, which is associated with generalized gingival inflammation, spontaneous gingival bleeding, ulcerations, dental mobility, and increased severity of periodontal infection.
Gingivitis is the most frequent periodontal alteration and, according to different studies, the plaque index is usually higher in anorexic patients than in bulimics.
Bruxism. The psychological factors present in anorexia and bulimia such as anxiety, anger, or frustration can favor the appearance of bruxism and, as a consequence, orofacial pain problems.
Dysfunctions of the temporomandibular joint
The lack of certain nutrients in the body can cause inflammation in the joints.
In case of presenting some degree of osteopenia or osteoporosis, the damage at the level of the bony components of the temporomandibular joint can manifest itself through dysfunctions.
For all these reasons, it is essential that dental professionals know the impact of anorexia and bulimia in the mouth and how to detect its manifestations in the oral cavity. Likewise, it is vital that they form part of the multidisciplinary treatment that people with these disorders should receive.
