Teenage Girls with Eating Disorders and Oral Health Issues

Since the late twentieth century, the number of people suffering from eating disorders has risen. Anorexia nervosa is the most common eating disorder defined as a psychological eating disorder that affects people of all ages, races, and sexes. Only a tiny proportion of the reported cases are boys, so this disorder is most common among caucasian teenage girls. Anorexia has the highest prevalence among teenage and young adult females, although it can affect anybody from the age of eight years old and has even been reported among 60-year-old adults. The media, family, and peer pressure are the primary factors that contribute to this disorder. The current paper aims to demonstrate that there is a causal relationship between oral health and eating disorders. It does this by exploring the relation between dental hygiene and eating disorders among teenage girls.

Eating disorders can be described as psychological conditions that develop as a result of self-evaluation by shape and weight perception that lead to a desire to be slim. Eating disorders can be either anorexia nervosa or bulimia nervosa, although anorexia nervosa is the most common. Eating disorders are typified by body weight that is less than 85% of the expected for the individual’s age, dissatisfaction with one’s body image, and endocrine disorders which may occur in the form of amenorrhea (American Psychiatrist Association 539). Teenage girls who have a distorted body image are most likely to induce weight loss which can be achieved by avoiding food, self-induced vomiting, purging, and exercising. Eating disorders are most prevalent in certain groups such as girls that are involved in performing arts or in elite athletes. In a survey, eighty-six percent of the teenage girls interviewed admitted to having induced vomiting at least one in as a way of weight management (Frydrych, Davies and McDermott 6).

Signs of eating disorders can be noticed on teeth, salivary glands, saliva as well as in serum amylase. It is argued that dentists are likely to be the first to notice signs of an eating disorder as the first symptoms appear in the mouth of the patient (Debate and Tedesco 1068). Eating disorders for girls who self-induced vomiting can be noticed through eroded dental enamels. Also known as perimolysis, it begins with a slight loss of the enamel and eventually the erosion of dentin on the lingual surfaces caused by the low ph of regurgitated contents as well as movements of the tongue. According to Steinberg et al. (288), perimolysis becomes clinically observable on a patient who has been binge eating and purging for more than two years. Moreover, there is a direct relationship between the degree of dentition and the prevalence and the intensity of vomiting as well as the patient’s dental hygiene habits. As a result, the patient may experience severe thermal sensitivity, making it harder for them to eat some kinds of food and making their condition even worse (Lo Russo et al. 481).

At the same time, individuals with an eating disorder are highly likely to neglect personal grooming and hygiene as they are distracted by issues of weight loss. They may therefore not take care of their teeth and oral soft tissues as frequently as is necessary. Those who do increase the risk of tooth erosion as they are likely to brush aggressively immediately after vomiting and cause further erosion of the fragile enamel. Additional effects of severe dentition include margins of restoration on the molars and premolars appearing higher than the rest of the teeth and the risk of developing an open bite for the anterior teeth.

Patients with eating disorders also experience swollen parotid glands as well as enlarged sublingual and submandibular glands. This is especially prevalent among bulimia nervosa patients who frequently engage in binge eating and purging. A patient usually experiences parotid swelling only a few days after an episode of binge eating and purging. When examined through the fingers and hands, parotid swelling is soft and maybe painless. For a patient at the initial stages of the disorder, swelling of parotid glands may occur intermittently, only appearing once in a while before it eventually becomes chronic. At this point, the condition becomes noticeable as it causes a widened, square-like appearance on the patient’s jaws and they have to seek medical attention (Price et al. e80). However, there may be a spontaneous regression of gland swelling if the patient stops purging.

Sometimes parotid swelling can block saliva from freely flowing. If saliva is unable to exit through the ducts, it flows back to the ducts, causing more swelling and may even be painful. The patient thus has difficulties eating as they experience pain when swallowing the food. Furthermore, for patients suffering from bulimia nervosa, the binge-purge cycle can lead to a reduced unstimulated flow of saliva. The reduced salivary flow could also be as a result of prolonged use of laxatives and diuretics (de Carvalho Sales-Peres et al. 68). Bulimic patients may, therefore, have an unusually dry mouth due to reduced salivary flow or as a result of dehydration from chronic vomiting and food restriction. A dry mouth, when combined with poor oral hygiene not only increases the risk of periodontal diseases but may also lead to poor food intake hence exacerbating the eating disorder.

Anorexic patients are more likely to have poor dental hygiene as compared to bulimic patients (American Dental Association 12). As noted, most bulimic patients aggressively brush their teeth immediately after an episode of regurgitation which contributes to a higher erosion of the enamel. Poor oral hygiene leads to higher plaque indices while the patients may also suffer from inflammation of the gums. Some studies have demonstrated that prolonged xerostomia and other effects of eating disorders such as nutrition deficiency may lead to generalized gingival erythema(Debate and Tedesco 1069). Finally, binging and purging may lead to traumatized pharynx and oral mucous membranes due to the intake of large amounts of food within a short time as well as the force of vomiting. At the same time, patients who use their fingers or other objects like tongue blades to induce vomiting may experience pharyngeal tears as well as erythema of the palate and tongue (Bergdahl and Bergdahl 352). Contents of the stomach have a low ph which is likely to add more insult to the soft tissues. Inflammation of the gums and other soft tissues and dehydration of the oral cavity make it harder for patients to take regular meals.

There is plenty of scientific evidence to suggest a causal relationship between eroded dental enamels and eating disorder and frequent purging. The practice of purging in order to maintain a certain body size is most prevalent among teenage girls due to influence from the media and peer pressure in the industrialized society. Binging and purging seem to increase the risk of many oral health complications, ranging from tooth erosion inflamed gums, erythema of the tongue, and swollen parotid glands, among others. In return, these complications are a sign of the onset of eating disorders and can be used by a dentist to diagnose anorexia nervosa and bulimia nervosa.

Works Cited

American Dental Association, Council on Access, Prevention and Interprofessional Relations. in: Women’s Oral Health Issues. American Dental Association, Chicago; 2006:11–14.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000. 539-550.

Bergdahl, Maud, and Jan Bergdahl. “Burning Mouth Syndrome: Prevalence And Associated Factors”. Journal of Oral Pathology & Medicine 28.8 (2007): 350-354. Web.

Debate, RD, and LA Tedesco. ”Increasing Dentists’ Capacity for Secondary Prevention of Eating Disorders: Identification of Training, Network, and Professional Contingencies.” Journal of Dental Education. 70.10 (2006): 1066-75. Web.

de Carvalho Sales-Peres, SílviaHelena et al. ”Prevalence, Severity And Etiology Of Dental Wear In Patients With Eating Disorders”. European Journal of Dentistry 8.1 (2014): 68. Web. 25 May 2017.

Frydrych, AM, GR Davies, and BM McDermott. ”Eating Disorders And Oral Health: A Review Of The Literature”. Australian Dental Journal 50.1 (2005): 6-15. Web.

Lo Russo, L et al. ”Oral Manifestations Of Eating Disorders: A Critical Review”. Oral Diseases 14.6 (2008): 479-484. Web.

Price, C. et al. ”Parotid Gland Enlargement In Eating Disorders: An Insensitive Sign?”. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 13.4 (2008): e79-e83. Web.

Steinberg, Barbara J. et al. ”Women’S Oral Health Issues”. Women’s Health in Clinical Practice (2008): 273-293. Web. 25 May 2017.