submitted by Dr. Michael Spadafora, D.D.S.
Recently, a distant relative asked if I would review the treatment plan proposed for his 17-year-old daughter in a large Midwestern city. He sent me the photos, as well as the extensive notes and plan that the treating dentist provided.
As I reviewed the information, I saw a large “red flag.” After consulting with my relative, my concern was validated.
The daughter had severe wear on the inside of her teeth; the tooth enamel was eroded beyond her years. My suspicions were correct – this teenager was suffering from bulimia, a common eating disorder that affects many, especially young women.
Bulimia and anorexia nervosa are eating disorders that have significant implications to the oral health of the patient. A bulimic patient usually will eat excessively (or binge) and then self-induce vomiting (purge).
The acids from the stomach can cause severe erosion of the teeth, as well as bad breath, mouth sores, and tenderness in the mouth. The teeth can become very sensitive and the color, length, and shape of the teeth can be altered.
The patient suffering from anorexia nervosa also deals with oral health issues. The lack of vitamins, minerals, proteins and other nutrients necessary for good health shows itself in the mouth also. These patients can have bad breath, sensitive teeth, dry mouth, and tenderness in the mouth.
A big issue with anorexic patients is osteoporosis, which leads to tooth loss.
The dentist can be one of the first to suspect that the patient has an eating disorder. If the patient is underage, the dentist can share this suspicion with the parent or guardian. If the patient is 18 or older, the dentist can only encourage the patient to seek counseling for the disorder, but cannot share the information with others.
Modern dentistry provides us with options to treat patients who have had damage from eating disorders. I would, however, caution anyone, just as I told my relative, to resolve the eating disorder first.
If the dentistry is completed before the issues are handled, the dentistry has an increased likelihood of failure.