The Effects of Purging on the Oral Health of Eating Disorder Patients

Eating disorders are psychiatric illnesses with physical manifestations. And years of starvation, bingeing, and purging behaviors take a huge toll on the human body — compromising virtually all vital organs and systems — including one’s oral health. 

While oral health is just one aspect of health, it is tied to overall well-being and quality of life—studies have shown a correlation between poor oral health and increased mortality. And unfortunately, once some of these oral health complications develop as a result of purging and/or malnutrition, they are often irreversible. Dental professionals, ENT (ear, nose, and throat) specialists, and other medical professionals are in an optimal position to observe and intervene on these oral complications in patients who may be silently struggling with eating disorders; unfortunately, few medical providers are trained in understanding eating disorder complications and without concurrent intervention for the eating disorder behaviors, the oral health complications will only continue to worsen. 

This puts healthcare professionals in a prime position to detect oral health problems caused by purging and use this opportunity to screen for covert eating disorders, discuss the health implications (and mortality risks) of eating disorders, refer patients out for eating disorder treatment, and save lives.  

Oral Health of Eating Disorder Patients

People who suffer from bulimia and anorexia nervosa binge eating/purging subtype (AN-BP) use purging behaviors to rid their bodies of ingested calories in order to prevent weight gain and/or to lose weight. These purging behaviors can range from intermittent to many times daily. Common purging methods include:  

• Self-induced vomiting 

• Laxative abuse 

• Diuretic abuse 

• Excessive exercise 

Vomiting and laxative abuse are the most common purging behaviors, with vomiting largely serving as the catalyst for oral health complications. Repeated vomiting, which brings gastric acid in contact with the teeth, negatively effects the dentition. Bulimia, like other eating disorders, can lead to nutritional deficiencies that can also contribute to oral health issues. Similarly, there are often changes to the foods consumed in individuals with eating disorders, which frequently includes more acidic and cariogenic foods, that can negatively impact the dentition. In addition, dehydration that develops from any of the purging methods mentioned previously can impact our oral health via decreased saliva production.  

At least one study found that 70% of patients who practiced self-induced vomiting regularly had visible indicators of dental erosion (also known as perimyolysis) on their teeth. Repeated vomiting episodes cause stomach acid to wear away at the tooth enamel, more commonly effecting the lingual (tongue) side of the teeth. Teeth may chip or become so thin that they appear translucent. Cavity risk increases and more serious consequences may also occur. If left untreated, tooth loss may occur. Chewing and eating may become very difficult and even painful.  

Oral Signs of Purging  

Whether an individual displays unusually bad breath, cuts or scratches within the mouth (from sticking items inside the mouth to trigger the gag reflex to vomit), numerous findings can indicate that a patient is struggling with purging behaviors: 

• Red, swollen or bleeding gums 

• Swollen or enlarged salivary glands (sialadenosis) 

• Chronic dry mouth (xerostomia) 

• Mouth sores 

• Bad breath 

• Dry, cracked, erythematous lips 

• Brittle, translucent and weak teeth 

• Infection, discoloration, or pulp death 

• Redness and cuts or scratches within the mouth due to self-induction of the gag reflex 

• Soft-tissue hemorrhagic lesions 

• Reduced salivary flow rate 

• Tooth hypersensitivity 

• Periodontal disease 

• Dental caries 

• Orange-yellow palate 

• Dental erosion (perimyolysis) 

Further, just as there is a risk for complications caused by purging behaviors, there is also a risk for medical complications in individuals who abruptly stop chronic purging behaviors. This can include sialadenosis, which can cause both physical and mental discomfort, as well as pseudoBartter syndrome, which is a hormonal condition predisposing toward edema formation. This highlights the need to refer patients out to experienced, trained eating disorder professionals for further guidance. 

Helping Individuals and Families Recover from Eating Disorders  

Maintaining one’s oral health is key to ensuring one’s overall health. While it is important to treat dental issues in a timely manner, oral health problems associated with purging will likely continue if individuals do not seek professional help for their eating disorders. For many individuals, the discomfort of medical complications is often the catalyst that leads them to finally seek help. The earlier eating disorders are detected, and the earlier that treatment is sought, the better the long-term outlook.  

For those suffering from severe and extreme purging, ACUTE’s hospital-based, inpatient medical stabilization unit can help those experiencing attendant medical complications or life-threatening complications related to purging. Contact ACUTE to learn more about current treatment options.  

References

• How eating disorders can affect your mouth. (2022, April 11). Oral Health Foundation. 

• Uhlen, M. M., Tveit, A. B., Refsholt Stenhagen, K., & Mulic, A. (2014). Self-induced vomiting and dental erosion – a clinical study. BMC Oral Health, 14(1).