Bulimia and Your Teeth
By Brian McKay, DDS
As a dentist, I am hyper-aware of people’s teeth and smiles. Over the years, I’ve noted how people try to hide what’s going on inside their mouths. I understand how the general public’s apprehension about the painful side of dentistry can make some people unwilling to sit in the dental chair and undergo treatment. This is especially true for those who are also bulimic
All too often behind that closed, non-smiling, and hand-zcovered mouth is a person who is in severe distress. Their teeth, gums, tongue, palate, and throat are suffering the damaging consequences of chronic vomiting. This is how the disease of bulimia nervosa presents itself to a dentist, and as a dentist, I am often the first person who detects that something is wrong.
The nature of bulimia most often demands that the person acts in secret, hiding their eating disorder from everyone. However, it is simply impossible to hide the effects from a dentist. The signs are unique and telltale. One classic sign is the inevitable loss of vital enamel and soft dentin from the upper, front inside surfaces of the teeth. These signs generally appear after someone has been purging for about two years. Of course, this is dependent upon how many times the person is purging and whether or not the person has good oral hygiene habits. A dentist can see other signs as well, such as parotid gland swelling, gum inflammation, dry mouth, and/or trauma. All of these signs add up to a patient who needs special treatment and care from a team of trained professionals who are sensitive to these issues.
Dentists have an obligation to be concerned not just about their patient’s oral health but their overall health and well-being. According to the Institute of Dental Research, 28 percent of bulimia cases are first diagnosed during a dental exam. There are two ways of looking at this statistic. First, it’s a fairly high percentage for a health profession that is not especially poised to deal with eating disorders. On the other hand, when you consider that dental professionals are usually the first ones to have access to the part of the body that is most likely to reveal the presence of this disease, then the percentage is probably too low.
The recurring vomiting of bulimia produces a distinctive erosion pattern that acts like a signature in a person’s mouth. There is no other erosion pattern quite like it. Dentists can tell if the person has a relatively new or chronic condition by the amount of damage done. There is no way to stop the hydrochloric acid from the stomach stripping the teeth of protective enamel and exposing the dentin underneath. The result is a long list of symptoms and conditions that include:
• Enamel Erosion
• Gum soreness, pain, and inflammation
• Dry mouth
• Chronic sore throat
• Inflammation of the esophagus
• Hemorrhaging Palates (tiny blood vessels on the roof of the mouth which burst open during purging)
• Dramatically reduced saliva production
• Difficulty in swallowing
• Dislocations of the lower jaw and temporomandibular joint (where the lower jaw hinges with the rest or the skull)
Thankfully, dental science and materials have progressed to the point where restoration of the teeth can be successful. However, steps to restore a patient’s oral health can only begin in earnest once the person has pursued treatment for their eating disorder and recovery is under way. Essentially, it is a waste of time and money to do extensive dental work if the person is still actively purging.
As a dentist, I’ve reached out to individuals who came to my office with the telltale signs of bulimia. Over the years, I’ve been fortunate to assist most of them in getting the treatment needed and then having the privilege of restoring their oral health and their smiles when they are finally ready to take that step.
I understand how difficult it can be to visit a dentist after years of bulimia. If you are getting an annual or semi-annual dental exam, but do not wish to talk about your eating disorder, most dentists will drop the subject and respect your wishes while keeping the condition of your mouth confidential. Frankly, it’s easier not to talk about the eating disorder. However, if you want to share and discuss your eating disorder and have restoration work done, a critical element is the initial interview. You’ll want to work with a dentist who is compassionate, trustworthy, informed, and respectful of your needs.
The dentist will most assuredly be able to see the damage. He or she will assess how open you are to talking about your eating disorder with just a few questions centered not on the disorder but on the teeth. This is the patient’s opportunity to open up and share. The dentist has a wealth of information for the asking. Most are discreet and sensitive enough not to impose the conversation on you unless you ask or are ready to share.
This is how the process works in my own practice: Once I conduct the exam, I dismiss my assistant, sit the patient up, pull my chair around so I can be face-to-face and get honest. I’ll start the dialogue by saying, “I’ve found some teeth I have concerns about and I need more information. Is it OK if I ask you some questions?” No one has ever answered “no” to that question. “The condition of your teeth is similar to the condition of others who have an eating disorder. Do you now or have ever had an eating disorder?” The odds are in my favor: More than 50 percent of the time the patient admits her bulimia.
A good dentist will respond to your eating disorder with empathy and an overall concern for your health. The key to success is two-way communication. The payoff is the smile. A positive self-image and self-esteem are critical for recovery and a restored, healthy smile is evidence of those feelings. Does having a new smile help that process? Absolutely. It can be and often is life-changing.
I cannot emphasize enough the power of a healthy, beautiful smile and how it radiates both outward and inward telling the world and yourself that you are on the road to recovery.
About the Author
Brian McKay, DDS, is a graduate of the University of Southern California School of Dentistry. He speaks on and teaches advanced dental techniques throughout the country. His practice is located in Seattle, WA.
Reprinted with permission from Eating Disorders Recovery Today
Spring 2007 Volume 5, Number 2
©2007 Gürze Books