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The results of an eating disorder will show in your mouth

    Not all women are aware that their oral health can be affected by general health problems such as eating disorders. 

Eating Disorders Update

Researchers determine the influence of bone density results in adolescents with anorexia

 Physicians have long recognized that early and severe osteoporosis is a serious consequence of anorexia nervosa. Researchers at Children's Hospital Boston developed a study to determine if having a bone measurement to screen for low bone density changes the attitude and behavior of young women with anorexia nervosa.

While examining normal and low bone density results, researchers found the results to be interpreted both positively and negatively by participants depending on what stage of illness, from diagnosis to recovery, they were in. Those closer to recovery reported bone density results further motivated their recovery.

Nine out of 12 anorexia patients had abnormal results. Ten of the participants stated that having a bone measurement did not enhance their recovery process at the time performed, but three of these 10 noted it motivated recovery later in their course.***

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Eating Disorder Awareness Week  

    A woman may know her body, but she may not know the impact it has on her oral health.

    A dentist can observe damaging effects on the inside surface of the upper front teeth of patients with eating disorders, especially bulimia, a disease which is prevalent among many older adolescents or young adult women. 

     The prolonged enamel erosion from the acidity caused by repeated regurgitation is a tell-tale sign that the patient may be suffering from bulimia.  

Toothbrushing is not recommended immediately after regurgitation as it may accelerate tooth enamel erosion.

     It is a sensitive topic, but one that needs to be addressed by a compassionate dentist in a non-threatening way. The dentist may recommend counseling and prescribe topical fluoride to reduce further tooth erosion.

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Q. What are eating disorders?

A. Each year, millions of people in the United States are affected by serious and sometimes life-threatening eating disorders. The vast majority -- more than 90 percent -- of those afflicted with eating disorders are adolescent and young adult women.

      One reason that women in this age group are particularly vulnerable to eating disorders is their tendency to go on strict diets to achieve an "ideal" figure. Researchers have found that such stringent dieting can play a key role in triggering eating disorders.

     Approximately 1 percent of adolescent girls develop anorexia nervosa, a dangerous condition in which they can literally starve themselves to death. 

     Another 2-3 percent of young women develop bulimia nervosa, a destructive pattern of excessive overeating followed by vomiting or other "purging" behaviors to control their weight. 

     The present of eating disorders in athletes is higher than in the general public.  The incidence of eating disorders in the normal population is 5 to 10 % but female athletes exhibit a 16-72% incidence.

     These eating disorders also occur in men and older women, but much less frequently.

    The consequences of eating disorders can be severe. For example, one in ten cases of anorexia nervosa leads to death from starvation, cardiac arrest, other medical complications, or suicide. Fortunately, increasing awareness of the dangers of eating disorders -- sparked by medical studies and extensive media coverage of the illness -- has led many people to seek help. 

     Nevertheless, some people with eating disorders refuse to admit that they have a problem and do not get treatment. Family members and friends can help recognize the problem and encourage the person to seek treatment.

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Q. What are the medical complications of eating disorders?

A. Medical complications can frequently be a result of eating disorders. Individuals with eating disorders who use drugs to stimulate vomiting, bowel movements, or urination may be in considerable danger, because this practice increases the risk of heart failure.

     In patients with anorexia, starvation can damage vital organs such as the brain and heart. To protect itself, the body shifts into "slow gear": monthly menstrual periods stop, breathing pulse and blood pressure rates drop, and thyroid function slows. Nails and hair become brittle; the skin dries, yellows, and becomes covered with soft hair called lanugo. 

     Excessive thirst and frequent urination may occur. Dehydration contributes to constipation, and reduced body fat leads to lowered body temperature and the inability to withstand cold.

     Mild anemia, swollen joints, reduced muscle mass, and light-headedness also commonly occur in anorexia. If the disorder becomes severe, patients may lose calcium from their bones, making them brittle and prone to breakage. 

     They may also experience irregular heart rhythms and heart failure. In some patients, the brain shrinks, causing personality changes. Fortunately, this condition can be reversed when normal weight is reestablished.

     Scientists have found that many patients with anorexia also suffer from other psychiatric illnesses. While the majority have co-occurring clinical depression, others suffer from anxiety, personality or substance abuse disorders, and many are at risk for suicide. 

    Obsessive-compulsive disorder (OCD), an illness characterized by repetitive thoughts and behaviors, can also accompany anorexia. Individuals with anorexia are typically compliant in personality but may have sudden outbursts of hostility and anger or become socially withdrawn.

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     Bulimia nervosa patients -- even those of normal weight -- can severely damage their bodies by frequent binge eating and purging. In rare instances, binge eating causes the stomach to rupture; purging may result in heart failure due to loss of vital minerals such as potassium. 

     Vomiting causes other less deadly, but serious, problems -- the acid in vomit wears down the outer layer of the teeth and can cause scarring on the backs of hands when fingers are pushed down the throat to induce vomiting. Further, the esophagus becomes inflamed and glands near the cheeks become swollen. As in anorexia, bulimia may lead to irregular menstrual periods. Interest in sex may also diminish.

     Some individuals with bulimia struggle with addictions including abuse of drugs and alcohol, and compulsive stealing. Like individuals with anorexia, many people with bulimia suffer from clinical depression, anxiety, OCD, and other psychiatric illnesses. These problems, combined with their impulsive tendencies, place them at higher risk for suicidal behavior.

      People with binge eating disorder are usually overweight so they are prone to the serious medical problems associated with obesity, such as high cholesterol, high blood pressure, and diabetes. Obese individuals also have a higher risk for gallbladder disease, heart disease, and some types of cancer. Individuals with binge eating disorder also have high rates of co-occurring psychiatric illnesses -- especially depression.

What are The Dental Complications?

     These disorders have a high relapse rate which can affect the patient's dental health.   Often the first manifestations of an eating disorder appears in the mouth.  Often the first health care professional to detect an eating disorder is a dental professional.  Oral complications are:


Erosion of  lingual tooth enamel.


Bad breath from constant purging


Increased cavity rate.


Sore throat


Oral sores with traumatic ulceration of the the palate from forced


Irritation to the lips and other soft tissues.


Dentinal sensitivity


Signs of malnutrition ( thinning hair, always cold, fatigue, hypothermia, facial hair, carotenemia)**


Decreased ability to concentrate




Low Body weight.


Abrasions or calluses on the dorsal surfaces of the fingers and hands due to friction from self-induced vomiting.  


Swelling or enlargement of the parotid salivary gland.


Damage is often found on the lingual aspect of the anterior teeth as a result of self induced vomiting. (Severe erosion can extend to the occlusal surfaces of the posterior teeth as well as the facial surfaces of the maxillary and mandibular teeth).


Swelling can also occur in the sublingual and submandibular glands.


Xerostomia around the mouth.


Trauma of oral and mucosal membranes.

     It is not unusual for people with eating disorders to weave elaborate stories about how their teeth were damaged, such as saying they have acid reflux or a so called alternative diet of citrus juices and vinegar.#

    Dental health professionals will tell a patient what they have noticed in terms of enamel erosion and what that kind of erosion usually indicates and will encourage the patient to see their family physician or nutritionist.  

Eating disorders and their effect on your teeth.

If you have anorexia nervosa or bulimia nervosa you may experience some problems with your teeth. You may have symptoms such as sensitive teeth, that is, you might experience a sharp pain when you eat very hot, cold or sweet foods, or you may get toothache, or perhaps your teeth have changed colour. Most of these problems are due to acid erosion of the surface of the teeth. This acid can come from two sources, acidic foods or drinks, and stomach acid as a result of vomiting.

Stomach acid washing over the teeth wears away the enamel layer of the tooth. This may lead to the pulp and nerve endings becoming exposed and the teeth may then have to be crowned or coated. Unfortunately much of the repair work undertaken to preserve the teeth of a person with an eating disorder will be ineffective unless they stop using self-induced vomiting as a method of weight control.

Drinking low calorie �fizzy� drinks, �sport/energy� drinks or fruit based drinks can also have similar effects because of the acid they contain. Constantly sipping these drinks can be particularly harmful to tooth enamel. Consider using a straw to direct the liquid past your teeth if you do consume a lot of fruit or �fizzy� drinks. A dry mouth (which may be due to the saliva glands becoming exhausted with overuse due to excessive vomiting) means that food acids and the acids produced by bacteria in the mouth are not being neutralised by the saliva in the usual way. This makes teeth more vulnerable to acid attack and caries (tooth decay). Some acid tablets such as chewable Vitamin C tablets can have a similar effect.

Care of Your Teeth

Scrubbing your teeth immediately after being sick is not advisable as this will damage the surface crystals on the enamel layer of the teeth. Dentists who specialize in problems related to enamel erosion, advise rinsing your mouth thoroughly with milk or water, (or even better water and sodium bicarbonate) after being sick, and then waiting several hours before drinking or eating anything acidic, such as fruit or fizzy drinks, or before brushing your teeth. This treatment enables the saliva to have a neutralizing effect on the stomach acid which seeps into the surface enamel after vomiting. If you clean your teeth whilst they are in this sensitive state, the abrasive properties of toothpaste will etch the enamel still further, so that over the years the enamel is progressively worn away.

Using an inexpensive mouthwash containing Fluoride is another alternative. If you wish to brush your teeth after being sick, avoid using toothpaste, particularly �smokers� toothpaste, just use a brush dipped in water.

Chewing sugar free chewing gum after meals can help to stimulate saliva production and counter some of the effects of a dry mouth.

Recent research has also shown that you can minimize the detrimental effects of acidity on dental enamel by eating cheese or drinking milk, but if eating these foods could cause a panic binge, then just settle for rinsing your mouth with water.

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Q. What causes eating disorders?

A. In trying to understand the causes of eating disorders, scientists have studied the personalities, genetics, environments, and biochemistry of people with these illnesses. As is often the case, the more that is learned, the more complex the roots of eating disorders appear.

Dental Treatment

For more information on dental treatment for the eating disordered person visit here:
Dental Treatment for Eating Disordered Persons


Source: "Eating Disorders", National Institute of Mental Health. Source:

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For more information.....

You can find out more about eating disorders and other mental disorders by contacting the following organizations:

Food and Nutrition Information Center

Academy for Eating Disorders
Phone: (703) 556-9222
Internet Address:

National Institute of Mental Health

American Anorexia/Bulimia Association, Inc.
Phone: (212) 575-6200
Internet Address:

Anorexia Nervosa and Related Eating Disorders, Inc.
Phone: (541) 344-1144
Internet Address:

Eating Disorders Awareness and Prevention, Inc.
Phone: (800) 931-2237
Internet Address:

National Eating Disorders Association
Phone: (206) 382-3587
Internet Address:

National Institute of Mental Health
Phone: (301) 443-4513
Internet Address:

National Association of Anorexia Nervosa and Associated Disorders
Phone: (847) 831-3438
Internet Address:

American Academy of Family Physicians and the National Institute of Mental Health (Facts about Anorexia Nervosa).

Eating Disorders: a Food and Nutrition Resource List for Consumers




A.D.A. Position Paper: Nutrition Intervention In the Treatment of Anorexia Nervosa, Bulimia Nervosa  and Binge Eating


Secrets of Eating Disorders.


Disordered Eating
Eating Disorder Referral and Information Center.


University of Berkeley Eating Disorder Resources

**Source: Women Dentist Journal, Female Athlete Triad Spell Triple Trouble, Dr. Doniger, pgs. 63-67, Jan/Feb 2003

***An abstract detailing these findings will be presented at the 2002 International Conference on Eating Disorders, April 25-28, in Boston, by Nava Stoffman, M.D., clinical fellow in the Department of Adolescent Medicine, and colleagues at Children's Hospital Boston.Other investigators of this study include: Estherann Grace, MD, associate in medicine, Beth Schwartz, research assistant, Catherine M.Gordon, MD, MSc, assistant in medicine, all at Children's Hospital Boston in the Department of Adolescent Medicine.

# Starved for Perfection, Matt Schlossberg; AGD Impact, June 2002; pages 8-12.

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February 06, 2008

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