Health Leader, Hideous Secret

STORY BY

Nora K. Shire

Part III of a Series
on Eating Disorders

At first glance, the mouth of a person with an eating disorder appears normal, but a closer look inside may reveal serious problems: erosion on the surfaces of the teeth, abscesses on the gums, glandular enlargement of the cheeks and a chemical change in the saliva.

Frequently, it is the dentist who is the first doctor to diagnose a patient with an eating disorder. All these changes are caused by the lack of proper nutrition and the acid from self-induced vomiting.

Don't be fooled by the smile

"These changes are most obvious on the back surfaces of the upper teeth, as well as those along the gum line and the chewing surfaces. The loss of tooth structure in these areas frequently causes sensitivity to hot and cold and can even result in the development of abscesses," explains Dr. Catherine M. Flaitz, dean of the University of Texas Dental Branch at Houston. "When there is significant destruction, the pulp or nerve of the tooth can become damaged and require root canal treatment and crown restorations."

Self-induced vomiting can cause trauma in the mouth, depending on what the person puts in her mouth to induce regurgitation.

If fingers are used regularly, a callous forms on the backs of the hands due to the repeated rubbing of the fingers against the upper teeth.
Fingernails can scratch the roof of the mouth.
The person can also get tears in the corners of the mouth from exaggerated opening.
Others get bruises or ulcers in the roof of the mouth or tonsil area from the pressure or from the object that is used to induce vomiting.

With loss of enamel from erosion, the teeth become thinner, smooth and glassy in appearance. These changes are usually seen after two years of binge eating and purging. With time, significant tooth erosion can develop, causing the teeth to yellow and become brittle. This deterioration of the enamel, which is the outer layer of the tooth, cannot be regenerated—once lost, it is gone forever. As the enamel wears off, the teeth appear yellow or amber in color.

Acid overdose

"These conditions are caused by acid in the mouth from self-induced vomiting, carbonated drinks and increased amounts of fruits that are consumed to cause diarrhea," Flaitz says. It is the citrus fruits—oranges, lemons, grapefruit—that do the most damage if eaten in large amounts. Tomatoes are highly acidic, also. Hard candies that are artificially fruit flavored can also cause significant damage because the flavoring is acidic and the candy slowly dissolves in the mouth.

Bleaching makes it worse

If young people with eating disorders notice that their teeth are turning darker, they may try to whiten their smiles with over-the-counter bleaching agents. These products not only won't improve the color of eroding teeth, but might further wear away enamel. Bleaching products will cause eroding teeth to be more sensitive and darker in color because the second layer of the tooth, dentin, becomes exposed.

Dry mouth

Another change is in the saliva. For some, there is a decreased amount, but for everyone the consistency thickens and cannot dilute, cleanse and neutralize the inside of the mouth as it did before. "To neutralize the inside of the mouth, we recommend the patient rinse with water either alone or containing a fourth teaspoon of baking soda. Another option is to rinse with an antacid," she explains.

Chewing sugarless gum helps stimulate saliva and promote the natural re-mineralization or re-hardening of teeth. The use of topical fluorides helps to decrease sensitivity and prevent cavities from forming.

To correct the damage done inside the mouth, the dentist can cover the teeth with restorations or crowns to help prevent further damage.

It gets worse

Even more changes take place inside the mouth:

The lining thins and pales due to a poor diet and anemia
Sores in the mouth result from a vitamin deficiency or from injuries by objects that are used to induce vomiting
Swelling of the glands in the cheeks is seen in 10 percent to 50 percent of bulimics who binge and purge
Facial enlargement occurs, depending on the length of time a person has been purging. The exact cause is unknown but might be related to chronic stimulation of the glands

Other possible head and neck problems from eating disorders are hair loss from nutritional deprivation, chapped lips and very dry skin from dehydration, and very fine fuzzy hair growth on the face.

"These changes are very disconcerting for a young person obsessed with their body image," Flaitz observes.

UPDATED: 12-15-2003

About Dr. Flaitz:

Dr. Catherine M. Flaitz is Dean of the UT Dental Branch.

See Dr. Flaitz also at:

Health Tip:

Fireworks
Don’t lose your independence
on Independence Day!

They’re beautiful, hypnotic, inspiring and dangerous. Each year, thousands of injuries occur from fireworks. The Centers for Disease Control and Prevention (CDC) cite

In 2006, 11 dead and an estimated 9,200 treated in emergency departments for fireworks-related injuries in the United States.
An estimated 5 percent of fireworks-related injuries treated in emergency departments required hospitalization.

Most injuries involved:

Hands (2,300 injuries), eyes (1,500 injuries), and the head, face, and ear (1,400 injuries).
Burns were the most common injury type to all body parts except the eyes and head areas, where contusions, lacerations and foreign bodies in the eye occurred more frequently.

Most common fireworks involved:

Firecrackers, associated with the greatest number of estimated injuries at 1,300. There were 1,000 injuries associated with sparklers and 800 associated with bottle rockets.
Sparklers, accounting for one-third of the injuries to children younger than 5.

Between 2000-05, more than one-third of the fireworks-related deaths involved professional devices that were illegally sold to consumers.

According to the American Academy of Ophthalmology, if you are going to light firecrackers:

Use a specially designed stick, or "punk," rather than a match to light fireworks.
Have a bucket of water ready.
Always follow manufacturers' directions and dispose of used fireworks properly.
Never give a firecracker or sparkler to a child.
Never use a bottle rocket.
Do not light firecrackers bigger than your pinkie, do not light them indoors, and avoid relighting duds.
Never put fireworks in your pocket, throw them while lit, or make homemade firecrackers.
In case of eye injury, do not touch the eye. Tape a clean paper cup over the eye to prevent contamination or further injury. Immediately seek medical attention from an ophthalmologist (eye MD).

What is banned nationwide: Any firecracker with more than 50 milligrams of explosive powder and any aerial firework with more than 130 milligrams of flash powder is banned under federal law, as are mail order kits and components designed to build these fireworks.