Dr O Dadashian
When people think about anorexia nervosa, they typically focus on the dramatic weight loss and psychological struggles. However, what many don’t realize is that this serious eating disorder can cause significant damage to your teeth and oral health β often before other physical symptoms become apparent. Understanding these dental consequences is crucial for early detection and prevention of permanent damage.
What is Anorexia and Why Does it Affect Your Mouth?
Anorexia nervosa is characterized by severe food restriction, leading to significant underweight, along with an intense fear of gaining weight and distorted body image. While not all people with anorexia engage in vomiting behaviours, many do β and this is where the most serious dental problems begin.
Recent comprehensive research involving over 1,600 patients with eating disorders found that 26.7% of people with anorexia experience tooth erosion. More alarmingly, individuals with anorexia are approximately 12 times more likely to develop dental erosion compared to healthy individuals. When vomiting is involved, this risk skyrockets to more than 16 times higher than normal.
The Two Faces of Anorexia – Vomiting vs Non-Vomiting Types
Not everyone with anorexia vomits, and this distinction is crucial for understanding dental risks. Research dating back to the 1970s has consistently shown a clear pattern:
Anorexia with vomiting behaviours:
Anorexia without vomiting:
The difference is stark β one study found that patients who vomited showed severe lingual-occlusal erosion almost universally, while this type of damage was virtually absent in non-vomiting patients.
The Perfect Storm – Multiple Factors Working Against Your Teeth
Anorexia creates several conditions that work together to damage your teeth:
Stomach Acid Exposure
When vomiting occurs, teeth are bathed in gastric acid with a pH as low as 1.5. This repeated acid exposure literally dissolves the protective enamel coating on teeth, creating the characteristic “shelled out” appearance where tooth crowns become hollowed.
Reduced Saliva Protection
People with anorexia often experience reduced saliva flow due to dehydration and the body’s starvation response. Saliva normally helps neutralise acids and repair early damage to teeth. When this natural defence system is compromised, teeth become much more vulnerable to erosion.
Dietary Factors
Many individuals with anorexia consume large amounts of acidic foods and drinks, particularly citrus fruits and diet beverages. While these foods are low in calories, they have a pH of 3-5, which can contribute to enamel breakdown over time.
Dehydration Effects
The dehydration that accompanies anorexia often leads people to consume acidic drinks like lemonade, fruit juices, or acid drops to relieve dry mouth β unfortunately, these provide temporary relief while causing long-term dental damage.
Age and Duration Matter – The Timeline of Damage
The severity of dental erosion in anorexia is closely linked to two key factors: the patient’s age and how long they’ve had the disorder. Younger patients and those with shorter illness duration typically show less severe damage, while older patients with long-standing anorexia often have extensive erosion.
Interestingly, one study of young women with anorexia lasting an average of just 2.5 months found no evidence of dental erosion, though 26% reported some history of binge-eating or purging. This suggests that significant dental damage takes time to develop, making early intervention crucial.
The Warning Signs – What to Look For
Dental erosion from anorexia follows predictable patterns that both patients and healthcare providers should recognize:
Early signs:
Progressive damage:
Modern Assessment – The BEWE Scoring System
Today’s dental professionals use standardized systems like the Basic Erosive Wear Examination (BEWE) to assess erosion severity. This system grades damage from 0 (no defect) to 3 (hard tissue loss affecting 50% or more of the surface area).
Recent studies using this system found that 18.9% of children and adolescents with anorexia had BEWE scores of 2 or higher, compared to only 2.9% of healthy controls. More concerning, some anorexia patients showed BEWE scores as high as 9-13, indicating severe, widespread damage.
Prevention and Management Strategies
While addressing the underlying eating disorder is paramount, several strategies can help minimise dental damage:
Immediate protective measures:
Professional dental care:
The Importance of Early Recognition
Dental professionals are often among the first healthcare providers to recognize signs of anorexia, as oral symptoms may appear before other physical manifestations become obvious. This makes regular dental visits particularly important for young people at risk.
The characteristic pattern of erosion β particularly on the palatal surfaces of upper front teeth β can serve as an early warning sign, prompting referral for comprehensive medical and psychological evaluation.
Hope for Recovery
While anorexia can cause serious dental damage, early intervention can prevent the most severe consequences. With proper treatment of the underlying eating disorder and appropriate dental care, much of the damage can be halted and, in some cases, repaired.
The key is recognizing that oral health and overall health are intimately connected. Protecting your teeth is an important part of recovery from anorexia, and seeking help early can preserve your smile for years to come.
If you or someone you know is struggling with anorexia, remember that help is available. Working with a comprehensive treatment team that includes mental health professionals, medical doctors, and dental specialists offers the best chance for full recovery β both physically and emotionally.
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