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Saving Your Teeth:
First, Reconsider When to Brush

Reprinted from Eating Disorders Today
Summer 2002 Volume 1, Number 3
©2002 Gürze Books

Given time, eating disorders like bulimia may lead to serious dental problems. Repeated vomiting can result in loss of tooth enamel, tooth decay, and gum disease. After frequent exposure to gastric acid, teeth become rounded and soft, as enamel is eaten away and fillings may stick out above the gum line. Loss of enamel and unconscious grinding of the teeth, usually during sleep, are the two most common causes of tooth loss.

Dentists: on the frontline of eating disorders
Sometimes a dentist is the first professional to suspect an underlying eating disorder. A recent survey of dentists and dental hygienists, conducted by eating disorders researchers at the University of North Dakota, showed that when the dental professionals suspected an underlying eating disorder, most discussed the problem with the patient or parents. However, 12% of the dentists and 22% of the hygienists reported that even when they suspect a patient may have a problem, they rarely or never mention it.

A particularly striking finding was that fewer than a third of the dentists or dental hygienists interviewed would refer a patient to another professional for evaluation or treatment for an eating disorder. When they did refer patients, it was usually to a family physician, rarely to a psychiatrist or psychotherapist.

Warning signs
Some of the signs and symptoms the dentist or dental hygienist see among people with eating disorders include the following:

* Chemical erosion of tooth enamel on the inside of the teeth, due to increased acidity from vomiting and exposure to gastric acid.

* Enlarged salivary glands (glands that control moisture in the mouth)

* Dryness of the mouth and decreased flow of saliva.

* Redness of the throat and the roof of the mouth (palate)

* Reddened, cracked, dry lips

How you can take better care of your teeth
To reduce the chances of enamel erosion and gum disease for those who have not yet been able to completely stop vomiting, the Eating Disorders Association of Queensland, Australia, advises patients to brush daily with fluoridated toothpaste after each meal, followed by flossing.

Some dentists recommend using a fluoride mouthwash or fluoride applications to help repair tooth damage. If tooth enamel has already eroded, another option is to have your teeth restored with resins or crowns because the inner portion of the tooth, also called the dentine, is especially vulnerable to acid erosion. Finally, if you are uncomfortable talking to the dentist about your concerns, it may be easier to speak privately with the dental hygienist first. Former American Dental Hygienist Association President Beverly P. Whitfords has found that many bulimic and anorexia patients are much more comfortable talking about an eating disorder with a dental hygienist first before confiding in the dentist.

Additional Resources:
Don't Diet, Live-it!
Eating Disorder Statistics
Eating Disorders and Self-Harm: A Chaotic Intersection
Eating Disorders at Middle Age, Part 1
Eating Disorders at Middle Age, Part 2