November 10, 2022

Most people know that dental health is related to the foods they eat, especially when it comes to sugar. For those with eating disorders (EDs) it is the foods we do not eat and/or the polluted nature of the foods we use for a binge that takes a toll. But what is not apparent to most people is just how devastating an ED can be on one’s general health. 

Over the years I have seen examples of the impact of anorexia, bulimia and bulimarexia on dental hygiene, and it isn’t pretty. There was the schoolteacher, who was Bulimic, whose teeth all turned black. She was asked to take a leave because she was scaring her students. There were dozens of patients who came to me with an entire mouth full of cavities that seemed to have appeared out of nowhere but were a result of their eating disorders. In most cases these were people who had never had cavities before the ED.

In 6 of the cases I have seen in treatment, the individuals lost all of their teeth. Fortunately, I have an orthodontist friend here in Cincinnati that is a genius when it comes to implanting teeth. In one case, however, not only did my patient lose all her teeth, but she also lost the jawbone necessary for the implant.  In other words, she will spend the rest of her life with the receded jaw of an 80-year-old and no teeth with which to chew her food. This is perhaps the saddest case I have ever seen. She had struggled valiantly for years with the ED, lost her teeth, and at that point realized the toll the disorder was taking on her health. It motivated her to recover and she sought me out for treatment. 

She eventually recovered completely but not in time to save her teeth or her bones. She was a trooper, however, and has a very successful home-based business. She also reaches out and offers support to others with EDs. Hands down, my best referral source.

Impact of EDs on Oral Health

Believe it or not, changes in the mouth are often the first physical signs of an eating disorder, although they are generally overlooked. For example, individuals with EDs often have chronic dry mouth because they do not hydrate, or because they purge, which also results in dehydration. 

Dry mouth, also known as xerostomia, causes the salivary glands to produce insufficient amounts of saliva. Saliva is an important component of oral health. It provides a natural defense against acid erosion by neutralizing acids within the mouth. It also washes away food debris, and restores minerals to the teeth. When an insufficient amount of saliva is produced and dry mouth regularly occurs, it can cause serious oral health issues, including:

  • Gum disease

  • Tooth decay

  • Enamel erosion

  • Dental staining

Food restriction

Food restriction is another major contributor to poor oral health among the ED population. Food restriction leads to deficiencies in calcium, iron, and B vitamins. Insufficient calcium promotes tooth decay and gum disease. Even if an anorexia patient does consume enough calcium, a lack of vitamin D will prevent the body from absorbing it. Insufficient iron can foster the development of sores inside the mouth. Insufficient amounts of vitamin B3 (also known as niacin) can contribute to bad breath and the development of canker sores on the lips or inside the mouth. Gums can also become red and swollen—almost glossy-looking—when food is restricted. This is most often a sign of gingivitis. 

For the Bulimic, the frequent vomiting leads to strong stomach acid repeatedly flowing over the teeth. Over time the tooth’s enamel is eroded causing the teeth to change in color, shape, and length as well as becoming brittle, translucent, and weak. When this happens, eating hot or cold food or drink may become uncomfortable. In addition, tissue loss and erosive lesions on the surface of the mouth may occur. The edges of teeth often become thin and break off easily leaving the pulp exposed. This leads to infection, discoloration, or even the death of the tooth. 

Did you know that excessive tooth brushing or rinsing after vomiting can actually lead to tooth decay? Another ironic kick in the ED butt. How can you prevent this? Stop vomiting. 

Other complications may also occur as a result of purging by vomiting. Degenerative arthritis within the temporomandibular joint in the jaw is a dental complication often associated with purging by vomiting. This joint is found where the lower jaw hinges to the skull. When arthritis begins in this joint besides pain in the joint area, it also results in chronic headaches, problems chewing, or opening/closing the mouth. Again, we see the ED leading to a condition that makes eating painful and possibly less likely, which means that it makes the ED worse.

Purging by inserting the knuckles into the mouth can also lead to redness, scratches and cuts inside the mouth, especially on the upper surface commonly referred to as the ‘soft palate.’ Such damage is a warning sign for dental professionals. Soft palate damage is often accompanied by cuts or bruises on the knuckles as a result of an individual’s teeth placing pressure on the skin while attempting to purge. 

The Thyroid and Teeth

EDs have been shown to be particularly hard on the thyroid (Klinkby Støving, 2001). For Example, the thyroid gland is very sensitive to food restriction. Under normal circumstances, it produces hormones needed for a vast range of bodily functions, to instill homeostasis across various systems in the body. If damaged, it either goes into override or a hiatus and shuts down. When either of these things happens, they wreak havoc across various parts of the body, including your mouth.

Thyroid problems are heavily linked to a wide range of dental ailments like gum disease and tooth decay. Those with hyperthyroidism or an overactive thyroid are more susceptible to dental problems like cavities, osteoporosis in the jaws, and rapid tooth growth in children. 

Thyroid patients in general are prone to oral problems like dry mouth. Besides dehydration, dry mouth is usually accompanied by other debilitating symptoms like sores in the mouth, difficulties with swallowing, and even tooth decay as described above. The trick is to restore normal eating as soon as possible while treating your thyroid imbalance. If you think you may have a thyroid problem, reach out to Dr. Norton for a list of the tests to have your doctor run. Many of which are not routinely run as EDs are often not diagnosed or are ignored. 

The Brain and Your Teeth

Are you aware that poor oral health can cause brain injury? That’s right: science has shown us that there is a strong link between poor oral health and poor brain health (Harrison, 2021). How is that even possible? Turns out your teeth and your brain are connected. In fact, there are multiple nerves in the oral cavity that attach to your brain. For instance, the trigeminal nerve is a cranial nerve that connects to your teeth, gums, jaw, and more. 

The upshot is that an untreated tooth infection can quickly become a brain infection (Daly, 2017). This happens when the tooth infection spreads to the bloodstream, which carries bacteria straight to the brain. At this point, the bacterial infection attacks neurons found in the brain, which can put you at risk of memory loss and other life-altering complications. In the most severe cases, a brain abscess can form. This is a rare condition in which pus invades the brain. 

Symptoms of brain infection from teeth include (Bonin & Lilly, 2022):

  • Fever

  • Lethargy

  • Headache

  • Nausea and vomiting

  • Trouble remembering

  • Increased confusion

  • Reduced mobility

  • Vision changes

The most common disease caused by poor dental hygiene is dementia, or memory loss. At times, the memory loss caused by dementia can be so extreme that it impacts daily functioning. Of course, the worst-case scenario is that it becomes progressive and ends up being Alzheimer’s disease which is considered to be irreversible. Though dementia usually occurs in old age, it can happen much sooner if there are oral health complications involved. 

For example, I believe that premature or presenile dementia is often the result of poor dental hygiene that is never addressed. I have seen several cases in which the individual presented initially with symptoms of dementia and when we used coconut oil and generally cleaned up their oral hygiene, the dementia cleared up permanently. 

You’d be surprised how often oral hygiene and diet can have devastating consequences that go untreated. In our society, we have a tendency to treat the symptoms and not even look for the causes let alone treat them. In cases such as these, treating the symptoms may help, or may make the situation worse. Better to be safe than sorry, which means it is better to identify the problem and treat it directly. Better yet, prevent the problem by using good oral hygiene. 

In our next article I will discuss good oral hygiene and reversing the effects of tooth decay in more detail. In the meantime, if you think your oral hygiene is affecting your health, contact a functional physician or a physician you trust to treat the problem and not just the symptoms. 

References

Bonin, C., & Lilly, N. (2022, September 29). 19 Symptoms of Tooth Infection Spreading to Body or Brain. NewMouth. Retrieved November 9, 2022, from https://www.newmouth.com/oral-health/tooth-infection-spreading/

Daly, B., Thompsell, A., Sharpling, J., Rooney, Y. M., Hillman, L., Wanyonyi, K. L., … & Gallagher, J. E. (2017). Evidence summary: the relationship between oral health and dementia. British dental journal, 223(11), 846-853.

Harrison, R. (2021, July 8). Tooth Loss Associated with Increased Cognitive Impairment, Dementia. NYU. Retrieved November 9, 2022, from https://www.nyu.edu/about/news-publications/news/2021/july/tooth-loss-cognitive-impairment.html

Klinkby Støving, R., Bennedbæk, F. N., Hegedüs, L., & Hagen, C. (2001). Evidence of diffuse atrophy of the thyroid gland in patients with anorexia nervosa. International Journal of Eating Disorders, 29(2), 230-235.