Erosive Tooth Wear Provides Clues to Eating Disorder Diagnoses

Dentistry Today


Each year, National Eating Disorders Awareness Week supports individuals and families struggling with anorexia nervosa, bulimia, and other illnesses by improving prevention, treatment, and access to care. Dentists also can play a key role in detecting these conditions as well as gastro-oesophageal reflux disease (GORD), according to King’s College London.

Many of the medical conditions that result in erosive tooth wear (ETW) can have serious and possibly fatal consequences if left undiagnosed or untreated. The researchers recommend that dentists be aware of the very specific oral signs of eating disorders, which include the erosion of the insides of the upper front teeth facing toward the roof of the mouth as well as the physical and psychological indicators of the conditions. 

In the United States, 35% of “normal dieters” progress to disordered eating, with 20% to 25% of them progressing to partial of full-syndrome eating disorders, according to the National Eating Disorders Association. Also, more than half of all teenage girls and nearly a third of teenage boys use unhealthy weight control behaviors such as fasting or vomiting.

In the United Kingdom, eating disorders affect about 725,000 people at a cost of approximately £15 billion per year. Early identification of the subtle signs of the developing condition, the researchers report, coupled with referrals to general practitioners, may lead to better health outcomes for patients and savings for the National Health Service. 

Dentists also may be able to identify GORD early, which develops when the reflux of stomach contents causes troublesome symptoms such as two or more heartburn episodes per week. Regurgitated or vomited stomach contents are highly acidic, and repeated contact with tooth enamel and dentin results in ETW.

Chronic alcoholism has an impact on oral health as well, according to the researchers, as many alcoholics present with ETW related to regurgitated or refluxed stomach juice. Alcoholism can result in gastritis and provide gastroesophageal reflux. Also, alcoholics are less likely to eat a healthy, balanced diet and tend to eat more acidic foods and drinks.

“There is a clear benefit to patients of the dental team being able to pick up on the early signs of conditions such as eating disorders or acid reflux, which may appear very subtle and difficult to detect,” said lead author Rebecca Moazzez, PhD, reader and consultant in restorative dentistry.

“Dental examinations should include the possibility of detecting signs of GORD and eating disorders, and, if detected, appropriate referral and liaison with medical professionals instigated, leading to better outcomes for the patient,” Moazzez said. 

The 2017 National Institute for Health and Care Excellence (NICE) guidelines provided dental recommendations on how to mitigate the impact of vomiting on oral health, including avoiding brushing teeth after vomiting and instead rinsing with a non-acid mouthwash, having regular dental and medical reviews, and avoiding highly acidic foods and drinks.

As the NICE guidelines recommend that dietary counseling should only be offered as part of a multi-disciplinary approach, the researchers suggest that it is most important for dentists to focus their advice on the timings of oral care routings. The role of dentists to spot the subtle signs of an eating disorder in its initial stages may be helpful in early identification, which has a better outlook for successful management.

The study, “Medical Conditions and Erosive Tooth Wear,” was published by the British Dental Journal.

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