Eating disorders through the periodontal lens

Abstract

People with eating disorders suffer from a mental disorder that negatively affects their physical and/or mental health. The three most frequent eating disorders are binge eating disorder, bulimia nervosa, and anorexia nervosa. Environmental and genetic factors are involved in the pathogenesis of eating disorders in vulnerable persons. Although treatment varies among different types of eating disorders, nutrition, medical care combined with psychotherapy and medications are standard of care. The aim of this review is to give an overview of the oral health impact of eating disorders with a special emphasis on the periodontium. Oral health professionals have a unique role to play in the early diagnosis of eating disorders because of the important impact that eating disorders have on the oral cavity. In vomiting-associated eating disorders, the risk of erosive tooth wear is mainly localized to the palatal surfaces of the incisors. Emerging evidence also indicates a high frequency of gingivitis and gingival recessions associated with compulsive toothbrushing. A holistic approach, including oral health and functional rehabilitation, should be promoted by physicians, psychiatrists, and dentists for people with eating disorders.

FIGURE 1

Generalized and advanced erosive tooth wear in a woman (38 years old), with vomiting episodes for more than 5 years related to anorexia nervosa. Anterior lingual and occlusal localizations of the erosive tooth wear are typical of vomiting-associated eating disorders

FIGURE 2

Early stage of erosive tooth wear in a woman (25 years old) with anorexia nervosa

FIGURE 3

Comparison of differences in mandibular erosive tooth wear caused by the combination of a nocturnal gastroesophageal reflux disease and a lateral sleeping position in a patient with eating disorder: A, left side, showing less advanced wear; B, right side

FIGURE 4

Oral mucosa ulceration of the soft palate (velo). This episodic injury was induced by the patient’s finger to provoke vomiting

FIGURE 5

Generalized buccal gingival recessions in a patient with anorexia nervosa. A compulsive (excessive and too frequent) toothbrushing was identified to initiate/favor the progression of the gingival recessions. The acid oral environment may be a modifier/amplifier in the pathogenesis of gingival recession in vomiting-associated eating disorders

FIGURE 6

Calculus accumulation at the site of the deep buccal gingival recession in a young woman with anorexia nervosa under enteral food without oral mastication. Gingival inflammation (plaque-associated gingivitis) is directly in relation with this local risk factor

FIGURE 7

Lingual localization of molar gingival recession that is frequently observed in patients with vomiting-associated eating disorders. Notice the erosive tooth wear on the cusp points of the premolars and molars

FIGURE 8

Clinical case of generalized erosive tooth wear restored with direct composite veneers and crowns. Notice the associated gingival recessions induced by a compulsive toothbrushing in a 29-year-old patient become blind and consecutively developing bulimia nervosa. In this case, the patient used to toothbrush after each vomiting episode