Heather Lawson-Myers - TOOTH TALK THERE IS a relatively new wave of health disorders affecting mainly young women. These are eating disorders such as anorexia nervosa (a condition manifested by extreme aversion to food) and bulimia (consuming large amounts of food followed by induced vomiting). These disorders may not be detected by loved ones for months or years as the victims often carry out their actions in secret.
Bulimia has oral manifestations which can be detected during a dental examination. The most dramatic oral problems seen in individuals with eating disorders stem from self-induced vomiting. The gastric juices in the stomach are very acidic, therefore the most common and dramatic effect of chronic regurgitation is smooth erosion of tooth enamel (the outer layer of the tooth) and dentin (middle layer of the tooth).
A casual glance at the bulimia sufferer's smile will not reveal anything, as the erosion is not evident on the tooth surfaces seen during smiling or talking. However, an examination of the tongue side of the teeth reveals a loss of tooth structure.
Sometimes the biting surfaces of the back teeth are also affected. Unfortunately, the clinical, observable signs of bulimia or any chronic vomiting disorder are not detectable for at least two years after the onset of the complaint.
There appears to be a relationship between the extent of tooth erosion and the frequency and degree of regurgitation, as well as with oral hygiene habits. Enlargements of the glands (parotid and sublingual) are frequent oral manifestations of the binge-purge cycle in individuals with eating disorders. The duration and severity of the bulimic behaviour determine the extent of swelling of the parotid glands.
The roof of and the soft tissues in the mouth may be traumatised in patients who binge eat and purge, both by the rapid ingestion of large amounts of food and by the forced vomiting. Objects used to induce vomiting such as fingers, combs and pens may also cause trauma to the oral tissues which may be red and inflamed because of dehydration and sores in the corners of the lips.
Dr. Heather-Dawn Lawson Myers is the President of the Jamaica Dental Association (2003/4).
