11 Ways to Spot an Eating Disorder
By David Dickerson, DDS and Ryan Torti, DDS
Of the three main eating disorders (i.e., anorexia nervosa, bulimia nervosa, binge eating disorder), bulimia presents the most symptoms to dentists and dental hygienists. (According to the Institute of Dental Research, 26 percent of all bulimia cases are first identified by a dentist.) The signs of bulimia vary and range from mild to severe, but much of the damage has one root cause: stomach acids, brought through the mouth by induced vomiting.
Six common physical signs
1. Erosion of the lingual surface of the front four maxillary incisors. Enamel erosion is the most common dental symptom of an eating disorder. It stems from excessive vomiting, which temporarily lowers the pH in the mouth. Bulimics often accelerate enamel erosion by brushing their teeth immediately after purging.
2. Swollen parotid glands located at the angle of the mandible. Also known as ‘chipmunk cheeks,’ enlarged salivary glands can be caused by excessive purging.
3. Sensitive teeth and dry mouth. Xerostomia is commonly seen in anorexic patients who restrict their food and liquid intake. (Some medications can also cause dry mouth.)
4. Signs of induced vomiting from fingers or foreign objects. Calluses on the patient’s knuckles (Russell’s sign) can indicate that fingers are used to induce vomiting, whereas traumatic lesions on the hard and soft palate can result from purging caused by foreign objects.
5. Amalgam Islands. Stomach acids can erode or soften teeth while fillings remain unaffected. Over time, fillings will begin to stick out above the tooth surface. They may also fracture or fall out.
6. A high number of cavities over a short time period. Bulimics often binge and purge on high-calorie, high-carbohydrate foods. When combined with hydrochloric acid from purging, sugar from the food accelerates decay.
Five common verbal indicators
1. “I have gastric reflux.”
2. “I suck on/eat lemons.”
3. “I drink a lot of white wines.”
4. “I drink a lot of soft drinks.”
5. “I grind my teeth.”
David Dickerson, DDS, and Ryan Torti, DDS, practice in Nashville and are members of the Eating Disorders Coalition of Tennessee’s Board of Directors.