Dr. Jones: There are some conditions that are more common in women, medical problems that can lead to problems with oral health. Today we're going to talk about eating behaviors and eating disorders and oral health in women on The Scope.
Announcer: Covering all aspects of women's health. This is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.
Dr. Jones: Well, I have a disclosure here on The Scope. My mother's pregnancy with me was diagnosed by a dentist. My mother was a dental hygienist, had perfect oral health, she brushed and flossed, and her teeth got all puffy and they bled. The dentist that she went to see said, "Oh, madam. I think it's not me that you should be seeing, but my partner down the hall who's the obstetrician." She didn't even know she was pregnant.
There are conditions more common in women in pregnancy, and today we're talking about eating disorders, which are more common in women that can change oral health. In the studio today, we have Dr. Lea Erickson, who's the Associate Dean for Student Life at our dental school. She has been an expert on the consequences of eating disorders in primarily women because women have more eating disorders than men, and their oral health. Welcome to the studio, Dr. Erickson.
Dr. Erickson: Thank you for the invitation.
Dr. Jones: So let's talk a little bit about eating disorders in women. I think of eating disorders in two forms, which are sometimes combined. There's anorexia where people just don't eat, and then there's bulimia where women make themselves throw up, and sometimes women have both. Can you talk about anorexia and oral health?
Dr. Erickson: So there aren't really any clearly defined links between oral health and anorexia in the absence of bulimia. It's logical to assume that the lack of adequate intake is going to have an impact on the quality . . . I mean, we know it has an impact on the quality of the bone and certainly it's reasonable to assume that it has an impact on the quality of the bone that's supporting the teeth. There's really no long-term evidence showing that.
Dr. Jones: But sometimes women, when they have an eating disorder, eat certain kinds of foods exclusively. So they'll eat more sour things or they may choose to drink more sodas that are sugar-free and not so much other things. Are there any kinds of foods that might be habitually used in people who are trying to decrease their calories that might be bad for your mouth?
Dr. Erickson: So all of the sugar-free sodas, all the diet sodas, really any fruit that's highly acidic, vegetables that are acidic are going to dissolve tooth structure. So potentially, those who have such a limited diet that their diet coke all day long, diet soda all day long are probably dissolving tooth structure.
Dr. Jones: Right. Well, in women with eating disorders, bulimia or forced vomiting is actually often associated with anorexia, and there are people who don't lose a lot of weight but have bulimia alone. Let's talk about forced vomiting and how that might affect oral health.
Dr. Erickson: The acid in the stomach that they're vomiting is constantly bathing the teeth and will dissolve the enamel and ultimately the dentin. So the teeth will become thinner and thinner from usually on the pallet side and these eventually dissolve away.
Dr. Jones: The pallet side, meaning on the inside where the tongue is . . .
Dr. Erickson: Correct.
Dr. Jones: . . . or sort of like that. Well, how about the way people make themselves throw up? Some women can just make themselves throw up by thinking about it. But quite often, young women are sticking their fingers down their throat. Does that affect their oral health?
Dr. Erickson: Sticking the fingers down the throat probably doesn't affect the oral health, although there can be some scarring on the pallet from it. Very often there's scarring on the fingers where the teeth are impacting them.
Dr. Jones: Oh, okay. Well, the other thing is that women who have bulimia are not often forthcoming about their problem. They're addicted to their vomiting. They realize that they have a problem. But they're often not telling either their parents, their family, their friends and certainly not their dentist. What might be the first sign that someone might have this problem?
Dr. Erickson: Very often, the dentist is going to be the first one to see evidence of this and it will be the thinning of the teeth. Usually the upper front teeth on the inside, they'll become thinner. The enamel will dissolve away. The teeth will become shortened. So really, the dentist can play an important role in identifying the problem.
Dr. Jones: I think the issue for women who are suffering with bulimia is recognizing that this is a disease. There are medical interventions that can help, as well as psychological interventions, and there are consequences whether or not it has to do with weight loss or whether women are just vomiting to try to maintain their weight. But there are significant consequences to their health and their oral health.
Dr. Erickson: The consequences can be phenomenal. I saw cases where the teeth were literally dissolved almost to the gum line.
Dr. Jones: Oh, no.
Dr. Erickson: So a disease that started with a teenager who wanted to be a cheerleader and so she started vomiting in an attempt to control her weight, and as you mentioned it is an addiction and continued until literally the teeth were short and black in the front. So devastating effects.
Dr. Jones: It's devastating, particularly for a young woman whose self-image was already in jeopardy leading to the efforts to maintain her weight and becoming bulimic, and now having a lifelong teeth presentation problem.
Dr. Erickson: Yeah. Then, she really does have a lifelong dental disability as a result of the bulimia.
Dr. Jones: When we're talking about bulimics, I think about something that starts young as kind of a fad. Girls do it together. You're talking about long-term effects on the teeth. Is this something that you might see if a young woman goes through kind of a fad stage where she's bulimic for maybe six months or a year? Or is this something, the kinds of changes that you've described, do they take a really long time?
Dr. Erickson: We're not going to see this, usually, until somebody's been vomiting, usually multiple times a day for a significant period of time.
Dr. Jones: Does that mean a year? Or how long is a significant period of time?
Dr. Erickson: The patients that I saw that had a substantial amount of damage had, most of them, been vomiting four or five times a day for seven to 10 years.
Dr. Jones: Right. Being honest and helping your clinician take the best care of you and your dentist take the best care of you is going to help you, if you suffer from these issues, when you finally recover, have the mouth that you want when this is all over.
Dr. Erickson: And certainly, talking with your dentist frankly and asking your dentist to help you find the resources to get the help that you need.
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