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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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Dr. Jones: Dry Mouth. Well, I have this problem and it makes me drink more and it's worse at night, so then I have to get up and go to the bathroom more.

What is this all about? This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology here at the University of Utah Health Care and we're talking about dry mouth on The Scope. And boy is my mouth dry.

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: Today in the studio, we're going to be talking with Dr. Lea Erickson, who is the Associate Dean for Student Life at our dental school here. And she is an expert on the issue of the older mouth, and that doesn't tell you how old I am, but about dry mouth in specifics. Welcome to The Scope studio, Dr. Erickson.

Dr. Erickson: Thanks for the invitation.

Dr. Jones: Sure. So let's talk about women's mouths with respect to dry mouth. So is it frequent? How often does it happen for women?

Dr. Erickson: So dry mouth is really common among older people, not necessarily always older people, but see it much more commonly; it's usually associated with the use of medications. There are also some autoimmune diseases like Sjrogen's syndrome, again more common in women, that will have a dry mouth. A dry mouth can be really devastating for the patient having, or the individual having it. It's uncomfortable. One of the common complaints is I can't lick a stamp, I can't eat a cracker, I have to have liquids with my food, I have to have sauces on my food so it really can affect quality of life.

Dr. Jones: Does it affect your sense of taste as well or does it just dry mouth?

Dr. Erickson: Oh, it absolutely affects the sense of taste. Food needs to be in solution to be tasted and so if it isn't in solution then the taste buds don't affect it, don't get it, and so people with dry mouth have much less pleasure in eating as well as just not tasting it.

Dr. Jones: Well, we know that people when they get embarrassed or when people are giving a talk, there's always a glass of water for them. So dry mouth can be an acute response to nervousness or stress. And we know that there are some medications that make us get rid of fluid, like high blood pressure medications. So aside from diuretics, what other kinds of medications can lead to dry mouth?

Dr. Erickson: The list of medications, I think the last time I saw it, said 400 medications that cause dry mouth.

Dr. Jones: Oh, that many? Okay. Good.

Dr. Erickson: So any of the drugs that treat depression, again commonly used on adult patients. Pain medications are the worst so any of the narcotics.

Dr. Jones: Narcotic pain medications.

Dr. Erickson: Absolutely.

Dr. Jones: And then so if we have people that need their medications or need their blood pressure or their anti-depressants, what kinds of things do we do for people?

Dr. Erickson: So, what we need to do is either anything that will stimulate salivary flow, so you . . .

Dr. Jones: Ooh, thinking about pizza does that for me.

Dr. Erickson: Ahh, well, you know, thinking about food will

Dr. Jones: Or lemons

Dr. Erickson: . . . do it.

Dr. Jones: Thinking about lemons. I'm thinking about lemons right now and that's doing it for me.

Dr. Erickson: So, thinking is always a little bit useful, but most people are not going to walk around thinking about lemons and pizza. However, putting a sugar-free lemon candy in your mouth will stimulate salivary flow and keep it coming and not contribute to tooth decay.

Dr. Erickson: Putting some gum in your mouth. Cinnamon's my favorite. Cinnamon can be irritating in a dry mouth, but whatever flavor does it for you. The citrus flavored gums will do a wonderful job of stimulating salivary flow. And then you've got your natural saliva.

Dr. Jones: Is there some way of making . . . is there a medication that makes more saliva?

Dr. Erickson: There are two medications that are available. They both were tested on either patients who've had cancer therapy, radiation to the glands, or have Sjrogren's syndrome, but are often used for medication-induced dry mouth. Salogen, pilocarpine is one and cymatidine is the other one. They're not used terribly commonly because they also have side effects of making people sweat. So they're less convenient, but among the very, very dry mouth, they're very effective and very helpful.

Dr. Jones: So you have dry mouth, you say, "Well," you see everybody walking around with a bottle of water anyway. Now it's so acceptable to take your bottle of water with you. What are the side effects or what are the long-term risks of having a dry mouth?

Dr. Erickson: So the water puts the moisture in your mouth, helps your comfort, but does not have an effect on the health of the teeth.

Dr. Jones: Oh, so saliva has more in it than just water, huh?

Dr. Erickson: Absolutely.

Dr. Jones: Oh, tell us about that.

Dr. Erickson: It has anti-microbials, it has ions in it that remineralize the teeth. So the teeth are in a constant flow of losing calcium and phosphate and regaining it. So they demineralize and remineralize and it's a constant flow back and forth. Without saliva, it tends to be just a flow outwards and makes the teeth at very, very high risk for aggressive tooth decay that goes rapidly.

Dr. Jones: Oh. Well, that's something new for me because I figured that it was just dry and now I think of saliva as being really an important part of my mouth's health.

Dr. Erickson: It's absolutely a critical bodily fluid that has huge really therapeutic or functional benefits for the mouth.

Dr. Jones: So do you think the average family doc or nurse practitioner knows about treatment? Let's say . . . women might not even talk to their doctor about treatment cause they think it's common, but if they do . . . should women who's got this problem, should they go to their doctor? Should they talk to their dentist? Should they talk to everybody, their best friend?

Dr. Erickson: Well, they probably should at least talk to their physician and their dentist about it. The physician in terms of are there some alternatives to the medications that might have less of an effect, but absolutely talk to the dentist, get a prescription for a high concentrated fluoride dentifrice to use that will help to increase the remineralization.

Dr. Jones: Is that a toothpaste you're talking about, the dentifrice thing?

Dr. Erickson: Yes, toothpaste, sorry. Yes, it's a 1.1% neutral sodium fluoride, it requires a prescription, a number of brands. And really, most dentists manage to carry it in the office and have it available.

Dr. Jones: So and so brushing and flossing's more important in an effort to try to prevent tooth decay.

Dr. Erickson: Yes, and the patients that have good salivary flow can get away with doing less . . . well, get away with being a little more cavalier about their oral health care. Somebody with a dry mouth has to do such an excellent job of cleaning that they leave no plaque.

Dr. Jones: Okay. All you flossers and all you brushers who are of a certain age, if you have dry mouth, you should be talking with your clinician about causes that might be changeable if it's your prescriptions, about new therapies that might be helpful for you, but get your teeth checked out and keep them healthy and strong.

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