Eating disorders

Overview

Board takeaway: Protect eroded teeth and arrange medical and mental health assessment; defer elective sedation when cardiovascular, hydration, or electrolyte status is unstable.

Adolescent eating disorders often show in the mouth first: palatal erosion, parotid enlargement and trauma from induced vomiting.

How should you discuss suspected eating-disorder findings and arrange care?

• Communication: Speak privately and without judgment; explain confidentiality and its safety/legal limits.
• Caregiver involvement: Encourage supportive caregiver involvement while following local minor-consent and privacy law.
• Referral: Refer to medical and mental health care

How should teeth be protected during ongoing vomiting from an eating disorder?

• After vomiting: After vomiting, rinse with water, a sodium bicarbonate rinse, or milk; avoid brushing immediately afterward
• Prevention: reduce acid exposure, support gentle brushing with fluoridated toothpaste, and use professional or prescription topical fluoride according to caries/erosion risk, age, and ability to use the product. Custom trays are an option for selected patients, not a requirement for every eating disorder.
• Restorations: treat pain, caries, and structural compromise without waiting for psychiatric recovery. Use protective or interim restorations when ongoing acid exposure threatens durability; coordinate extensive definitive rehabilitation with control of erosion.

When should dental treatment or sedation be deferred for a patient with an eating disorder?

• Before sedation or GA: assess medical stability with the treating team, including cardiovascular findings, hydration, nutrition, and whether current electrolytes are needed.
• Escalation: Syncope, marked weakness, dehydration, or arrhythmia symptoms require prompt medical assessment; defer elective care when unstable.

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Arrange medical and mental health care while protecting teeth. Symptoms of dehydration, syncope, marked weakness, or arrhythmia need prompt medical assessment; elective sedation is deferred when unstable, while urgent dental needs are coordinated.

Exam pearl

What are Eating disorders?

Serious mental illnesses involving disturbed eating behaviors that harm physical or psychological health. Examples include anorexia nervosa (restriction with low body weight and fear of weight gain), bulimia nervosa (binge eating with compensatory behaviors), binge-eating disorder, and avoidant/restrictive food intake disorder (ARFID).

What are the main systemic features of Eating disorders?

• Who is affected: Can affect people of any sex, gender, age, or body size; serious medical and psychiatric risks include suicide and complications of malnutrition
• Anorexia: restriction, bradycardia, hypotension, osteoporosis, amenorrhea, electrolyte disturbance
• Bulimia: binge eating with compensatory behaviors; body weight may be in the expected range, and Russell sign (knuckle calluses) may occur with induced vomiting
• Arrhythmia risk: Hypokalemia from vomiting or laxatives can cause arrhythmia

What oral findings occur in Eating disorders?

• Erosion: Erosion of palatal surfaces of maxillary teeth (perimolysis) may reflect recurrent gastric acid exposure; the appearance does not establish how long purging has occurred
• Glands: Bilateral painless parotid enlargement (sialadenosis)
• Mucosa: Palatal trauma or erythema from induced vomiting; xerostomia, angular cheilitis
• Dental symptoms: Dentin hypersensitivity, caries

For Eating disorders, why are maxillary palatal surfaces affected by purging?

• Gastric acid from vomiting reaches maxillary palatal surfaces first
• Tongue protects mandibular lingual surfaces
• Restorations stand proud of eroded tooth structure
• Diagnostic limit: erosion is compatible with repeated vomiting, but reflux and other acid exposures remain in the differential. Its extent does not date onset or prove an eating disorder

A 16-year-old has smooth erosion on the palatal surfaces of the maxillary anterior teeth and bilateral parotid swelling. How do you raise this?

Speak privately and without judgment:

“I’m seeing acid wear on your teeth. Reflux, vomiting, and some drinks can cause this. Has any of that been happening?”

• Confidentiality: explain confidentiality and when information must be shared for safety or under local law.
• Shared plan: encourage the adolescent’s participation in involving a supportive caregiver and arranging medical/mental health assessment; do not promise absolute secrecy or automatically disclose every detail.
• Documentation: document findings and, with appropriate consent, photographs.

Sources

• Supplemental study guide: Pediatric Dental Study Guide: Eating disorder/ Bulimia/ Anorexia
• Definition: NIMH: Eating disorders
• Adolescent Oral Health Care
• Supplemental clinical source: ADA: Dental Erosion