Society for Women's Health Research

Eating disorders have reached epidemic proportions in the United States. According to the National Eating Disorders Association in Seattle, Washington, an estimated five to ten million girls and women are dealing with some sort of eating disorder after puberty. In addition, close to 80 percent of American women are displeased with their appearance at some time or another. The American Anorexia/Bulimia Association estimates that approximately 5 percent of college women in the US have bulimia.

Oral health practitioners can play an integral role in the diagnosis of eating disorders, according to an article published in a 2001 special issue devoted to women's health in the dental journal, Compendium. Signs of self-induced vomiting, one of the hallmarks of the condition bulimia nervosa, become evident on the teeth and can easily be spotted by dentists, hygienists and other oral health experts.

"The dental team may be the first to pick up signs of an eating disorder," according to Barbara J. Steinberg, DDS, Clinical Professor of Surgery at Drexel University College of Medicine. Dr. Steinberg spoke at a recent conference sponsored by the American Dental Association and the Society for Women's Health Research about issues pertaining to women and oral health. "It is a rarity that young women will admit to the behavior of an eating disorder," Dr. Steinberg explains. Because very few women will seek medical attention for eating disorders, the role of the oral health community becomes even more important.

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The most common and significant consequence of chronic regurgitation is erosion of the enamel or perimyolysis. According to Dr. Steinberg, "If a person has been vomiting for two years or more, you will start to see erosion." The erosion is often seen on the inside surface of the upper teeth. The teeth will commonly appear smooth without any visible lines. Another effect of chronic vomiting is teeth sensitivity, which is associated with the eroding enamel. According to Steinberg, "If a young girl complains of sensitive teeth, it is usually a telltale sign."

When patients with bulimia gag themselves to induce vomiting, red areas become visible on the roof of the mouth or soft palate due to trauma. Some people will develop calluses on their knuckles, particularly the middle and forefinger, due to using their fingers to induce vomiting. Swelling of the salivary or parotid gland is seen in an estimated 10-50 percent of patients suffering from bulimia, and can often be a warning sign to health experts. "If young women constantly complain of dry mouth, I am automatically suspect," explains Dr. Steinberg. Bulimics are often dehydrated from vomiting, laxative use and low water intake.

Many women who suffer from eating disorders will deny that they have a problem. Dr. Steinberg explains that oral health experts can play a vital role by confronting the patient and referring to a primary care physician. "I recommend confronting the person in a non-threatening manner, telling the patient that their enamel is eroding and gently asking if they are aware of the reasons why." Eating disorder patients have needs that must be addressed on several levels. "A multi-disciplinary approach is necessary which can treat the mental, emotional, medical, oral and nutritional aspects of these diseases," explains Steinberg.

July 10, 2003

© July 2003 Society for Women's Health Research

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The Society for Women’s Health Research is the nation’s only not-for-profit organization whose sole mission is to improve the health of women through research. Founded in 1990, the Society brought to national attention the need for the appropriate inclusion of women in major medical research studies and the resulting need for more information about conditions affecting women. The Society advocates increased funding for research on women’s health, encourages the study of sex differences that may affect the prevention, diagnosis and treatment of disease, and promotes the inclusion of women in medical research studies.