Oral hygiene Habits and Knowledge of Eating Disorder Patients

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We all know that clinical eating disorders have direct and devastating effects on our dental hygiene and long-term dental health. Dentists and hygienists can sometimes tell, or at least suspect, when one of their patients has an eating disorder based on the state of their teeth. Many questions begged to be asked, but our researchers have a specific one in mind.

Diet And Behavioral Habits Related To Oral Health In Eating Disorder Patients: A Matched Case-Control Study by Ann-Katrin Johansson, Claes Norring, Lennart Unell, and Anders Johansson studies the dental hygiene behaviors of patients with eating disorders when they have good days to that of their bad days. The researchers compare their findings to a control group of healthy people the same age and sex of those studied. The hypothesis is that a person’s hygiene habits change depending on their mental and physical state.

The Patients

Each patient chosen to be a part of this study was enrolled in a certain eating disorder clinic. There were fifty women and four men. A control group was chosen from a nearby dental clinic that mirrored each patient in age and sex for comparative purposes.

Their median age was 21.5 years. A detailed questionnaire was given to the eating disorder (ED) patients about how they viewed their oral health care on ‘good days’ and ‘bad days’ and whether or not they purged on any of these days. Purging, of course, did not happen in every single patient every single day, but diet changes from bad days to good days have a direct effect on dental health.

Most people with eating disorders have good days, where they have more control over their disease and their lives, and bad days, where diet, purging, laxative use, and starvation are more chaotic. The ED patients recorded more self-aware hygiene practices during their good days than their bad.

Eating Disorders and Dental Health

The ED patients reported a significantly higher intake of artificially sweetened caffeinated sodas than the control group did as a whole. The intake doubled that of the control group to lower their appetite. Caffeine doesn’t have a documented negative effect on oral hygiene, but the same can’t be said about artificial sweeteners and the acidic acids in the soda.

Some patients with ED smoke cigarettes to lessen hunger, which has always harmed dental health. Along with skipping meals, all of these issues contribute to both a lack of saliva and a change in the actual chemistry of the saliva in our mouths.

The ED patients went to the dentist less often than the control group but brushed their teeth more after a purging episode, which can further damage teeth in such a sensitive state due to stomach acids and vitamin deficiencies caused by their disease.

The Control Group

Compared to the ED group, the control group did tend to eat more sugary sweets and starchy foods at a more consistent rate throughout the trial. They also brushed their teeth less than the ED patients whose disease has obsessive-compulsive tendencies.

They brushed their teeth more often and much more intensely, sometimes due to the purging, which does further damage to the already weakened enamel. The ED group did seem to be more aware of the dangers that vomiting had on their teeth and the immediate damage brushing could cause than the control group who had not been educated on the fact.

The control group of patients saw their dentists for regular cleanings and took care of any issues that came up during their check-ups. The majority of patients with ED reported being too nervous and distracted to keep the appointments, and thus caries and other dental problems went unchecked. These patients need to be encouraged more frequently to visit the dentist.


It’s no secret the people who suffer from eating disorders also suffer from negative dental hygiene issues. It’s all part of the disease. Comparing their practices to the routines of people who do not suffer from the disease has brought out some enlightening facts.

Those who suffer from ED are aware that their dental health is at risk, and many are aware that brushing immediately after purging causes even further harm. The ED patients suffer dental problems from more than just purging, their lower intake of food and higher intake of diet sodas change the biochemistry of their saliva composition, and vitamin deficiency weakens the tooth from the inside out.

It is essential for medical professionals in an ED clinic or inpatient/outpatient program to communicate information about dental hygiene to their patients, and dialogue should be commenced. If a dental professional recognizes signs of purging and over-brushing, it is their responsibility to educate the patients in an appropriate manner the correct way to take care of their hygiene and encourage more frequent visits.

Dental professionals should also educate their patients on correct dental procedures after vomiting due to the immediate damage from stomach acid simply because everyone gets sick, and the majority of people run to brush their teeth right afterward.

Now Listen to the Today’s RDH Dental Hygiene Podcast Below: