The Oral Health Risks of Adolescent Bulimia and Vaping: Understanding and Addressing Key Issues

Adolescence is a critical time for physical, emotional, and social development, but it’s also a period when risky behaviors can impact overall health. Among these, bulimia nervosa and vaping are growing concerns that dental professionals are uniquely positioned to detect early. These behaviors not only pose general health risks but can also leave a lasting mark on oral health.

The Oral Health Impact of Bulimia Nervosa

Bulimia nervosa, characterized by cycles of binge eating followed by purging, is often hidden from family and healthcare providers (Lin et al., 2021; Presskreischer et al., 2023). However, its effects on oral health may often be the first visible signs.

Oral manifestations of bulimia nervosa are varied, but over time can be significant indicators of long-term damage. Dental erosion becomes significantly more evident after 4 years of binging cycles, and is likely seen on more than 7 teeth in the whole dentition (Nijakowski et al., 2023). Soft tissue damage includes increased salivary gland enlargement, Vitamin B and C deficiencies, and mucosal bleeding and bruising (Nijakowski et al., 2023), as well as increased gingival recession (Lin et al., 2021). Oral health professionals are trained and adept at identifying these oral manifestations at routine care appointments.

Dental professionals can play a crucial role in identifying these symptoms early. Unfortunately, oral health providers typically do not refer patients for treatment and if they do refer, they are referring to primary care providers when they should be seeking out a mental health professional (Presskreischer et al., 2023). Understanding the connection between these oral signs and potential underlying eating disorders can facilitate timely referrals to other healthcare providers for comprehensive care. Practice and case-based role play can increase oral health providers’ comfort when making referrals.

Vaping and Its Consequences for Oral Health

Vaping, often seen as a safer alternative to smoking, has gained significant popularity among adolescents. Many are advertised as a method to attempt smoking cessation (Caie & Ran, 2023).  Vaping is chosen by adolescents for a number of social reasons, including the social relevance in the circle of friends, seeing others use vapes, and being influenced by peer and personal relationships (Caie & Ran, 2023). Some adolescents are even able to purchase online without identification so they were easy to access (Caie & Ran, 2023). However, the oral health consequences are becoming more evident:

Oral manifestations are generally seen in the gingiva, presenting as gingival inflammation and irritation caused by xerostomia (Holliday et al., 2021). The pH of the liquids used in the electronic cigarettes are highly acidic, and erosive potential is hard to predict based on product alone (Fairchild & Setarehnejad, 2021).  Oral manifestations of vaping can also be linked to systemic diseases. In one case study, the use of a vape has been linked to an erythema multiforme outbreak that only produced lesions in the oral cavity and nowhere else on the body (Santo et al., 2024). For these reasons, dental professionals should be alert that the trending use of electronic cigarettes and vaping is increasing oral manifestations. By recognizing these oral manifestations, dental professionals can provide essential guidance and education to adolescent patients and their families about the potential risks associated with vaping.

The Importance of a Multidisciplinary Approach

Addressing the oral health impacts of bulimia and vaping requires more than just dental treatment, and both of these conditions have many similar associated mental illnesses (Lin et al., 2021; Becker et al., 2023). It involves understanding the psychological, social, and physical aspects of these behaviors. Collaborating with pediatricians, psychologists, mental health professionals, and nutritionists is crucial to ensuring that patients receive holistic care (Lin et al., 2021; Becker et al., 2023). In practice, this means that dental professionals may be the first to notice signs of bulimia or vaping-related damage. This also means that dental professionals need to feel comfortable making referrals to mental health professionals and create local relationships in their communities that they can use to consult with. By taking a sensitive and supportive approach, they can open up a dialogue with patients and families, encouraging further evaluation and support.

Using Case Studies for Practical Understanding

One way to enhance awareness and diagnostic skills is through analyzing case studies. These real-life scenarios help practitioners recognize patterns, assess both oral and psychosocial factors, and develop appropriate intervention strategies. By learning from actual cases, dental professionals can better support adolescents facing these challenges in their practices.

A Call to Action: The Role of Dental Professionals in Adolescent Health

Ultimately, dental professionals are on the front lines of identifying early signs of bulimia and vaping-related issues. By being aware of the oral health risks and collaborating with other healthcare providers, they can play a vital role in protecting the overall well-being of adolescents. Understanding these risks and incorporating early intervention strategies into routine dental care can make a significant difference in the lives of young patients.

Through continuous learning and staying informed about the latest developments in adolescent health, dental practitioners can be powerful advocates for their patients’ well-being.

For more information Katie Pudwill is presenting on this subject.  Click here for course details.

References

Becker, T. D., Arnold, M. K., Ro, V., Martin, L., & Rice, T. R. (2021). Systematic review of electronic cigarette use (vaping) and mental health comorbidity among adolescents and young adults. Nicotine and Tobacco Research, 23(3), 415-425.

Caie, S., & Ran, G. J. (2023). The rationale of non-smoking adolescents’ use of electronic cigarettes (vaping): A scoping review. Aotearoa New Zealand Social Work, 35(1), 85-94.

Fairchild, R., & Setarehnejad, A. (2021). Erosive potential of commonly available vapes: a cause for concern?. British Dental Journal, 231(8), 487-491.

Holliday, R., Chaffee, B. W., Jakubovics, N. S., Kist, R., & Preshaw, P. M. (2021). Electronic cigarettes and oral health. Journal of dental research, 100(9), 906-913.

Lin, J. A., Woods, E. R., & Bern, E. M. (2021). Common and emergent oral and gastrointestinal manifestations of eating disorders. Gastroenterology & Hepatology, 17(4), 157.

Nijakowski, K., Jankowski, J., Gruszczyński, D., & Surdacka, A. (2023). Eating disorders and dental erosion: a systematic review. Journal of Clinical Medicine, 12(19), 6161.

Pelc, A., Winiarska, M., Polak-Szczybyło, E., Godula, J., & Stępień, A. E. (2023). Low self-esteem and life satisfaction as a significant risk factor for eating disorders among adolescents. Nutrients, 15(7), 1603.

Presskreischer, R., Prado, M. A., Kuraner, S. E., Arusilor, I. M., & Pike, K. (2023). Eating disorders and oral health: a scoping review. Journal of eating disorders, 11(1), 55.

Virgili, F., Nenna, R., Ben David, S., Mancino, E., Di Mattia, G., Matera, L., … & Midulla, F. (2022). E-cigarettes and youth: an unresolved Public Health concern. Italian journal of pediatrics, 48(1), 97.