Bulimia nervosa, an eating disorder marked by cycles of binge eating and compensatory behaviors like self-induced vomiting, can significantly impact oral health. The repeated exposure of teeth to stomach acid and the physical forces involved in purging create a range of serious dental problems.
Common Dental Problems
Enamel erosion is a frequent dental issue, where the protective outer layer of teeth wears away. This erosion makes teeth appear smooth, glassy, or translucent, particularly on the tongue-facing surfaces of the upper front teeth. As enamel thins, teeth can become sensitive to hot, cold, or sweet foods and drinks.
The loss of enamel also increases the risk of dental caries, commonly known as cavities. When enamel is compromised, teeth become more susceptible to decay from bacteria. In severe cases, the structural integrity of teeth can be weakened, leading to chipping, cracking, or even tooth loss. Teeth may also discolor, becoming yellowish as the underlying dentin is exposed.
How Damage Occurs
The primary mechanism of dental damage in bulimia is the highly acidic nature of stomach contents. Stomach acid, with a pH ranging from 1 to 3, is corrosive and can dissolve tooth enamel upon contact. Each episode of self-induced vomiting exposes the teeth to this acid, leading to demineralization and erosion of the enamel. This process is damaging because enamel, once eroded, cannot regenerate naturally.
Physical actions associated with purging further contribute to dental wear. Brushing teeth immediately after vomiting can exacerbate enamel erosion, as the softened enamel is more vulnerable to abrasion from a toothbrush. Additionally, inducing gagging, often with fingers or other objects, can cause trauma to the soft tissues of the mouth and tooth wear.
Other Oral Health Impacts
Beyond direct effects on tooth structure, bulimia can impact other oral tissues and glands. The salivary glands may swell due to frequent vomiting. This swelling can cause a puffy appearance in the cheeks, sometimes referred to as “bulimia cheeks.” Saliva, which normally helps neutralize acids and protect teeth, may also be reduced in flow due to dehydration or certain medications, further increasing the risk of damage.
Gum health can also suffer, leading to inflammation, bleeding, or gum recession. The soft tissues of the mouth and throat are susceptible to irritation, sores, and even small hemorrhages from repeated exposure to stomach acid and physical trauma.
Seeking Help and Management
Addressing dental problems associated with bulimia requires a comprehensive approach. Dental professionals can provide care to manage and minimize damage, including regular professional cleanings and fluoride treatments to strengthen remaining enamel and reduce sensitivity. Applying topical fluoride gels or using prescription-strength fluoride rinses can help remineralize weakened tooth surfaces. For significant enamel loss, restorative procedures such as veneers, crowns, or bonding may be necessary to rebuild tooth structure and improve function and appearance.
It is important to avoid brushing teeth immediately after vomiting; instead, rinsing the mouth thoroughly with water or a baking soda solution can help neutralize stomach acid and protect enamel. Waiting at least 30 to 60 minutes before brushing allows enamel to reharden. Ultimately, resolving the underlying eating disorder is the most effective way to prevent further dental damage. A multidisciplinary team, including dentists, medical doctors, and mental health professionals, offers the best support for recovery and long-term well-being.