While the toll of eating disorders is often obvious from the sufferer’s appearance and compromised health, there are hidden, high-risk dangers specific to the patient’s oral health as well. And they are serious.

Among American women, especially young American women, the two most common eating disorders are bulimia and anorexia nervosa.

Bulimia

Bulimia is defined by a pattern of alternately bingeing and purging, and anorexia nervosa by extremely limiting the intake of food and by severe weight loss. The frequent vomiting that marks bulimia floods the teeth with gastric acids. These acids erode the protective enamel that covers the teeth. Over time, the teeth are worn away and can become soft and extensively decayed.

A telltale sign of acidic erosion occurs when the tooth structure is worn away and metallic fillings stay intact and appear to extend above the tooth’s surface. The enamel on the backs of the upper molars also dissolves if bulimia continues untreated. In addition, the exposed dentin will be vulnerable to cavities. Although fillings can alleviate them to some extent, they do not cover and protect the teeth against the continuing onslaught of stomach acids. So for molars, crowns are also the best treatment.

At NYC Smile Design, we are aware of the sensitivity of both the physical and psychological aspects of eating disorders. We take pride in being able to provide our patients with a serene and supportive atmosphere. All treatments are conducted in the strictest privacy of our offices, with great respect for each individual’s needs. Coupled with our experience in the most complex reconstructions is our deep concern for the patient’s confidentiality. Dental treatment concurrent with psychological and medical care is the best initial course for most patients. We are also glad to offer suggestions for ongoing care once the treatments are completed.

Why Dental Treatment Is Crucial for Bulimia Patients

To understand how crucial dental intervention and treatment are, the patient should be aware that, without them, the teeth will continue to erode and decay until they have died. At this stage, only root canal therapy and crowns can protect what is left of each tooth.

Further, the same stomach acid that has melted the teeth is equally corrosive to the body: It can cause burns at the corners of the mouth, seriously impair the esophagus and the throat, induce long-term hoarseness and cause the parotid (salivary) glands to become swollen, causing the patient’s jowls and lower jaw to become enlarged.

Another result of long-term bulimia is bite-change. It can become so extreme that the patient’s jaw joints are gradually misaligned, causing severe TMJ-related facial pain (which may domino and lead to headaches, neck and shoulder pain as well). Because many patients induce vomiting by forcing two fingers of their right hand down their throat, sores may develop in the hand just below the knuckle where the hand pushed against the upper front teeth. Oral lacerations and bruises may also develop from the use of various objects to induce vomiting. Additionally, braces and temporary restorations may not adhere to the teeth because the acid will dissolve the cement used to keep these materials in place.

Acids are neutralized by bases: If the hydrochloric acid is neutralized and washed away immediately, bulimia’s terrible consequences for oral health can be minimized. One treatment is to dissolve bicarbonate of soda (such as Arm and Hammer Baking Soda) in water and refrigerate it in a bottle. If the solution is swished around the mouth immediately after vomiting, it will neutralize the hydrochloric acid and lessen its effect.

Essential Information about Bulimia:

Erosion is bulimia's primary effect on the teeth

Erosion takes about three years of bulimic vomiting to become apparent

Fillings will look higher than the tooth when the tooth becomes eroded

Additional Signs and Symptoms:

Pronounced redness of gums

Chronic sore throat

Presence of scratches on the soft palate (from using fingers to induce vomiting)

Swollen parotid and submaxillary glands

Dry mouth

Sensitive teeth

Darkening of teeth (exposed dentin)

In severe cases, teeth may begin to break off

Not All Erosion Is Due to Vomiting:

43% from combined gastrointestinal problems and acid diet

25% upper GI disorders

24% acid diet

6% eating disorder

2% unknown cause

Bulimic Patients Can Improve Their Health By:

(following the suggestions below may help contain some of the erosion caused by bulimia)

Not brushing teeth after vomiting; rinse with water instead

Using a base rinse, such as baking soda and water, to neutralize the acid

Reducing sugar in their diet

Removing plaque by brushing and flossing properly

Chewing sugarless gum to increase the flow of saliva, or using artificial saliva

Using in toothpaste, rinses, or gels to reduce sensitivity of the teeth and to build resistance to decay from acid

Other behaviors, disorders and symptoms that can appear similar to that of bulimia (acid erosion):

Holding colas in the mouth for a period of time before swallowing (drinking a lot of soda/cola or acidic juices)

Cavities

Cavities Hereditary disorders

Tooth grinding, which may cause teeth to wear away

Sucking on lemons or other citrus foods may cause just the front teeth to erode

Certain diseases and prescription drugs may cause dry mouth and burning of the tongue

Sever infections, certain drugs, vitamin C deficiency and hot foods may cause lesions on the palate or gums

Frequent and vigorous brushing may cause recession of the gums

Other agents, such as coffee and tobacco discolor the teeth

Periodontal disease and chemotherapy may cause bleeding of the gums

If a patient suffering from bulimia requires scheduling intensive treatment in a curtailed period of time, we are able to create a course of treatment that will permit optimum results in a caring and efficient manner. For patients in the tri-state area, as well as those from out-or-town, this can ensure an excellent outcome, even in extremely advanced cases.

We can also assist patients with financing such intensive care so that every aspect of the procedures can be completed on schedule.

Because of the particularly sensitive nature of bulimia, and because of their past success in dealing with bulimic patients, Drs. Mello and Tabib encourage patients to meet them for a confidential consultation to discuss their needs. You may simply call 212-452-3344 or email our office in New York City to arrange a consultation.