Dr O Dadashian
When we think about bulimia nervosa, we often focus on the psychological and nutritional aspects of this serious eating disorder. However, what many people don't realize is that bulimia can have devastating effects on oral health, particularly causing severe tooth erosion that can permanently damage your smile. Understanding these dental consequences is crucial for both patients and their families.
What is Bulimia and How Does it Affect Your Mouth?
Bulimia nervosa is an eating disorder characterized by cycles of binge eating followed by compensatory behaviours, most commonly self-induced vomiting. Unlike anorexia, people with bulimia often maintain a normal body weight, which can make the condition harder to detect. However, the frequent exposure to stomach acid from vomiting creates a perfect storm for dental problems.
When you vomit, your teeth are bathed in gastric acid with a pH as low as 1.5 – that's incredibly acidic. To put this in perspective, battery acid has a pH of around 1, while normal saliva has a pH of about 7. This repeated acid exposure literally dissolves the protective enamel coating on your teeth, leading to what dentists call dental erosion.
Recent research involving nearly 1,700 patients with eating disorders found that more than half of people with bulimia – specifically 54.4% – experience tooth erosion. Even more concerning, individuals with bulimia are more than 10 times more likely to develop dental erosion compared to healthy individuals.
The Tell-Tale Signs: Where Erosion Strikes First
Dental erosion from bulimia follows a predictable pattern that experienced dentists can often recognize immediately. The most commonly affected areas include:
This distinctive pattern occurs because these are the areas that come into direct contact with vomit during purging episodes. The damage typically appears as smooth, glossy depressions in the tooth surface, quite different from the rough, irregular appearance of tooth decay.
The Progression: From Bad to Worse
The severity of dental erosion in bulimia patients directly correlates with how long they've been engaging in vomiting behaviours. Studies show that people who have been vomiting for more than four years have significantly more severe erosion (55.2%) compared to those vomiting for four years or less (24.3%).
Initially, you might notice increased tooth sensitivity, particularly to hot, cold, or sweet foods and drinks. As the condition progresses, teeth may appear shorter, more transparent, or develop a "dished out" appearance. In severe cases, the erosion can extend deep into the tooth, exposing the underlying dentin and potentially requiring extensive dental treatment.
The Saliva Factor: Your Mouth's Natural Defence System
People with bulimia often experience changes in their saliva that compound the erosion problem. Research shows that individuals with eating disorders frequently have:
Saliva normally helps neutralize acids and remineralize teeth after acid exposure. When this natural defence system is compromised, teeth become even more vulnerable to erosion.
Common Mistakes That Make Things Worse
Many people with bulimia instinctively brush their teeth immediately after vomiting, thinking this will help protect their teeth. Unfortunately, this well-intentioned action can actually accelerate enamel loss. When teeth are softened by acid exposure, brushing can literally scrub away the weakened enamel.
Studies have shown that 50% of patients who brushed immediately after vomiting had signs of erosion, suggesting that this practice may promote rather than prevent enamel loss.
Protective Strategies: What Actually Helps
While the best protection is addressing the underlying eating disorder, there are steps that can help minimize dental damage:
Immediate post-vomiting care:
Daily oral care:
The Importance of Professional Care
If you or someone you know is struggling with bulimia, it's crucial to involve both medical and dental professionals in the treatment plan. Dentists can often be the first to recognise signs of an eating disorder, as oral symptoms may appear before other physical manifestations.
Early intervention can prevent more severe damage and preserve as much natural tooth structure as possible. In cases where significant erosion has already occurred, treatments may include fluoride applications, dental bonding, crowns, or other restorative procedures.
Hope for Recovery
While the dental consequences of bulimia can be serious, it's important to remember that with proper treatment and care, both the eating disorder and its oral health effects can be managed. The key is seeking help early and working with a comprehensive treatment team that includes mental health professionals, medical doctors, and dental specialists.
Recovery is possible, and protecting your oral health is an important part of that journey. If you're struggling with bulimia, please reach out for help – your teeth, and your overall health, depend on it.
References:
Design By Dental Media
