How bulimia affects your teeth

Why does bulimia affect oral health?

Bulimia nervosa is a mental health condition that impacts eating behaviors and attitudes around body image. Typically, individuals with bulimia engage in binge eating episodes, in which they will eat an excessive amount of food in a short time, followed by purging episodes, which can include self-induced vomiting, abusing laxatives, fasting, or excessive exercising ^[1].

Bulimia can have serious physical effects, impacting various areas of the body and causing damage to vital organs. Oral health can also be severely affected by bulimia nervosa, particularly in those who engage in self-induced vomiting, as this causes various effects to the teeth, mouth, and throat ^[2][3].

Vomiting

When an individual vomits, stomach acid enters the mouth which can cause damage to the teeth and gums. Because of this, frequent vomiting can cause ongoing and increasing damage, including dental erosion and decay, and sores in the mouth ^[4].

Individuals with bulimia might brush their teeth immediately after vomiting, in an attempt to hide the behavior or remove the taste, which in fact causes more damage, as the stomach acid is brushed into the teeth, increasing the risk of erosion ^[5].

Furthermore, when inducing vomiting, individuals often use their fingers or an item pushed to the back of the throat, which can cause sores or damage to the mouth and throat ^[6].

Dehydration

Oral health can also be impacted by dehydration, which not only occurs in those with bulimia who engage in self-induced vomiting but can also occur in those who utilize laxatives and diuretics or excessive exercising to manage weight ^[5][7].

Dehydration and excessive vomiting can cause a reduction in saliva, which may lead to many changes in oral health, including dry mouth, pain with swallowing, changes in taste, and swollen salivary glands ^[7][8].

Dietary choices

Individuals with bulimia may regularly consume foods with a high sugar content, either to manage cravings and hunger, or as part of a binge eating episode in which large quantities of these foods could be consumed. This can also be very detrimental to oral health as sugar causes damage to teeth and gums, such as erosion and decay ^[2].

Ways that bulimia can affect your teeth and mouth

Changes to oral health caused by bulimia can include:

• Erosion: Dental enamel is a protective layer over the teeth, which can become eroded by stomach acid that enters the mouth from vomiting, or by the consumption of carbonated drinks. Erosion will often worsen as bulimia continues and can lead to sensitivity and further damage of the teeth ^[4].
• Decay and cavities: Severe erosion, consuming sugary or acidic foods and drinks, and poor dental hygiene practices can lead to worn down and broken teeth, decay, and cavities ^[2][6].
• Sores: Stomach acid that enters the mouth during vomiting can cause the gums and lining of the mouth to develop sores and lesions, which can be painful. Similarly, inserting items into the mouth and throat to induce vomiting can also cause sores or cuts ^[7].
• Yellow teeth: As teeth become increasingly eroded, their appearance will change, and they will become more yellow and smooth ^[2].
• Pain: Erosion and decay cause the teeth to become very sensitive. Previously covered layers of the teeth become exposed, which can cause pain or sensitivity when consuming hot or cold food and drink. Similarly, regular vomiting can cause pain in the throat and mouth from repeated strain and exposure to acid ^[4].
• Dry mouth: It is common for those with bulimia to become dehydrated, particularly if they engage in self-induced vomiting. Dehydration effects on the salivary glands and can lead to a reduction in saliva production. Often referred to as xerostomia, dry mouth can cause pain or a burning sensation when swallowing and changes in taste. Reduced saliva production also contributes to a worsening of dental erosion, as saliva is protective and restorative against sugar and acid ^[2][8].
• Swollen glands: Regular self-induced vomiting will often affect the salivary glands, causing them to become overactive. This can lead to a swelling of these glands, particularly the parotid glands, which causes an appearance of large, puffy cheeks. This effect can be reduced by stopping self-induced vomiting and usually will have no long-lasting impact following treatment ^[6][9].

Early signs of bulimia

Early signs of bulimia may include various changes in behavior and eating habits, such as ^[1]:

• Hoarding foods for binge episodes
• Avoiding eating with others
• Going to the bathroom immediately after meals
• Regular comments on body shape or appearance

As bulimia often causes complications to oral health, it is possible that the presence of the condition could first be suspected by the individual’s dentist, who may notice signs such as ^[6]:

• Sores or scratches in the mouth or throat
• Early stages of tooth erosion
• Tooth sensitivity
• Bleeding gums
• Reduced saliva

Treatment for oral health complications caused by bulimia

Dental

Trying to manage or prevent severe consequences on oral health caused by bulimia can be challenging if the condition itself is not yet being treated, as ongoing purging will likely continue worsening oral health. However, it is important to practice good dental hygiene regardless, as it may help to manage the severity of this impact ^[6].

For example, it is advised that individuals wait at least an hour after vomiting before brushing their teeth, as this allows time for the stomach acid that has entered the mouth to be mostly cleared, thus preventing brushing the acid onto the teeth further. Washing out or rinsing the mouth after vomiting can also help with this ^[6][7].

As is advised for all, those with bulimia should brush their teeth twice per day, as well as flossing to protect teeth and gums. ^[2].

Additionally, it is recommended for those with bulimia to regularly attend the dentist. Although dental issues such as erosion, decay, and cavities may be irreversible, dentists can help to manage these complications, as well as any pain that may occur, while providing appropriate advice ^[7].

Treating bulimia

The best way to manage oral health effects of bulimia is to treat the condition itself. Seeking professional help can be challenging but is often necessary to receive the best chance of recovery and prevent serious or fatal health consequences. This might include input from physicians, therapists, dieticians, and other eating disorder specialists ^[1][3].

Other physical effects of bulimia

Prolonged or untreated bulimia can lead to several physical health complications. Some of these complication can be improved or reversed with professional treatment, while others may cause long-term health issues.

Some of the other potential physical effects of bulimia nervosa include ^[1][3]:

• Weight loss or fluctuations
• Excessive tiredness
• Decline in cognitive functioning
• Dehydration
• Worsening skin condition, including dryness or spots
• Dry and brittle hair and nails
• Bloating and constipation
• Stomach pain
• Irregular or abnormal bowel movements
• Heart irregularities and complications
• Sudden cardiac arrest
• Kidney failure