What purging does to your teeth?

Bulimia nervosa is a mental health disorder that causes chaotic and disordered eating habits followed by inappropriate compensatory behaviors (behaviors to try and counteract the effects), such as purging. Self-induced vomiting, laxative abuse, and diuretic abuse are the most common methods of purging.

Self-induced vomiting is the most common purging method reported by 56-86% of individuals. A common side effect of self-induced vomiting is bulimia teeth. Bulimia teeth describes a variety of oral health problems resulting from frequent binging and purging through self-induced vomiting.

Bulimia nervosa is a type of eating disorder that is characterized by recurrent episodes of binge eating followed by compensatory behavior in order to prevent weight gain. This behavior is largely driven by a person's perception of their body shape, size, and weight, which greatly influences their emotional well-being and sense of self-worth.

Binge eating episodes are characterized by:

• Eating a much larger amount of food than most people would eat in a similar period of time within any 2-hour period
• Feeling that they can't stop eating or control what or how much they're eating

Inappropriate compensatory behaviors to prevent weight gain may include:

• Self-induced vomiting
• Inappropriate use of laxatives, diuretics, or other medications
• Fasting
• Excessive exercise

These episodes occur on average two times per week for three months. They are further characterized as mild, moderate, or severe based on the number of compensatory behaviors each week.

Bulimia nervosa can have serious and harmful effects on the body's systems including:

• Irregular heartbeats, possible heart failure, seizures, and muscle cramps
• Slowed digestion, pain, and bloating
• Weak and damaged intestines that are unable to properly digest and expel waste from the body
• Ruptured stomach or esophagus
• Inflammation in the pancreas
• Inability to focus, irritability, difficulty sleeping, fainting, or dizziness
• Sleep apnea, a disorder when a person stops breathing regularly when sleeping
• Lowered hormone production, which can cause menstruation to stop or cause bones to become weak and brittle
• Reduced metabolism
• Hypothermia
• Kidney failure
• Malnutrition

While many of the body's internal processes are disrupted by bulimia nervosa, one of the more prominent visible symptoms is its impact on oral hygiene.

This repeated process of self-induced vomiting causes dental problems include tooth erosion, tooth sensitivity and pain, xerostomia (dry mouth), and increased risk of cavities and gum disease.

One study reported that patients who self-induce vomiting were 5.5 times more likely to experience dental erosion compared with healthy individuals without bulimia nervosa. That's because vomiting after a binge also brings large amounts of stomach acid into the mouth. The acid can break down and wear away tooth enamel, the hard outer layer of teeth that protects from decay, sensitivity, and fractures.

Additionally, acid washing over the gums can also cause a variety of problems. One study showed that 69% of patients with bulimia experienced gum sensitivity, 39% experienced gum recession, and 20% reported ulcers or lesions in the mouth. The gums can be further inflamed and damaged by vigorous brushing.

While vomiting brings stomach acid into the mouth which damages the teeth, saliva has a protective factor. Saliva helps to wash away, dilute, and neutralize the acid, which protects the teeth from acidic damage.

Unfortunately, a common side effect of frequent vomiting is the enlargement of salivary glands which reduces the amount of saliva that is made.

Additionally, many people with bulimia also suffer from dehydration, either from fluid restriction, excessive exercise, or medications. Dehydration further reduces saliva production and contributes to both erosion and xerostomia (dry mouth).

During binge periods, many people with bulimia nervosa choose high-energy, sugary foods that are normally restricted. Those who consumer more sugary foods often show more dental erosion. A study showed that on average, people with bulimia consumed 21% more carbohydrates than average, which contribute to the development of cavities.

Self-induced vomiting, the most common purging behavior for individuals with bulimia nervosa, can cause serious dental problems.

Signs of bulimia teeth can start within 6 months of binging and purging behavior, which is why dental professionals are often the first to catch the signs. Some of the telltale signs of bulimia teeth include:

• Enamel erosion: As enamel is eroded, teeth may become more transparent or see-through. Enamel erosion will be noticed most prominently on the upper teeth facing the tongue.
• Changes to the appearance of teeth: If teeth become severely eroded, teeth can become more easily broken or cracked which can result in jagged-looking teeth.
• Tooth discoloration: Once enamel is eroded away, dentin becomes exposed. Dentin is the surface of the teeth below the enamel and has a dark yellow/orange/brown color.
• Teeth and gum sensitivity: Teeth may become overly sensitive to hot, cold, or sweet foods and drinks. The gums may also become irritated, painful, and bleed.
• Dry mouth and lips: Reduced saliva production and general dehydration are common and may cause the mouth to feel dry and lips to become itchy and crack at the edges.
• Swollen or puffy jaw: Swelling or puffiness may be visible around the mouth near the ears. This is due to the swelling of the salivary glands.
  

If you are experiencing symptoms of dental problems related to bulimia nervosa, it is important to seek information about oral health care. It is very common to feel shame, embarrassment, awkwardness, or fear, but seeking help as soon as possible from qualified oral health professionals can help to minimize and/or repair oral damage.

In addition to oral health professionals, a multidisciplinary team is required to help treat bulimia nervosa. Treatment may include psychotherapists, nutrition counselors, and medications to aid in recovery from bulimia nervosa. Early intervention can help improve prognosis for people with bulimia nervosa.

Many people with bulimia nervosa want to keep their illness hidden because of the shame and guilt associated with the disease. If you suspect that someone may have bulimia nervosa, it is important to approach the conversation gently and in a way that builds trust. Use a non-confrontational approach, ask questions without judgment or assumptions, and express compassion. When it is appropriate, refer them to an eating disorder specialist.

Dentists are able to treat any present conditions, such as filling cavities, repairing broken teeth, caring for gums, and providing any appropriate prescriptions such as special mouthwashes for dry mouth or enamel strengthening toothpaste. If there has already been significant damage to the oral cavity, dentists can help provide a treatment plan to help repair teeth and gums.

A survey showed that while many patients with bulimia teeth acknowledged dental problems, less than a third of discussed these issues with a dentist. However, your dentist may be the first healthcare providers to see the signs of self-induced vomiting and provide oral hygiene instructions to minimize further damage.

Dental care can be expensive, especially if there is extensive damage that must be repaired. If you're afraid to see dentist because of the cost, you may be able to find free or low-cost options.

The US Department of Health and Human Services recommends a variety of resources, including:

• Local health departments
• Medical insurance programs such as Medicare, Medicaid, and CHIP
• Dental schools
• Clinical trials
• State and local resources
• United Way

During recovery, it is difficult to immediately cease binging and purging behavior. That being said, there are some steps that you can take at home to help reduce the damage to your teeth and oral health. These include:

• Avoid tooth brushing after vomiting
• Rinse the mouth with water or fluoride solution after binging
• Regularly brush teeth with fluoride toothpaste (outside of vomiting episodes)
• Floss teeth daily
• Have regular dentist visits for regular dental care
• Drink more water regularly
• Avoid consuming sugary drinks and foods
• Chewing sugar-free gum
  

Bulimia teeth is a serious and irreversible condition that is progressive without intervention. Getting help for bulimia teeth can feel terrifying, but putting off treatment can have serious implications. Working with a dental health provider that you trust can help support you to minimize oral and dental damage during recovery and prevent long term damage.

Frequently Asked Questions

• Can dentists tell if you've been binging and purging?

  Dental practitioners who have been trained can pick up on early warning signs of binging and purging. However, more education for dental practitioners are needed. One study found that less than half of dentists and dental hygienists consistently assess patients for the oral implications of eating disorders and less than half of patients suspected of having eating disorders were provided with relevant dental care instructions.

• When do the effects of bulimia start to damage the teeth?

  Signs of bulimia teeth including increased cavities, sensitivity to hot and cold foods and drinks, dry mouth, enamel erosion, and swelling of the salivary glands can develop within six months of the onset of bulimia nervosa.

• Are bulimia teeth preventable?

  Drinking water before vomiting may offer some protection but the negative effects of frequent vomiting on dental and oral health are generally not preventable. The only way to prevent further damage is to stop binging and purging behavior.