How Does Bulimia Affect Your Teeth?
Here’s an article I wrote for the Emily Program, a US organisation that supports people with eating disorders change their life.
With over 19 years experience, Dr. Kumar Kolar is a dentist in London, England. He is focused on empowering readers to learn about their dental health and have confidence in their teeth and smile.
Like all eating disorders, bulimia nervosa is a mental health disorder that also affects the well-being of our physical bodies. One of the first places that exhibits physical signs of damage is the mouth and teeth. People with bulimia may experience pain, discomfort, and sensitivity when chewing as a result of bulimic behaviors.
What is Bulimia?
Bulimia is characterized by bingeing, or eating unusually large amounts of food in a single episode, and purging. Feelings of shame and disgust often accompany these binge eating episodes, leading to compensatory behaviors such as self-induced vomiting, laxative abuse, over-exercising, and/or restricting food.
Interestingly, the damage to dental health is not primarily caused by bingeing. Though acid from food can destroy teeth and create cavities, saliva provides a natural defense to this acid. Saliva washes away, dilutes and neutralizes the acid, and thus protects the teeth from harm. Therefore, most of the dental complications of bulimia are not caused by bingeing but rather purging behaviors.
Why is Purging Harmful to Teeth?
Self-induced vomiting
The stomach is packed with some of the most potent acids in the body. When vomiting, these acids enter the mouth and erode the enamel as well as the layer directly beneath the enamel, called dentin. This progressive damage thins these outer layers of teeth, making them brittle, weak, and sensitive.
Laxative and diuretic abuse
Laxatives and diuretics remove water from the body, which can lead to dehydration. With dehydration comes reduced saliva and swollen salivary glands. Less saliva weakens the defense to bacteria and acids in the mouth.
Excessive exercise and restriction
Excessive exercise and restriction—especially when fluids are restricted—also contribute to dehydration. Sugary sports drinks can cause further damage without the natural protection of saliva. Dehydration can also lead to cracking in the corners of the lips, as well as fungal and bacterial infections.
Dental Signs and Symptoms of Bulimia
Some common signs of dental complications related to bulimia include:
- Teeth erosion: As teeth erode, they become transparent and see-through. There may be an irregular, jagged edge to the tips of the teeth. This damage can happen slowly over time.
- Sensitivity: As the protective outer layer of the tooth is lost, the nerve is closer to the surface, which increases sensitivity to cold, hot, and sweet substances.
- Changes in the shape and length of teeth: Thinner teeth are prone to breaking, which causes them to become shorter. Less of the teeth may be visible when smiling or talking.
- Darker teeth: As enamel is lost, the darker second layer of teeth, dentin, is exposed. This appears as a yellow/orange/brown color.
- Dry mouth: The tongue will have a shiny appearance, and lines running along the tongue will become more prominent. Food will stick in between teeth more frequently. Lips will become dry and crack easily.
- Swollen salivary glands (sialadenitis): Saliva glands may become inflamed and have a puffy appearance. This is especially prominent around the corner of the jaw, near the ear.
- Altered taste sensation
- Cracks at corners of the mouth (angular cheilitis): The corners of the mouth become red and crack. They may have a crusty appearance and be itchy and painful.
The Role of Your Dentist
It can be daunting to visit a dentist, but dentists are there to support you and keep your teeth healthy. Most dentists have been trained to recognize the signs of eating disorders in their patients, and they will understand the impact of these disorders on your teeth.
Your dentist will be able to record the condition of your teeth, which will serve as a baseline for reference at future appointments. The baseline records may include x-rays, photographs, and intraoral scans.
Next, dentists will be able to give you personalized preventative advice and work with you to make sure it works. If you are suffering with pain or the appearance of your teeth, they can help with this as well.
It’s important to find a dentist you have a connection with so that you have confidence in the service they are providing. If you don’t have a good experience the first time, don’t give up on dentists; look for another one.
Eating disorders can cause serious long-term damage not only to your teeth, but to your overall physical, mental, and emotional health. But these disorders don’t have to be permanent. Recovery is possible. If you or a loved one are struggling, reach out to The Emily Program at 1-866-479-9990.
References
- Scully, C., Diz, D.P., & Kumar, N. (2007). Special Care in Dentistry E-Book: Handbook of Oral Healthcare, Elsevier Health Sciences, London. Available from: ProQuest Ebook Central. [29 May 2020].
- Kumar Kolar. (2020). See Through Teeth. Available: https://kumarkolar.com/see-through-teeth/. Last accessed 29/5/2020.
- University of Washington. (2011). Adults With Eating Disorders. Available: http://dental.washington.edu/wp-content/media/sp_need_pdfs/Eating-Adult.pdf. Last accessed 28/5/2020
- Strumia, R. (2013). Eating disorders and the skin. Clinics in Dermatology, 31(1), 80–85.
- Milosevic, A. (1999). Eating disorders and the dentist. British Dental Journal, 86(3):109–13.
- Little, J.W. (2002) Eating disorders: dental implications. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, 93(2): 138–143.