Here's How Purging with Bulimia Impacts Your Teeth and Mouth

What is bulimia?

Bulimia nervosa (referred to here as bulimia) is a common eating disorder that can cause a number of serious health complications. Here, I discuss changes to the teeth and mouth that can come from self-induced vomiting, also known as purging.

As a physician who specializes in treating individuals with eating disorders, I want to first offer my support to anyone reading this who has an eating disorder or has a loved one with an eating disorder. Eating disorders are complex and can be difficult to overcome, but recovery is possible and most medical complications from eating disorders are fully reversible with treatment.

View bulimia symptoms here.

What does bulimia do to your teeth?

Self-induced vomiting with bulimia can cause erosion of the enamel and dentin of the teeth, affecting nearly half of all people who purge this way ^[1].

• Enamel is the very hard outer layer of the tooth.
• Dentin is an inner layer of the tooth, between the enamel and pulp.

The parts of the teeth first affected by purging are the upper front teeth closest to the tongue (the lingual surfaces). This is a different location compared to damage to teeth related to binge eating or drinking highly acidic foods and liquids. The medical term for this erosion is perimylolysis, which can typically be seen six months after purging begins ^[2].

Signs of bulimia tooth damage

Erosion of the enamel and dentin caused by purging has a characteristic pattern. This makes it easy to spot during a dental exam. Because of this, it is common for the first diagnosis of bulimia to come from a dental professional.

Following are the signs of tooth damage caused by bulimia.

• Dental erosion may initially make the teeth look smooth and glossy.
• Later, the erosion may cause teeth to appear shorter in length.
• Enamel surfaces will appear dull with irregular edges.
• Teeth may become very sensitive to hot and cold temperatures.
• Fillings/amalgams may appear raised above the teeth.
• An increase in cavities may occur ^[3].

Does bulimia increase the risk for cavities?

The science is mixed as to whether purging with bulimia increases the risk of cavities ^[1]. Some research suggests that people with bulimia do not have a higher rate of cavities compared to the general population. Other studies suggest that the opposite is true, and that people with bulimia do have more cavities ^[3].

What is known is that someone with bulimia may engage in behaviors that can increase cavities. This includes bingeing on sweet, sugary, carbohydrate-rich foods or drinking highly acidic beverages ^[2,3]. Additionally, reduced salivary flow is seen in people who purge. Reduced salivary flow can increase the risk of cavities.

Other signs of bulimia related to the mouth and face

Self-induced vomiting can lead to many other serious health complications in the mouth, face and cheeks. These include:

• Swelling of the salivary glands (known as “puffy” or “chipmunk” cheeks )
• Reduced salivary flow rate
• Cavities
• Gum disease (gingivitis)
• Dry mouth
• Cracked, dry lips
• Lesions in the corners of the mouth (which can sometimes scar)
• Mouth sores
• Loss of the gag reflex
• Increased risk of jaw fracture due to bone density loss

Calluses on the back of the hands and knuckles may appear if the fingers are irritated by the teeth during purging episodes. This is known as Russell’s sign.

Bulimia can also cause other serious health problems throughout the body. Therefore, a full physical and dental examination is recommended for individuals who are showing signs of an eating disorder.

How to reduce tooth damage caused by purging

A primary goal of bulimia treatment is to stop episodes of purging, including self-induced vomiting. If patients are still actively purging, they can discuss any concerns about tooth damage with their treatment providers. It is very important that they follow up regularly with their dentist.

Bulimia treatment options

Most medical complications from eating disorders are fully reversible with full treatment of the eating disorder. However, dental erosion related to chronic regurgitation with self-induced vomiting is permanent. Maintaining good dental health is vital. Only essential restorative dental work should be completed until the patient is no longer purging since acid erosion will shorten the life of the dental restorations.

Find recovery from bulimia

The best way to reduce tooth damage and other oral health effects related to bulimia is to stop purging. Treatment for purging is similar to treatment for other eating disorders. A three-pronged approach is recommended that includes:

• Medical management
• Evidence-based therapies for eating disorders
• Nutritional counseling and education

Every day, I work to help my patients overcome the challenges related to eating disorders. If you would like to learn more about how Eating Recovery Center can help you, please call us at 866-622-5914. Recovery is possible and we can help you find it.

Learn more about bulimia treatment options.

Read more on this topic:

• Bulimia Face Swelling: How to Resolve Puffy Cheeks
• Bulimia Warning Signs: Know What to Watch for
• Anorexia vs. Bulimia: What’s the Difference?
• Do I Have Bulimia? Take the Quiz

Sources

1. Mehler, P.S., & Andersen, A.E. (2022). Eating disorders: A comprehensive guide to medical care and complications (4th ed.). Johns Hopkins University Press.
2. Douglas, L. (2015). Caring for dental patients with eating disorders. BDJ Team 1, Article number 15009. https://doi.org/10.1038/bdjteam.2015.9.
3. Rosten, A., & Newton, T. (2017). The impact of bulimia nervosa on oral health: A review of the literature. British Dental Journal, 223, 533–539. https://doi.org/10.1038/sj.bdj.2017.837.