Bulimia is an eating disorder which can affect anybody but is most common amongst females, especially younger women. The condition seems to be primarily psychological in origin and associated with a person’s dissatisfaction with their own body image.
A person’s physical appearance can have a profound adverse effect on their self-confidence, if they think they look too different from other people in one way or another. Someone who is very short, very obese, or even has a face full of freckles may feel socially disadvantaged and even of less value as a person, although perhaps at a less than conscious level.
In the case of bulimia it seems that commonly a person tries to keep their weight down by severely restricting their food intake, but the person is unable to maintain a constant restriction on calorie intake and often resorts to binging on food and then tries to compensate or atone for that by making themselves vomit.
Apart from the social and psychological problems associated with this behavior it can have a devastating effect on the teeth, because the stomach contents which are brought up into the mouth are acidic and cause erosion of the teeth. Tooth enamel, (the outer covering layer of a tooth), is a crystalline form of calcium phosphate and this will soften and dissolve in acid, so that if a person vomits frequently there is likely to be gradual loss of tooth enamel involving many teeth.
If you do not have the problem yourself, but are worried about someone you know… The bulimic person may tend to be self-deprecatory, shy, lacking in self-confidence or even depressed. The signs of a bulimic tendency can be frequent bathroom visits, visible face flushing, and sometimes marks on the knuckles due to attempts to induce being sick.
The effects on the teeth
A persistent bulimic habit is likely to cause irreversible damage to the teeth from acid erosion, compounded eventually by actual physical breakdown of parts of teeth when they become overly weakened. The forces transmitted through teeth can be extraordinarily high when biting or chewing certain kinds of foods, and a tooth with a lot of its substance missing may give way under the strain. Inevitably this kind of damage can lead to expensive dental bills for restorative treatment; although there is little point in embarking on treatment until the bulimia is under control.
In addition to the mechanical problems caused by physical loss of tooth substance there are likely to be problems due to sensitivity of teeth as the enamel layer is thinned. The underlying more sensitive dentin of teeth is exposed where enamel has been lost and a person may find it difficult to eat ice-cream or drink cold beverages without feeling a sharp pain, and this can cause a lot of day-to-day misery. The actual amount of sensitivity experienced does, to a degree, depend on the rate of enamel loss. Where the rate of loss is slower, the pulp of the tooth may insulate itself from the outside. This can result in less pain. So do not assume that there is no underlying issue – just because you are not having symptoms of sensitivity.
It is often the back of the teeth facing the roof of the mouth which suffer the worst of the acid erosion but the generalised effect is also increased attrition, or wear, affecting many teeth to greater or lesser degree. The combination of erosion and attrition can gradually reduce the height of the teeth, and this can have a considerable ageing effect on a person’s appearance. The molars (back teeth) are primarily responsible for maintaining the height of the face and if they wear down substantially the face loses “vertical dimension” and becomes somewhat “crumpled” as in an old person.
Some bulimics tend to drink an excess of sodas to encourage vomiting and these drinks are themselves quite acidic, thus adding to the overall erosion of tooth substance and aggravating the dental problems.
Some may resort to brushing their teeth much more frequently than normal to try to get rid of the sour taste of vomit and often brush incorrectly and again this simply increases the amount of enamel loss. One should never brush immediately after vomiting, as you will be scrubbing away the weakened enamel. Wait 20-30 minutes before brushing. Rinse out your mouth with a mouthwash or water immediately after any vomiting.
When teeth are affected by erosion and attrition they are more susceptible to picking up stains from foods, drinks, and smoking since the exposed dentin layer is more porous than enamel. This brings further problems in that teeth may become discolored and unsightly.
Periodontal disease is also at increased risk of developing, due to the lack of nutrients a bulimic person will be absorbing.
Restorative dental treatment might include topical fluoride applications to strengthen remaining enamel and reduce sensitivity, followed by build-ups by bonding resin materials (composites) to correct the size and shape of teeth and gradually increase the overall vertical dimension towards what it should be.
Eventually more long-lasting restorations such as crowns can be provided, but it is essential that the bulimic habit be overcome in order for dental treatment to be successful.
Treatment can be difficult, prolonged and expensive depending on the amount of tooth substance loss.
Anyone suffering from bulimia needs to first recognise that they have a problem and seek professional help, perhaps in the first instance from their doctor or dentist. Sometimes a course of antidepressants can be sufficient to break the habit, but otherwise a referral to a specialist psychologist or eating disorder service may be necessary and involve a tailored program of cognitive behavioral therapy.
There is no need to feel ashamed or reticent about seeking treatment for bulimia – It is a recognized syndrome which can be successfully treated just like many other disorders which we humans may suffer from at one time or another.
Apart from seeking professional help, which is the most important first step, this website may be of some help - www.nationaleatingdisorders.org.
Read more on erosion, the main dental issue with eating disorders, by clicking here.