The following information was written by Dr. Minsk and published on various internet web-sites.
Bulimia nervosa and anorexia nervosa are two conditions that are prevalent primarily among older adolescents and young
adult women. Both are characterized by a distortion of body image and an over concern with body shape and/or weight.
Bulimia nervosa is characterized by recurrent episodes of binge eating, followed by self-induced vomiting, the use of
laxatives, diuretics, fasting or excessive exercise. The vomiting results in prolonged acid exposure to the teeth. The
protective enamel covering of the teeth literally dissolves away, leaving the dentin of the teeth exposed. The dentin is a
much more porous material that when exposed can result in extreme sensitivity to changes in temperature. These changes
are most apparent on the inside of the upper teeth which are most affected by the acid from repeated vomiting.
Repeated vomiting can also result in enlargement of the salivary glands, especially the parotid glands on the side of the
cheeks. Not only can this reduce the flow of saliva and create a dry mouth, but also this enlargement may give a
‘chipmunk’ appearance to the bulimia sufferer.
Anorexia nervosa patients have an intense fear of becoming fat and a distorted body image. Although not all do, anorexia
patients that vomit repeatedly after eating may suffer from the same oral changes as bulimia nervosa patients. If anorexia
patients have poor oral hygiene, and more plaque accumulation, they may also have increased rates of cavities and
Other changes common to both conditions relate to poor nutrition and general systemic dehydration. In the mouth, the
color and texture of the gums may change, becoming pale pink and weak. Also, the corner of the mouths can become
severely chapped in a condition called angular chelitis. Low water intake can also lead to dry mouth with a reduction in
the saliva’s ability to neutralize the plaque that can cause cavities and periodontal disease.
Bulimia and anorexia nervosa are complex problems that need to be treated in conjunction with a physician and a mental
health provider. A dental care provider should treat the oral problems associated with these conditions. Frequent
professional cleanings are very helpful to aid in the prevention of cavities and periodontal disease. Topical fluoride
treatment can be beneficial in preventing acid erosion and reducing dentin sensitivity. It is important to rinse with water
after vomiting and to follow this with a fluoride rinse to neutralize the acid and protect the tooth surfaces. Brushing
immediately after regurgitation and before rinsing with water and fluoride may actually accelerate the tooth erosion. If the
teeth are severely eroded, they may require restorations to improve function and cosmetics. Simple restorations may
involve bonding of the teeth, but more advanced tooth erosion may require porcelain laminates or even full mouth
capping. Daily home application of a fluoride gel may also be indicated, and people that have dry mouth may benefit from
SWARTHMORE DENTAL ASSOCIATES
Nikolaos D. Karellos, D.M.D. | prosthodontist
Laura Minsk, D.M.D. | periodontist
Nikolaos D. Karellos, D.M.D.
Laura Minsk, D.M.D.
801 Yale Ave.
Swarthmore, PA 19081