How Bulimia Affects the Teeth: Signs, Dental Repair

Many people with bulimia nervosa experience changes to their teeth as a result of frequent self-induced vomiting. Self-induced vomiting is the most common purging method reported by 56%-86% of individuals with bulimia nervosa.

A common side effect of self-induced vomiting is called bulimia teeth. Bulimia teeth describes a variety of oral health problems including enamel erosion, tooth and gum sensitivity, cavities, and more.

This article discusses how bulimia can affect your dental health, as well as ways you can protect your teeth from damage.

Sings of Bulimia Teeth - Illustration by Jessica Olah — Verywell / Jessica Olah

Oral Effects of Bulimia

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.

Teeth and Gums

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.

Salivary Glands

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.

Cavities

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.

The Signs of Bulimia Teeth

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 six 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.

Accepting Help and Beginning Recovery

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.

Helping Someone 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.

Treating Bulimia Teeth

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 provider to see the signs of self-induced vomiting and provide oral hygiene instructions to minimize further damage.

Can Dentists Tell if You've Been Binging or 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.

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 U.S. 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

At-Home Treatment

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:

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
Chew sugar-free gum

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.

Summary

Bulimia teeth is a serious and irreversible condition that can develop within six months of the onset of bulimia nervosa. Dental problems associated with repeated vomiting include increased cavities, sensitivity to hot and cold foods and drinks, dry mouth, enamel erosion, and swelling of the salivary glands. Treatment of bulimia teeth involves 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.

7 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Rebecca Valdez, MS, RDN
Valdez is a registered dietitian nutritionist, health writer, and nutrition consultant. She received her MS degree in nutrition from Columbia University.

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