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Bulimia, tooth wear, and the dentist's role

21 February 2014

Bulimia, tooth wear, and the dentist's role

Smile-on News looks at the impact bulimia can have on teeth and the role dentists have in minimising tooth wear.

Figures suggest that 1.6 million people in the UK are affected by an eating disorder, 40 per cent of whom are bulimic. With Eating Disorders Awareness Week (organised by charity Beat) just around the corner (24 February – 2 March 2014), dental teams are urged to look out for the signs of bulimia in patients and hopefully prevent tooth wear.

Bulimia often involves a cycle of eating a large amount of food and then making yourself sick. As well as causing sore throats, dehydration, and kidney and bowel problems, bulimia can cause extensive damage to teeth.

Repeated acid regurgitation, along with frequent consumption of carbonated soft drinks, sports drinks and alcohol, and teeth brushing immediately after vomiting to avoid bad breath, all lead to tooth erosion. Teeth can become and unattractive as well as rough or sensitive. Speaking or chewing can become a problem and come people will end up with a mouth full of fillings or having teeth removed.

Dentists are well positioned to be the first health professional to spot the signs of an eating disorder, and must act accordingly with effective communication and without judgement.

Sam received support from Beat and as a result has overcome her eating disorder. She suffered from anorexia and bulimia for 15 years and as a result has had tooth decay, intensive root canal treatment and numerous fillings, and has three missing teeth.

She says: “[Oral health] wasn’t high on my list of priorities, being thin was. When you have such a low opinion of yourself your teeth…is just one thing in a long list of things that you hate about yourself.”

Sam continues: “My dentist reacted with what I perceived to be disgust and a total lack of sympathy. She was very dismissive and offered very little support and advice…it made me feel really bad about myself and like I had no one to turn to. I saw the hygienist and broke down about my problems and told her how I feel about my teeth. She was very supportive and told me there are lots of things that can be done but I would need to be referred to a private clinic.”

Sam’s advice to dentists is: “Don’t be judgemental; eating disorders are not a lifestyle choice, they are serious illnesses. Educate yourself about eating disorders, the effects they can have on teeth and the signs to look out for.”

Signs of bulimia include increased levels of sensitivity and sharp or chipped front teeth. Acid erosion presents on the palatal and occlusal surfaces of the teeth, where acidic fluid pools in the mouth, and back teeth can become rounded and lose some of their surface characteristics, while front teeth may become translucent at the biting edges. If abrasion is also present, grooves may develop in the teeth near to where they meet the gums.

Anyone concerned that they are suffering an eating disorder is advised to seek help from a medical professional, as well as a dentist to help prevent future tooth wear. Simple steps to help protect the teeth include waiting at least an hour to brush teeth after vomiting, chewing sugar-fee gum after vomiting, and using a fluoridated mouthwash every day at a different time to tooth brushing.

The London Tooth Wear Centre® offers a comprehensive approach to managing tooth wear. Its Clinical Director, Professor Andrew Eder, says: “We understand the challenges faced by sufferers and are here to help, so don’t be worried about talking to your dentist.”

For more information regarding eating disorders and tooth wear, visit and

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