Bulimia’s Effects on the Mouth
Bulimia nervosa (BN) is an eating disorder marked by cycles of binging and purging.
Someone can have non-purging type BN, where they make up for binging behavior through excessive exercise or limited food intake. More often, people experience purging-type BN, where self-induced vomiting is the favored compensatory behavior.
While both types of BN can cause a number of dangerous health effects, it’s the latter form that’s more impactful on oral health.
Oral Health Impacts of Bulimia
Repeated exposure to stomach acid can have several negative effects on a person’s mouth, throat, teeth, and overall oral health. Some of the most common issues include: [1]
- Dental caries (tooth decay), or tooth erosion
- Decreased saliva secretion
- Decreased salivary pH
- Swollen salivary glands (sometimes called “bulimia cheeks”)
- Jaw pain or jaw misalignment
- Esophageal ulcers, tears, or rupture
- Trouble swallowing food or speaking
While some of these issues can correct themselves if a person is able to reduce or eliminate purging behavior, other issues may require surgery to completely correct. In the case of an esophageal tear or rupture, the condition can be deadly if not treated immediately.
It’s also important to remember that these aren’t the only oral health issues related to bulimia nervosa. They are just some of the more common conditions that have been linked to the disorder.
Signs of Damage to the Mouth From Bulimia
Bulimia nervosa has such a significant impact on oral health it’s not unusual for a person’s dentist to be the first one to notice signs of the disorder.
Some early warning signs that BN is negatively impacting someone’s oral health include:
- Sore or irritated throat
- Red gums or bleeding gums
- Tooth sensitivity
- Dry mouth
- Teeth that appear darker
- Weak teeth, which may easily break, chip, or crack
Often, a dentist will be able to paint a more complete picture of how bulimia may be affecting someone’s oral health, including in ways that may not be obvious while looking in the mirror.
Why Does This Damage Occur?
The biggest factor in oral health issues related to BN is stomach acid.
When self-induced vomiting is the compensatory behavior of choice, it frequently brings this corrosive substance into the throat and mouth. And the hydrochloric acid that makes up the bile can inflict serious damage, not just on the sensitive tissue of the esophagus and mouth, but on the hard surface of tooth enamel. [2]
Repeated exposure to hydrochloric acid can cause what is referred to as microtrauma in the throat. This can lead to a number of health complications, including a higher risk of developing esophageal cancer. [3]
Hydrochloric acid is also capable of dissolving the protective enamel on teeth, exposing the more vulnerable layers beneath. This damage can be aggravated if a person brushes their teeth immediately after vomiting, as this can wipe away enamel while it’s softest.
In addition, inducing vomit with the fingers or another object can inflict its own damage, including leaving a person with oral lacerations or bruises.
How to Restore Oral Health
There are several options for someone struggling with bulimia nervosa to treat their oral health.
A dentist can help replace teeth that may have been lost or loosened and employ other techniques to bring oral health back up to speed. Depending on the severity of the damage done, surgical procedures may be needed to correct some issues.
Still, the best way to stop or reverse the impact of bulimia nervosa on oral health is to reduce or eliminate purging behavior.
Options for Treating Bulimia Nervosa
Bulimia nervosa is primarily treated with psychosocial interventions, although other forms of counseling, including nutritional counseling, can also be effective at restoring mental and physical health.
Some types of medication are also sometimes used as a supplemental treatment.
Preferred treatment options for bulimia nervosa depend entirely on an individual patient’s condition, history, and specific needs.
Mental Health Treatments for Bulimia Nervosa
One of the most effective and widely-accepted treatments for bulimia nervosa is cognitive behavioral therapy (CBT).
A type of talk therapy, CBT is based on the idea that unhelpful behaviors are caused by unhelpful thoughts. As such, the program focuses on restructuring the way someone thinks about different aspects of their life in an attempt to break unhealthy cycles and make a positive impact on their behaviors.
Dialectical behavior therapy (DBT) is another popular psychosocial treatment for BN. An offshoot of cognitive behavioral therapy, DBT also works to change someone’s unhelpful thinking patterns but simultaneously attempts to help them find greater acceptance of the world as it is and let go of any fears or anxieties that may be driving their behavior.
Physical Health Treatments for Bulimia Nervosa
To help someone address the physical impacts of bulimia nervosa, including its effects on oral health, nutritional counseling is often recommended.
These programs can help someone learn more about nutritional health and how a healthy and balanced diet can help restore their health and keep their body functioning properly.
Occasionally, certain medications are also prescribed to help someone with both mental and physical health aspects of their condition. Selective serotonin reuptake inhibitors (SSRIs), including Prozac, are commonly used to this end.
Generally, though, medications are not recommended as a primary treatment, with many practitioners preferring to use them as a supplemental treatment.
Finding Help for Bulimia Nervosa
Regardless of the course of treatment chosen, recovery from bulimia nervosa is often a long-term process.
Disordered behavioral and thought patterns can be deeply ingrained, and it can be difficult to reconfigure someone’s negative view of their body and self-worth. Recovery requires deep work on an individual level, and ongoing support from friends, family, or a care team is essential.
Still, the important thing to remember is that treatment is always available, and recovery is always possible.
If you’re experiencing signs of bulimia nervosa, you should seek treatment as soon as possible, to give yourself the greatest chance of stopping or reversing any damage to your oral, mental, or physical health.
Resources
- Bretz W. A. (2002). Oral profiles of bulimic women: Diagnosis and management. What is the evidence? The journal of evidence-based dental practice; 2(4):267–272.
- How Does the Stomach Work? (2016, August 21). Institute for Quality and Efficiency in Health Care. Accessed September 16, 2022.
- Brewster, D. H., Nowell, S. L., & Clark, D. N. (2015). Risk of oesophageal cancer among patients previously hospitalised with eating disorder. Cancer epidemiology; 39(3): 313–320.