Bulimia Nervosa and Its Effects on Oral Health

People who are preoccupied with the shape of their body usually judge themselves for their self-perceived flaws. They mentally engrave the thought of being overweight. Bulimia Nervosa is a serious mental illness. It is potentially a life-threatening eating disorder.

People who have bulimia, tend to lose control over eating and then purge to get rid of the calories in an unhealthy way. Self-induced vomiting, misuse of laxatives, enemas and weight loss supplements are the methods used to cut down the calories during bulimia.


Such unhealthy ways severely affect oral health. Malnourishment, poor healing and increased risk of periodontal disease are some of the common health effects of bulimia. Surveys have shown that around 1-4% of young women and 0.1-0.5% men in the United States of America, have bulimia.

Bulimia Nervosa is the most common type of eating disorder which requires intensive treatment. In this article, we will read about bulimia, its effects on oral health and the importance of a dentist in treating the effects of bulimia.

What is Bulimia Nervosa?

Bulimia Nervosa, also called Bulimia, is a serious eating disorder. It is typically characterized by loss of control over eating habits followed by purging to get rid of the calories. (1)

Loss of control over eating refers to binge eating a large amount of food in a short period. A person with bulimia typically consumes around 2000 – 3000 calories in one sitting.

Purging usually refers to attempts to get rid of the food consumed. Purging may include a combination of vomiting, use of laxatives or enema, weight loss supplements and fasting for several days.

What causes Bulimia?

Though multiple factors may contribute to the development of this eating disorder, the exact cause of bulimia is still unknown. Some of the common reasons include –

  • Stress
  • Change in lifestyle
  • History of trauma or abuse
  • Mental illness
  • Negative body image
  • Poor self-esteem

What are the types of Bulimia?

Bulimia is divided into two categories depending on the methods of purging used by an individual.

  • Purging type – Majority of the bulimia cases come under this category. The method of purging involves self-induced vomiting or misuse of laxatives and enema.
  • Non-purging type – In this type, the purging methods are different from vomiting. Prolonged fasting and excessive exercising are some of the methods used by a bulimic person.

Common signs and symptoms

The severity of bulimia and its symptoms depends on the mental status and the number of times a person purges in a week. Some of the typical signs may include –

  • Fear of weight gain
  • Repeated episodes of binge eating (2)
  • Self-induced vomiting
  • Abuse of laxatives, diuretics, and enema
  • Compulsive exercise
  • Prolonged fasting
  • Use of dietary supplements for weight loss

The cumulative effect of bulimic signs can severely affect the health of an individual. Some of the common symptoms may include –

  • Severe dehydration
  • Nutritional deficiencies
  • Change in body weight
  • Acid reflux
  • Irregular menstruation
  • Arrhythmia or heart failure in extreme cases

How does bulimia affect oral health?

Frequent episodes of self-induced vomiting cause four significant effects – (3)

Acid reflux and vomiting also erode the layer of enamel, especially, on the palatal surface of upper incisors. Such incidents increase the risk of dental caries and tooth sensitivity. (4)

Severe tooth erosions can change the bite of the patient. It typically takes around three months to notice such changes in the mouth.

One of the main effects of bulimia is malnourishment. The nutritional deficiencies caused by bulimia can have a severe impact on the healing of oral wounds. It also affects the periodontal health of an individual.

Treatment of bulimia may take a long time. However, a person recovering from bulimia can minimize the damage done to the oral tissues by following specific preventive measures –

  • Rinse your mouth with a mouthwash that contains 0.5% fluoride. Rinsing the mouth with a mixture of baking soda and water is equally effective.
  • Do not brush teeth immediately after an episode of vomiting
  • Use a fluoridated toothpaste to strengthen the weaken enamel
  • Drink plenty of water to stay hydrated
  • Salivary supplements, fluoride supplements can help to maintain good oral health

How can a dentist help?

Dental procedures are an essential part of bulimia treatment. A dentist works in coordination with the health care team to treat the oral effects of this eating disorder. (5)

A dentist may provide a protective dental appliance to cover severe tooth damage in patients who are undergoing treatment for bulimia. These dental appliances also prevent the teeth from the effects of acid reflux.

Acid erosion of enamel is treated with professional fluoride gel applications. Regular dental visits help to detect any tooth decay or infections that may need immediate attention.

Once the bulimia is under control, the damaged teeth can be restored with the help of composite or amalgam. A dental bridge or implant can replace severely damaged teeth or lost teeth.

A study done by Harvard School of Medicine reveals that about one in every four patients recover without treatment while more than half of them get better with proper counseling and health care treatment. (6)

Take away message

Negative body image and poor self-esteem can significantly affect the health of an individual. A bulimic person develops abnormal eating behavior and avoids social interactions.

Such effects create a stressful strain between the sufferer and his/her family and friends. At this time, it is essential to have an open conversation about the concerns.

Family support and encouragement can take the patient a long way in recovering from bulimia.


Although the exact cause of bulimia is unknown, the main contributors are rational thoughts and negative perspectives of a person towards the body shape and weight.

Early diagnosis of bulimia increases the chances of good outcomes.


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