Bulimia Nervosa and Dental Damage: Mechanisms and Multidisciplinary Care

Recurrent vomiting in bulimia nervosa causes characteristic dental erosion and pathology.

Pathophysiology of Dental Injury

1. Acid Erosion: Gastric acid (pH 1.5–3.5) demineralizes enamel → perimolysis (smooth, glassy loss on lingual/palatal surfaces of maxillary anteriors).
2. Acid Reflux (GERD): Chronic reflux from sphincter incompetence adds to acid exposure.
3. Xerostomia: Dehydration + anticholinergic meds → ↓ saliva → loss of buffering, remineralization, antimicrobial protection.
4. Nutritional Deficiencies: Calcium, vitamin D, phosphate deficiency → impaired remineralization.
5. Cariogenic Binges: High-sugar intake during binges → plaque acid production → caries.

Clinical Signs

• Lingual enamel erosion (maximillary incisors, canines)
• Occlusal wear, dentin hypersensitivity
• Increased caries (cervical, interproximal)
• Parotid enlargement (sialadenosis)
• Mucosal trauma (Russell's sign on dorsum of hand)

Management

• Medical/Psychiatric: CBT-E, SSRIs, nutritional rehab — treat the eating disorder.
• Dental: Fluoride varnish/gel, remineralizing agents (CPP-ACP), bonding/composites for erosion, night guard if bruxism.
• Behavioral: Rinse with water/baking soda after vomiting (do NOT brush immediately — abrasion on softened enamel). High-fluoride toothpaste.

Early dental intervention combined with eating disorder treatment preserves dentition.