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Bulimia and your teeth
One of the most common physical effects of bulimia, and often the first one anyone outside notices, shows up in the mouth. Repeated self-induced vomiting exposes the teeth to stomach acid, which slowly wears away enamel. The result is a recognizable pattern of erosion that a dentist can spot, and it is frequently how an eating disorder is first identified. The damage to enamel is permanent, but further harm is preventable, and bulimia itself is treatable.
This page explains what purging does to the teeth, what the damage looks like, and why the dental office matters. For the full condition, see bulimia: signs, symptoms, and treatment.
How purging damages teeth
When stomach contents are brought back up, the teeth are bathed in gastric acid. Over time that acid dissolves enamel, the hard outer layer of the tooth. The damage has a characteristic pattern: it concentrates on the tongue-side (lingual and palatal) surfaces of the upper front teeth, where the acid pools during vomiting.12 Dentists call this acid erosion perimylolysis.
It is common and it appears early. The American Dental Association reports erosion in over 90 percent of people with bulimia, and a clinical study of people with a history of self-induced vomiting found erosion in about 70 percent.13 Erosion can become visible as early as six months after regular purging begins.2
What it looks like
Erosion
Thinning, translucent, or chipped edges on the upper front teeth, and a smooth, worn look on their tongue-side surfaces.
Sensitivity and decay
Teeth that hurt with hot, cold, or sweet, and more cavities than usual as the protective enamel is lost.
Permanence
Many effects of an eating disorder reverse with recovery; enamel loss does not. The hard-tissue damage is permanent, though it can be restored by a dentist.
Dentists often notice first
Because the erosion pattern is so distinctive, dentists and dental hygienists are frequently the first health professionals to recognize an eating disorder, sometimes before anyone else.4 That puts the dental office in a useful position. Telling your dentist what is happening is not something to be ashamed of: it lets them protect your teeth, treat the damage, and point you toward care.
Getting help
Tooth erosion is a sign of bulimia, and bulimia is a treatable illness. Addressing the eating disorder is what stops the damage at its source; a dentist then restores the teeth. To understand the condition and the levels of care, see bulimia: signs, symptoms, and treatment; if you are supporting someone, how to help a loved one start treatment.
References
References
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American Dental Association: Dental Erosion. Describes the characteristic lingual-palatal erosion of the upper front teeth (perimylolysis) from vomiting and erosion prevalence over 90 percent in bulimia. ↩ ↩
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Mehler PS, Rylander M. Bulimia Nervosa: medical complications. Journal of Eating Disorders. 2015;3:12. Dental erosions typically occur on the lingual surfaces of the maxillary (upper) teeth and may be apparent as early as six months after regular self-induced vomiting begins. ↩ ↩
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Uhlen MM, Tveit AB, Stenhagen KR, Mulic A. Self-induced vomiting and dental erosion: a clinical study. BMC Oral Health. 2014;14:92. Erosion was found in about 70 percent of patients with a self-induced-vomiting history, concentrated on palatal/lingual surfaces; hard-tissue damage to teeth is not reversible. ↩
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University of Washington School of Dentistry, Adults with Eating Disorders: A Guide for Dental Professionals. Frames dental professionals as frequent early detectors of eating disorders. ↩
Common questions
How does bulimia damage your teeth?
Self-induced vomiting bathes the teeth in stomach acid, which dissolves enamel over time. The classic pattern is erosion on the tongue-side surfaces of the upper front teeth (called perimylolysis). It can also cause increased sensitivity and more cavities. Erosion has been reported in over 90 percent of people with bulimia.
Is the tooth damage from bulimia permanent?
The enamel loss is. Unlike many effects of an eating disorder, damage to the hard tissue of the teeth does not reverse on its own. Further erosion can be prevented once the purging stops, and a dentist can restore damaged teeth.
Can a dentist tell if someone is bulimic?
Often, yes. The erosion pattern on the upper front teeth is distinctive, and dentists are frequently the first health professionals to spot signs of an eating disorder. Telling your dentist what is going on lets them protect your teeth and connect you with care.
Will my teeth get better if I stop purging?
Stopping purging halts further erosion, which is the most important step. The enamel already lost will not grow back, but a dentist can treat sensitivity, repair cavities, and restore worn teeth, and your overall oral health improves once the acid exposure ends.
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