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Bulimia nervosa is characterized by periods of normal eating followed by dieting or severe restrictions of food intake, often ending in binge-eating. Binge-eating episodes must occur at least twice a week for three months to be diagnosed as bulimia nervosa. Weight gain is controlled by self-induced vomiting, strict fasting, vigorous exercise, and abuse of laxatives or diuretics.
Repeated episodes of induced vomiting can lead to enamel erosion of all teeth due to the chronic exposure to acid in vomit. Bulimia nervosa, and its accompanying dry mouth from decreased salivary flow and parotid gland dysfunction, also can lead to a dramatic increase in cavities because of excessive carbohydrate intake during binge-eating.
Typically, patients who suffer from bulimia nervosa have small, purplish-red lesions on their palate due to contact with objects used to induce vomiting. Silver fillings often become raised due to erosion of the teeth, and braces and temporary restorations may not stay on the teeth because the acid will dissolve the temporary cement used to keep these materials in place. Teeth may be discolored or look dull from the acid.
Avoid brushing teeth after vomiting, and rinse with water instead. Use a basic rinse, such as baking soda and water; immediately after vomiting to neutralize the acid. Remove plaque by brushing and flossing properly. Chew sugarless gum to increase salivary flow or use artificial saliva. Use fluoride either in toothpastes, rinses or gels to reduce sensitivity of teeth and build resistance to decay from acid.