Bulimia nervosa or bulimia is a psychological eating disorder that can cause serious medical and dental problems.
A person with bulimia will frequently and repeatedly binge (eat very large quantities of food in a short period of time) and then purge by inducing vomiting, using laxatives or diuretics, fasting, or engaging in vigorous exercise to counteract the binging. Episodes of binging may bring on a feeling of happiness in response to depression or stress. The happiness soon gives way to self-loathing which triggers the need for purging.
Bulimia is much more common among females than males, and is usually brought on by dissatisfaction with one's body image. An estimated 5% of college-age women are thought to be suffering from bulimia.
Some of the medical complications from bulimia results from acid-containing vomit that causes ulcers or ruptures in the esophagus. Abuse of diuretics and laxatives can cause dependence on them for normal elimination, as well as fluid or electrolyte imbalances that can be life threatening. Bulimia during pregnancy can have serious consequences for the unborn child.
The dental complications from bulimia are from the acid containing vomit during purging. The stomach acid causes the outer surface of the tooth to erode. This is most commonly observed on the enamel of the inside of the front teeth. The damage to the protective enamel makes the teeth highly susceptible to tooth decay, and more serious infections of the nerves within the teeth. The saliva-producing glands in the mouth can also become swollen due to frequent vomiting. This is most commonly seen in the parotid salivary glands that are inside the cheeks.
The dental effects of bulimia can be quite devastating. I have treated many young women and some men with this disorder. After all of the damaged teeth are repaired, I prescribe highly concentrated fluoride gels for the patient to brush with. The patient needs to keep his or her mouth as clean as possible by brushing teeth and flossing several times a day. I like to see these patients every three to six months to monitor the condition of their mouths. If there is no significant improvement, I will make soft custom trays that cover the teeth. The trays are filled with fluoride and worn while the patient sleeps.
An important step toward curing bulimia is the patient acknowledging the problem. I recommend the patient talk to his or her family doctor about the disorder. In some cases, a psychiatrist or psychologist may be needed. Nutritional education and behavior management can help the patient find healthier alternatives to weight management. Others may find group counseling or support groups to aid in the recovery process. Ultimately, the patient needs to have the disorder under control or cured to prevent a lifetime of dental and medical problems.
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