This study investigated oral pathologies associated with bulimia nervosa and examined the relationship between these pathologies and the bulimic's binge eating, vomiting, and postvomiting oral hygiene. Results revealed a greater prevalence of enamel erosion, dental caries, dentin hypersensitivity, parotid dysfunction, and xerostomia in the bulimic group when compared with a nonbulimic control group. Enamel erosion was related to the duration of vomiting behavior. After 6 months the majority of bulimics exhibited erosion, which increased in severity with time. Tap water rinsing appeared to enhance erosion and cannot be recommended as a postvomiting hygiene practice. Since oral pathology may be the only detectable sign of bulimia nervosa, the information provided by this study facilitates the identification of bulimic patients and provides guidelines for evaluation of oral pathology in bulimia nervosa.

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To study the possible role of plasma beta-endorphin in bulimia, we measured plasma beta-endorphin immunoreactivity in 34 female patients with normal-weight bulimia and 34 normal female controls matched for weight as percent of ideal. Plasma beta-endorphin immunoreactivity in bulimics (mean 59.6 pg/ml; SEM 5.6) was significantly lower (p less than 0.05) than in controls (mean 79.5 pg/ml; SEM 8.5). Within the bulimic group, plasma beta-endorphin immunoreactivity correlated inversely with severity of bulimic symptomatology as measured by the Eating Attitudes Test Bulimia Subscale (p less than 0.05). Endorphin level did not correlate with severity of depression or with percent ideal body weight. Abnormalities in opioid metabolism may be implicated in eating disorders and account for the addictive properties of these disorders.

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