The impact of bulimia nervosa on oral health: A review of the literature

Abstract

Eating disorders are a potentially life-threatening group of mental disorders, which affect a patient's relationship with food and their body. This manifests itself through chaotic and disordered eating habits. One such eating disorder is bulimia nervosa, which has a lifetime prevalence of 1%. While there is consensus that bulimic behaviour directly causes dental erosion due to vomiting and acidic food choices, there is less clear evidence for a direct link between bulimia nervosa and dental caries, although there does still appear to be an association. Reduced salivary flow rate is a common feature among bulimics, but this is often due to anti-depressant medication rather than dietary habits or vomiting, and the effects are largely limited to unstimulated whole salivary flow rate and don't affect stimulated whole salivary flow rate. Parotid enlargement is present in a number of cases but this tends to be a minority. Further research is required given the limitations of current studies, especially gender imbalances among the populations studied and a lack of clear focus on bulimia nervosa.

Dental aspects of purging bulimia

“…The aim of the research was designed after analysis of numerous scientific papers regarding bulimia and its oral manifestations, considering claims of significantly greater possibility of developing erosive and caries lesions in these patients, as well as eventual changes of lifestyle habits 6,12,13 . While fast modernization of society raises the prevalence of diseases such as bulimia, oral manifestations of ED are not sufficiently recorded and monitored by dentists in Southea- stern Europe, so dental protocols for prevention and treatment of bulimic patients are still missing.…”

“…Regarding dental aspects of bulimia, frequent purging and impact of gastric juice are the most dominant factors causing hard tissue loss due to high acidity (mean pH 2.9), which is below critical pH for enamel dissolution 5,6 . Dental erosion (DE) are early and most common oral finding among bulimics, usually encountered on the palatal surfaces of teeth as a consequence of intense and repeated gastric juice influence, without bacterial involvement or trauma [7][8][9] .…”

“…Unfortunately, the process is irreversible, so early diagnosis of bulimia is crucial for prevention of oral complications 13 . Accompanying characteristics of bulimia, such as lack of oral hygiene, rich carbohydrate nutrition during binge, xerostomia and dominance of aciduric microbes, could increase risk of caries development 5,6,11,12,14 . However, studies concerning relationship between caries and bulimia are equivocal, and require questioning of many factors that influence and modify carious process [12][13][14][15] .…”

Erosive tooth wear - why clinicians should be aware of this condition

“…17 Regarding exogenous causes, it has been stated a possible dose-response relationship between ETW and the consumption of acidic diets. 18,19 However, some people who consume dietary acids develop erosive lesions and some do not. 20 These individual variations could be addressed to saliva protecting effect and oral hygiene habits.…”

“…[27][28][29] Bulimic behaviour directly causes ETW due to compensatory methods, such as self-induced vomiting (SIV) practices 30 and acidic food choices. 19 According to a systematic review, several studies have identified significantly higher values of ETW among diagnosed patients suffering from eating disorders compared to control groups. 30 Due to dental implications, dentists may be capable of suspecting eating disorders and contributing to early referral for specific treatment.…”