Eating disorders (bulimia/anorexia)

Oral health effects

• Tooth erosion from vomiting (perimylolysis)

  Self-induced vomiting produces erosion of the palatal surfaces of upper anterior teeth, often with sensitivity.

  Mechanism: Repeated exposure to gastric acid.

  Clinical management: Sensitive, non-judgmental approach; fluoride, avoid brushing right after purging, refer for medical/psychological care.

• Swollen salivary glands and dry mouth (parotid enlargement / xerostomia)

  Parotid enlargement occurs in a minority of patients who purge. Dry mouth is common but is often caused by antidepressants or other medications rather than the eating disorder itself.

  Clinical management: Supportive care; caries prevention.

• Increased tooth decay (dental caries)

  People with eating disorders have more severe caries, linked to binge eating of sugary foods, reduced salivary flow and low salivary pH.

  Clinical management: Perform caries risk assessment; prescribe high-fluoride toothpaste and in-office fluoride varnish; give dietary counselling sensitively; coordinate with the medical/ED care team.

• Sensitive teeth (dentin hypersensitivity)

  Acid erosion exposes dentin, so tooth sensitivity to cold, sweet or touch is more common in people with eating disorders.

  Clinical management: Recommend desensitizing toothpaste and fluoride varnish; advise rinsing with water or a baking-soda solution after vomiting and waiting before brushing; use gentle instrumentation and consider topical anesthetic.