Many patients with bulimia and some patients with anorexia nervosa engage in self-induced vomiting. Recurrent emesis results in enamel erosion, especially the lingual surface of the maxillary incisors in a specific pattern termed perimolysis.
Enamel erosion may expose nerve endings, causing tooth sensitivity, and increase the risk of caries, tooth fracture, and gingivitis.
Enamel: Intensely hard calcareous substance that forms a thin layer partly covering the teeth; the hardest substance of the animal body; consists of minute prisms arranged at right angles to the surface and bound together by a cement substance.
Gingivitis: Inflammation of the gums.
Patients should rinse their mouth with water, water with baking soda or a fluoridated mouth-rinse to neutralize the gastric acid after all episodes of emesis. Counsel patients not to brush the teeth for 30-60 minutes after emesis to reduce risk of toothbrush abrasion.
All patients with recurrent emesis should be counseled to avoid acidic drinks such as soda and to use a soft toothbrush.
Patients with self-induced or recalcitrant emesis should be referred to a dentist for evaluation and treatment in addition to a comprehensive medical and psychological evaluation of the eating disorder.