People with bulimia may try to compensate for eating large quantities of food by vomiting.
When you vomit, your stomach empties some of its contents out through your mouth. The stomach acid in vomit is very strong – with a pH in the range of 1.5-3.5. When stomach acid washes over your teeth it can damage your teeth.
When your teeth are exposed to acid, minerals are dissolved from the enamel and dentine in your teeth causing a type of chemical tooth wear called acid erosion.
Early stages of acid erosion
Acid erosion can wear away the enamel and dentine from your teeth. Initially acid erosion can make your teeth look very clean and shiny, as your enamel begins to wear away just a little.
Advanced stages of acid erosion
Over time, as the enamel layer wears very thin, your teeth start to look more yellow. This is due to the yellow coloured dentine under your enamel becoming more visible. When the dentine is no longer covered by any enamel it can feel very sensitive to cold, hot, sweet, and touch.
Severe acid erosion
As the dentine wears thinner the sensitivity may get worse. Eventually the dentine wears so thin that the living part of the tooth (the pulp), becomes inflamed. An inflamed pulp can feel sore, cause a severe toothache and even death of the tooth. When a tooth dies, sometimes a dental abscess can develop causing pain and swelling.
Acid erosion and other types of tooth wear
In addition to chemically dissolving the enamel and dentine from your teeth, the removal of minerals from your teeth causes your teeth to soften so they are more susceptible to mechanical tooth wear.
Acid erosion and toothbrushing
Brushing your teeth after vomiting can speed up mechanical tooth wear caused by your toothbrush called dental abrasion. The back and forth action of your toothbrush can rub one or more horizontal grooves into your teeth. This happens much faster if your teeth are softened by acid erosion before your brush.
Acid erosion and grinding
Grinding your teeth after vomiting can speed up tooth wear caused by your teeth rubbing together called dental attrition. Grinding your teeth can wear them down from the biting surfaces, and this happens much faster if your teeth are softened by acid erosion.
Dental Treatment for bulimia and acid erosion
The best treatment for dental acid erosion is to try and avoid washing your teeth with more acid.
If you haven’t already, you should book an appointment with your GP and ask for information about the best ways to treat or mange your eating disorder. Ultimately if you continue to vomit on a regular basis, the acid erosion will have an impact on your teeth and your ability to smile, talk and eat.
Unfortunately fluoride cannot reverse or fully prevent toothwear if you vomit on a regular basis, but it does strengthen enamel and dentine and so fluoride can help slow down tooth wear.
The best way to apply fluoride to your teeth is to brush your teeth for 2 minutes, twice daily, with a fluoride toothpaste containing at least 1450ppm of fluoride.
Avoid brushing after vomiting
Avoid brushing your teeth while they are softened by acid. Wait at least 20 minutes (ideally 45 minutes) after vomiting or eating/drinking something acidic before you brush your teeth. Instead, if you want to wash away the bad taste and help strengthen your teeth, you should rinse with a fluoride mouthwash.
The next best way to apply more fluoride, on top of brushing, is to rinse with a fluoride mouthwash separate times of day to brushing, ideally after eating and vomiting.
Avoid rinsing after brushing
You should spit out excess toothpaste after brushing but don’t rinse your mouth out to avoid rinsing away the fluoride from your toothpaste. Mouthwashes are instead best used at a different time of day to brushing – ideally after eating and vomiting.
Visit your dentist
Your dentist will be able to check your teeth for signs of toothwear caused by bulimia, vomiting and acid erosion and give you tailored advice for your situation. Your dentist may prescribe a special high fluoride toothpaste and fluoride mouthwash, may apply a fluoride varnish to your teeth, or suggest fillings, crowns or referral to specialist restorative dentist in a dental hospital.