Bulimia and Your Oral Health

Echo, Cultura, Getty Images

Bulimia Nervosa can cause serious medical problems.  It’s well-known that bulimia nervosa that includes self-induced vomiting may cause serious oral problems, but what exactly are the concerns?

Tooth erosion:  

Studies show that between 47 and 93% of bulimia patients who vomit exhibit damage to tooth enamel.  If you engage in self-induced vomiting, you should be aware that bringing acidic contents of your stomach into your mouth may cause erosion of the enamel surface of your teeth.

 This damage usually appears disproportionately on the inside and biting surfaces of the teeth, and the extent of the damage to the enamel can vary between patients.  Some factors believed to influence one’s susceptibility to tooth erosion include dietary and oral hygiene habits as well as how often the self-induced vomiting occurs.

Individuals who induce vomiting up to several times a day have a higher risk of developing dental erosion than those who seldom practice that behavior.  Tooth erosion may become apparent after only six months of self-induced vomiting.  Ironically, brushing one’s teeth after vomiting, which is a common behavior, can worsen the damage to the teeth due to the abrasion from the toothbrush.  Over time as the enamel is eroded by repeated exposure to gastric acid, teeth may lose their shine, turn yellow, chip, and look ragged. 

Tooth decay is much more than a cosmetic concern.

  Your teeth may feel more sensitive to heat and cold.  In extreme cases, the teeth may die and extensive and expensive dental work to repair the damage may be needed. 


Regardless of whether or not they engage in self-induced vomiting, many individuals with bulimia who binge consume high sugar foods, which can increase the risk for cavities.

  Those who vomit have an even higher risk for dental cavities due to the additional stomach acid.  Dentists have recognized a higher incidence of cavities in individuals with bulimia. 

Effect on Mouth and Salivary Glands:

Frequent vomiting can cause gum irritation and bleeding.  It can also cause enlargement of the salivary glands along the lower jawbone and in front of the ear, which can cause a “chipmunk cheek” look.  Purging may cause a reduction in saliva that can in turn lead to dry and/or cracked lips, dry mouth, and a burning sensation in the mouth, particularly on the tongue.

What to do:

Recovery is the best way to limit tooth damage and prevent medical consequences.  If you are suffering from untreated bulimia, seek help from a treatment professionalCognitive behavioral therapy can be an effective treatment for bulimia nervosaSelf-help versions of cognitive behavioral therapy may also be helpful for some.

According to the American Dental Association, if you engage in self-induced vomiting, you should not brush your teeth right afterward because it can cause further damage to the tooth enamel.

 Instead you can rinse your mouth out with baking soda to minimize the impact of the stomach acid.  Then wait several hours before brushing your teeth or consuming anything acidic.  You also may be able to minimize effects of the stomach acid by eating cheese or drinking milk. 

Although you may feel embarrassed, you should also see a dentist regularly for check-ups.  Try to be honest with them about your bulimia so they can help prevent more serious dental issues. 


Herrin, M. & Matsumoto, N. The Parent’s Guide to Eating Disorders

Romanos, G., Javed, F. Romanos, E., & Williams, R. (2012)  Oro-facial manifestations in patients with eating disorders.  Appetite, 59, 499-504. 

Hermont, A., Pordeus, I., Paiva, S., Nogueira, M., Abreu, G., & Auad, S. (2013).  Eating Disorder Risk Behavior and Dental Implications Among Adolescents.  International Journal of Eating Disorders, 46, 677-683. 

Uhlen, M., Bveit, A., Stenhage, K., & Mulic, A. (2014).  Self-induced vomiting and dental erosion – a clinical study.  BMC Oral Health

Mehler, P. & Rylander, M. (2015).  Bulimia Nervosa – medical complications.  Journal of Eating Disorders.  

Continue Reading