Effect on teeth

If you have anorexia nervosa or bulimia nervosa you may experience some problems with your teeth. You may have symptoms such as sensitive teeth, that is, you might experience a sharp pain when you eat very hot, cold or sweet foods, or you may get toothache, or perhaps your teeth have started to change colour. Most of these problems are due to acid erosion of the surface of the teeth. This acid can come from two sources, acidic foods or drinks, and stomach acid as a result of vomiting.

Stomach acid washing over the teeth wears away the enamel layer of the tooth. This may lead to the pulp and nerve endings becoming exposed and the teeth may then have to be crowned or coated. Unfortunately much of the repair work undertaken to preserve the teeth of the person with an eating disorder will be ineffective unless they stop using self-induced vomiting as a method of weight control.

Drinking low calorie ‘fizzy’ drinks, ‘sports/energy’ drinks or fruit based drinks can also have similar effects because of the acid they contain. Constantly sipping these drinks can be particularly harmful to tooth enamel. Consider using a straw to direct the liquid past your teeth if you do consume a lot of fruit or ‘fizzy’ drinks.  A dry mouth (which may be due to the saliva glands becoming exhausted with overuse due to excessive vomiting) means that food acids and the acids produced by bacteria in the mouth are not being neutralised by the saliva in the usual way. This makes teeth more vulnerable to acid attack and caries (tooth decay). Some acid tablets such as chewable Vitamin C tablets can have a similar effect.

Care of Your Teeth

Scrubbing your teeth immediately after being sick is not advisable as this will damage the surface crystals on the enamel layer of the teeth. Dentists who specialise in problems related to enamel erosion, advise rinsing your mouth thoroughly with milk or water, (or even better water and sodium bicarbonate) after being sick, and then waiting several hours before drinking or eating anything acidic, such as fruit or fizzy drinks, or before brushing your teeth. This treatment enables the saliva to have a neutralising effect on the stomach acid which seeps into the surface enamel after vomiting. If you clean your teeth whilst they are in this sensitive state, the abrasive properties of toothpaste will etch the enamel still further, so that over the years the enamel is progressively worn away.

Using an inexpensive mouthwash containing fluoride is another alternative. If you do use a mouth wash then it needs to have a neutral or alkaline ph (The ph should be >7,) as acidic mouthwash will contribute to the erosion of the enamel. 

If you wish to brush your teeth after being sick, avoid using toothpaste, particularly ‘smokers’ toothpaste, just use a brush dipped in water.

Chewing sugar free chewing gum after meals can help to stimulate saliva production and counter some of the effects of a dry mouth.

Recent research has also shown that you can minimise the detrimental effects of acidity on dental enamel by eating cheese or drinking milk, but if eating these foods could cause a panic binge, then just settle for rinsing your mouth out with water.