September 7, 2000
Dear Dr. Mady: I am a twenty-nine year old female who is suffering from an untreated case of bulimia. I do plan on getting help, but right now I need some advice. My front upper teeth seem to be crumbling and I want to know if this is related to my eating disorder and what can be done.- S.B.Dear S.B.- This eating disorder that you possess has many characteristics associated with it. The most common behaviors may include episodes of binge eating with lack of control, use of laxatives or diuretics, vigorous exercising, severe fasting or dieting, obsessive concern over body weight and appearance, and self induced vomiting.
This vomiting and regurgitation of stomach contents is what directly relates bulimia to dentistry and oral health. Frequent gastric regurgitation or vomiting causes what is known as dental erosion. This means that your teeth are deteriorating via stomach acid destruction during vomiting episodes.
During this process, tooth enamel and dentin (the next layer under the enamel) are destroyed by the action of acid on the teeth. This is a different process than the damage caused by acid from bacteria as in the case of tooth decay, but decay is still common in bulimics due to a high intake of carbohydrates.
Most of the decalcification related to vomiting occurs on the lingual or palatal side of the front teeth and occasionally on the occlusal or biting surfaces of posterior or back teeth. Unlike tooth decay, erosion affects the entire surface of the tooth.
Recurrent and frequent exposure to acid over a long period of time leads to progressive loss of enamel and the tooth will appear to shrink and begin crumbling from the biting edge. Eventually the yellow dentin layer is exposed and pain and tooth death can result. This situation is irreversible and will require extensive and expensive dentistry in order to restore function and cosmetics to your teeth.
Even at that point, your teeth will again deteriorate beyond the margins of the restorative work if your disorder goes untreated. I do recommend that you see your physician immediately to seek treatment, and until you do I suggest that you do not brush your teeth for at least a half an hour to an hour after vomiting.
The reason for this is because the acid exposure initiates instant softening of the enamel and the brushing will further damage the enamel and speed up the erosion. Calcium salts in your saliva will re-mineralize and harden some of the softened tooth structure over time.
Also try to avoid any acidic soft drinks or juices that can only add to the problem. Your physician will be able to advise you on the various drug and behavior therapies available and best suited for you. If you seek treatment now, you have an excellent chance of beating this disease.
After you begin treatment, consult with your dentist to discuss your dental restorative options.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5
