Eating disorders can damage both physical and psychological health. At least two types—bulimia nervosa and anorexia nervosa—can also create problems for the teeth and gums.

For bulimics, dental problems often arise from the disorder’s characteristic “binge and purge” cycles, the consumption of large quantities of food followed by induced vomiting. This introduces stomach acid into the mouth that over repeated episodes can erode tooth enamel, specifically on the back and biting sides of the top front teeth (the tongue helps protect the bottom teeth from acid contact during vomiting).

In addition, bulimics may also have enlarged salivary glands, which can give a puffy appearance to the facial area under the ears. Areas within the mouth like the palate or throat can incur damage from the use of fingers or other objects used to induce vomiting, as well as soft tissue ulceration from contact with stomach acid.

Oral problems with anorexics are more related to a general neglect of grooming and hygiene characteristic of this eating disorder. A lack of oral hygiene can drastically increase the risk of both tooth decay or gum disease. The anorexic patient may also indulge in binge-purge behavior that increases the risk of erosion.

Because enamel doesn’t replace itself, it’s critical to address any growing problem as soon as possible to avoid tooth loss. This may often involve both long- and short-term approaches. For the long-term, it may be helpful to seek professional help in treating the disorder itself. The National Eating Disorders Association ( provides resource information if you suspect a family member may have an eating disorder.

You should also take steps in the short-term to protect tooth enamel. Patients should avoid immediately brushing after purging, which could slough off minute particles of enamel softened by acid. Instead, they should rinse with plain water or water with a little baking soda to help neutralize any remaining mouth acid. Along with daily brushing and flossing, patients may also benefit from a fluoride mouthrinse to help strengthen enamel.

An eating disorder can be a difficult situation for patients and families alike. But there are things you can do, including protecting a loved one’s teeth and gums from lasting harm.

If you would like more information on the effect of eating disorders on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”

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