Ask the Expert: Can Damage to My Daughter's Teeth from Bulimia be Corrected?

Bulimia is an eating disorder that often involves vomiting, which can cause damage to the patient’s teeth over time. The American College of Prosthodontists and Kenneth S. Kurtz, D.D.S., FACP, a board-certified prosthodontist, offer dental advice for those who have or know someone who has bulimia, including how to evaluate the extent of the damage and whether it can be corrected.

How can I evaluate the damage?

While the effects of anorexia become noticeable to others, the visible effects of bulimia are subtler. A tooth is like a chocolate-coated candy: a hard shell (enamel) on the outside yet soft on the inside (dentin). At first, teeth may not look damaged from the front for many bulimics. The patient may not notice it when they look in the mirror.

Prosthodontists see a different story when performing a dental exam. Prosthodontists are specialized dentists with advanced training in oral health issues such as restoring tooth enamel eroded in the prolonged acidic environment of a bulimic's mouth. “During the dental exam, I see severe wear behind the teeth due to acid erosion,” says Kenneth S. Kurtz, D.D.S., FACP, and board-certified prosthodontist. “When patients come to us, their teeth can already be severely damaged.”

The teeth are like any other organ in the body—they can become severely damaged from destructive habits. “Like most complex medical problems, it depends on the age of onset of bulimia and if the incidence of purging can be categorized as mild, moderate, or severe in frequency,” Dr. Kurtz says. “With severe bulimia, if a patient is purging 20 times a day, in three to four years the teeth can readily chip.”

First, the edge of tooth chips, after the tooth becomes brittle from bulimic erosion. Next, as patients continue to purge their stomach content, the width of the tooth diminishes so that it can no longer resist fracture by harder food items. When an afflicted patient bites on a pretzel stick at 18 years old, the tooth resists fracture, but at 20 years old, biting the same kind of pretzel stick chips the tooth. After part of the tooth structure is lost, the patient becomes aware of the severity of the tooth damage.