How bulimia harms the teeth
The damage is caused mainly by stomach acid entering the mouth during vomiting. It is far more aggressive than the fruit acids in everyday food and acts for longer, because saliva neutralises it only slowly. The result is dental erosion: a gradual loss of tooth substance through repeated contact with acid.
About 70% of those affected have erosion, mainly on the backs of the teeth. First signs can appear after just six months; dentists are often the first to recognise bulimia from wear on the backs of the front teeth. It is important to seek professional help for the physical and psychological effects of the eating disorder. Other effects:
- Sensitivity to hot, cold, acidic and sweet food and drinks
- Rounded tooth contours and loss of the chewing-surface relief
- Thin, shortened, translucent edges of the front teeth
- Secondary deep bite
- Gum inflammation due to the falling pH, with pain and receding gums
- Exposed, painfully sensitive tooth necks
- Bad breath (halitosis) from stomach acid and food particles
Empathetic care
Dr Nina van Sprundel knows how hard it is for those affected to talk about their illness. Our whole team is aware how sensitive the subject is and makes sure you feel safe and understood throughout treatment. Dr van Sprundel is the author of numerous publications on bite elevation after erosion damage, including bite elevation through all-ceramic reconstruction, and combines professional expertise with empathetic care. We always plan enough time for consultation and treatment.
Stages and diagnosis
Normally, demineralisation and remineralisation of the enamel are in balance. When this balance is disturbed, erosion develops – at first without discomfort. Only when the dentine is exposed do pain and temperature sensitivity follow. An erosion index distinguishes:
With bulimia or reflux, the backs of the upper incisors are usually affected; with acid from outside, rather the front surfaces. For the diagnosis we examine surfaces, changes in shape and discoloration, and ask about diet and conditions such as reflux or eating disorders. Photos and impressions record the extent and allow us to monitor progress.
- Grade 0: no erosion, the enamel is shiny
- Grade 1: superficial enamel loss; the enamel looks matt and smooth, often unnoticed
- Grade 2: dentine exposed on less than half of the tooth surface
- Grade 3: dentine exposed on more than half of the tooth surface, often with a secondary deep bite
What speeds up enamel loss
Frequent acidic fruit such as oranges and apples, soft drinks, fruit juices, sports drinks and wine; acidic medication and vitamin C supplements; dry mouth, because neutralising saliva is missing; aggressive brushing with hard bristles, heavy pressure or abrasive toothpaste; grinding your teeth at night. With eating disorders or reflux, medical treatment is important.
Tooth care after vomiting
Stomach acid softens the enamel very quickly – so do not brush your teeth straight away. Wait about 30–60 minutes until saliva has neutralised the acid. Before that, a mouth rinse with sodium bicarbonate or a fluoride mouthwash helps neutralise it.
If you vomit frequently, use a soft brush with rounded bristles, brush with little pressure and without scrubbing sideways, use fluoride toothpaste and a fluoride gel once a week. The best protection is a custom-made medication carrier splint: it is put in before vomiting, ideally with a neutral fluoride gel, and can also be worn overnight to strengthen the enamel. Avoid acidic foods and have your teeth professionally cleaned and fluoridated regularly.
Treatment by stage
The first step is to remove the cause. Lost enamel does not grow back; depending on the degree of damage, we treat as follows:
A healthy mouth and physical well-being go together – take care of your teeth as well as the underlying psychological problems.
- Sealing: in early stages, a special varnish prevents further loss; it lasts about six to nine months
- Restoration: we fill uneven areas with composite; inlays, onlays or veneers can also protect and rebuild the teeth
- Reconstruction: if chewing is impaired, dental restorations, for example in ceramic, restore appearance and function
- Veneers: wafer-thin, durable ceramic shells, especially for the incisors, for a natural look
Bite elevation step by step
If the teeth are severely worn and the bite is disturbed, a bite elevation can restore it. Do not wait too long: teeth that are too short make it harder to attach crowns.
Often all front and back teeth of the upper jaw receive new crowns, and the lower jaw too if needed. All-ceramic restorations cannot be told apart from natural teeth and help you feel comfortable in your own skin again.
- Examination of teeth, jaws and jaw joints, including with a digital scanner; we choose the solution together
- Treatment simulation in the laboratory: a wax-up on study models shows the goal, a plastic mock-up in the mouth the possible result, including the facial profile
- A plastic temporary in the shape and colour of your future teeth, worn for a few weeks
- Adjustment of the temporary and digital production of the permanent ceramic restoration