Bulimia nervosa and the damage that induced vomiting can cause to the teeth

March 15, Lilac Bow Day: spotlight on food disorders. The occasion is the right one to talk, for example, about bulimia nervosaan eating disorder, which affects more and more people of young age, above all.

Bulimia nervosa is a condition characterized by recurrent episodes of hyperphagia associated with the feeling of losing control when taking food, which determines later compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics or other medications, fasting, excessive exercise, or a combination of these (source: National Institute of Mental Health). The diagnosis of bulimia nervosa requires that excesses and compensatory behaviors both occur at least once a week for 3 months.

In Italy the average age of onset is between 15 and 19 years, with a tendency in recent years to an even earlier onset. The estimated incidence of bulimia nervosa is at least 12 new cases per 100,000 people in one year among women and about 0.8 new cases per 100,000 people in one year among men. The male/female ratio is 1:9but the number of male cases is growing, as revealed by the most recent estimates by the Ministry of Health.

It is an eating disorder with important psychological and physical repercussions, and in the latter case it is good to take stock of the damage to the detriment of the smile. The self-induced vomitingin fact, leads todental erosion and this over time causes dental sensitivity, loss of shape, size and volume of the teeth, which appear yellow precisely because they have lost part of their structure, up to chewing problems.

For this, the doctor Clotilde AustoniSmile Influencer and Dentist specialist in Odontostomatological Surgery, dedicated an entire chapter of his first book Let’s brush our ideas, published by Mondadori, to all those who are facing the battle against bulimia, providing valuable advice to limit or repair the functional and aesthetic damage caused by eating disorders.

Together with her we have deepened these topics related to oral health better.

In your book you have decided to dedicate a chapter to eating disorders: how can dentistry serve a cause like this?

« Defeat i eating disorders it is possible, but it takes teamwork. Often those who suffer from it hide within themselves very deep ailments and discomforts, sometimes associated with the need to keep every aspect under control of daily life and the destabilizing awareness of not being able to do it. Defeating bulimia is possible and the first step is right ask for help and rely on all the professionals you need (dietician, psychotherapist, endocrinologist, dentist…).

Bulimia nervosa also has a direct impact on oral health, yet there is little information about it. Precisely for this reason I have decided to dedicate a chapter to it: informing, raising awareness and making those who suffer from it and those close to you aware is the first step in fighting the disease. Many people suffer from bulimia nervosa without knowing the damage this causes to their smile and even without knowing that there are therapies for smiling, which is why I am very keen on “providing information”».

What happens to the teeth during episodes of self-induced vomiting?
“When vomiting is induced, gastric juices travel up from the stomach to the mouth. These are highly acidic and as such, having an erosive action, corrode the teeth. Normally saliva is able to counteract acidity, exerting a buffer effect, however if an acidic environment is frequently created in our mouth (as in the case of bulimia), saliva is no longer able to counteract this acidity and demineralization begins i.e. the loss of minerals.

As erosion progresses, the teeth wear out and they get thinner and thinner. A sign that can be noticed, observing the smile in front of the mirror, is precisely the margins of the front teeth that appear gray.

Over time, the dental sensitivity, a consequence of the fact that the teeth have worn down to expose the innervated part, or the dentin. The latter is yellow, which is why in the more advanced stages the smile loses its shine, appears yellowed and dull. If no action is taken, the teeth lose more and more dental substance, change shape and size, lose volume until occlusion problems are highlighted”.

Can oral health awareness help you become aware of your own body perception?
“Of course yes. Sometimes we forget that the mouth is part of our body and is connected to it. Just to give an example, if we have a malocclusion (an abnormal relationship between the dental arches) or if we suffer from bruxism (we grind or clench our teeth), this also affects the rest of the body, including posture. Worrying about your smile isn’t just a matter of aesthetics, first of all it’s about health. Having a healthy smile that looks good often translates into an even more beautiful smile and therefore a happy smile.
Today, thanks to scientific dissemination on social media, it is possible to reach a much wider pool of users and what I try to do every day from my Instagram page as Smile influencer is precisely this: making people aware of their own health and the importance of always seeking it, without giving up or settling for a smile they don’t like, because a smile is the mirror of our soul”.

Moving away from the topic of eating disorders, how important is prevention for dental health? How is prevention done in this field?
«Prevention is everything in life. I perform it daily in the studio with my patients, but that’s not enough. We need to reach as many people as possible. This is why I opened my Instagram profile, a tool at the service of everyone, which can quickly reach a potentially huge pool of users. Prevention in 2023 is also done on social media. Thanks to the dissemination that I carry out on Instagram, people become aware of problems and situations that concern them and that they did not know they had until then, they discover alarm bells that otherwise they would have ignored and perhaps understand how important it is to prevent rather than cure.

Prevention in my field means go to the dentist regularlyby submitting to one professional hygiene session and check-up every 6 months. This allows us to intercept any type of problem at an early stage and intervene in minimally invasive ways. Conversely, if you only go to the dentist when you have a toothache, as I always say, it’s already too late.

Prevention also means not ignoring signs and symptoms. Sometimes when these involve the mouth they are taken lightly. If the gums bleed for example, most people consider it normal or at best go to the pharmacy in search of a miraculous product (which does not exist) and rarely to the dentist who is the only one able to understand and solve the problem.

Let’s remember that prevention starts with the little ones: it’s essential to teach them that brushing their teeth is not a task they MUST do, but a pleasure to feel and feel good. Prevention also means taking your child to the dentist for first visit around 18 – 24 months: it is here that parents learn how to take care of their smile work, which bad habits to avoid, and it is always here that the foundations are laid for oral health and for a peaceful relationship with the dentist».

SOS gastric juices and acidity: tips to protect your teeth

«The advice to follow has been designed to accompany people who are facing the battle against bulimia, in the hope of making them feel better. I don’t have the ambition to solve the problem, but to give them support and strength to face a healing journey that can, at times, seem long and uphill», concludes Dr. Austoni.

After a bout of vomiting, rinse your mouth out with water and a teaspoon of baking soda

To rebalance the pH, bringing it back to neutral values ​​and counteracting the action of acidic gastric juices, it is useful to rinse the mouth with water and bicarbonate.

Always use only soft bristle toothbrushes

To avoid further damaging the teeth, already under constant acid attacks, it is advisable to avoid medium/hard bristle brushes and to choose a toothpaste which, in addition to fluoride, contains remineralizing and desensitizing molecules, in order to counteract the onset of the disease as much as possible. tooth sensitivity and protect the enamel.

Perform remineralizing treatments at the dentist

Your dentist will be able to advise you on a “shock” remineralizing and desensitizing protocol that includes chairside sessions and home treatments.

Use a remineralizing mousse at home

Apply a remineralizing mousse to your teeth for four or five minutes and then spit it out without rinsing. The procedure must be repeated two or three times a day for at least a month, also on the basis of specific protocols created ad hoc on the basis of the individual case.

From tooth reconstruction to dental veneers

If the teeth are very worn, but especially if they have lost their original shape and size, it is advisable to reconstruct them: restoring the proportions they had before they were damaged is essential to allow you to chew correctly. If you allow dental erosion to reach the dentin – the layer underneath the enamel – this, being less hard than the enamel, will wear even faster and your teeth will rapidly lose further healthy tissue. To protect worn teeth and rebuild your smile, you can create a project that restores the volume and shape of the past. You will then run a simulation in your mouth which will allow you to preview how your smile might look like again. If you decide to proceed with the definitive solution, you will be able to evaluate the materials to use, such as for example the composite for the aesthetic reconstructions or the ceramic for the dental veneers.

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