Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

The impact of bulimia nervosa on oral health: A review of the literature

Key Points

  • Bulimia nervosa is a psychological disorder which has serious implications for oral health.

  • Points out that, given the relatively high prevalence of this disorder among young people, dental practitioners are likely to encounter individuals with bulimia nervosa.

  • Discusses the likely oral manifestations of the disorder, which will enable the practitioner to plan comprehensive treatment.

Abstract

Eating disorders are a potentially life-threatening group of mental disorders, which affect a patient's relationship with food and their body. This manifests itself through chaotic and disordered eating habits. One such eating disorder is bulimia nervosa, which has a lifetime prevalence of 1%. While there is consensus that bulimic behaviour directly causes dental erosion due to vomiting and acidic food choices, there is less clear evidence for a direct link between bulimia nervosa and dental caries, although there does still appear to be an association. Reduced salivary flow rate is a common feature among bulimics, but this is often due to anti-depressant medication rather than dietary habits or vomiting, and the effects are largely limited to unstimulated whole salivary flow rate and don't affect stimulated whole salivary flow rate. Parotid enlargement is present in a number of cases but this tends to be a minority. Further research is required given the limitations of current studies, especially gender imbalances among the populations studied and a lack of clear focus on bulimia nervosa.

This is a preview of subscription content

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Figure 1

References

  1. 1

    Lo Russo L, Campisi G, Di Fede O, Di Liberto C, Panzarella V, Lo Muzio L . Oral manifestations of eating disorders: A critical review. Oral Dis 2008; 14: 479–484.

    Article  Google Scholar 

  2. 2

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM5®). Washington D.C: American Psychiatric Publishing, 2013.

  3. 3

    Kessler R C, Berglund P A, Chiu W T et al. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry 2013; 73: 904–914.

    Article  Google Scholar 

  4. 4

    Hoek H W, Van Hoeken D . Review of the prevalence and incidence of eating disorders. Int J Eat Disord 2003; 34: 383–396.

    Article  Google Scholar 

  5. 5

    McManus S, Meltzer H, Brugha T T, Bebbington P P, Jenkins R . Adult psychiatric morbidity in England, 2007 Results of a household survey. 2009. Available online at http://discovery.ucl.ac.uk/164862/ (accessed September 2017).

    Google Scholar 

  6. 6

    Health and Social Care Information Centre. Hospital episode statistics, admitted patient care, England 2012–2013. 2013. Available online at http://www.hscic.gov.uk/catalogue/PUB12566 (accessed September 2017).

  7. 7

    Garfinkel P, Lin E, Goering P et al. Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups. Am J Psychiatry 1995; 152: 1052–1058.

    Article  Google Scholar 

  8. 8

    Kisely S, Baghaie H, Lalloo R, Johnson N W . Association between poor oral health and eating disorders: systematic review and meta-analysis. Br J Psychiatry 2015; 207: 299–305.

    Article  Google Scholar 

  9. 9

    Rytomaa I, Jarvinen V, Kanerva R, Heinonen O P . Bulimia and tooth erosion. Acta Odontol Scand 1998; 56: 36–40.

    Article  Google Scholar 

  10. 10

    Hague A L . Eating disorders – screening in the dental office. J Am Dent Assoc 2010; 141: 675–678.

    Article  Google Scholar 

  11. 11

    Fonteini P, Kamposiora P, Papavisiliou G . A multidisciplinary approach to the functional and esthetic rehabilitation of a patient with bulimia nervosa: A clinical report. Int J Dent Oral Sci 2015; 2: 53–58.

    Google Scholar 

  12. 12

    DeBate R D, Tedesco L A, Kerschbaum W E . Knowledge of oral and physical manifestations of anorexia and bulimia nervosa among dentists and dental hygienists. J Dent Educ 2005; 69: 346–354.

    PubMed  PubMed Central  Google Scholar 

  13. 13

    Mulic A, Tveit A B, Songe D, Sivertsen H, Skaare A B . Dental erosive wear and salivary flow rate in physically active young adults. BMC Oral Health 2012; 12: 10.1186/1472-6831-12-8.

  14. 14

    Dynesen A W, Bardow A, Petersson B, Nielsen L R, Nauntofte B . Salivary changes and dental erosion in bulimia nervosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: 696–707.

    Article  Google Scholar 

  15. 15

    Touyz S W, Liew V P, Tseng P, Frisken K, Williams H, Beumont P J . Oral and dental complications in dieting disorders. Int J Eat Disord 1993; 14: 341–347.

    Article  Google Scholar 

  16. 16

    Öhrn R, Enzell K, Angmar-Månsson B. Oral status of 81 subjects with eating disorders. Eur J Oral Sci 1999; 107: 157–163.

    Article  Google Scholar 

  17. 17

    Oliva C L, Jornet P L, Alonso F C, Salinas J E . Study of oral changes in patients with eating disorders. Int J Dent Hyg 2008; 6: 119–122.

    Article  Google Scholar 

  18. 18

    Johansson AK, Norring C, Unell L, Johansson A . Eating disorders and oral health: a matched case-control study. Eur J Oral Sci 2012; 120: 61–68.

    Article  Google Scholar 

  19. 19

    Health NCC for M. Eating disorders: Core interventions in the treatment and management of eating disorders. NICE Guidelines 2009; 32: 809–819.

  20. 20

    Zero D T, Lussi A . Erosion – Chemical and biological factors of importance to the dental practitioner. Int Dent J 2005; 55: 285–290.

    Article  Google Scholar 

  21. 21

    Jarvinen V, II R, Heinonen O . Risk factors in dental erosion. J Dent Res 1991; 70: 942–947.

    Article  Google Scholar 

  22. 22

    Banerjee A, Watson T . Pickard's Guide to Minimally Invasive Operative Dentistry. 10th ed. Oxford University Press, 2015.

    Google Scholar 

  23. 23

    Yan-Fang R . Dental erosion: Etiology, diagnosis and prevention. Regist Dent Hyg Publication date: April 2011.

  24. 24

    Emodi-Perlman A, Tal Y, Rosenberg N, Eli I, Alter Z, Wincour E . Prevalence of psychologic, dental, and temporomandibular signs and symptoms among chronic eating disorders patients: A comparative control study. J Orofac Pain 2008; 22: 201–208.

    PubMed  PubMed Central  Google Scholar 

  25. 25

    Hermont A P, Pordeus I A, Paiva S M, Abreu M H N G, Auad S M . Eating disorder risk behaviour and dental implications among adolescents. Int J Eat Disord 2013; 46: 677–683.

    Article  Google Scholar 

  26. 26

    Uhlen M M, Tveit A B, Stenhagen K R, Mulic A . Self-induced vomiting and dental erosiona clinical study. BMC Oral Health 2014; 14: 92.

    Article  Google Scholar 

  27. 27

    Milosevic A, Brodie D A, Slade P D . Dental erosion, oral hygiene, and nutrition in eating disorders. Int J Eat Disord 1997; 21: 195–199.

    Article  Google Scholar 

  28. 28

    Bartlett D W, Coward P Y . Comparison of the erosive potential of gastric juice and a carbonated drink in vitro. J Oral Rehabil 2001; 28: 1045–1047.

    Article  Google Scholar 

  29. 29

    Barron R P . Dental erosion in gastroesophageal reflux disease. J Can Dent Assoc 2003; 69: 1–6.

    Google Scholar 

  30. 30

    Dawes C . What is the critical pH and why does a tooth dissolve in acid? J Can Dent Assoc 2003; 69: 722–724.

    PubMed  PubMed Central  Google Scholar 

  31. 31

    Lussi A, Jaeggi T, Jaeggi-Scharer S. Prediction of the erosive potential of some beverages. Caries Res 1995; 29: 349–354.

    Article  Google Scholar 

  32. 32

    Al-Dlaigan, Y H ; Shaw L, Smith A . Dental erosion in a group of British Part II: Influence of dietary intake. Br Dent J 2001; 190: 258–261.

    Article  Google Scholar 

  33. 33

    Gokul G . Eating disorders and its effect toward the oral cavity: A review. Asian J Pharm Clin Res 2016; 9: 40–42.

    Article  Google Scholar 

  34. 34

    Jugale P V, Pramila M, Murthy A K, Rangath S . Oral manifestations of suspected eating disorders among women of 20–25 years in Bangalore City, India. J Heal Popul Nutr 2014; 32: 46–50.

    Google Scholar 

  35. 35

    Price C, Schmidt M A, Adam E J, Lacey H . Parotid gland enlargement in eating disorders: An insensitive sign? Eat Weight Disord 2008; 13: e79–e83.

    Article  Google Scholar 

  36. 36

    Riad M, Barton J R, Wilson J A, Freeman C P, Maran A G . Parotid salivary secretory pattern in bulimia nervosa. Acta Otolaryngol 1991; 111: 392–395.

    Article  Google Scholar 

  37. 37

    Abraham S F, Beumont P J . How patients describe bulimia or binge eating. Psychol Med 1982; 12: 625–635.

    Article  Google Scholar 

  38. 38

    Lester I H, Ian H . Australia's Food & Nutrition. 1994.

  39. 39

    Romanos G E, Javed F, Romanos E B, Williams R C . Oro-facial manifestations in patients with eating disorders. Appetite 2012; 59: 499–504.

    Article  Google Scholar 

  40. 40

    Frydrych A M, Davies G R, McDermott B M . Eating disorders and oral health: a review of the literature. Aust Dent J 2005; 50: 6–15; quiz 56.

    Article  Google Scholar 

  41. 41

    Harper D S, Osborn J C, Clayton R, Hefferren J . Modification of food cariogenicity in rats by mineral-rich concentrates from milk. J Dent Res 1987; 66: 42–45.

    Article  Google Scholar 

  42. 42

    Silva M D, Burgess R C, Sandham H J, Jenkins G N . Effects of water-soluble components of cheese on experimental caries in humans. J Dent Res 1987; 66: 38–41.

    Article  Google Scholar 

  43. 43

    Belli W A, Marquis R E . Adaptation of Streptococcus mutans and Enterococcus hirae to acid stress in continuous culture. Appl Environ Microbiol 1991; 57: 1134–1138.

    PubMed  PubMed Central  Google Scholar 

  44. 44

    Young W . The oral medicine of tooth wear. Aust Dent J 2001; 46: 236–250; quiz 306.

    Article  Google Scholar 

  45. 45

    Ly K A, Milgrom P, Rothen M . The potential of dental-protective chewing gum in oral health interventions. J Am Dent Assoc 2008; 139: 553–563.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to A. Rosten.

Additional information

Refereed Paper

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rosten, A., Newton, T. The impact of bulimia nervosa on oral health: A review of the literature. Br Dent J 223, 533–539 (2017). https://doi.org/10.1038/sj.bdj.2017.837

Download citation

Further reading

Search

Quick links