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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.


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.

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Correspondence to A. Rosten.

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Rosten, A., Newton, T. The impact of bulimia nervosa on oral health: A review of the literature. Br Dent J 223, 533–539 (2017).

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