• An eating and psychiatric compulsive disorder.
• Periods of normal eating followed by dieting or severe restrictions of food intake often ending in binge-eating.
• Binge-eating episodes must occur at least twice a week for 3 months to be diagnosed as bulimia nervosa.
• Weight gain is controlled by self-induced vomiting, strict fasting, vigorous exercise and abuse of laxatives or diuretics.

• 14 out of 100,000 people suffer from bulimia nervosa.
• Primarily affects adolescent and young adult females. (1-4% of females between 18-30 years suffer from it)
• 1 in 10 patients are male.
• 1/3 of those who suffer from bulimia nervosa have a history of anorexia nervosa.
• 1/3 of those who suffer from bulimia nervosa have a history of obesity.

• Bulimics have an obsession with weight, food and eating.
• Bulimics realize they have abnormal eating habits but get addicted to the binge-eating, purge cycle and lose control.

• Changing weight gain of 5-20 pounds per week.
• Dry lips and skin around the mouth.
• Swollen lymph nodes and parotid gland enlargement.
• Broken blood vessels in an around eyes (blood shot eyes) due to stretch and strain of repeated vomiting.
• Callous on or near the first knuckle of the index finger due to pushing against the upper teeth to induce vomiting.

Silver Fillings Are Significantly Raised

• Braces and temporary restorations may not stay on the teeth because the acid will dissolve the temporary cement used to keep these materials in place.
• Teeth may be discolored or look dull from the acid.
• Bleeding of the gums.

What are Some Ways to Improve the Problems in the Mouth Associated with Bulimia Nervosa?

• To prevent further wearing of teeth, do not brush teeth after vomiting, rinse with water instead.
• Use a basic rinse, such as baking soda and water; immediately after vomiting to neutralize the acid.
• Reduce sugar in diet.
• Remove plaque by brushing and flossing properly.
• Chew sugarless gum to increase salivary flow or use an artificial saliva.
• Use fluoride either in toothpastes, rinses or gels to reduce sensitivity of teeth and build resistance to decay from acid.

What Are Some Other Behaviors and Disorders That Could Cause Similar Signs in the Mouth?

• Tooth grinding may cause teeth to wear away.
• Sucking on lemons or citrus foods may cause just the front teeth to wear away.
• Certain drugs and diseases may cause dry mouth and burning of the tongue.
• Severe infections, certain drugs, vitamin C deficiencies and hot foods may cause lesions on the palate or gums.
• Frequent and vigorous tooth brushing may cause recession of the gums.
• Many other agents, such as coffee and smoking discolor the teeth.
• Periodontal disease and chemotherapy may cause bleeding of the gums.

How Might an Individual Identify a Bulimic Person?

• On average, bulimic patients brush their teeth more than twice a day and may also brush their teeth each time they vomit; up to 7-8 times/day.
• Chronic gum chewing (7-8 packs/day), compulsive use of mouthwash, increased diet soda intake (10-12 cans/day), ice chewing and nail biting.
• Complaints of dizziness, thirst and fainting due to dehydration
• Complaints of muscle cramps and weakness.
• Complaints of heartburn and abdominal pain.
• Complaints of sensitive teeth and sore throat.

What Are Some Complications of Bulimia Nervosa?

• 35-70% of bulimics suffer from depression.
• May begin to abuse alcohol or drugs.
• May lose some sense of taste.
• May be dehydrated due to vomiting an/or laxative and diuretic abuse.
• May be constipated and rely on laxatives for bowel movements.
• May vomit without inducing it, preventing bulimics from eating in public.
• May have an irregular heartbeat.
• May be at a higher risk for heart attacks.
• May become life threatening.

When Do Bulimics Seek Help?

• Initially they may seek help for the problems associated with bulimia nervosa.
• Less than 1/3 of those who have bulimia nervosa will seek help; either on their own or due to intervention, often waiting many years, usually because they are desperate for relief from something they can’t control or overcome.

Who and What May Be Involved in the Treatment?

• Psychiatrists, psychologists, gastroenterologists, dieticians and dental professionals.
• Psychological treatment is a major component.
• Dental treatment should occur immediately if the patient is in pain or if there is extensive tooth loss.
• Dental treatment may be discouraged until the patient is psychologically ready and the eating disorder is controlled.

What Are the Long-Term Implications of Bulimia Nervosa?

• Estimated 40-50% of bulimics who undergo treatment are thought to be no longer preoccupied with food and their weight and are considered cured.
• Death is more likely in bulimia nervosa than other eating disorders (such as anorexia) due to the greater incidence of more serious medical complications.
• Suicide rates are higher in persons with bulimia nervosa than other eating disorders because depression occurs more often.