The Effects of Purging on Oral Health

Purging, often associated with disordered eating behaviors like bulimia, involves self-induced vomiting to rid the body of food. This practice can severely damage oral health due to the acidic stomach contents repeatedly coming into contact with the teeth. This can lead to enamel erosion, tooth decay, gum disease and bad breath. 

Purging & Eating Disorders

Purging is a common compensatory method for those suffering from bulimia nervosa and other eating disorders. Compensatory methods include any disordered eating behavior used to compensate for food intake or alleviate feelings of guilt or shame. Some of the most common purging methods include self-induced vomiting, diuretic misuse and laxative misuse.

Purging is also included in diagnostic criteria in multiple eating disorder diagnoses, including:

• Bulimia nervosa
• Anorexia nervosa binge eating and purging subtype
• Other specified feeding or eating disorder

Impact of self-induced vomiting on oral health

Oral health has been tied to overall wellbeing and quality of life, with studies showing a correlation between poor oral health and increased mortality. While many of the complications associated with bulimia nervosa and purging resolve with treatment, some of the effects on oral health are irreversible. This emphasizes the importance of dental professionals, ENT (ear, nose and throat) specialists and primary care physicians in identifying these complications, providing education and screening for eating disorders in patients who may be secretly struggling with an eating disorder.

Oral & dental complications of bulimia nervosa

Enamel erosion (perimylolysis)

Chronic exposure to stomach acid can cause dental erosion, one of the most common oral complications in people who purge through self-induced vomiting. Repeated exposure to vomit erodes the backside of the teeth, causing the teeth to become weak, brittle and hypersensitive over time. When the enamel of the teeth wears away and exposes the dentin, continued exposure to vomitus can cause infection, discoloration or pulp death of the teeth. Perimylolysis is irreversible once it has developed. 

Chipmunk cheeks

Also known as parotid gland enlargement or sialadenosis, chipmunk cheeks are one of the most well-known markers of self-induced vomiting. Sialadenosis typically occurs 3-4 days after purging has stopped and causes bilateral enlargement of the parotid glands and sometimes enlargement of the other salivary glands.

It is thought to occur due to either a backup of saliva that is no longer needed, cholinergic stimulation of the glands or hypertrophy of the glands to help meet demands of increased saliva production.

Hyperamylasemia

Patients who experience sialadenosis may also develop hyperamylasemia (high serum amylase). Amylase is produced by the salivary glands and pancreas, and it can be indicative of vomiting behaviors.

Gingivitis & periodontitis

Purging through self-induced vomiting and dry mouth can also cause gum disease (gingivitis). Chronic irritation from exposure to stomach acid can cause inflammation, bleeding and pain of the gums. If left untreated, it can develop into more severe and largely irreversible periodontal disease, known as periodontitis (degradation of the jawbone). Over time, pockets form around the gums, which can fill with plaque and bacteria, increasing a patient’s risk of infection as well as tooth pain, loose teeth and tooth loss.  

Soft tissue damage

Pressure from vomiting can cause blood vessels in the mouth to burst, causing the palate and tongue to turn an orange-yellow color. The act of inserting a hand or object into the mouth to induce vomiting can cause redness, cuts, scratches or bleeding lesions in the soft tissue of the mouth too.

Other oral & dental complications

Several other oral complications include:

• Chronic dry mouth (xerostomia)
• Bad breath
• Dry, cracked or inflamed lips