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Oral Manifestations, continued
Many patients with bulimia and some patients with anorexia nervosa engage in self-induced vomiting as part of their purging behaviors.

Consider the following information about bulimia:

Recurrent emesis results in
Enamel: Intensely hard calcareous substance that forms a thin layer partly covering the teeth; the hardest substance of the animal body; consists of minute prisms arranged at right angles to the surface and bound together by a cement substance.
enamel erosion, especially the lingual surface of the maxillary incisors in a specific pattern termed perimolysis. Enamel erosion may expose nerve endings, causing tooth sensitivity, and increase the risk of caries, tooth fracture,
Gingivitis: Inflammation of the gums.
gingivitis, and dry mouth.
Other physical findings include painless enlargement of the parotid glands, palatal petechiae from instrument use to induce emesis,
and callous or scarring of the dorsal aspect of the knuckles (Russell’s sign).
Patients should be counseled to rinse their mouth thoroughly with water, a fluoridated mouth-rinse, or water with baking soda to neutralize the gastric acid after all episodes of emesis. Brushing of the teeth immediately after emesis is controversial due to concern of accelerating the enamel erosion and should be discussed with the consulting dentist.
All patients with recurrent emesis should be counseled to avoid acidic drinks (eg, soda) and to use a soft toothbrush.
All patients with self-induced or recalcitrant emesis should be referred to a dentist for evaluation and treatment in addition to a comprehensive medical and psychological evaluation of the
eating disorder.

Perimolysis is a specific pattern of enamel erosion resulting from repeated emesis.
It is important for patients to rinse their mouth after all emesis, but brushing is controversial.
A dental evaluation should accompany the medical and psychological evaluation of a suspected eating disorder.

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