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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Oral Manifestations, continued
Many patients with bulimia and some patients with anorexia nervosa engage in self-induced vomiting. Recurrent emesis results in 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, and gingivitis

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.
Gingivitis: Inflammation of the gums.

Patients should rinse their mouth with water, water with baking soda or a fluoridated mouth-rinse to neutralize the gastric acid after all episodes of emesis.  Counsel patients not to brush the teeth for 30-60 minutes after emesis to reduce risk of toothbrush abrasion.

All patients with recurrent emesis should be counseled to avoid acidic drinks such as soda and to use a soft toothbrush. 

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.

Fast Facts
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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