Special Clinic for Bulimia

For most patients, damage to the hard tooth structure (enamel or dentine) can be detected. The severity of the hard tooth structure damage depends on factors such as duration of the disorder, vomiting frequency, saliva buffering capacity, salivary flow rate and a few other parameters. In addition, incorrect oral hygiene behaviour such as tooth brushing immediately after vomiting has an adverse effect.

At the Special Clinic, we care for our patients individually, taking into consideration all factors pertaining to the case and adjust our counselling accordingly.

The frequent self-induced vomiting leads to gastric acid coming into contact with the oral cavity. Especially the hard tooth structure can be irreversibly damaged by this direct contact with acid. So-called erosions occur. At first mostly painless, there is a loss of enamel and this then leads to an exposure of the underlying dentine. This can cause a heightened sensitivity of the teeth regarding changes in temperature and to pain when consuming sweet or sour food. In case of further progression, wedge-shaped defects of the tooth structure may arise, which may even lead to pulp exposure and necessitate a root canal treatment.

Dentists are often the first to identify the signs of bulimia in patients, because the characteristic pattern of tooth erosion can be seen in the chewing apparatus. Among these are:

• round tooth outlines, which have lost the sharp, occlusal relief of a healthy tooth
• instead of a cusp, there is often a wedge, an “inverted” cusp
• the incisal edges of the anterior teeth appear thinned out and transparent and can be severely shortened at a later stage.
• metallic fillings can project over the tooth level
• secondary overbite  
• special sensitivity of the teeth to hot, cold, sour, sweet
• in addition, a swelling of the salivary glands, reduced salivary flow, cracked corners of the mouth and injuries of the palate and throat can also occur due to self-induced vomiting

At the Special Clinic for Bulimia we examine patients with a lot of delicacy and understanding for their illness. Depending on the state of the teeth and the oral cavity we use different diagnostic methods.

Our dentistry team provides the patient with recommendations for preventive measures. It is especially important to consider the following:

• no tooth brushing immediately after vomiting, instead it is better to rinse the mouth with a neutralising liquid, such a fluoridated solution, water or milk.
• use a toothpaste of low abrasive value
• use a “soft” or “extra-soft” toothbrush with rounded bristles
• apply low pressure to the toothbrush
• remineralisation of the teeth with calcium, phosphate and fluoride products to decrease the teeth’s heightened sensitivity

Demineralised teeth can be remineralised to a certain degree with various products such as those containing calcium, phosphate and fluoride and thus be made more resistant.

For patients with a diagnosis of bulimia, general and psychotherapeutic counselling is urgently recommended. The Special Clinic for Bulimia at the University Clinic of Dentistry Vienna cooperates closely with other fields to support those affected as well as possible.

Innovative processes can restore even very severely damaged teeth. Through an aesthetic and functional trial run, we ensure that patients accept the new restoration and experience it as pleasant and attractive.