Bulimia may be easy to hide from parents, friends or even physicians. But it’s something that dentists can detect fairly easily just by giving patients a regular dental exam.

Patients with bulimia, a serious eating disorder, have recurrent episodes of binge eating following by self-induced vomiting. According to a study in a recent issue of the General Dentistry, the journal of the Academy of General Dentistry, binges can includes as much as seven pounds of food and 20,000 calories, with purging episodes occurring as frequently as 40 times per day.

These episodes bring stomach acids up through the mouth that are damaging to a tooth’s enamel. “The damage from purging mostly occurs inside the upper front teeth which causes erosion of the tooth’s enamel, sensitivity, thinning and chipping,” says Maharukh Kravich, DDS.

Though it may seem odd, dentists are cautious about confronting patients they suspect may suffer from bulimia, especially on the first visit. After all, a person doesn’t need to have bulimia to exhibit the effects of tooth erosion.

Gastroesophageal reflux disorder (GERD), dietary or occupational exposure to acids (professional wine tasters), or “morning sickness” in pregnant women also can cause wear patterns. Dentists generally try to gently figure out the source of the problem and can provide a mouthguard or fluoride regimen to protect a patient’s teeth if the episodes are frequent.

Dr. Kravich recommends that dentists caution patients with frequent vomiting episodes, including bulimia, to perform the following tasks.

• After vomiting, immediately rinse with soda water (bicarbonate). Or, use a sugar-free mouth rinse.
• Swish water around the oral cavity if nothing else is available.
• Brush with a soft-bristled toothbrush and fluoride toothpaste.

Researchers are looking for answers

The issue of eating disorders has become fodder for a variety of research projects. Consider the following studies, all reported within the past year and which represent only a handful of projects being conducted.

• A study in the journal Archives of Pediatric and Adolescent Medicine suggests that girls develop eating disorders because they believe they can be as thin as movie stars and runway models. Researchers from the Brigham and Women’s Hospital and Harvard Medical School followed 6,982 girls between the ages of 9 and 14. They found that those who developed severe eating disorders — particularly using vomiting and laxatives to lose weight — were usually trying to look like the women they saw on TV or in the movies. Girls who said they wanted to look like movie stars had about a 30% likelihood of developing an eating disorder.
• According to the December 1999 issue of the journal Eating and Weight Disorders, people with eating disorders usually are bothered by their problem but they still don’t want to be treated because they’re afraid they’ll gain weight when they undergo treatment. However, their fears probably are unfounded. When 94 women were treated for eating disorders at the Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center, researchers found that successful treatment generally didn’t lead to excessive weight gain. Most of the women were able to deal with their eating problems and weight concerns at the same time. However, younger women were more likely to keep their weight down after therapy than older women.
• Other people realize their medical or psychological conditions are something that should be kept from others. However, keeping the secret can be difficult. A 1999 report in the Journal of Personality and Social Psychology describes people with eating disorders who tried to hide the disorder. Researchers discovered the more they tried to be secretive, the worse the problem grew in their own minds. Though they didn’t want anybody to know about their situation, thoughts of eating disorders and words relating to the problem began creeping into their conversation.

Ontario provides money for treatment

Just last month, the Ontario government announced something unusual, but welcoming to dentists and other healthcare professionals. It will provide an additional $7 million a year to improve treatment for those with eating disorders.

“The $7 million in additional funding will significantly increase eating disorder treatment services throughout Ontario, making them available closer to home for those who need them,” says Elizabeth Witmer, Ontario’s Health Minister.

“We have heard from families and health-care providers that more resources were needed to help people — especially young people — with eating disorders and we have more than tripled our funding in response.”

The province already had pledged $2.7 million the province to the provincial eating disorder network, which started in 1997 to create or improve eating disorder services in Ottawa, Toronto, Windsor and the York Region. But politicians realized more was needed to combat eating disorders effectively.

The new total of $9.7 million will be allocated to seven regions in the province, including those with existing services, based on population in the region and on prevalence of eating disorders. The regional centers will work with local hospitals and community agencies to better coordinate services.

“This funding is a tremendous step forward that will allow us to provide a comprehensive and coordinated model of care for patients of all ages with eating disorders throughout Ontario,” says Dr. Debra Katzman, medical director of the eating disorder program at Toronto’s Hospital for Sick Children.

“This investment will enhance specialized treatment for eating disorder patients and their families and respond to the growing demand for more effective and efficient services.”

She says that studies show that anorexia nervosa affects about 1% of Canadian women. Bulimia is estimated to affect 3% of all women, and 5% of adolescent girls.

Research from various jurisdictions suggests that the mortality rate for those with eating disorders is as high as 20%.