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When the Mouth Reveals More Than You Expect
[00:00:04 – 00:01:25]
Eating disorders and oral health are more closely connected than many people realise. Signs of disordered eating can appear in the mouth before they are noticed anywhere else, making dentists an important part of early detection and compassionate care.
This episode explores the specific ways bulimia and anorexia affect teeth and gums, what dentists look for, and how patients can protect their oral health during and after recovery.
How Bulimia Damages Teeth Differently to Acid Reflux
[00:01:25 – 00:05:04]
Gastric acid has a pH close to 1 — far more acidic than lemon juice or cola — and anything below pH 5.5 begins dissolving enamel. During bulimic purging, this acid is brought forcefully into the mouth, bathing the teeth directly and repeatedly in a way that ordinary acid reflux does not.
The resulting damage tends to appear as smooth, glassy erosion on the inner surfaces of the upper front teeth, with thinning enamel and increasing translucency. Over time, the underlying dentine becomes exposed, leading to sensitivity, structural weakness, and sometimes fractures.
Importantly, guilt often outweighs the actual damage. Many patients who have moved past bulimia are surprised to find their teeth are in better condition than feared. A confidential, non-judgemental check-up can provide reassurance and a clear picture of what, if anything, needs treatment.
Perimolysis: The Clinical Name for Acid Erosion
[00:05:04 – 00:05:43]
Perimolysis is the clinical term for the specific pattern of enamel erosion caused by stomach acid on the back surfaces of the upper front teeth. Under magnification, the surface has a characteristic polished appearance that is distinct from other forms of tooth wear.
Why You Should Never Brush Immediately After Vomiting
[00:05:43 – 00:06:50]
After acid exposure, enamel becomes temporarily softened. Brushing at this point does not clean the teeth — it accelerates their wear. This advice also applies to people experiencing morning sickness during pregnancy.
The recommended approach is to rinse gently with water or a dilute bicarbonate of soda solution to neutralise the acid, then wait 30 to 60 minutes before brushing. Chewing sugar-free gum or using a minty water rinse in the meantime stimulates saliva, which helps remineralise the tooth surface.
How Dentists Recognise the Signs Before Anyone Else
[00:06:51 – 00:08:35]
Dentists are often among the first to notice the oral signs of an eating disorder. Perimolysis, unexplained sensitivity, rapid enamel thinning, and new cavities in a patient with otherwise good oral hygiene are all patterns that can appear before the patient has sought help or disclosed anything.
The dentist’s role is not to diagnose the eating disorder itself, but to recognise the oral signs and open a gentle conversation. A direct but respectful question — such as asking whether the patient has ever experienced bulimia or makes themselves vomit — is rarely offensive when approached with care, and may be the prompt a patient needs to seek help.
Oral Signs of Anorexia and Restrictive Eating
[00:08:36 – 00:10:51]
Anorexia is a distinct and medically serious condition that presents differently in the mouth. Common oral signs include dry mouth, dehydration, increased cavity risk, gum inflammation, delayed healing, ulceration, and vitamin deficiencies — particularly vitamins B and C — which can cause sore, bleeding gums and changes to the soft tissues.
Bone density loss associated with severe anorexia can also affect the jawbone. These signs are not limited to clinical anorexia; people with extreme restrictive eating combined with very high exercise volumes can present with similar findings, even if they appear fit and healthy on the surface.
Restoring Teeth Thinned by Acid Erosion
[00:10:52 – 00:12:11]
Treatment focuses on preserving the remaining enamel while protecting teeth from further damage. The preferred first-line approach is adhesive composite bonding, particularly injection-moulded composiet verlijming, which restores thickness and improves aesthetics without any drilling.
veneers and crowns are rarely the first choice, as they require removing more tooth structure. A staged rehabilitation is preferred over full-mouth reconstruction, and stabilisation of any active disorder always takes priority before cosmetic work begins.
Managing Dental Care When the Disorder Is Still Active
[00:12:11 – 00:13:09]
Ongoing acid exposure compromises the bonding of restorations, increases sensitivity, and accelerates their breakdown, so cosmetic dentistry is not appropriate until the underlying issue is under control. In the meantime, protective measures can be applied.
Glass ionomer — a fluoride-releasing material that bonds naturally to teeth — can be painted onto vulnerable surfaces to reduce further damage. It is not as cosmetically refined as composite, but it provides meaningful protection while the patient works through recovery.
Approaching the Conversation With Compassion
[00:13:09 – 00:14:54]
For dentists who have not had this conversation before, focusing on observed clinical findings rather than assumptions is a useful starting point. Describing what you see — such as a pattern of acid wear that often accompanies frequent acid exposure — opens a discussion without accusation or judgement.
Being too indirect can cause confusion, so a measured level of directness is often more effective. The goal is to ensure the patient leaves having been offered an opportunity to discuss what is happening, and to know that the practice is a safe, supportive space rather than one of fear or shame.
Home Care Routines to Protect Enamel During Recovery
[00:14:55 – 00:16:27]
Neutralising acid promptly, using a high-fluoride toothpaste, and brushing without rinsing so that fluoride residue remains on the teeth are all important habits. Products such as Tooth Mousse, applied in a custom tray, can further support remineralisation.
Saliva stimulation through sugar-free gum, fluoride varnishes, and glass ionomer application all play a role. Dietary choices matter too — reducing additional acidic foods and including neutralising options such as cheese can help limit further damage alongside whatever treatment the dentist recommends.
Salivary Gland Swelling and Other Visible Signs
[00:16:27 – 00:17:59]
Repeated purging can cause the parotid salivary glands — located in the lower cheeks — to enlarge, producing a distinctive facial swelling sometimes described as chipmunk cheeks. This results from glandular irritation, inflammation, and altered salivary flow, and often reduces when purging stops, though chronic changes are possible.
Salivary gland changes represent another early sign that an oral health professional may detect, reinforcing why regular dental assessment is valuable even when someone is not yet ready to disclose what is happening.
Afschrift
Eon Engelbrecht (0:04)
Hello and welcome to Save Your Money, Save Your Teeth, the podcast where we unpack the dental topics that can make a real difference to your health, your confidence, and also your quality of life. I’m Eon, and today we’re talking about a sensitive but very important subject: eating disorders and oral health. This is one of those topics where the signs can sometimes show up in the mouth before they’re noticed anywhere else. It also reminds us that oral health is very often connected to a person’s overall physical and emotional well-being. Joining us again is Dr Clifford Yudelman from OptiSmile to help us better understand the warning signs, the dental damage that can happen, and how dentists can respond with care and compassion. Dr Yudelman, it’s great to have you with us again.
Dr Clifford Yudelman (0:57)
Great to be back. Thanks for having me, and I’m looking forward to today’s episode. Hopefully this helps people who suffer from an eating disorder, or perhaps a brother or sister of someone, since siblings often notice these things before parents do. It may also help parents who suspect their child has a problem like this.
Eon Engelbrecht (1:25)
Doctor, let’s dive right in. How does bulimia specifically damage the teeth compared to regular acid reflux?
Dr Clifford Yudelman (1:34)
It has a very specific pattern of damage, because the teeth are directly and repeatedly exposed to strong stomach acid during vomiting. Gastric acid has a pH close to 1. For context, 7 is neutral. We’ve spoken about acids before. Lemon juice sits around pH 2 to 3, and a cola drink is roughly 3 to 3.5. Anything under 5.5 starts dissolving the teeth, and stomach acid is far more acidic than anything you can put on your teeth from outside.
Unlike acid reflux, which affects the back of the throat and happens intermittently, bulimic vomiting brings acid forcefully into the mouth, bathing the teeth directly and frequently. The damage tends to be more severe, more rapid, and more localised. What we often see is a smooth, glassy erosion on the inside surfaces of the upper teeth, with thinning enamel and increasing translucency, especially behind the front teeth. It looks as though someone has taken a drill and polished the enamel away from behind the front teeth, as if they were filing them down for a veneer, but from the back instead of the front.
Over time, this exposes the dentine, which leads to sensitivity, structural weakness, and sometimes fractures. Studies show that the frequency of acid exposure is the main factor determining the extent of damage. Even small amounts of acid, repeated often enough, will overwhelm the tooth’s natural repair mechanisms.
Having said that, I want to add something important. I’ve seen a number of patients in their mid to late twenties who tell me they haven’t been to a dentist for a long time. They are very worried about their teeth because they have finally moved past their binging and purging or bulimia, and they feel they’ve completely destroyed their teeth. In many cases, there is more guilt than there is actual damage. I’ve seen a number of patients with bulimia whose teeth aren’t badly damaged at all.
So if you do have bulimia, don’t be shy or embarrassed about seeing the dentist just for a regular checkup. The dentist is not going to necessarily spot the problem and run to tell your parents. And even if they do suspect something, anything you disclose to a dentist confidentially is treated as such. It also depends on age, which is beyond the scope of this podcast, but most of the patients I see in this situation are older teenagers or young adults, and I’m not going to tell their parents anything they’ve shared with me in confidence.
Eon Engelbrecht (5:04)
And what is perimolysis, and why does it happen on the back of the upper teeth, doctor?
Dr Clifford Yudelman (5:11)
Perimolysis is a specific pattern of enamel erosion caused by stomach acid, on the back surfaces of the upper front teeth. It’s essentially what we were just discussing. Under magnification, particularly with a microscope, we can clearly see that characteristic polished appearance. Perimolysis is simply the clinical name for it.
Eon Engelbrecht (5:43)
And I believe a patient should never brush their teeth immediately after vomiting. Is that statement true?
Dr Clifford Yudelman (5:51)
Yes, and this also applies to people who experience a lot of morning sickness during pregnancy. You shouldn’t rush to brush, because after acid exposure the enamel becomes quite soft. Brushing a softened surface doesn’t clean the teeth, it wears them away. You end up wearing down your teeth more quickly.
The recommendation is to rinse gently with water, or with a little bicarbonate of soda in water to neutralise the acid, and to wait 30 to 60 minutes before brushing. You can also chew sugar-free gum, or rinse with a minty water rinse and then chew gum, which stimulates saliva that helps remineralise the tooth surface. That one piece of advice alone is worth listening to this podcast for. If it helps people avoid brushing away their enamel, I’m happy.
Eon Engelbrecht (6:51)
How can a dentist spot the signs of an eating disorder before anyone else? What would you see? What do you look for?
Dr Clifford Yudelman (7:00)
We often notice these signs before patients, their doctors, or their parents. The clues are the perimolysis I described, sensitive teeth, rapid enamel thinning, and someone who has otherwise good oral hygiene yet keeps getting cavities. These are patterns that can appear before a patient seeks help or discloses an eating problem. A trained dentist can recognise them.
It’s not about judging personal behaviour. It is a disease. The role of the dentist isn’t to diagnose the eating disorder itself, but to recognise the oral signs. That gives an opportunity for early and compassionate intervention. You can ask gently, “Do you have a problem with your stomach?” or you can be more direct.
After 43 years, I do tend to ask patients directly. I might say, “Do you have, or have you ever had, bulimia?” If they don’t know what I’m talking about, I’ll ask, “Do you make yourself vomit?” because that’s what the picture looks like clinically. If it isn’t true, they’ll simply say no, and they won’t usually be offended when you approach it respectfully. The dentist really has nothing to lose by asking, although you do need to judge how fragile the person is and whether there may be other psychological considerations at play.
Eon Engelbrecht (8:36)
Okay. And when it comes to the oral signs of anorexia, what else is there? Vitamin deficiency or dry mouth?
Dr Clifford Yudelman (8:45)
Anorexia is something completely different from bulimia. Anorexia is where you see people who become extremely underweight, sometimes to the point of looking very skeletal in advanced stages, which is heartbreaking to see. I don’t know as much about the psychological aspect, but these patients often still perceive themselves as overweight when they look in the mirror and want to lose more and more weight. Bulimia tends to be a condition that continues for years, involving overeating followed by purging, and there are different types. Anorexia is a completely different and more medically serious disease.
Common oral signs include dry mouth, dehydration, sometimes caused by medications, increased cavity risk, gum inflammation, delayed healing, ulceration, and vitamin deficiencies, especially B and C, which can cause sore gums, bleeding, and mucosal changes. People with anorexia can look quite sickly, almost as though they’re going through chemotherapy.
Bone density is also a concern. Very low bone density can affect the jawbone as well. The mouth reflects the whole system. This applies not only to people with clinical anorexia but also to people with extreme restrictive eating and very high exercise volume, who are sometimes described as borderline anorexic. They may look fit and toned, but they can have similar oral signs, and this is something we do see at the dental practice.
Eon Engelbrecht (10:52)
Sure, it’s quite heavy. Doctor, how do you restore teeth that have become thin and translucent from acid?
Dr Clifford Yudelman (11:00)
We focus on preserving what remains while protecting the teeth from further damage. Minimal intervention is critical, because the remaining enamel is very precious. Our first-line approach is adhesive composite bonding, particularly injection-moulded composite bonding. We’ve spoken about it a lot before. It restores thickness, protects the dentine, and improves aesthetics without aggressive drilling. In fact, there is no drilling at all.
In some cases on the back teeth we may use overlays, but veneers and crowns are rarely a first choice because they drill away more of the tooth. We prefer a staged rehabilitation rather than a full-mouth reconstruction. If someone has an active or recently active disorder, stabilisation always comes before any cosmetics. Restoring teeth without first addressing ongoing acid exposure simply leads to the restorations failing.
Eon Engelbrecht (12:11)
Okay. And is it safe to do cosmetic work while the eating disorder is still active?
Dr Clifford Yudelman (12:18)
We approach it differently. Ongoing acid exposure compromises the bonding, increases sensitivity, and accelerates the breakdown of restorations. The priority is protection and stabilisation. Temporary, protective restorations can be used. We can paint on a material called glass ionomer, which contains fluoride and bonds naturally to teeth, and which can actually strengthen the tooth surface. It’s a white filling material, but it isn’t as cosmetic as composite and can’t be polished to the same shine. There are ways to place it on the teeth to reduce further damage until the underlying issue is resolved, and then we can start rebuilding the teeth properly.
Eon Engelbrecht (13:09)
And doctor, how do we approach this sensitive topic with patients compassionately?
Dr Clifford Yudelman (13:16)
We started touching on this earlier. For someone who has never had this kind of conversation with a patient, I have a few tips.
Focus on the observed clinical findings rather than assumptions or labels. You can say, “I’m seeing a pattern of acid damage here that we often see with frequent acid exposure,” which invites discussion without accusation. Compassionate, non-judgemental communication builds trust.
The right approach depends on the age of the dentist, the age of the patient, and the situation. These days people are often quite direct, and if you beat around the bush, they may wonder what you’re getting at. I might be more direct and say, “I see a lot of wear on the back of your teeth. We usually see that in patients who vomit a lot. I’ve had patients with bulimia whose teeth looked exactly like yours. Could this be a factor?”
You’re talking about health concerns. You don’t want a patient to leave the practice without having raised it at least once. If you handle the discussion well, it increases the likelihood that they’ll seek help. Dentistry should be a safe space, not a place of fear or judgement.
Eon Engelbrecht (14:55)
So true. Doctor, what home care routines can protect enamel during recovery?
Dr Clifford Yudelman (15:04)
Neutralising acid after exposure, using a high-fluoride toothpaste, and brushing and spitting without rinsing so the toothpaste residue stays on the teeth. High-fluoride toothpastes can be hard to find in South Africa. There’s also a product called Tooth Mousse, which we’ve discussed before. You can put Tooth Mousse in a whitening tray or a medicament tray to support remineralisation.
Saliva support is critical. Sugar-free chewing gum stimulates saliva flow. There are fluoride varnishes, and the painted-on glass ionomer I mentioned earlier. Dietary advice is important too, to reduce additional acid exposure. If someone with bulimia is also eating a lot of lemons or other acidic foods, that compounds the problem. Cheese and healthy fats are more likely to help neutralise acid. It’s a complex situation, but your own dentist can help you save your teeth, so that when you do get through the underlying issue, as most people do with bulimia, you still have healthy teeth that won’t cost a fortune to maintain.
Eon Engelbrecht (16:27)
And can your salivary glands swell up, doctor? Chipmunk cheeks, so to speak, due to the purging?
Dr Clifford Yudelman (16:34)
Yes. Repeated vomiting can enlarge the parotid salivary glands, which are the ones in the lower cheeks, and that can cause facial swelling that looks a bit like chipmunk cheeks. It’s due to glandular irritation, inflammation, and altered salivary flow. The swelling often reduces when the purging stops, but chronic changes are possible. Salivary gland changes are another sign that an oral health professional may notice early, which reinforces the value of regular dental assessment. To be honest, I’ve never personally seen this in 43 years of practice, but I’ve read about it many times in the literature.
Eon Engelbrecht (17:30)
I think the only chipmunk cheeks I can think of are when you’ve had your wisdom teeth removed.
Dr Clifford Yudelman (17:37)
Yes, 100 per cent. Then you’re guaranteed chipmunk cheeks.
Eon Engelbrecht (17:41)
Yes, awesome. Well, that was Dr Clifford Yudelman from OptiSmile, once again sharing some really valuable insights into how eating disorders can affect your oral health, and why early support and understanding matters so much. Dr Yudelman, thank you so much once again.
Dr Clifford Yudelman (18:00)
Thank you, and it’s great to chat to you. I’m looking forward to speaking to you next time.
Eon Engelbrecht (18:08)
Absolutely. I think the big message from today’s conversation is simple. The mouth can reveal important signs of what is happening in the rest of the body, and dental care should always be approached with compassion, not judgement, as Dr Yudelman said. To learn more or to book an appointment, visit OptiSmile.co.za. Like and subscribe. Thanks for listening to Save Your Money, Save Your Teeth, and we’ll catch you again next time.
Omroeper (18:55)
Ontdek de wereld van tandheelkundige uitmuntendheid met OptiSmile. Neem deel aan een wekelijkse podcast met dr. Clifford Yudelman, een doorgewinterde expert met 40 jaar tandheelkundige ervaring op vier continenten. Verkrijg unieke inzichten en deskundig tandheelkundig advies door naar OptiSmile.co.za te gaan voor artikelen die het pad naar een optimale mondgezondheid belichten. Als u op zoek bent naar ongeëvenaarde tandheelkundige zorg in Kaapstad, neem dan contact op met OptiSmile of boek direct online op OptiSmile.co.za. OptiSmile, waar mondiale expertise en lokale zorg samenkomen.
Disclaimer: de inhoud in deze podcast, “Bespaar je geld, bespaar je tanden” op medische maandagen, is uitsluitend bedoeld voor informatieve en educatieve doeleinden. Het is niet bedoeld als tandheelkundig of medisch advies. De inzichten en meningen van Dr. Clifford Yudelman en eventuele gasten zijn bedoeld om een beter begrip van de tandheelkundige gezondheid, preventieve maatregelen en algemeen welzijn te bevorderen, maar mogen niet worden geïnterpreteerd als professionele tandheelkundige of medische aanbevelingen.Dr. Clifford Yudelman diagnosticeert, behandelt of biedt geen preventiestrategieën aan voor gezondheidsproblemen rechtstreeks via deze podcast. Dit platform is geen vervanging voor de persoonlijke zorg en het advies van een erkende tandarts of gezondheidszorgprofessional. We moedigen onze luisteraars sterk aan om hun eigen tandheelkundige zorgverleners te raadplegen om individuele tandheelkundige zorgbehoeften en -problemen aan te pakken. De hier gedeelde informatie is bedoeld om luisteraars te voorzien van kennis over tandheelkundige gezondheid, maar mag niet worden gebruikt als basis voor het nemen van gezondheidsgerelateerde beslissingen zonder professionele begeleiding. Uw tandheelkundige zorgverlener is de beste bron van advies over uw tandheelkundige en algehele gezondheid. Vraag altijd advies aan uw tandarts of andere gekwalificeerde zorgverleners als u vragen of zorgen heeft over de gezondheid van uw gebit.
