EPISODE · May 4, 2026 · 19 MIN
The OPTISMILE Podcast 106 - Eating Disorders and Oral Health
from eRadio SA
Eating disorders often reveal themselves in the mouth before anyone else notices. In this episode, Dr Clifford Yudelman from OptiSmile discusses the dental signs associated with bulimia and anorexia, explains why stomach acid can erode enamel far more rapidly than dietary acids, and outlines what dentists look for during an examination. He also talks about compassionate communication, protective home care during recovery, and minimally invasive ways of restoring teeth damaged by acid exposure. The conversation is reassuring for anyone who has worried about the state of their teeth after struggling with disordered eating, and useful for parents, siblings, and friends who want to understand what oral signs to be aware of.10 Questions with Summary Answers1. [1:25] How does bulimia specifically damage the teeth compared to regular acid reflux?Stomach acid has a pH close to 1, far more acidic than lemon juice or cola. Unlike reflux, which tends to affect the back of the throat intermittently, bulimic vomiting brings acid forcefully and repeatedly into contact with the teeth themselves. The result is a distinctive smooth, glassy erosion on the inside surfaces of the upper front teeth, with thinning enamel and increasing translucency. Over time it can expose dentine, cause sensitivity, and lead to fractures. Dr Yudelman also notes that in many patients the perceived damage is worse than the actual damage, so there is no need to avoid the dentist out of shame.2. [5:04] What is perimolysis, and why does it appear on the back of the upper teeth?Perimolysis is the specific pattern of enamel erosion on the back surfaces of the upper front teeth caused by stomach acid. Because the tongue tends to protect the lower teeth during vomiting, the upper teeth take the brunt of the acid. Under magnification, perimolysis looks like enamel that has been polished away, as though someone has filed the back of the teeth down.3. [5:43] Why should patients never brush their teeth immediately after vomiting?Acid softens the enamel temporarily, and brushing a softened surface wears it away rather than cleaning it. The same principle applies to morning sickness during pregnancy. Instead, rinse gently with water, or water with a little bicarbonate of soda to neutralise the acid, and wait 30 to 60 minutes before brushing. Chewing sugar-free gum in the meantime helps saliva remineralise the surface.4. [6:51] How can a dentist spot the signs of an eating disorder before anyone else does?Dentists often see the physical signs before a doctor, a parent, or even before the patient has talked to anyone about it. The pattern of perimolysis, rapid enamel thinning, unusual sensitivity, and a high cavity rate in someone with otherwise good oral hygiene are strong clues. The dentist's role is not to diagnose the eating disorder itself, but to recognise the oral signs and open a compassionate conversation that may lead to the patient seeking help.5. [8:36] What are the oral signs of anorexia, such as vitamin deficiency or dry mouth?Anorexia and bulimia are very different conditions, and anorexia tends to be more medically serious. Common oral signs include dry mouth, dehydration, increased cavity risk, gum inflammation, delayed healing, ulceration, and vitamin B and C deficiencies producing sore or bleeding gums. Low bone density can also affect the jawbone. The mouth often reflects what is happening systemically, which also applies to people who are not clinically anorexic but who eat very restrictively and exercise excessively.6. [10:52] How do you restore teeth that have become thin and translucent from acid?The priority is preserving whatever enamel remains. The first-line treatment is typically adhesive composite bonding, especially injection-moulded composite bonding, which restores thickness, protects the dentine, and improves appearance without drilling. On back teeth, overlays may be needed in some cases. Veneers and crowns are rarely the first choice because they require removing more tooth. If the disorder is still active, stabilising protection always comes before cosmetic restoration.7. [12:11] Is it safe to do cosmetic work while an eating disorder is still active?Generally no, because ongoing acid exposure compromises bonding and accelerates the breakdown of restorations. In this situation the focus should be on protection and stabilisation. Temporary and protective materials such as glass ionomer, which contains fluoride and bonds naturally to the teeth, can be painted on to reduce further damage. These are less cosmetic than composite, but they buy time until the underlying condition is resolved.8. [13:09] How do you approach this sensitive topic with patients compassionately?By focusing on clinical findings rather than assumptions. Saying something like, "I'm seeing a pattern of acid damage that we usually see with frequent acid exposure," opens the conversation without judgement. Compassionate, non-judgemental communication builds trust. Dentistry should feel like a safe space. Letting a patient leave the practice without raising a clear clinical observation is a missed opportunity to help.9. [14:55] What home care routines can protect enamel during recovery?Neutralise acid after exposure with water or a small amount of bicarbonate of soda, use a high-fluoride toothpaste, and brush and spit without rinsing so the fluoride stays on the teeth. Tooth Mousse applied in a tray helps remineralise. Sugar-free chewing gum supports saliva flow. Fluoride varnishes and glass ionomer applied by the dentist add extra protection. Cheese and other dairy foods help neutralise acid in the diet.10. [16:27] Can salivary glands swell up, causing so-called chipmunk cheeks?Repeated vomiting can enlarge the parotid salivary glands in the lower cheeks, causing noticeable facial swelling from glandular irritation and altered salivary flow. Swelling may reduce when the behaviour stops, but chronic changes are possible. Dr Yudelman notes that while he has read extensively about it, he has not personally seen this in more than four decades of practice, suggesting that it tends to occur in more advanced cases than he typically treats.OutroThe biggest message from this conversation is that the mouth often reflects what is happening in the rest of the body, and a dentist can sometimes be the first person to notice what is going on. Dental care for people who have struggled with disordered eating should always be approached with compassion and without judgement. It is also worth knowing that many patients worry more about the state of their teeth than is actually warranted, and that even when damage has occurred, modern minimally invasive dentistry can usually restore function and appearance without aggressive treatment. If you are unsure about the condition of your teeth, a confidential checkup is always a good place to start. To learn more or to book an appointment, visit OptiSmile.co.za.Further ResourcesEpisode 73: Acid Reflux and Tooth Erosion (Podcast)https://optismile.co.za/blog/acid-reflux-tooth-erosion/The closest companion episode to this one, covering how stomach acid reaches the teeth and what it does to enamel over time.Episode 10: The Secrets of Tooth Sensitivity (Podcast)https://optismile.co.za/blog/secrets-of-tooth-sensitivity-and-cost-saving-dental-care/Useful follow-up listening on why teeth become sensitive when enamel thins and dentine is exposed, and what can be done about it.Injection Moulded Composite Bonding and Veneershttps://optismile.co.za/dental-solutions/injection-moulding-technique/The minimally invasive, no-drill technique Dr Yudelman describes as the first-line approach for rebuilding teeth worn thin by acid erosion.What You Need to Know About Dental Bondinghttps://optismile.co.za/blog/what-you-need-to-know-about-dental-bonding/Background on how composite bonding works in practice, including how it can restore the appearance and function of eroded front teeth.Dental Checkups in Cape Townhttps://optismile.co.za/dental-solutions/dental-checkup/What to expect at a confidential OptiSmile dental checkup, including how enamel erosion and early damage are identified.Book a Confidential Consultation at OptiSmilehttps://optismile.co.za/If you have concerns about your teeth, a no-judgement assessment is the first step to protecting what enamel remains and planning for gradual restoration.Disclaimer: The content provided in this podcast, "Save Your Money Save Your Teeth" on Medical Mondays, is for informational and educational purposes only. It is not intended to serve as dental or medical advice. The insights and opinions expressed by Dr. Clifford Yudelman and any guests are designed to foster a better understanding of dental health, preventive measures, and general well-being, but should not be interpreted as professional dental or medical recommendations. Dr. Clifford Yudelman does not diagnose, treat, or offer prevention strategies for any health conditions directly through this podcast. This platform is not a substitute for the personalized care and advice provided by a licensed dental or healthcare professional. We strongly encourage our listeners to consult with their own dental care providers to address individual dental health needs and concerns. The information shared here aims to empower listeners with knowledge about dental health but must not be used as a basis for making health-related decisions without professional guidance. Your dental care provider is the best source of advice about your dental and overall health. Please always seek the advice of your dentist or other qualified health professionals regarding any questions or concerns about your dental health.
What this episode covers
Eating disorders often reveal themselves in the mouth before anyone else notices. In this episode, Dr Clifford Yudelman from OptiSmile discusses the dental signs associated with bulimia and anorexia, explains why stomach acid can erode enamel far more rapidly than dietary acids, and outlines what dentists look for during an examination. He also talks about compassionate communication, protective home care during recovery, and minimally invasive ways of restoring teeth damaged by acid exposure. The conversation is reassuring for anyone who has worried about the state of their teeth after struggling with disordered eating, and useful for parents, siblings, and friends who want to understand what oral signs to be aware of.10 Questions with Summary Answers1. [1:25] How does bulimia specifically damage the teeth compared to regular acid reflux?Stomach acid has a pH close to 1, far more acidic than lemon juice or cola. Unlike reflux, which tends to affect the back of the throat intermittently, bulimic vomiting brings acid forcefully and repeatedly into contact with the teeth themselves. The result is a distinctive smooth, glassy erosion on the inside surfaces of the upper front teeth, with thinning enamel and increasing translucency. Over time it can expose dentine, cause sensitivity, and lead to fractures. Dr Yudelman also notes that in many patients the perceived damage is worse than the actual damage, so there is no need to avoid the dentist out of shame.2. [5:04] What is perimolysis, and why does it appear on the back of the upper teeth?Perimolysis is the specific pattern of enamel erosion on the back surfaces of the upper front teeth caused by stomach acid. Because the tongue tends to protect the lower teeth during vomiting, the upper teeth take the brunt of the acid. Under magnification, perimolysis looks like enamel that has been polished away, as though someone has filed the back of the teeth down.3. [5:43] Why should patients never brush their teeth immediately after vomiting?Acid softens the enamel temporarily, and brushing a softened surface wears it away rather than cleaning it. The same principle applies to morning sickness during pregnancy. Instead, rinse gently with water, or water with a little bicarbonate of soda to neutralise the acid, and wait 30 to 60 minutes before brushing. Chewing sugar-free gum in the meantime helps saliva remineralise the surface.4. [6:51] How can a dentist spot the signs of an eating disorder before anyone else does?Dentists often see the physical signs before a doctor, a parent, or even before the patient has talked to anyone about it. The pattern of perimolysis, rapid enamel thinning, unusual sensitivity, and a high cavity rate in someone with otherwise good oral hygiene are strong clues. The dentist's role is not to diagnose the eating disorder itself, but to recognise the oral signs and open a compassionate conversation that may lead to the patient seeking help.5. [8:36] What are the oral signs of anorexia, such as vitamin deficiency or dry mouth?Anorexia and bulimia are very different conditions, and anorexia tends to be more medically serious. Common oral signs include dry mouth, dehydration, increased cavity risk, gum inflammation, delayed healing, ulceration, and vitamin B and C deficiencies producing sore or bleeding gums. Low bone density can also affect the jawbone. The mouth often reflects what is happening systemically, which also applies to people who are not clinically anorexic but who eat very restrictively and exercise excessively.6. [10:52] How do you restore teeth that have become thin and translucent from acid?The priority is preserving whatever enamel remains. The first-line treatment is typically adhesive composite bonding, especially injection-moulded composite bonding, which restores thickness, protects the dentine, and improves appearance without drilling. On back teeth, overlays may be needed in some cases. Veneers and crowns are rarely the first choice because they require removing more tooth. If the disorder is still active, stabilising protection always comes before cosmetic restoration.7. [12:11] Is it safe to do cosmetic work while an eating disorder is still active?Generally no, because ongoing acid exposure compromises bonding and accelerates the breakdown of restorations. In this situation the focus should be on protection and stabilisation. Temporary and protective materials such as glass ionomer, which contains fluoride and bonds naturally to the teeth, can be painted on to reduce further damage. These are less cosmetic than composite, but they buy time until the underlying condition is resolved.8. [13:09] How do you approach this sensitive topic with patients compassionately?By focusing on clinical findings rather than assumptions. Saying something like, "I'm seeing a pattern of acid damage that we usually see with frequent acid exposure," opens the conversation without judgement. Compassionate, non-judgemental communication builds trust. Dentistry should feel like a safe space. Letting a patient leave the practice without raising a clear clinical observation is a missed opportunity to help.9. [14:55] What home care routines can protect enamel during recovery?Neutralise acid after exposure with water or a small amount of bicarbonate of soda, use a high-fluoride toothpaste, and brush and spit without rinsing so the fluoride stays on the teeth. Tooth Mousse applied in a tray helps remineralise. Sugar-free chewing gum supports saliva flow. Fluoride varnishes and glass ionomer applied by the dentist add extra protection. Cheese and other dairy foods help neutralise acid in the diet.10. [16:27] Can salivary glands swell up, causing so-called chipmunk cheeks?Repeated vomiting can enlarge the parotid salivary glands in the lower cheeks, causing noticeable facial swelling from glandular irritation and altered salivary flow. Swelling may reduce when the behaviour stops, but chronic changes are possible. Dr Yudelman notes that while he has read extensively about it, he has not personally seen this in more than four decades of practice, suggesting that it tends to occur in more advanced cases than he typically treats.OutroThe biggest message from this conversation is that the mouth often reflects what is happening in the rest of the body, and a dentist can sometimes be the first person to notice what is going on. Dental care for people who have struggled with disordered eating should always be approached with compassion and without judgement. It is also worth knowing that many patients worry more about the state of their teeth than is actually warranted, and that even when damage has occurred, modern minimally invasive dentistry can usually restore function and appearance without aggressive treatment. If you are unsure about the condition of your teeth, a confidential checkup is always a good place to start. To learn more or to book an appointment, visit OptiSmile.co.za.Further ResourcesEpisode 73: Acid Reflux and Tooth Erosion (Podcast)https://optismile.co.za/blog/acid-reflux-tooth-erosion/The closest companion episode to this one, covering how stomach acid reaches the teeth and what it does to enamel over time.Episode 10: The Secrets of Tooth Sensitivity (Podcast)https://optismile.co.za/blog/secrets-of-tooth-sensitivity-and-cost-saving-dental-care/Useful follow-up listening on why teeth become sensitive when enamel thins and dentine is exposed, and what can be done about it.Injection Moulded Composite Bonding and Veneershttps://optismile.co.za/dental-solutions/injection-moulding-technique/The minimally invasive, no-drill technique Dr Yudelman describes as the first-line approach for rebuilding teeth worn thin by acid erosion.What You Need to Know About Dental Bondinghttps://optismile.co.za/blog/what-you-need-to-know-about-dental-bonding/Background on how composite bonding works in practice, including how it can restore the appearance and function of eroded front teeth.Dental Checkups in Cape Townhttps://optismile.co.za/dental-solutions/dental-checkup/What to expect at a confidential OptiSmile dental checkup, including how enamel erosion and early damage are identified.Book a Confidential Consultation at OptiSmilehttps://optismile.co.za/If you have concerns about your teeth, a no-judgement assessment is the first step to protecting what enamel remains and planning for gradual restoration.Disclaimer: The content provided in this podcast, "Save Your Money Save Your Teeth" on Medical Mondays, is for informational and educational purposes only. It is not intended to serve as dental or medical advice. The insights and opinions expressed by Dr. Clifford Yudelman and any guests are designed to foster a better understanding of dental health, preventive measures, and general well-being, but should not be interpreted as professional dental or medical recommendations. Dr. Clifford Yudelman does not diagnose, treat, or offer prevention strategies for any health conditions directly through this podcast. This platform is not a substitute for the personalized care and advice provided by a licensed dental or healthcare professional. We strongly encourage our listeners to consult with their own dental care providers to address individual dental health needs and concerns. The information shared here aims to empower listeners with knowledge about dental health but must not be used as a basis for making health-related decisions without professional guidance. Your dental care provider is the best source of advice about your dental and overall health. Please always seek the advice of your dentist or other qualified health professionals regarding any questions or concerns about your dental health.
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The OPTISMILE Podcast 106 - Eating Disorders and Oral Health
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