Ask the Gentle Dentist-Bulimia and its affect on oral and systemic health

And Burning mouth syndrome

Bulimia or Bulimia nervosa is a psychological eating disorder that usually affects women starting in the teen years and continuing into adulthood.  Bulimia is a condition where a person overeats with large quantities of food. They usually feel that they cannot stop eating or control what and how much they eat.  To compensate for their overeating and potential weight gain they will then purge by self induced vomiting.  Over exercising and the use of laxatives is also common to avoid weight gain.  These women usually have an inaccurate view of their bodies and are influenced by the gaunt look that is popular in fashion and culture.

This disorder can exist in a constant cycle from a few times per week to even daily. Common problems that bulimics face is gastric reflux (heart burn), esophagus inflammation, dehydration, constipation and oral trauma from sticking a finger down the throat.

The upper front teeth are severely worn down due to the fact that strong acid from the stomach passes across the teeth surface, eroding the enamel from the teeth.  The wear is caused mostly by tooth brushing after one of these episodes as it microscopically breaks down the fragile matrix in the enamel.  Teeth can appear very thin, uneven and tattered on the edges.  They may even appear dark on the edges where light shines through them.

Treatment for bulimia consists of psychological therapy to help these people get over the habit and to create a better self image of themselves.

If they are in therapy we as dentists want to also stop the effect it has on the teeth.  I have made thin plastic trays like bleaching trays that go over the teeth.  The patient fills them with fluoridate to remineralize the teeth.  Porcelain dental veneers also help to rebuild the areas that have the erosion of enamel.

Bulimics are very quiet and discrete in what they do, but if you notice that the one you love seems to overeat and then dismiss themselves from the meal you might be direct and lovingly confront them.  Tell them that you noticed a change in their behavior and that you have concerns about their health.  The affected individual needs to know they are loved and matter.

A well informed and observant dentist can see the effects from constant purging when examining the teeth.  If you are making an appointment for the teenager you suspect to may be wise to discretely give the dentist a heads up to take notice if there are any changes in the appearance of the upper front teeth.  Many times the message is received more openly if it comes from a dentist or dental hygienist rather than from a family member. I have diagnosed a few young women who had this disorder and the way we handled it was critically important to letting the patient know the damage they are doing to their bodies and teeth and that they matter.  It really takes a lot of time to effectively talk to a practicing bulimic and not have them get defensive, yet get the message across.

If you suspect that your wife or daughter is practicing this, you can give me a call to discuss the situation.  We can be the objective observer and direct their treatment accordingly.  We have a psychologist we work with to help treat the bulimia.  Our phone number is 586-247-3500 or you can email me privately at

Question: I have had a burning tongue for the last 6 months or so and don’t know what to do about it.  I am a 60 year old female and wonder what it caused from.  Could you please provide some information for me to treat this irritating and painful situation

Answer: If you have a perfectly normal looking tongue, but as the day wears on, the burning sometimes seems to progress. You may even experience some tastes that have no apparent cause. If you are having these mysterious and irritating sensations, you may be suffering from burning tongue syndrome, also known as burning mouth.

Causes and Possible Solutions

Although burning tongue is not a common condition, sufferers are generally older women. Only about four or five percent of American adults suffer from it. It’s not known exactly what causes the condition, although there are many factors. In some cases, more than one cause may be at work.

Sometimes the cause is as simple as irritation from various sources. One culprit may be your toothpaste or mouth rinse. To test this, switch toothpastes to a plain fluoride toothpaste, without any tartar-control or tooth-whitening ingredients. Also, stop using any mouth rinses except plain water or salt water. If you wear dentures or other oral appliances, they may be irritating to mouth tissues and contributing to burning mouth. If you suspect this, let us know right away so we can check them out and adjust them as necessary. Another source of irritation is acidic drinks, like soda pop, citrus, and tomato beverages. Try eliminating them from your diet, and see if your symptoms improve.

Certain hormone-related conditions can also be causes. Fluctuating hormone levels during menopause can lead to burning mouth, and the high blood sugar levels that occur with diabetes can also be irritating to oral tissues. Managing these conditions can sometimes help relieve burning mouth symptoms.

Another thing to consider is medications that you may have begun taking at about the time your symptoms began. Some drugs can cause burning tongue as a side effect.  Blood pressure medications,  antidepressants and diuretics can cause dry mouth, which can lead to a burning sensation. Talking with your physician about changing medications may do the trick.

There is some speculation that burning mouth syndrome is caused by damage or irritation to the nerves that control taste and sensation on the tongue and mouth. Some medications for controlling the nervous system, such as antidepressants, anticonvulsants, or pain medications, can help. Your physician may be able to prescribe these for you after a thorough exam.

Some people have experienced relief by rinsing their mouths with water and capsaicin (sometimes called capsicum). Capsaicin is the ingredient that makes hot peppers hot, and it’s used in pain-relief creams meant for treating nerve and muscle pain. You can try mixing about one part hot sauce with two or three parts water, rinsing your mouth with the mixture, and then spitting it out. Start by doing this every two or three hours for the first day or two, then tapering off to once or twice a day. Rinsing with this mixture will probably cause a burning sensation, and it’s thought that this burning temporarily interferes with the body chemicals that transmit pain messages. If you try this, though, be very careful. Once you get out the hot sauce and start working with it, don’t touch your nose or eyes until you’ve spit the mixture out and washed your hands thoroughly. Also, some people are sensitive to capsaicin, so if the burning is severe, stop using it immediately.

There are some other coping methods that may bring relief. If you drink alcoholic products or smoke, try to stop because these both irritate and dry out oral tissues. Avoid cinnamon and mint products. Chewing sugar-free gum or sucking on sugar-free candies or ice chips might also help. Vitamin deficiencies can be a contributing factor, so try taking a multivitamin supplement if you’re not doing that already.

If you’re suffering from burning in your mouth, let us know. We’ll want to check your mouth for sores, irritations, or other conditions that might be causing the pain. In some cases, we may want to work with your physician in determining the best course of treatment for you.

Dr. Antolak can be reached at or call the office at (586)247-3500. If you have any questions that you would like answered you can do it also by writing at Ask The Dentist  15055 22 Mile #2, Shelby Twp. Michigan  48315 (Macomb County)