Eating disorders such as bulimia, and to some extent, anorexia, can go undiagnosed for years, especially when the person does not seek medical treatment. Both illnesses are characterized by a distorted self-image that changes how the person sees herself and feels about her body and its relationship with food. With anorexia nervosa, the person has such an unrealistic and obsessive fear of gaining weight that she refuses to eat and can eventually starve to death. Anorexia has the highest mortality rate of all mental illnesses. Of the two major types of eating disorders, it is also the easiest for friends and family to detect, especially in cases where there is severe weight loss. In a typical case of bulimia nervosa, the person binges on food and later purges (vomiting, laxatives, diuretics) in order to avoid weight gain. Since a bulimic’s weight may actually stay the same, it is harder to detect. Although those suffering from eating disorders often resist regular doctor appointments in an attempt to avoid detection of their illness, medical doctors are not the only professionals in a position to help. For decades dentists have been instrumental in detecting illnesses such as cancer and heart disease in their patients, especially in cases where the illness has affected the teeth, tongue, gums or the ability to clot. Now, dentists are playing a role in detecting eating disorders such as bulimia and anorexia as many of the early signs of eating disorders appear in the mouth. The repetitive, self-induced vomiting that is characteristic of many bulimics and even a few anorexia patients causes the damaging stomach acid to pool in the mouth and erode tooth enamel. In fact, brushing the teeth directly after vomiting can increase the damage because the acid is actually being forced into the pits and crevices of an individual tooth. Symptoms such as dry mouth, enlarged saliva glands (that lead to swollen cheeks), tooth sensitivity and erosion and an increase in cavities often put a dentist on notice that his patient may have an eating disorder. An unusually high number of cavities over a short period of time, especially in a patient not typically prone to cavities, is often a very strong indicator of bulimia as bulimics tend to gorge and purge on high-calorie, sugary foods. The sugars can actually increase the acidity of saliva in the mouth, even when the patient has not purged. When purging does occur, the amount of corrosive acid is intensified. In severe eating disorder cases, nerves in the teeth can be exposed to the air causing an infection, discoloration or even tooth death or tooth loss. A dentist will have to repair this damage using costly treatments such as the installation of crowns or veneers. A dentist who notices the symptoms of an eating disorder should discuss his concerns with the patient in an unthreatening and non-confrontational manner. In an ideal situation, the dentist will work with the patient’s internal medicine doctor so that the dentist can be aggressive in handling the symptoms of the eating disorder in order to avoid additional emotional trauma related to changes in the physical appearance of the teeth and gums. If you suffer from an eating disorder such as anorexia or bulimia, you should notify your dentist so that proactive steps can be taken to protect the integrity of your teeth and reduce the risk that cosmetic intervention would be needed in the future.