TMJ 'dysfunction' - Health implications

Bulimia nervosa is supposed to be a psychiatric problem that takes the form of over eating and purging by self induced vomiting. The condition usually begins in the late teens (coincidental upon the time a child needs or is having corrective orthodontic treatment) but can also occur earlier. Bulimia is often linked with anorexia. It is mainly a condition that affects females, one in ten bulimics are male.

Experience shows that many patients needing TMJ treatment have Bulimia as one of the symptoms. In less severe cases it disappears fairly rapidly after proper symmetry treatment is instituted. Others may take longer but eventually all patients seem to recover.

Patients often present with severe attrition of the teeth. This observation is very real for the patient but convention has it that psychiatric care is needed and any attention to the teeth is only undertaken because of the severe sensitivity which develops from constant vomiting as in the next photograph.

Please note the severe attrition on the biting edge of the teeth. The erosion on the palatal surfaces is because of vomiting out partly digested acidic food.


Bulimia can cause very serious dental problems, and the longer the condition exists the worse the problem will be. The frequent vomiting that occurs with bulimics can cause the enamel on teeth to wear down over time, resulting in tooth decay, tooth loss, and gum disease. The damage is most obvious on the palatal surfaces of upper teeth which get affected by the acidic projectile vomiting.

Bulimics are advised not to brush their teeth immediately after purging. Enamel softens within the first 10 seconds. Holding a bit of milk in the mouth immediately afterwards within seconds of contact with the gastric acid will lessen the damage and help remineralise the tooth.

The consequences for a bulimic's teeth can be severe and loss of teeth further imperils their health. Tooth erosion can occur over a very short space of time if purging is frequent.

A complete dental plan including dental restorations using crowns and composite resins for damaged teeth has to be undertaken together with jaw correction.

Before the psychiatrists condemn these patients into psychiatric care they must examine their teeth and refer them to an appropriate dentist. It is criminal not to do so.