About Mark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present Clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Question Dear Dr. Bornfeld,
I'm a male (27 yrs old) and have been suffering from bulimia for about seven years. Needless to say my teeth are a mess. I have already lost three teeth from erosion. The fillings came off, root got infected, it hurt like hell but I didn't go to a dentist (couldn't afford). The pain gradually disspidated but the teeth broke apart to the point where only the roots are left. Now I have another two teeth requiring root canal treatment but this time I decided to go to the dentist. Naturally, being a straight guy I'm embarassed to death to admit to being a bulimic, so I told the dentist I suffer from gastroesophageal reflux disease, which I guess she bought (I don't use fingers or anything to induce vomiting). She adviced I get all my teeth crowned, which financially is out of the question. What I'd like to know is the following:
- I'm working on overcoming my eating disorder but I relapse a lot. What can I do to lessen the damage done to my teeth? Right now I just rinse my mouth with water and sodium bicarbonate (after purging), wait a while then brush and floss.
- If I put bridges to cover the gap left by the missing teeth, are they going to always stay in place or could they soon fall off with repeated exposure to gastric acid? What about crowns?
- Any other advice you could give me would be deeply appreciated.
Many thanks,
Ken
Answer Dear Ken,
Your current strategy of rinsing with sodium bicarbonate solution after purging is rational. By alkalinizing the mouth, you will limit the amount of additional acid demineralization of your teeth. However, the magnitude of your tooth erosion as you describe it suggests that much of the softer dentin has already been exposed by the loss of your tooth enamel. This will make your teeth increasingly vulnerable to mechanical wear. You will need to pay special attention to the way you clean your teeth, so as not to inflict excessive abrasion. Take care that you are using a soft-bristled toothbrush, and an ADA-approved toothpaste (these toothpastes have demonstrated to the ADA's satisfaction that they are not excessively abrasive), and apply scrupulous oral hygiene so as to prevent decay, which tends to progress rapidly in acid-softened teeth. Also examine your dietary habits, and avoid frequent consumption of those foodstuffs that are excessively acidic (vinegar, citrus, and artificially acidified beverages such as colas and fruit drinks).
Also be aware that although your claim of GERD was a fabrication, it does not mean that spontaneous acid reflux is not a problem. Long-term purging can weaken the lower esophageal sphincter, leading to reflux esophagitis and tooth erosion. This is something to investigate when you present to your physician for your next physical examination.
As far as crowns or fixed bridges are concerned, they are the only reliable way of protecting your teeth from continued chemical and mechanical wear. Crowns will not be affected by either gastric or dietary acids. However, nothing "always stays in place", as you put it, and to expect permanence from almost anything is not realistic. However, there is nothing else that dentistry has to offer that will be as valuable in the effort to save your teeth.
Hope this helps...
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
