Smiling from the Inside Out: Restoring a Smile After an Eating Disorder

by Susan McMahon, DMD

chairside@glidewelldental.com

Treating patients with teeth ravaged by the effects of eating disorders requires a level of care and consultation beyond what is necessary for almost any other presenting dental scenario. It would clearly be counterproductive to restore the smile of someone still struggling with bulimia because the continued purging would destroy new restorations as completely as it did the patient’s natural teeth. But how can dentists be certain their patient’s struggles with purging are no longer present? How can we address the shame and secrecy that so commonly accompany these patients?

I was fortunate with Peggy. It was clear from our first consultation that she had freed herself from the grasp of anorexia and bulimia, and was well on her way to achieving optimal health. She spoke with focused intention about being ready to have her teeth fixed and “feel whole again.” This is not common. More typically, such consultations require careful questioning, asking if perhaps the client is experiencing digestive problems like acid reflux or GERD, and even those questions often can’t compete with the shame-driven evasiveness of a patient with an eating disorder.

Peggy’s teeth told a devastating story. Repeated exposure to highly corrosive stomach acids had almost completely stripped the palatal side of her upper teeth of their enamel and shortened their length. After some consultation, we decided together that a full-arch reconstruction of her maxillary teeth was the best option.

Figure 1a

Figure 1a, 1b: Peggy presented with teeth badly misshapen and damaged by the effects of bul

Figure 2: As is evident in this view of her upper arch, the repeated purging of stomach contents had stripped away enamel from the palatal of Peggy’s teeth. Further decay around existing fillings was visible as well.

Figure 3: Effectively restoring Peggy’s smile required elongating her teeth. Here you can see the patient’s preoperative teeth through the prep guide and the length to which I elected to extend them.

Figure 4a

Figures 4a, 4b: Peggy’s teeth were prepared for full-coverage BruxZir® Esthetic Solid Zirconia restorations. Note the rounded preps and chamfer margins. The prep shade was recorded, and the horizontal and midline records were taken for the lab.

Figure 5a

Figure 5b

Figures 5a–5c: Peggy’s temporaries gave us a glimpse of just how astonishing her restored smile would be. She and I evaluated the look and function of her temporaries, and the provisionals were then used as a prototype for the restorations fabricated by Glidewell.

Figure 6a

Figures 6a, 6b: The CAD image of the patient’s final restorations, and the finished BruxZir Esthetic crowns.

Figure 7a

Figure 7b

Figures 7a–7c: Before and after images illustrate how remarkably the BruxZir Esthetic crowns renewed Peggy’s smile, elevating it to match the new quality of life she now enjoys with her bulimia behind her.

Peggy’s presenting smile was the manifestation of the pain and trauma created by her eating disorder. Today she smiles often and freely, secure in the knowledge that her disorder no longer haunts her and that her new look is indicative of the joy she feels each day. CM