In bulimia, which factor in the mouth is primarily responsible for enamel erosion?

• A. Vitamin deficiency
• B. Ingestion of acidic foods
• C. Stomach acid from vomiting
• D. Lack of brushing

Answer: (C)

Enamel erosion in bulimia is caused by exposure to stomach acid during vomiting. Gastric juice is highly acidic, with a very low pH, and its hydrochloric acid rapidly dissolves the mineral content of enamel. Each vomiting episode can coat the front teeth, especially the palatal surfaces of the upper teeth, leading to smooth, shiny lesions and sensitivity as the enamel wears away. Over time, repeated exposure overwhelms the mouth’s natural buffering from saliva, so the damage accumulates.

Other factors may contribute in different ways, but they are not the primary cause in this situation. Vitamin deficiencies can affect mucosal health and overall oral condition, acidic foods can contribute to erosion but are not the defining factor in bulimia-related enamel loss, and not brushing mainly increases plaque or surface staining rather than the acid-driven dissolution seen with gastric juice.