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Pathology · single question

In a patient with bulimia nervosa, dental erosion is characteristically seen in all of the following locations EXCEPT:

  1. The lingual surfaces of the mandibular anterior teeth
  2. The occlusal surfaces of the posterior teeth
  3. The palatal surfaces of the maxillary posterior teeth
  4. The palatal surfaces of the maxillary anterior teeth
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Correct answer: A. The lingual surfaces of the mandibular anterior teeth

  • A. ✅ CORRECT — This is the EXCEPTION. The MANDIBULAR ANTERIOR LINGUAL surfaces are the most PROTECTED area in the mouth: the tongue covers them during vomiting, and the submandibular and sublingual duct openings bathe them in buffering saliva. Erosion here is characteristically absent.
  • B. ❌ Posterior occlusal surfaces show erosion with cupping of the cusps and amalgam restorations standing proud of the dissolved enamel.
  • C. ❌ Maxillary posterior palatal surfaces are affected as the regurgitant flows over them.
  • D. ❌ The maxillary anterior palatal surfaces are the classic site — 'perimolysis'. Gastric acid pools against them.

Note: This is a sensitive area of practice — dentists are often the first to detect it. Management includes gentle, non-judgmental conversation, referral for medical and psychological care, fluoride, and advising a bicarbonate rinse (NOT brushing) after an episode.

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