La cantidad de bibliografía es extraordinariamente escasa en este tema de inquietud creciente. Los efectos más relevantes sobre la cavidad bucal producidos por la Bulimia (vómitos inducidos en pacientes preferentemente jóvenes, con predominancia del sexo femenino, generalmente asociada a la Anorexia Nerviosa o Nervosa) son: Erosión de las piezas dentarias mayormente expuestas a los fluídos ácidos provenientes del estómago en el momento del vómito, (particularmente las caras palatinas del grupo anterosuperior) aumento en la incidencia de caries por la presencia de una mayor acidez en el medio, pero, principalmente por una disminución del flujo salival, este hecho se encuentra completamente demostrado, sin embargo, no existe una etiología consistente para explicar su fisiopatología. Esto último, puede ser de particular ayuda en el diagnóstico.
Consulte por antecedentes de anorexia, vómitos, disminución en la cantidad de saliva…. Haga una interconsulta con el Psiquiatra (o Psicólogo) tratante si lo hay. Un diagnóstico a tiempo puede mejorar el pronóstico en la rehabilitación del paciente.
Dr. Jorge Garat
Gen Dent. 2008 Nov-Dec;56(7):719-26.
Dental erosion linked to dysmenorrhea.
Department of Restorative Dentistry, Temple University, School of Dentistry, Philadelphia, Pennsylvania, USA.
This article examines the case of a woman with hard dental tissue loss that was similar to perimolysis caused by bulimia nervosa; however, the patient’s health history, signs and symptoms, and dietary habits refuted any eating disorder. All extrinsic causes and the majority of intrinsic causes were examined carefully and eliminated. The patient had undergone endometrial surgery 32 years earlier to remove a tumor, a procedure that was believed to be unrelated to the dental professionals’ realm; however, a detailed patient history revealed severe pain associated with abdominal cramps that were in concert with the menstrual cycle. Over a period of nearly three decades, these cramps frequently caused forceful purging of stomach contents during episodes of dysmennorhea. The mechanism, force, direction, and frequency of purging closely resembled that of bulimia, producing similar (if not identical) consequential damage to the dental hard tissues. The process of identifying, differentially diagnosing, and finally determining the etiology of the erosion lesions was based on an in-depth knowledge of systemic disorders, recognition of various characteristics and causes of erosion lesions, and an accurately detailed systemic and dental health history.
J Contemp Dent Pract. 2008 Nov 1;9(7):89-96.
Eating disorders part II: clinical strategies for dental treatment.
Aranha AC, Eduardo Cde P, Cordás TA.
Department of Restorative Dentistry, School of Dentistry, University of São Paulo, SP, Brazil. acca@usp.br
AIM: To present the strategies of treatment for dental implications of eating disorders. METHODS AND MATERIALS: A comprehensive review of the literature was conducted with special emphasis on the treatment of the oral implications of anorexia nervosa and bulimia nervosa, dividing the treatment into different parts. RESULTS: Oral manifestations of eating disorders represent a challenge to the dental practitioner. Dental erosion, caries, xerostomia, enlargement of parotide glands, traumatized oral mucosa, and other oral manifestations may present in anorexic and bulimic patients. CONCLUSION: Often the dentist is the first healthcare provider to observe the clinical symptoms of an eating disorder. Dental treatment should be carried out simultaneously with the medical treatment. However, dentists are not aware of the fundamental importance of the dentist’s participation in the multidisciplinary treatment and no training is provided with regard to the strategies involved in the dental treatment. CLINICAL SIGNIFICANCE: Oral complications of eating disorders are a major concern. The difficulties of recognizing the oral manifestations, and the failure to do so, may lead to serious systemic problems in addition to progressive and irreversible damage to the oral hard tissues. Considering the increasing incidence and prevalence rates of eating disorders, the dentist’s participation and dental treatment should be discussed.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Nov;106(5):696-707. Epub 2008 Sep 20.
Salivary changes and dental erosion in bulimia nervosa.
Dynesen AW, Bardow A, Petersson B, Nielsen LR, Nauntofte B.
Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. awd@odont.ku.dk
OBJECTIVE: Our aim was to study if bulimia nervosa (BN) has an impact on salivary gland function and if such changes are related to dental erosion. STUDY DESIGN: Twenty women with BN and twenty age- and gender-matched controls participated. Flow rate and composition of whole and glandular saliva, as well as feeling of oral dryness were measured. Dental erosion was measured on casts. RESULTS: Compared with control subjects, unstimulated whole saliva (UWS) flow rate was reduced in persons with BN, primarily owing to intake of medication (P = .007). No major compositional salivary changes were found. In the BN group, the dental erosion score was highest and complaints of oral dryness were more frequent. CONCLUSIONS: The BN persons had impaired UWS, mainly owing to medication; increased feeling of oral dryness; and more dental erosion. Dental erosion was related to the duration of eating disorder, whereas no effect of vomiting frequency or intake of acidic drinks on reduced UWS was observed.
Oral Dis. 2008 Sep;14(6):479-84.
Oral manifestations of eating disorders: a critical review.
Lo Russo L, Campisi G, Di Fede O, Di Liberto C, Panzarella V, Lo Muzio L.
Department of Oral Sciences, Faculty of Medicine, Oral Medicine Section, School of Dentistry, University of Palermo, Palermo, Italy. lorusso.lucio@tiscali.it
BACKGROUND: Eating disorders (ED) are a group of psychopathological disorders affecting patient relationship with food and her/his own body, which manifests through distorted or chaotic eating behavior; they include anorexia nervosa, bulimia nervosa and ED not otherwise specified and may be burdened with life-threatening complications. As oral manifestations of ED can occur in many phases of disease progression, they play a significant role in assessment, characterization and prognosis of ED. METHODS: Mucosal, dental, and salivary abnormalities associated with ED have been reviewed. Relations between oral menifestations and pathogenesis, management and prognosis of ED have been critically analysed. RESULTS: Oral manifestations of ED include a number of signs and symptoms involving oral mucosa, teeth, periodontium, salivary glands and perioral tissues; differences exist between patients with anorexia and bulimia. Oral manifestations of ED are caused by a number of factors including nutritional deficiencies and consequent metabolic impairment, poor personal hygiene, drugs, modified nutritional habits and underlying psychological disturbances. CONCLUSION: Oral manifestations of ED can cause impairment of oral function, oral discomfort and pain, and an overall deterioration of aesthetics and quality of life. Their treatment can contribute to overall patient management and prognosis.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Nov;106(5):696-707. Epub 2008 Sep 20.
Salivary changes and dental erosion in bulimia nervosa.
Dynesen AW, Bardow A, Petersson B, Nielsen LR, Nauntofte B.
Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. awd@odont.ku.dk
OBJECTIVE: Our aim was to study if bulimia nervosa (BN) has an impact on salivary gland function and if such changes are related to dental erosion. STUDY DESIGN: Twenty women with BN and twenty age- and gender-matched controls participated. Flow rate and composition of whole and glandular saliva, as well as feeling of oral dryness were measured. Dental erosion was measured on casts. RESULTS: Compared with control subjects, unstimulated whole saliva (UWS) flow rate was reduced in persons with BN, primarily owing to intake of medication (P = .007). No major compositional salivary changes were found. In the BN group, the dental erosion score was highest and complaints of oral dryness were more frequent. CONCLUSIONS: The BN persons had impaired UWS, mainly owing to medication; increased feeling of oral dryness; and more dental erosion. Dental erosion was related to the duration of eating disorder, whereas no effect of vomiting frequency or intake of acidic drinks on reduced UWS was observed.
Korean J Gastroenterol. 2008 Aug;52(2):69-79.
Extraesophageal manifestations of gastroesophageal reflux disease
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. doc0224@chol.com
Gastroesophageal reflux disease (GERD) often presents as typical symptoms such as heartburn or acid regurgitation. However, a subgroup of patients presents a collection of symptoms and signs that are not directly related to esophageal damage… These are known collectively as the extraesophageal manifestations of GERD, such as non-cardiac chest pain, laryngitis, chronic cough, hoarseness, asthma or dental erosion. They have a common pathophysiology, involving microaspiration of acid into the larynx and pharynx, and vagally mediated bronchospasm and laryngospasm. The role of extraesophageal reflux in such disorders is underestimated due to often silent symptoms and difficult confirmation of diagnosis. Endoscopy and pH monitoring are insensitive and therefore not useful in many patients as diagnostic modalities. Thus, anti-secretory therapy by proton pump inhibitor is used as both a diagnostic trial and as a therapy in the majority. Attention to optimizing therapy and judicious use of endoscopy and reflux monitoring are needed to maximize treatment success.
Gen Dent. 2008 Nov-Dec;56(7):719-26.
Dental erosion linked to dysmenorrhea.
Department of Restorative Dentistry, Temple University, School of Dentistry, Philadelphia, Pennsylvania, USA.
This article examines the case of a woman with hard dental tissue loss that was similar to perimolysis caused by bulimia nervosa; however, the patient’s health history, signs and symptoms, and dietary habits refuted any eating disorder. All extrinsic causes and the majority of intrinsic causes were examined carefully and eliminated. The patient had undergone endometrial surgery 32 years earlier to remove a tumor, a procedure that was believed to be unrelated to the dental professionals’ realm; however, a detailed patient history revealed severe pain associated with abdominal cramps that were in concert with the menstrual cycle. Over a period of nearly three decades, these cramps frequently caused forceful purging of stomach contents during episodes of dysmennorhea. The mechanism, force, direction, and frequency of purging closely resembled that of bulimia, producing similar (if not identical) consequential damage to the dental hard tissues. The process of identifying, differentially diagnosing, and finally determining the etiology of the erosion lesions was based on an in-depth knowledge of systemic disorders, recognition of various characteristics and causes of erosion lesions, and an accurately detailed systemic and dental health history.
J Contemp Dent Pract. 2008 Nov 1;9(7):89-96.
Eating disorders part II: clinical strategies for dental treatment.
Aranha AC, Eduardo Cde P, Cordás TA.
Department of Restorative Dentistry, School of Dentistry, University of São Paulo, SP, Brazil. acca@usp.br
AIM: To present the strategies of treatment for dental implications of eating disorders. METHODS AND MATERIALS: A comprehensive review of the literature was conducted with special emphasis on the treatment of the oral implications of anorexia nervosa and bulimia nervosa, dividing the treatment into different parts. RESULTS: Oral manifestations of eating disorders represent a challenge to the dental practitioner. Dental erosion, caries, xerostomia, enlargement of parotide glands, traumatized oral mucosa, and other oral manifestations may present in anorexic and bulimic patients. CONCLUSION: Often the dentist is the first healthcare provider to observe the clinical symptoms of an eating disorder. Dental treatment should be carried out simultaneously with the medical treatment. However, dentists are not aware of the fundamental importance of the dentist’s participation in the multidisciplinary treatment and no training is provided with regard to the strategies involved in the dental treatment. CLINICAL SIGNIFICANCE: Oral complications of eating disorders are a major concern. The difficulties of recognizing the oral manifestations, and the failure to do so, may lead to serious systemic problems in addition to progressive and irreversible damage to the oral hard tissues. Considering the increasing incidence and prevalence rates of eating disorders, the dentist’s participation and dental treatment should be discussed.
Prevalence of psychologic, dental, and temporomandibular signs and symptoms among chronic eating disorders patients: a comparative control study.
Emodi-Perlman A, Yoffe T, Rosenberg N, Eli I, Alter Z, Winocur E.
Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
AIMS: To compare the prevalence of psychologic, dental, and temporomandibular disorder (TMD) signs and symptoms between young women suffering from chronic eating disorders (ED) and a control group of age-matched, healthy women, and to evaluate the impact of frequent vomiting on these signs and symptoms among the ED group. METHODS: Clinical examination and self-administered questionnaires were used to evaluate psychologic, dental, and TMD signs and symptoms among 79 women hospitalized because of chronic ED and 48 age-matched healthy women (as controls). ED patients were further analyzed according to their habit of daily vomiting (43 vomiting versus 36 nonvomiting patients). Pearson chi-square and analysis of variance were used to analyze categorical differences between study groups. RESULTS: Women with ED showed a significantly higher sensitivity to muscle palpation (P < .001) and higher levels of depression, somatization, and anxiety (P < .001), as well as a higher prevalence of intensive gum chewing (P < .001), dental erosions (P < .001), and attrition (P < .001), than the healthy controls. Vomiting patients showed higher muscle sensitivity to palpation than nonvomiting patients (P < .001) and greater emotional and psychologic distress (P < .001). CONCLUSION: Women with chronic ED suffer from higher muscular sensitivity to palpation, greater emotional distress, and more hard tissue destruction (dental erosions, dental sensitivity) than healthy women.
Oral Dis. 2008 Sep;14(6):479-84.
Oral manifestations of eating disorders: a critical review.
Lo Russo L, Campisi G, Di Fede O, Di Liberto C, Panzarella V, Lo Muzio L.
Department of Oral Sciences, Faculty of Medicine, Oral Medicine Section, School of Dentistry, University of Palermo, Palermo, Italy. lorusso.lucio@tiscali.it
BACKGROUND: Eating disorders (ED) are a group of psychopathological disorders affecting patient relationship with food and her/his own body, which manifests through distorted or chaotic eating behavior; they include anorexia nervosa, bulimia nervosa and ED not otherwise specified and may be burdened with life-threatening complications. As oral manifestations of ED can occur in many phases of disease progression, they play a significant role in assessment, characterization and prognosis of ED. METHODS: Mucosal, dental, and salivary abnormalities associated with ED have been reviewed. Relations between oral menifestations and pathogenesis, management and prognosis of ED have been critically analysed. RESULTS: Oral manifestations of ED include a number of signs and symptoms involving oral mucosa, teeth, periodontium, salivary glands and perioral tissues; differences exist between patients with anorexia and bulimia. Oral manifestations of ED are caused by a number of factors including nutritional deficiencies and consequent metabolic impairment, poor personal hygiene, drugs, modified nutritional habits and underlying psychological disturbances. CONCLUSION: Oral manifestations of ED can cause impairment of oral function, oral discomfort and pain, and an overall deterioration of aesthetics and quality of life. Their treatment can contribute to overall patient management and prognosis.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Sep 19.
Salivary changes and dental erosion in bulimia nervosa.
Dynesen AW, Bardow A, Petersson B, Nielsen LR, Nauntofte B.
Department of Odontology.
OBJECTIVE: Our aim was to study if bulimia nervosa (BN) has an impact on salivary gland function and if such changes are related to dental erosion. STUDY DESIGN: Twenty women with BN and twenty age- and gender-matched controls participated. Flow rate and composition of whole and glandular saliva, as well as feeling of oral dryness were measured. Dental erosion was measured on casts. RESULTS: Compared with control subjects, unstimulated whole saliva (UWS) flow rate was reduced in persons with BN, primarily owing to intake of medication (P = .007). No major compositional salivary changes were found. In the BN group, the dental erosion score was highest and complaints of oral dryness were more frequent. CONCLUSIONS: The BN persons had impaired UWS, mainly owing to medication; increased feeling of oral dryness; and more dental erosion. Dental erosion was related to the duration of eating disorder, whereas no effect of vomiting frequency or intake of acidic drinks on reduced UWS was observed.
J Contemp Dent Pract. 2008 Sep 1;9(6):73-81.
Eating disorders. Part I: Psychiatric diagnosis and dental implications.
Aranha AC, Eduardo Cde P, Cordás TA.
Department of Restorative Dentistry, University of São Paulo, SP, Brazil. acca@usp.br
AIM: The aim of this article is to present a review of the literature on eating disorders and related oral implications in order to provide oral healthcare professionals and psychiatrists with information that will enable them to recognize and diagnose these disorders and render appropriate treatment. METHODS AND MATERIALS: A comprehensive review of the literature was conducted with special emphasis on the oral implications of anorexia nervosa and bulimia nervosa. RESULTS: Currently, available knowledge that correlates eating disorders with dental implications is supported by data derived from well-conducted psychiatric and psychological literature. However, little is known about the aspects of oral medicine concerned with the subject. Dental erosion, xerostomia, enlargement of the parotid gland, and other dental implications might be present in individuals with eating disorders. CONCLUSIONS: Eating disorders are a serious concern with regard to the oral health of patients. They represent a clinical challenge to dental professionals because of their unique psychological, medical, nutritional, and dental patterns as well as their unique characteristics. However, there is a general lack of awareness of the fundamental importance of the dentist’s role in the multidisciplinary treatment of affected patients. CLINICAL SIGNIFICANCE: The failure of oral healthcare professionals to recognize dental characteristics of eating disorders may lead to serious systemic problems in addition to progressive and irreversible damage to the hard tissues. Considering the increasing incidence and prevalence rates of eating disorders the participation of oral healthcare professionals in a multidisciplinary team to provide care for affected patients rises to greater importance.
Ann Acad Med Stetin. 2007;53(1):90-3.
Dental status in patients with eating disorders
Buczkowska-Radli?ska J, Kaczmarek W, Tyszler ?, Miko?ajczyk E, Fraczak B.
Zak?ad Stomatologii Zachowawczej Pomorskiej Akademii Medycznej w Szczecinie al. Powsta?ców Wlkp. 72, 70-111 Szczecin.
Anorexia nervosa and bulimia are serious eating disorders on the mental background that affect a significant number of young people. They lead to many complications including the ones within the oral cavity. The most frequent effects concerning tooth hard tissue are dental erosions. Erosions are characterized by the irreversible process of demineralization of the external layers of tissues of the tooth. This paper reviews literature to assess the oral status and dental complications in patients with eating disorders.
Fogorv Sz. 2006 Dec;99(6):223-30.
Destructive and protective factors in the development of tooth-wear
Máté J, Gábor V, Zsuzsanna T.
Semmelweis Egyetem, Fogpótlástani Klinika, Budapest.
The experience of the past decade proves that tooth wear occurs in an increasing number of cases in general dental practice. Tooth wear may have physical (abrasion and attrition) and/or chemical (erosion) origin. The primary physical causes are inadequate dental hygienic activities, bad oral habits or occupational harm. As for dental erosion, it is accelerated by the highly erosive foods and drinks produced and sold in the past decades, and the number of cases is also boosted by the fact that bulimia, anorexia nervosa and gastro-oesophageal reflux disease prevalence have become more common. The most important defensive factor against tooth wear is saliva, which protects teeth from the effect of acids. Tertiary dentin formation plays an important role in the protection of the pulp. Ideally, destructive and protective factors are in balance. Both an increase in the destructive forces, and the insufficiency of defense factors result in the disturbance of the equilibrium. This results in tooth-wear, which means an irreversible loss of dental hard tissue. The rehabilitation of the lost tooth material is often very difficult, irrespectively of whether it is needed because of functional or esthetic causes. For that reason, the dentist should carry out primary and secondary dental care and prevention more often, i.e. dental recall is indispensable every 4-6 months.
N Y State Dent J. 2006 Nov;72(6):36-9.
Diagnosing bulimia nervosa with parotid swelling. Case report.
Park MJ, Mandel L.
Emory University, Atlanta, GA, USA.
Patients with bulimia nervosa (BN) may show dental erosion, resulting from the effect of acid regurgitation. Asymptomatic bilateral parotid swellings may also be present. Other signs include serum electrolyte imbalance and Russell’s sign. The authors describe the case of a 26-year-old woman with BN, whose only clinical manifestation of BN was her bilateral parotid swellings. Because patients with BN tend to be secretive about their purging, it is important that the clinician consider BN as part of a differential diagnosis when faced with such painless parotid gland swellings.
J Dent Educ. 2006 Oct;70(10):1066-75.
Increasing dentists’ capacity for secondary prevention of eating disorders: identification of training, network, and professional contingencies.
Debate RD, Tedesco LA.
Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC Box 56, Tampa, FL 33612, USA. rdebate@health.usf.edu
The incidence of eating disorders has increased substantially over the last forty years. Primary care physicians and dentists share a parallel challenge for secondary prevention of anorexia nervosa and bulimia nervosa. The dentist, in particular, has a uniquely important and valuable role with respect to assessment of oral and physical manifestations, patient communication, referral, case management, and restorative care. Despite this crucial role, few dentists are engaged in eating disorder-specific secondary prevention. The purpose of this study was to explore beliefs, attitudes, and experiences of general dentists regarding eating disorder-specific secondary prevention behaviors using focus group methodology. Three ninety-minute focus groups were conducted with twenty-one general dentists (seventeen male, four female) recruited from the 2004 Academy of General Dentistry Leadership Conference. Data from the focus groups were analyzed to identify two over-arching themes and associated subthemes with regard to supports and barriers to eating disorder-specific secondary prevention practices. Analysis of data revealed that training, network, and dental professional contingencies emerged as places of influence for increasing capacity among dentists with regard to secondary prevention of eating disorders. This exploratory assessment identifies leverage points where strategic interventions including curriculum development, policies, and practices can be developed to support and sustain secondary preventive clinical behaviors among dentists.
Aust Dent J. 2005 Dec;50(4):228-34.
The potential for dental plaque to protect against erosion using an in vivo-in vitro model–a pilot study.
Cheung A, Zid Z, Hunt D, McIntyre J.
School of Dentistry, The University of Adelaide, South Australia.
BACKGROUND: Tooth erosion is a problem for professional wine tasters (exogenous erosion from frequent exposure to wine acids) and for people with gastro oesophageal reflux disease (GORD) and bulimia who experience frequent reflux of gastric contents into the mouth (endogenous erosion from mainly HCl). The objective in this study was to determine whether plaque/pellicle could provide teeth with any protection from two common erosive acids, using an in vivo-in vitro technique. METHODS: Tiles of human tooth enamel and root surfaces were prepared from six extracted, unerupted third molar teeth and sterilized. Mandibular stents were prepared for six volunteer subjects and the tiles bonded to the buccal flanges of these stents. They were worn initially for three days to permit a layer of pellicle and plaque to form over the tile surfaces, and for a further 10 days of experimentation. Following cleaning of the plaque/ pellicle layer from the tiles on the right side flange, all the tiles were submerged in either 0.06M HCl or white wine for an accumulated time of 600 and 1500 minutes, respectively. Depths of erosion were determined using light microscopy of sections of the enamel and root tiles. SEM of the lesion surfaces was carried out to investigate the nature of erosive damage and of plaque/pellicle remnants. RESULTS: Retained plaque was found to significantly inhibit dental erosion on enamel, from contact with both HCl and wine, compared with that resulting following its removal. However, it was found to provide no significant protection on root surfaces. SEM analysis of the tile surfaces revealed marked etching of enamel on the cleaned surfaces, and considerable alteration to the appearance of remaining plaque and pellicle on most surfaces. CONCLUSION: Within the limitations of numbers of specimens, dental plaque/pellicle provided a significant level of protection to tooth enamel against dental erosion from simulated gastric acids and from white wine, using an in vivo-in vitro model. It was unable to provide any significant protection to root surfaces from these erosive agents. Possible reasons for this difference are explored.
Gen Dent. 2006 May-Jun;54(3):198-200.
An uncommon dental presentation during pregnancy resulting from multiple eating disorders: pica and bulimia: case report.
Johnson CD, Koh SH, Shynett B, Koh J, Johnson C.
Department of Restorative Dentistry and Biomaterials, University of Texas Health Science Center, Houston Dental Branch, USA.
Pica is a compulsive eating disorder involving non-nutritive substances. The etiology of this eating disorder is unknown but it often is associated with subclinical mineral deficiencies. This article focuses on the simultaneous occurrence of two types of eating disorders, the co-existence of depression during four pregnancies, and the resulting dental clinical implications. The literature is substantial enough to support a possible etiological association between these eating disorders and depression during pregnancy. Associations between eating psychopathology, depression, and anxiety have been described consistently. The diagnosis of pica and the dental treatment related to it are not a common part of most dental practices; knowing the clinical features and detecting the condition depend on careful questioning and diligence. At present, no one has described the physiologic or psychological basis for pica. This article reviews the published literature pertaining to pica, specifically pagophagia.
Psychiatr Pol. 2006 Jan-Feb;40(1):109-18.
Evaluation of oral health in bulimia nervosa
Paszy?ska E, Limanowska-Shaw H, S?opie? A, Rajewski A.
Katedra i Zak?ad Biomateria?ów i Stomatologii Do?wiadczalnej AM w Poznaniu.
AIM: The aim of the study was to evaluate the dental status of bulimics with self inducing vomiting. METHOD: 33 bulimic female patients aged between 17 to 20, who were in need of hospitalization in the Department of Psychiatry, Pozna? University of Medical Sciences, were compared to 31 age and sex matched healthy controls aged between 18 to 36. For each subject dental examination including calculation of caries, erosion and oral hygiene indexes: PlI, OHI-S, DMFT and TWI was performed. In both groups salivary flow and pH of the whole saliva were measured. RESULTS: Bulimics manifest a significantly higher retention of dental plaque and also higher frequency of enamel erosion, which were not present in the control group. Additionally, bulimics had more intense caries. Stimulated and resting salivary flow were poor, although they had the lowest pH values but were within the normal range. CONCLUSION: Patients with bulimia nervosa showed a higher number and severity of enamel erosion. There is also the high difference in amount of dental plaque, caries and changes in salivary secretion. These results highlight a need for close cooperation between the dentist and the patient’s physician, which will then improve the diagnosis and treatment of this disease.
Schweiz Monatsschr Zahnmed. 2005;115(12):1163-71.
Eating disorders (II)–dental aspects
Imfeld C, Imfeld T.
Patients suffering from eating disorders exhibit oral symptoms indicative to the otherwise concealed illness. The most striking features are the intrinsic erosions due to the regular surreptitious vomiting. They occur in very typical locations within the dental arches and have been termed “perimolysis”. Dental professionals are often the first to discover and diagnose eating disorders by detecting perimolysis and consequently face the difficult task to motivate the patients–who often deny their illness–to seek psychiatric help and dental care. Such motivation must be done while respecting the patients’ integrity and sense of self-worth. The primary goal of dental care is to preserve the remaining teeth and to prevent further erosive loss of dental hard tissue. The key elements of a dental preventive programme based on pathophysiologic grounds are to enhance local defence mechanisms, to offer chemical and mechanical protection and to diminish abrasive and erosive challenges. Dental restorative therapy must be part of a combined medical and dental treatment plan and should not be started before the eating disorder has been treated and the patients are considered to have stable prognosis. In view of the young age of the patients, the large extension of the erosive lesions and in order to avoid endodontological treatment of mostly sound pulps, non-invasive restorative concepts using adhesive technology should be preferably used. Prophylactic measures and restorative treatment are covered by health insurance (KGV; KLV 18c, 7) if the patients undergo psychiatric or similar adequate treatment.
Schweiz Monatsschr Zahnmed. 2005;115(10):917-46.
Erosion. Clinical aspects–diagnosis–risk factors–prevention–therapy
Stich H.
Universität Bern, Klinik für Zahnerhaltung, Präventiv- und Kinderzahnmedizin.
Dental erosions have a multifactorial genesis. Acids of intrinsic and extrinsic origin are thought to be the main aetiologic factors, but also abrasive components can be involved in tooth destruction. This overview gives information about the clinical appearence and the risk factors for the developement of erosive lesions. In addition, preventive and therapeutic measures are discussed. The knowledge about the patient’s history, the accurate clinical examination and the correct diagnosis are prerequisites for an adequate preventive and therapeutic concept. It is important to get data about diet habits and host factors like salivary flow rate, buffering capacity and pH as well as intrinsic factors like the occurence of gastroesophageal reflux or vomiting. A novel scheme showing the dependences of the different risk factors is given. To determine the patient’s individual risk for erosion, the dentist must be able to assess the erosive potential of these parameters. Data about the distribution and clinical appearance of erosive defects, photographs and study casts are important to plan the prevention and therapy and to judge the success of such measures.
Eur J Oral Sci. 2005 Aug;113(4):297-302.
Dental fear, regularity of dental attendance and subjective evaluation of dental erosion in women with eating disorders.
Willumsen T, Graugaard PK.
Institute of Clinical Odontology, University of Oslo, Oslo, Norway. tiril@odont.uio.no
This questionnaire study, with a response rate of 53%, examined self-induced vomiting, erosions and dental attendance in women with eating disorders (EDs) as well as dental fear and its effect on attendance and communication with the dentist. A survey of 371 responding women with EDs, who were recruited from a self-help organization, revealed that dental fear was higher in women with EDs compared to the general population. Dental fear was present in 32.1% of women with EDs, and very high dental fear was present in 16.5% of women with EDs. Of those with very high dental fear, 32.3% had not visited a dental clinic at all in the preceding 2 yr, and 43.5% only initiated contact when they had symptoms. Self-induced vomiting was especially frequent in women with bulimia nervosa (87.9%) and in those with more than one ED (the ‘mixed group’) (80.6%). Among those with self-induced vomiting, 45.3% thought that they had erosions, although only 28.4% had erosions diagnosed by a dentist. Of women with EDs, 61.4% failed to disclose their condition. High dental fear did not affect willingness to disclose the ED. We conclude that dentists should examine ED patients carefully for dental erosions. Moreover, they should realize that most ED patients avoid disclosing their disorder and that dental fear further complicates dental treatment in these patients.
J Pediatr. 2002 Apr;140(4):474-8.
Gastroesophageal reflux disease and dental erosion in children.
Dahshan A, Patel H, Delaney J, Wuerth A, Thomas R, Tolia V.
Division of Pediatric Gastroenterology, Oklahoma University College of Medicine, Tulsa 74129, USA.
Recurrent exposure to gastric acid as in children with bulimia and gastroesophageal reflux disease (GERD) may contribute to dental erosion. We performed a prospective study to evaluate the presence of GERD and dental erosions in children with primary and permanent dentition. Children undergoing elective endoscopy for possible GERD (n = 37) underwent evaluation of their teeth for the presence, severity, and pattern of erosion and stage of dentition: 24 patients had GERD. Dental erosions were identified in 20; all had GERD. Erosion patterns showed more involvement of the posterior teeth. Many affected patients had primary dentition.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002 Feb;93(2):138-43
Eating disorders: dental implications.
Little JW. wlittle17@home.com
This article presents updated information on the 2 major eating disorders, anorexia nervosa and bulimia nervosa. Both conditions are found primarily in women. The eating disorders have significant morbidity and mortality associated with them. Patients are vulnerable to sudden death from cardiac arrhythmias. Suicide is a concern in some patients. The etiology of the eating disorders is unknown, but genetic, cultural, and psychiatric factors appear to play a role. Medical management may involve hospitalization to stabilize the patient, behavior modification, drugs, and psychotherapy. The long-term outcome of treatment is unclear at this time. The role of the dentist as a “case finder” is discussed. Also, the role of the dentist in restoring the dental and oral tissues to a healthy state in patients with eating disorders is presented.
Pesqui Odontol Bras 2001 Oct-Dec;15(4):359-63
Behavioral eating disorders and their effects on the oral health in adolescence
Traebert J, Moreira EA.
Universidade Federal de Santa Catarina.
Anorexia nervosa and bulimia nervosa are serious eating disorders that affect a significant number of adolescents and young adults. Individuals with anorexia nervosa tend to ignore or deny their excessive dieting and may present purging habits. The individual with bulimia nervosa spends great effort and time in compensating the effects of binge eating with dieting and fasting, self-inducing vomiting, utilization of laxatives or overexercising. The incidence of those behavioral disorders seems to be increasing, but there are no epidemiological data on that matter in Brazil. The dental practitioner has an important role in identifying these disorders since toothwear is very frequent due to the acidic oral environment caused by vomiting. The dentist can help to minimize the effects of anorexia and bulimia on the dentition. The objective of this study is to review the features of those behavioral eating disorders and to highlight the importance of being prepared to diagnose them and implement a comprehensive treatment of patients.
Int J Eat Disord 2001 Nov;30(3):252-8
Bulimia and swallowing: cause for concern.
Mendell DA, Logemann JA.
Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois 60208, USA.
OBJECTIVE: To determine whether there is evidence of a relationship between bulimia and abnormalities in swallowing function. METHOD: Literature review across a variety of professional areas concerning the physiological effects of bulimia on oropharyngeal swallow structures and function. RESULTS: Investigations of bulimic subjects have identified abnormalities in the oral cavity and oropharynx including dental erosion, changes in taste, tissue manifestations, and potential motility disorders that could impact swallowing function. DISCUSSION: While there is cause for concern regarding the effects of repeated self-induced vomiting behavior in bulimic subjects on swallowing function, more research is needed. Copyright 2001 by John Wiley & Sons, Inc.
Eur J Prosthodont Restor Dent 2001 Mar;9(1):25-9
Preventative measures for bulimic patients with dental erosion.
Sundaram G, Bartlett D.
Floor 25, Division of Conservative Dentistry, Guy’s, King’s and St Thomas’ Dental Institute, Guy’s Tower, London Bridge SE1 9RT.
The preventative techniques suggested to bulimic patients are frequently undervalued and ignored in favour of restorative treatment, possibly because the dentist may not be aware of the eating disorder. Educating bulimic patients about fluoride application, the use of brushing techniques, antacids, cheese, xylitol chewing gum and the possible use of mouth guards may minimise the effect of acids. Together with attempts at improving patient compliance they can be a valuable adjunct to treatment of bulimic patients with dental problems. Monitoring the wear on teeth by comparing study casts is a good way to maintain control but there are circumstances when restorations are indicated, perhaps when further delay may result in the prognosis of the teeth being compromised. Following a brief introduction to causes of bulimia and the consequences to the dentition, this paper, based on a literature review, considers patient-orientated techniques for prevention and provisional management of erosion of dental hard tissues for patients with bulimia nervosa.
Quintessence Int 2001 Jun;32(6):469-75
Oral rehabilitation of a bulimic patient: a case report.
Bonilla ED, Luna O.
Division of Restorative Dentistry, University of California (UCLA) School of Dentistry, Los Angeles 90024, USA. edbonilla2@juno.com
Bulimia nervosa is among the most common health problems in contemporary society. It is a self-induced weight loss syndrome associated with distinct dental manifestations involving physical and psychologic symptoms. It is characterized by recurrent binge-purge episodes that occur at least once a day. This article describes the complete-mouth rehabilitation of a bulimic patient with a generalized enamel erosion of her dentition and a poor esthetic appearance. Porcelain-fused-to-metal restorations were used as the definitive treatment. Good esthetics and high self-esteem were the final results. Comprehensive restorative therapy was applied in this clinical case report to achieve both function and esthetics in a demanding situation.
Dent Clin North Am 2001 Jul;45(3):491-511
Eating disorders in women’s oral health.
Studen-Pavlovich D, Elliott MA.
Department of Pediatric Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. das12@pitt.edu
Eating disorders such as anorexia nervosa, bulimia nervosa, and binge-eating disorder are a serious concern in women’s oral health and a clinical challenge to dental professionals. Each of these eating disorders presents with unique patterns of psychologic, medical, and dental characteristics. Appropriate dental treatment is based in the multidisciplinary facets of these conditions. The dental team should be mindful that individuals who suffer from these disorders may relapse into previous negative eating behaviors. The knowledgeable dental professional may be able to intercept these habits through regular recall intervals and thorough examination.
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