Odontoclinica

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

Am Fam Physician. 2010 Dec 1;82(11):1381-8.

Oral manifestations of systemic disease.

Chi AC, Neville BW, Krayer JW, Gonsalves WC.

Medical University of South Carolina, Charleston, 29425, USA. chi@musc.edu

Abstract

Careful examination of the oral cavity may reveal findings indicative of an underlying systemic condition, and allow for early diagnosis and treatment. Examination should include evaluation for mucosal changes, periodontal inflammation and bleeding, and general condition of the teeth. Oral findings of anemia may include mucosal pallor, atrophic glossitis, and candidiasis. Oral ulceration may be found in patients with lupus erythematosus, pemphigus vulgaris, or Crohn disease. Additional oral manifestations of lupus erythematosus may include honeycomb plaques (silvery white, scarred plaques); raised keratotic plaques (verrucous lupus erythematosus); and nonspecific erythema, purpura, petechiae, and cheilitis. Additional oral findings in patients with Crohn disease may include diffuse mucosal swelling, cobblestone mucosa, and localized mucogingivitis. Diffuse melanin pigmentation may be an early manifestation of Addison disease. Severe periodontal inflammation or bleeding should prompt investigation of conditions such as diabetes mellitus, human immunodeficiency virus infection, thrombocytopenia, and leukemia. In patients with gastroesophageal reflux disease, bulimia, or anorexia, exposure of tooth enamel to acidic gastric contents may cause irreversible dental erosion. Severe erosion may require dental restorative treatment. In patients with pemphigus vulgaris, thrombocytopenia, or Crohn disease, oral changes may be the first sign of disease.

Oral Dis. 2010 Nov;16(8):807-11. doi: 10.1111/j.1601-0825.2010.01692.x.

Comparison of oral mucosal pH values in bulimia nervosa, GERD, BMS patients and healthy population.

Aframian DJ, Ofir M, Benoliel R.

Department of Oral Medicine, Salivary Gland Clinic and Saliva Diagnostics Laboratory, Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel. dorona@cc.huji.ac.il

Abstract

OBJECTIVES: The aim of this study was to compare the oral mucosal pH in healthy individuals to patients with gastroesophageal reflux disease (GERD), Bulimia nervosa (BN) and burning mouth syndrome (BMS).

SUBJECTS AND METHODS: Using a flat pH meter sensor, pH levels were established in eight mucosal sites in 26 healthy individuals, 26 GERD patients, 22 BN patients and 29 BMS patients.

RESULTS: A significantly lower pH was found in the BN and GERD groups (6.38 ± 00.45, 6.51 ± 0.32 respectively, P < 0.05) and a higher, but non-significant, pH level in the BMS group (7.01 ± 0.34, P > 0.05) compared with the control (C) group (6.82 ± 0.33).

CONCLUSIONS: BMS patients showed no pH differences from C group. The mucosa of BN and GERD patients was significantly acidic relative with controls; thus this simple technique may serve as a diagnostic tool for identifying gastro-esophageal conditions.

J Am Dent Assoc. 2010 Jun;141(6):675-8.

Eating disorders: screening in the dental office.

Hague AL.

Division of Dental Hygiene, College of Dentistry, The Ohio State University, 305 W. 12th Ave., Columbus, Ohio 43210, USA. hague.23@osu.edu

Abstract

BACKGROUND: Eating disorders are serious illnesses that often are not detected by health care professionals. The author presents techniques that the oral health care professional (OHCP) can use to screen at-risk patients for eating disorders during routine preventive care appointments.

CONCLUSIONS: OHCPs often are the first health care professionals to encounter patients with undiagnosed eating disorders. Because early detection of eating disorders is challenging, screening tools can be helpful. Early detection of eating disorders, with appropriate referral, is associated with fewer dental and systemic adverse effects and a more favorable prognosis.

CLINICAL IMPLICATIONS: OHCPs are in an ideal position to screen patients for eating disorders. They can accomplish this via a valid, reliable, brief questionnaire and careful patient assessment.

Dis Esophagus. 2010 Jul 23. [Epub ahead of print]

Gastroesophageal reflux disease and bulimia nervosa – a review of the literature.

Denholm M, Jankowski J.

University of Oxford, Oxford, UK.

Abstract

SUMMARY Bulimia nervosa and other eating disorders have been on the increase for the past half century. Self-induced vomiting is often practiced as a method of weight control in these patients, potentially causing acidic damage to the esophagus of the kind observed in cases of gastresophageal reflux disease. To ascertain whether patients suffering from bulimia nervosa had an increased rate of reflux-related symptoms, potentially placing them at risk of developing sequelae such as Barrett’s esophagus and esophageal adenocarcinoma, a literature review was performed via searches of databases including PubMed, Medline, OVID and PsycINFO and a recursive search of the literature. The search terms were: bulimia nervosa; reflux; esophageal adenocarcinoma; Barrett’s esophagus; eating disorders; oral; dental; complications. Several case reports were identified detailing the occurrence of an esophageal tumor in patients with a history of bulimia. This was supported to some degree by studies detailing higher incidences of reflux symptoms in eating disordered patients compared to controls but there was large variability in study design, quality and results. From these results an association is suggested as possible but is far from being proved conclusively. Further investigation is required using larger patient groups, better study design controlling for confounding factors and symptom characterisation.

Oral Dis. 2010 Jul 20. [Epub ahead of print]

Comparison of oral mucosal pH values in bulimia nervosa, GERD, BMS patients and healthy population.

Aframian D, Ofir M, Benoliel R.

Department of Oral Medicine, Salivary Gland Clinic and Saliva Diagnostics Laboratory, Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel.

Abstract

Oral Diseases (2010) doi: 10.1111/j.1601-0825.2010.01692.x Objectives: The aim of this study was to compare the oral mucosal pH in healthy individuals to patients with gastroesophageal reflux disease (GERD), Bulimia nervosa (BN) and burning mouth syndrome (BMS). Subjects and methods: Using a flat pH meter sensor, pH levels were established in eight mucosal sites in 26 healthy individuals, 26 GERD patients, 22 BN patients and 29 BMS patients. Results: A significantly lower pH was found in the BN and GERD groups (6.38 +/- 00.45, 6.51 +/- 0.32 respectively, P < 0.05) and a higher, but non-significant, pH level in the BMS group (7.01 +/- 0.34, P > 0.05) compared with the control (C) group (6.82 +/- 0.33). Conclusions: BMS patients showed no pH differences from C group. The mucosa of BN and GERD patients was significantly acidic relative with controls; thus this simple technique may serve as a diagnostic tool for identifying gastro-esophageal conditions.

Eur J Esthet Dent. 2010 Spring;5(1):28-48.

Composite resin rehabilitation of eroded dentition in a bulimic patient: a case report.

Spreafico RC.

Abstract

Eating disorders such as bulimia nervosa can have a significant impact on the structure of the teeth. Gastric acid not only causes enamel and dentin to dissolve but also causes a progressive deterioration of dental health, which leads to functional esthetic and biological consequences. According to the classic concepts of restorative dentistry, the rehabilitation of such clinical cases will involve numerous full crowns and root canal treatments, a process which is expensive financially, biologically, and in terms of time. However, the development of resin composite and adhesive systems has made it possible, today, to reconstruct teeth with minimal dental preparation. This article will look at the dental treatment of a bulimic patient who had numerous serious erosions with a significant loss of dental tissue. All teeth were reconstructed with a nano-hybrid resin composite and, as very little preparation was necessary, the teeth’s vitality was maintained and did not require laboratory collaboration. Furthermore, all biological, functional, and esthetic requisites were successfully met in a very short period of time.

Minerva Stomatol. 2000 Mar;49(3):119-27.

[Odontostomatologic symptomatology in eating disorders. A controlled study]

[Article in Italian]

Sivolella S, Cordioli GP, Consolati E, Favaro A, Santonastaso P.

Università degli Studi-Padova. bivos@hotmail.com

BACKGROUND: This study investigated odontostomatologic signs and symptoms associated with Anorexia Nervosa and Bulimia Nervosa (Eating Disorders, ED). METHODS: The authors have examined the following conditions in a group of 14 female subjects (average age: 23.5 +/-4.8) suffering for ED, compared to a control group of 12 female subjects (average age: 22.58 +/-1.83) negative for ED diagnostic criteria: temporo-mandibular joint status, salivary pH, periodontal indexes (plaque index, bleeding index, pockets presence, gingival recession presence), dental indexes (DMF-T, DMF-S; dental erosion or perymolisis), salivary glands swelling, oral hygiene habits (related to vomiting behavior). RESULTS: The results obtained revealed a greater prevalence of gingival recession, diffuse marginal gingivitis, perymolysis, salivary glands involvement, lower salivary pH in the Eating Disorders (ED) group when compared with a non-ED control group. The results, obtained for the first time from a group of Italian subjects resident in a mediterranean country, agree with those obtained by authors working in an anglo-saxon area. CONCLUSIONS: Since odontostomatologic pathologies may be the only detectable sign of Anorexia Nervosa and/or Bulimia Nervosa,the data presented in this study could facilitate the early identification of these patients and provide guidelines for the evaluation of oral pathologies in anorexic and bulimic patients.

Gen Dent. 2008 Nov-Dec;56(7):719-26.

Dental erosion linked to dysmenorrhea.

Bassiouny MA.

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

Kim GH.

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… Continue reading Bulimia – Odontología. Bibliografía.