Esthetic management of perimolysis with porcelain laminate veneers

This report deals with the dental manifestations of bulimia nervosa. Differential diagnosis of perimolysis was identified and compared with other manifestations of systemic or exogenous causal factors. Conservative cosmetic dental management of the dental erosion that occurred as a result of bulimia nervosa was described and discussed in comparison with other currently accepted treatment modalities.     

Integrating dental and medical care for the chronic bulimia nervosa patient: a case report

Excessive tooth erosion and resulting sensitivity and esthetic concerns are well-documented problems in patients with eating disorders. Several techniques for restoring lost tooth structure have been reported in the literature. However, the potential significant role of dental care in the comprehensive treatment of the chronically bulimic patient has received little attention. Integration and coordination of dental treatment with medicopsycho-social therapy of the bulimic patient may enhance the patient's success in combating this complex disorder. The key to proper dental management is a definitive approach to data collection and close coordination among all health care personnel providing primary health care therapy. A specific dental approach model is recommended in this report of a patient with a 15-year history of bulimia.     

Dental erosion related to alcoholism and an eating disorder: a case report

Dental erosion has been reported in the literature with particular attention to etiology and diagnosis of the disorder. Unfortunately, little information exists to guide dental professionals in treatment planning predictable restorative outcomes for this patient population. This case report describes a unique presentation of severe dental erosion related to alcoholism and an eating disorder. Diagnosis and etiology of the condition are discussed and a comprehensive list of treatment options is evaluated. The interim occlusal overlay prosthesis is presented as a diagnostic and therapeutic appliance for use in this unique patient population.     

Dental erosion caused by silent gastroesophageal reflux disease

BACKGROUND: Gastroesophageal reflux disease, or GERD, is a relatively common condition, in which stomach acid may be refluxed up through the esophagus and into the oral cavity, resulting in enamel erosion. Symptoms such as belching, unexplained sour taste and heartburn usually alert the patient to the condition. In silent GERD, however, these symptoms do not occur, and enamel erosion of the posterior dentition may be the first indication of GERD. CASE DESCRIPTION: A 30-year-old man came to a dental clinic with enamel erosion on the occlusal surfaces of his posterior teeth and the palatal surfaces of his maxillary anterior teeth. He reported no history of gastrointestinal disease or heartburn. CLINICAL IMPLICATIONS: Enamel erosion may be a clinical sign of silent GERD that allows the dentist to make the initial diagnosis. Referral to a physician or gastroenterologist is necessary to define the diagnosis; however, dental expertise may be essential in distinguishing between differential diagnoses such as bulimia, attrition and abrasion. Successful treatment of this medical condition is necessary before dental rehabilitation can be initiated successfully.     

Enzyme activities in the oral fluids of patients suffering from bulimia: a controlled clinical trial

Patients with bulimia nervosa are at high risk for dental erosion. However, not all bulimic patients suffer from erosion, irrespective of the severity of their eating disorder. It is often speculated that differences in the saliva are important, however, little is known about salivary parameters in bulimic patients, particularly directly after vomiting. The aim of the clinical trial was to compare different salivary parameters of subjects suffering from bulimia with those of healthy controls. Twenty-eight subjects participated (14 patients with bulimia nervosa, 7 of them with erosion; 14 matched healthy controls). Resting and stimulated saliva of all participants was analysed as well as saliva collected from bulimic patients directly and 30 min after vomiting. Parameters under investigation were flow rate, pH, buffering capacity and the enzyme activities of proteases in general, collagenase, pepsin, trypsin, amylase, peroxidase, and lysozyme. Regarding flow rate, pH and buffering capacity only small differences were found between groups; buffering capacity directly after vomiting was significantly lower in bulimic subjects with erosion than in subjects without erosion. Differences in enzymatic activities were more pronounced. Activities of proteases, collagenase and pepsin in resting and proteases in stimulated saliva were significantly higher in bulimic participants with erosion than in controls. Peroxidase activity was significantly decreased by regular vomiting. Proteolytic enzymes seem to be relevant for the initiation and progression of dental erosion directly after vomiting, maybe by both hydrolysis of demineralized dentine structures as well as modulation of the pellicle layer.     

Eating disorder-induced dental complications: a case report

Eating disorders are potentially life threatening and have not lost their relatively poor prognosis in the last decades. Whereas the increase in incidence and prevalence rates of anorexia nervosa over time are questionable, an increasing trend in incidence and prevalence of bulimia nervosa has been reported. Dentists are often involved in treating teeth of patients with both anorexia nervosa and bulimia nervosa because the teeth of these patients are regularly affected by erosion and caries. Without identification of the underlying evidence of psychological problems and consequent treatment, a patient's medical and dental health will deteriorate as the eating disorder progresses. The dentition of the patient with an eating disorder may offer specific signs and characteristics to alert the dentist.     

Etiology of dental erosion – intrinsic factors

Dental erosion due to intrinsic factors is caused by gastric acid reaching the oral cavity and the teeth as a result of vomiting or gastroesophageal reflux. Since clinical manifestation of dental erosion does not occur until gastric acid has acted on the dental hard tissues regularly over a period of several years, dental erosion caused by intrinsic factors has been observed only in those diseases which are associated with chronic vomiting or persistent gastroesophageal reflux over a long period. Examples of such conditions include disorders of the upper alimentary tract, specific metabolic and endocrine disorders, cases of medication side-effects and drug abuse, and certain psychosomatic disorders, e.g. stress-induced psychosomatic vomiting, anorexia and bulimia nervosa or rumination. Based on a review of the medical and dental literature, the main symptoms of all disorders which must be taken into account as possible intrinsic etiological factors of dental erosion are thoroughly discussed with respect to the clinical picture, prevalence and risk of erosion.     

Prosthodontic Management of a Completely Edentulous Patient with Microstomia: A Case Report

Patients with microstomia who need to wear removable dental prosthesis often face difficulty of being unable to insert or remove the prosthesis because of restricted opening of the oral cavity. Prosthetic rehabilitation of patients with microstomia presents difficulties in all the clinical steps. In such patients, it is difficult to make impressions and fabricate dentures using conventional method. This clinical report describes prosthodontic management of a completely edentulous patient with microstomia developed due to oral sub mucous fibrosis. Sectional maxillary denture was fabricated using a sectional impression tray technique. With the use of magnets and palatal midline press button attachment, the denture could be easily inserted and removed in two parts. Mandibular denture was fabricated by the conventional method.     

Dental wear as a stomatologic manifestation of bulimia nervosa--a clinical case

The number of patients with anorexia and bulimia nervosa is increasing nowadays. The typical oral feature of these eating disorders is the dental erosion which causes sensitivity of the teeth and esthetic problems for the involved patients. This phenomenon is a characteristic feature in these cases and it may be the first sign of the mentioned disorders. The purpose of the study was to describe the generally the most characteristic oral findings of bulimia nervosa and anorexia nervosa because the dentists play a significant role in recognizing the basic problem of the patients, and they can send them for medical treatment of the serious general problems.     

Oral symptoms in bulimia nervosa. A survey of 34 cases.

Bulimia nervosa is increasingly recognized as an eating disorder with significant medical and dental complications, including increased caries rate, thermal hypersensitivity, enamel erosion, xerostomia, and parotid gland hypertrophy. This article reviews the oral manifestations in bulimia nervosa and presents a questionnaire study of oral symptoms in 34 women with bulimia nervosa. Twenty-three (68%) of the subjects reported dental symptoms, such as hypersensitive teeth (47%), tooth pain (18%), dental fractures (6%), and subjectively increased caries rate (29%). Twelve women (35%) reported dry mouth or dry eyes as a daily experience, and 10 (29%) reported intermittent parotid gland swelling. To the author's knowledge, this is the first report that evaluates the frequency of subjectively experienced oral symptoms in bulimia nervosa.     

Dental erosion due to wine consumption

BACKGROUND: Dental erosions can result from numerous causes, but extrinsic dietary factors are the most common. Because of wine's acidity, it may have a deleterious effect on teeth. Its use must be considered during an evaluation of erosive dental changes. CASE DESCRIPTION: The author examined a 56-year-old woman because her referring dentist had noted extensive erosive loss of tooth structure, mainly enamel. The author eliminated the usual causes of dental erosion. It was only after a detailed history was obtained and dietary investigation was undertaken that the author determined that the amount, manner and timing of the patient's wine drinking was the cause of the problem. CLINICAL IMPLICATIONS: Dentists should be aware that wine could be a cause of dental erosion. Early recognition negates progressive dental damage with its need for extensive dental restoration. Furthermore, because patients with wine-incited dental erosions consume large volumes of wine with its significant alcohol content, medical referral by the dentist for a liver assessment is indicated.     

Using a Visible Light‐Polymerized Resin to Fabricate an Interim Partial Removable Dental Prosthesis

An interim partial removable dental prosthesis (RDP) is any dental prosthesis that replaces some teeth in a partially dentate arch designed to enhance esthetics, stabilization, and/or function for a limited period of time, after which it is to be replaced by a definitive dental prosthesis. This article describes a technique that uses a visible light‐polymerized (VLP) resin as the base material for an interim partial RDP. This technique can be easily accomplished in a dental office or laboratory and results in a predictable dental prosthesis. This technique eliminates the need for laboratory processing.     

Accidental aspiration in a patient with Parkinson's disease during implant-supported prosthesis construction: a case report

This article reports on a case history of an elderly patient with Parkinson's disease (PD) who sought treatment at a private dental office. His chief complaint was "difficulty in eating due to an illfitting prosthesis." Laboratory tests and oral radiographs were made. The surgical placement of an implant was done and, subsequently, an implant-supported prosthesis was fitted for the patient. During the impression for the construction of the implant-supported prosthesis, the patient accidentally aspirated the implant screwdriver. The object was found in the lower right lobe of the bronchus, and its removal was necessary in a hospital using bronchoscopy under general anesthesia. Patients with PD are considered at risk of aspirating and/or ingesting dental instruments. Short treatment periods are recommended, preferably during the morning, when the medication prescribed for PD is most effective. When treating patients who have a risk for aspirating and ingesting small objects, it is important to treat them in a more vertical position, and small-sized objects should be secured with dental floss to aid retrieval.     

Improving the delivery of a fixed bridge

Force loading of dental prosthesis is generally a guessing game played by the operator with the patient. Relying on a patient is comfort level to adjust occlusion is now being replaced by sound force information provided by the T Scan II. Proper use of the T Scan II when installing a segmental fixed prosthesis gives a more precise, comprehensive occlusion. Porcelain surfaces, solder joints, and the underlying abutment teeth can now be loaded with low-to-moderate forces because the operator can fine-tune the occlusal forces precisely. With proper force loading, greater material and prosthesis longevity is significantly enhanced.     

Oral care for patients with bulimia

Various conditions cause rapid and debilitating erosion of teeth. One of the most common is bulimia, or the binge-purge syndrome. Dentists frequently encounter patients who have this problem. The dentist should confirm the possibility of bulimia, refer the patient to a competent eating-disorder clinic, counsel the patient about her or his condition and restore the patient's mouth to a state of health and esthetic acceptability. Dental treatment of such patients will vary depending on the severity of the erosion.     

Managing dental erosion

The clinical signs of dental erosion are initially subtle, yet often progress because the patient remains asymptomatic, unaware and uninformed. Erosion typically works synergistically with abrasion and attrition to cause loss of tooth structure, making diagnosis and management complex. The purpose of this article is to outline clinical examples of patients with dental erosion that highlight the strategy of early identification, patient education and conservative restorative management. Dental erosion is defined as the pathologic chronic loss of dental hard tissues as a result of the chemical influence of exogenous or endogenous acids without bacterial involvement. Like caries or periodontal disease, erosion has a multifactorial etiology and requires a thorough history and examination for diagnosis. It also requires patient understanding and compliance for improved outcomes. Erosion can affect the loss of tooth structure in isolation of other cofactors, but most often works in synergy with abrasion and attrition in the loss of tooth structure (Table 1). Although erosion is thought to be an underlying etiology of dentin sensitivity, erosion and loss of tooth structure often occurs with few symptoms. The purpose of this article is threefold: first, to outline existing barriers that may limit early management of dental erosion. Second, to review the clinical assessment required to establish a diagnosis of erosion. And third, to outline clinical examples that review options to restore lost tooth structure. The authors have included illustrations they hope will be used to improve patient understanding and motivation in the early management of dental erosion.     

Application of cast magnetic attachments to sectional complete dentures for a patient with microstomia: a clinical report

Patients with microstomia who must wear removable dental prostheses often state that they are unable to insert or remove the prosthesis because of the constricted opening of the oral cavity. This article presents a cast iron-platinum magnetic attachment system applied to sectional collapsed complete dentures for an edentulous patient with microstomia. With the use of lingual and palatal midline hinges and a cast iron-platinum magnetic attachment, the sectional prosthesis was successfully and easily inserted and provided adequate function in the patient's mouth.     

Full-mouth rehabilitation of a patient with bulimia nervosa. A case report.

Anorexia and bulimia nervosa are eating disorders seen mainly in adolescents or young patients. The dentist should be in the position to recognize early signs of the disorder and alert the patient (and the patient's parents, if necessary) of the possible physical, psychologi cal, and dental consequences. Such dental treatment may help motivate the patient to confront the problem. In this paper the full-mouth rehabilitation, using a combination of galvano- and metal-ceramic restorations, of a young patient suffering from bulimia nervosa is described.     

Knowledge of oral and physical manifestations of anorexia and bulimia nervosa among dentists and dental hygienists

Despite the crucial role oral health care providers can have in the early identification of eating disorders and the referral and case management of patients with these disorders, little is known concerning their knowledge of oral complications of these disorders. The purpose of this study was to determine the knowledge among dentists and dental hygienists concerning the oral and physical manifestations of eating disorders. Employing a randomized cross-sectional study, data were collected from 576 dentists and dental hygienists randomly selected from the American Dental Association and the American Dental Hygienists' Association. Results indicated low scores concerning knowledge of oral cues, physical cues of anorexia, and physical cues of bulimia among study participants. More dental hygienists than dentists correctly identified oral manifestations of eating disorders (p=.001) and physical cues of anorexia (p=.010) and bulimia (p=.002). As the first health professional to identify oral symptoms of eating disorders, the most important task of the dental care provider when identifying oro-dental signs of eating disorders is to ensure that the patient receives treatment. Implications for education include the addition of conceptual, procedural, and skill-based curricula objectives addressing etiologic assessment and patient communication--thus increasing behavioral capacity for delivery of restorative care and patient referral.