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.     

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.     

Sex differences among dentists regarding eating disorders and secondary prevention practices

BACKGROUND: The purpose of this cross-sectional study was to assess sex differences among dentists pertaining to current behaviors and behavioral beliefs with regard to eating disorders. METHODS: The authors collected data via a self-administered paper-and-pencil questionnaire from a randomized sample of 350 practicing male and female dentists. RESULTS: The results showed a low level of practice regarding secondary prevention (that is, measures leading to early diagnosis and prompt intervention) of eating disorders. The authors found statistically significant differences, with more female than male dentists reporting that they assessed patients for oral cues (P < .001), more female dentists reporting that they provided specific dental care instructions (P = .038) and more female dentists referring patients who have oral signs of eating disorders (P = .028). They also found sex differences with regard to mediating factors. Female dentists had greater knowledge of oral manifestations of eating disorders (P = .001), greater knowledge of physical cues of anorexia nervosa (P < .001), greater perception of the severity of anorexia nervosa (P = .007) and greater knowledge of physical cues of bulimia nervosa (P < .001). CONCLUSIONS: Although the dentist may be the first health care provider to assess oral effects of eating disorders, his or her involvement may be influenced in part by sex and sex-related health beliefs. CLINICAL IMPLICATIONS: Female dentists may be more sensitive to oral cues related to women's health issues. Further research is warranted to explore the mediating factors regarding secondary prevention of eating disorders.     

Increasing dentists' capacity for secondary prevention of eating disorders: identification of training, network, and professional contingencies

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.     

Oral findings in anorexia nervosa and bulimia nervosa: a study of 47 cases

These two clinically oriented articles deal with problems dentists are seeing more frequently. One hospital dental service sees an average of four to five patients weekly with eating disorders. The first article is a research study discussing problems found in 47 study participants with the eating disorders anorexia nervosa and bulimia nervosa. The second article describes a helpful technique for oral rehabilitation.     

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.     

Eating disorder patients. Recognition and intervention

The prevalence of eating disorders is increasing, as are the chances that one or more of your patients may be suffering from anorexia nervosa, bulimia nervosa, or a combination of these disorders (bulimarexia). Although the dental profession has focused attention on the related oral and dental pathoses that occur in this population, limited information is available in the area of intervention. Recognition of these individuals is only the first step. Should a patient be suspected of having any of these disorders, intervention is the next step, to actually link the patient to medical help. This paper reviews pertinent behavioral characteristics, medical complications, and the oral, dental, and physical manifestations of these disorders in order to aid the dental hygienist in the recognition of eating disorder patients. Guidelines for conducting interventions are provided and sources for referral identified.     

Eating disorders in women's oral health

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.     

Eating disorders and their implications on oral health--role of dentists

Eating disorders (EDs) are primary psychological conditions, often associated with severing medical complications. EDs are characterized by perturbed eating behavior patterns. Their increasing incidence and prevalence is causing concerns to healthcare professionals. Because eating disorders are a complex issue, a multidisciplinary approach to treatment is required and this team includes Psychiatrists, Psychologists and Nutritionists. The purpose of this paper is to review the role of the dentists especially the pediatric dentist and orthodontist in identifying oral manifestations of EDs, which may be utilized for oral diagnosis, referral and management of underlying psychiatric condition and also secondary oral conditions.     

The role of third molar surgery in the exacerbation of eating disorders.

PURPOSE: Eating disorders are a major public health problem. This study was undertaken to investigate the role of dental surgery in the etiology and clinical course of these serious and occasionally life-threatening disorders. METHODS: Three questions concerning dental therapy were included in a pretreatment assessment of 97 consecutive patients entering an eating disorder therapy program during a 22-month period. These questions were designed to determine the influence of dental surgery, including frequency and severity, on eating disorders. RESULTS: All 97 patients, of which 96 were female, complied with the questionnaire. Seventy-five of 97 were 25 years or younger, and 53 of 97 were diagnosed as having anorexia nervosa. Sixteen patients (16.5%) reported having had orthodontic therapy, and 21 (21.6%) had undergone third molar surgery. Nine patients (9.3%) (1 orthodontic, 8 third molar surgery) indicated that dental procedures had caused exacerbation or relapse of their eating disorders; 8 of 21 (38%) who had undergone third molar surgery were positive respondents. None of the patients linked dental care to the initial onset of their eating disorders. CONCLUSIONS: These data reveal that dental procedures, specifically third molar surgery, can significantly alter the course of eating disorders, causing exacerbation or relapse. No patient indicated that dental therapy was the primary cause of these multifactorial psychonutritional disorders. A history of eating disorder should alert the practitioner to the risks of performing third molar surgery without a medical or psychotherapy consultation unless there is documentation of remission. Delay of surgical intervention is recommended if third molars are asymptomatic. If surgery is necessary, the surgeon and other members of the psychotherapy team should establish clear guidelines regarding behavior and postoperative nutrition and should monitor the patient's nutritional status.     

Eating disorders: identification and intervention

Society's preoccupation with outward appearance and thinness has increased the incidence of both anorexia nervosa and bulimia nervosa, two potentially threatening diseases. Unfortunately, it is difficult to obtain accurate statistics on these eating disorders. Those with an eating disorder are often unwilling to admit they have this disorder and are reluctant to seek help. Subsequently, eating disorders have become a serious concern for medical and dental professionals. Since dental professionals see patients on a regular basis, he/she may be the person to whom the eating disorder patient confides.1 For the same reason, the oral care provider may be the first to notice oral manifestations of disease in the anoretic or bulimic person.2,3 The dental professional can serve as an important link between the person with an eating disorder and professional therapy. Knowledge of the signs and symptoms for these diseases is important because early diagnosis and treatment can result in more successful therapy.     

Dental fear, regularity of dental attendance and subjective evaluation of dental erosion in women with eating disorders

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.     

Eating disorders in the oral health curriculum

Due to the oral/systemic nature of eating disorders, this serious health issue requires comprehensive patient assessment and coordinated health treatment. The purpose of this study was to assess the breadth and depth of eating disorder and comprehensive care within the dental and dental hygiene curriculum. Survey data were collected from deans of U.S. dental programs (n=24) and dental hygiene program directors (n=94). Statistically significant differences were observed between dental programs (DP) and dental hygiene programs (DHP) as more DHP reported including anorexia nervosa (p<.001), bulimia nervosa (p<.001), and oral manifestations of eating disorders (p=.003) within their curricula. Clock hours dedicated to these topics ranged from seventeen to thirty-five minutes, with no statistically significant differences observed between DP and DHP. Only 58 percent of DP and 56 percent of DHP included patient communication skills specific to eating disorders. Moreover, DHP were observed dedicating more instruction time for this skill (p=.011). As greater emphasis is placed on oral/systemic health and the provision of comprehensive care, many oral health professionals may not be adequately trained to identify, provide education, and communicate with patients regarding the oral/systemic nature of eating disorders. The findings from this study indicate that there is a need for appropriate training to better prepare oral health professionals for comprehensive patient care.     

Eating disorders in the female patient: pathophysiology and treatment strategies

Eating disorders are common in girls and women. Two common eating disorders--anorexia nervosa and bulimia nervosa--have significant medical complications. Oral and maxillofacial surgeons must be cognizant of the signs, symptoms, and medical consequences of these disorders. The increased incidence of these diseases has implications in the surgical management the oral and maxillofacial surgery patient. A review of the literature and guidelines in the perioperative management of these surgical patients are presented in this article.     

Vitamin deficiency in the elderly

The oral manifestations of vitamin deficiencies are often the first indications of malnutrition. This is especially true among the elderly, whose more frequent physical and/or psychological disorders may prevent them from eating a balanced diet. The following is a guide to the dentist, who is often the first health professional to recognize nutritional deficiencies in this age group.     

Oral manifestations of eating disorders: a critical review

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.     

Lingual abscess in a patient with anorexia nervosa

A 30-year-old female patient suffering from anorexia nervosa, developed an acute submandibular cellulitis. She was found to have a lingual abscess, for which the only detectable source of infection was a grossly carious lower molar. The oral features of the more common eating disorders are described.     

Access to special care dentistry, part 6. Special care dentistry services for young people

This article brings together some of the 'hidden disabilities' common amongst adolescents and young adults. Many of these conditions carry a social stigma and some are associated with secretive behaviour and even denial. The article will describe the features, management and oral implications of five eating disorders (Prader-Willi syndrome, anorexia nervosa, bulimia nervosa, binge eating disorder and pica) and three types of mental health problems (schizophrenia, obsessive-compulsive disorder and bipolar disorder). Without the input of the dental profession, and in the main the primary dental care service, all these conditions can have a detrimental effect on the dentition at a relatively early stage in life. Mental health problems are more common in adolescents and young adults than most people realise and this article will also consider the impact on oral health and delivery of dental care to young people who have experienced childhood sexual abuse.     

Oral profile of eating disorders patients: Case series

Oral alterations in patients diagnosed with eating disorders (ED) are reported in the literature, but few articles demonstrate these changes in a specific population. This study aims to summarize the findings of 26 patients with ED in a Brazilian dental clinic, through analyzing the body mass index and oral conditions (decayed, missing and filled teeth—DMFT, dental wear, salivary flux, xerostomia, oral hygiene—OHI‐S, oral lesions, and the prevalence of candidiasis), in order to facilitate recognition and enable accurate diagnosis for the general dentist. Probably, the premature diagnosis of ED resulted in lower DMFT and oral lesions.     

The dentist as biobehavioral clinician.

At the core of all clinical dental practice is the interpersonal interaction between dentist and patient. An expansion of the dentist's responsibility in the unique dentist-patient relationship is suggested. Such an expanded role encourages dentists to engage the emotional and behavioral health of dental patients who are appearing in dental offices for treatment of orofacial diseases and other conditions. The term "biobehavioral clinician" is used to refer to this broadened role for the dentist. It is suggested that such a biobehaviorally oriented dentist will be a powerful ally on behalf of the health of patients, attending to more dimensions of the patient's presentation and management than the diagnosis and treatment of oral pathobiology. It seems entirely appropriate that dentists have such a role in its future, engaging as they do millions and millions of Americans on a regular basis and a productive and collaborative dentist-patient relationship is already an accomplished fact for most dentists with most of their patients across all stages of the life span. The benefit to patients' overall health and well-being could be tremendous and would add an enriching and personally rewarding dimension to being a dentist.