An investigation of the oral pathologies occurring in bulimia nervosa

Altshuler, Barbara D.; Dechow, Paul C.; Waller, David; Hardy, Bettie W.

doi:10.1002/1098-108x(199003)9:2<191::aid-eat2260090208>3.0.co;2-n

Cited by 46 publications

(48 citation statements)

References 16 publications

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“…Dental erosion can alter the aesthetics of bulimic women (Figs 2 and 3), provoke dental hypersensitivity and pain, 2,8 and result in tooth loss. 1 The literature on the treatment of bulimic patients is restricted to case reports of restoration of the damaged surfaces with porcelain-laminated veneers, dentin-bonded crowns with minimal tooth preparation, composites, and complete-coverage restorations.…”

Section: Treatmentmentioning

confidence: 99%

Oral profiles of bulimic women: Diagnosis and management. What is the evidence?

Bretz¹

2002

The Journal of Evidenced-Based Dental Practice

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This article is a critical appraisal of the literature on the oral complications of bulimia. The MEDLINE database yielded a total of 82 English-language reports published between 1966 and 2002 that were pertinent to the topic of oral manifestations and treatment of bulimia. The literature is composed primarily of reviews, letters, case reports with or without restorative management, and descriptive studies of small sample sizes. At present, retrospective case-control studies are the only studies available with levels of evidence in the vicinity of 3 to 4. From these studies it is apparent that bulimic women present with a variety of oral and pharyngeal signs and symptoms, including dental caries and tooth erosion, dental pain, increased levels of cariogenic bacteria, orthodontic abnormalities, xerostomia (the subjective complaint of a dry-mouth) and decreased saliva secretion (the objective measure), decreased salivary pH, decreased periodontal disease, parotid enlargement, and swallowing impairments. Dental erosion is the major finding associated with bulimia. Case reports describe restoration of damaged surfaces with porcelain-laminated veneers, dentin-bonded crowns with minimal tooth preparation, composites, and completecoverage restorations. However, what is really needed is identification of oral markers of bulimic behavior for early detection of bulimic patients by dentists and by physicians that can prevent the deleterious effects of frequent vomiting on the oral/dental tissues.Bulimia nervosa is a constellation of nutritional and psychological disorders that is characterized by uncontrollable eating binges usually followed by periods of fasting, purging, or vomiting. These bingeing/vomiting episodes presumably affect oral health. Oral symptoms related to bulimia nervosa that have been described in case reports, descriptive studies, and case-control studies include enamel erosion, dental caries, dental pain, orthodontic abnormalities, xerostomia, reduced saliva secretion, parotid enlargement and dysphagia, among others. All but 2 of the oral symptoms can be reversed: dental caries and tooth erosion. The dental profession can promptly diagnose these pathoses. However, this diagnosis reflects an established condition that leaves the professional with no other option than repair of damaged dental surfaces. Although it is important to diagnose erosion of the teeth in order to advise patients to seek medical treatment, the diagnosis of an established pathosis fails to anticipate its development and progression and does not permit the professional to implement interceptive and preventive strategies. EPIDEMIOLOGY OF BULIMIA NERVOSAThe eating disorders anorexia nervosa, bulimia nervosa, and their variants affect an estimated 5 million Americans yearly. 22 Although the prevalence of bulimia nervosa is unknown, the prevalence of dieting is very high. Modern women are bombarded with unrealistic images of what they should look like and what they should achieve. A recent survey of the San Francisco Bay area r...

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Section: Treatmentmentioning

confidence: 99%

Oral profiles of bulimic women: Diagnosis and management. What is the evidence?

Bretz¹

2002

The Journal of Evidenced-Based Dental Practice

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“…Plaque levels and gingival condition were similar in eating disorder groups and controls (Milosevic and Slade, 1989), gingivae were reportedly healthier in anorexics and bulimics compared to controls (Philipp et al, 1991) and plaque levels were signi®cantly lower in the eating disorder groups (Touyz et al, 1993). Finally, Altshuler et al (1990) found no signi®cant differences in Gingival Index, Periodontal Index or Plaque Index between a bulimic and control group.…”

Section: Periodontal Diseasementioning

confidence: 76%

“…This seems logical given that eatingdisordered subjects demonstrated high positive personal perfectionism (Terry-Short et al, 1995) and might therefore be obsessive with respect to oral hygiene which would also be re¯ected in plaque levels and gingival health. Unfortunately, the results regarding caries remain equivocal, since Altshuler et al (1990) reported no difference in Decayed Missing Filled Surfaces (DMFS) index between a bulimic group and a control group, yet con¯icted this by stating that the bulimics had a greater mean number of carious lesions. The relationship between caries and diet in these groups is less clear.…”

Section: Cariesmentioning

confidence: 99%

Eating disorders—a dentist's perspective

Milosević

1999

Eur. Eat. Disorders Rev.

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“…[8][9][10][11][12][13][14][15][16][17][18][19][20][21] Intraoral manifestations differ depending on the specific behaviors associated with the different types of eating disorders. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] Intraoral manifestations differ depending on the specific behaviors associated with the different types of eating disorders.…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17] Physical manifestations associated with anorexia include lanugo (growth of fine body hair), loss of head hair as a result of malnutrition and loss of body fat, and weight changes ranging from being at a normal weight to being extremely thin in severe cases. 12,13,25,26 The dental hygienists_ role also extends to tertiary prevention (management of relapse) by way of regular oral checkups every 6 months. 22,23 Secondary prevention consists of early identification, referral, and treatment of those who exhibit signs and symptoms of eating disorders.…”

Section: Introductionmentioning

confidence: 99%

Integration of Oral Health Care and Mental Health Services: Dental Hygienists’ Readiness and Capacity for Secondary Prevention of Eating Disorders

DeBate

Plichta²,

Tedesco³

et al. 2006

J Behav Health Serv Res

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Often the first to observe overt health effects of eating disorders, dentists and dental hygienists play a fundamental role in the secondary prevention of eating disorders. The purpose of this study was to explore readiness and capacity for integration of oral health and mental health services. Employing a randomized cross-sectional study based upon the Transtheoretical and Health Belief Models, data were collected from 378 dental hygienists. Results reveal that the majority do not currently engage in secondary prevention practices. Only 18% of respondents indicated referring patients exhibiting oral manifestations of eating disorders to treatment. Significantly increasing the likelihood of assessment, referral, and case management included modifying factors regarding greater perceived self-efficacy, and knowledge of oral cues of disordered eating, as well as the individual's perception pertaining to severity of eating disorders. Implications for bridging dental care to mental health services include increasing behavioral capacity among dental hygienists via consciousness raising and improved self-efficacy.

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An investigation of the oral pathologies occurring in bulimia nervosa

Cited by 46 publications

References 16 publications

Oral profiles of bulimic women: Diagnosis and management. What is the evidence?

Oral profiles of bulimic women: Diagnosis and management. What is the evidence?

Eating disorders—a dentist's perspective

Integration of Oral Health Care and Mental Health Services: Dental Hygienists’ Readiness and Capacity for Secondary Prevention of Eating Disorders

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