Self-induced vomiting and dental erosion – a clinical study

Abstract

BackgroundIn individuals suffering from eating disorders (ED) characterized by vomiting (e.g. bulimia nervosa), the gastric juice regularly reaches the oral cavity, causing a possible risk of dental erosion. This study aimed to assess the occurrence, distribution and severity of dental erosions in a group of Norwegian patients experiencing self-induced vomiting (SIV).MethodsThe individuals included in the study were all undergoing treatment at clinics for eating disorders and were referred to a university dental clinic for examinations. One calibrated clinician registered erosions using the Visual Erosion Dental Examination (VEDE) system.ResultsOf 72 referred patients, 66 (63 females and three males, mean age 27.7 years) were or had been experiencing SIV (mean duration 10.6 years; range: 3 – 32 years), and were therefore included in the study. Dental erosions were found in 46 individuals (69.7%), 19 had enamel lesions only, while 27 had both enamel and dentine lesions. Ten or more teeth were affected in 26.1% of those with erosions, and 9% had ≥10 teeth with dentine lesions. Of the erosions, 41.6% were found on palatal/lingual surfaces, 36.6% on occlusal surfaces and 21.8% on buccal surfaces. Dentine lesions were most often found on lower first molars, while upper central incisors showed enamel lesions most frequently. The majority of the erosive lesions (48.6%) were found in those with the longest illness period, and 71.7% of the lesions extending into dentine were also found in this group. However, despite suffering from SIV for up to 32 years, 30.3% of the individuals showed no lesions.ConclusionsDental erosion commonly affects individuals with ED experiencing SIV, and is more often found on the palatal/lingual surfaces than on the buccal in these individuals, confirming a common clinical assumption.

Dental Implications of Eating Disorders

“…Otsu et al [16] did not note dental erosion in 14% of the vomiting patients. The above data shows that erosive lesions are due to numerous factors and the cavities are a consequence of the interactions between them all [14,20].…”

“…Hermont et al [19] found erosion in 45% of the people affected, contrary to the healthy individuals in whom 8.8% had such lesions. Still, Uhlen et al [20] noted erosion in nearly 70% of patients affected with eating disorders. It must be emphasized that the incidence of erosion varies in the group of patients with such an entity and is related to the type of a disorder.…”

“…The quoted data leads to the conclusion that erosive lesions are more frequent in patients with eating disorders than in the rest of population. Still, some patients do not show erosion of teeth despite long-term presence of the disease, where one of the symptoms is repeated vomiting [15,16,20]. Moreover, it was proved that the average time needed for the first visible signs of dental erosion to appear is two years from the disease onset [21,22].…”

“…The acids contained in foods fall into the latter category. Destructive impact of the diet is related to a pH value of a consumed product, the content of calcium and phosphate ions in it, and the way sour foods are consumed [15,20,23].…”

“…Formation of an erosive lesion, its extent and depth is related to the amount of acids, their pH as well as the frequency and time hard dental tissues are exposed to them. It has been confirmed that in patients suffering from eating disorders, especially those accompanied by vomiting, the extent and depth of erosive lesions is directly proportional to the disease duration and to the frequency of vomiting episodes [15,20,23]. However, not all vomiting patients exhibit hard dental tissue lesions.…”