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Oral and Physical Manifestations of Anorexia and Bulimia Nervosa
Abstract
Food avoidance and disordered eating behavior are hallmarks of the psychopathologic disorders known as anorexia nervosa and bulimia nervosa. Anorexia nervosa is characterized by severe restriction of food intake, which leads to weight loss and the medical consequences of starvation. Bulimia nervosa is characterized by attempts to curtail food intake, interspersed with binge eating, followed by self- induced vomiting to rid the body of food. Tooth erosion and heightened sensitivity, caused by tooth contact with gastric acid during vomiting, are among several intraoral signs and symptoms of anorexia nervosa and bulimia nervosa. Self-induced vomiting in bulimic patients may cause trauma to intraoral soft tissues in the form of epithelial ulceration. Dentists and dental hygienists are often the first health care providers to examine patients with anorexia nervosa and bulimia nervosa, and are in a good position to recognize the physical and oral effects of eating disorders. Unfortunately, too few oral health practitioners consistently assess patients for oral manifestations of eating disorders, and equally few patients suffering with eating disorders regard their oral health practitioners as an important source of information about eating disorders. Lack of knowledge about the intra- and extraoral effects of eating disorders creates barriers that prevent patients from speaking frankly with oral health practitioners about their issues. It is incumbent upon oral health practitioners to recognize and diagnose the effects of these disorders and render appropriate treatment.
... In AN, oral manifestations include enamel erosion, the trauma of oral mucosa and pharynx, parotid gland enlargement and xerostomia. Prevalence of dental caries and periodontal diseases among AN remains unclear (21)(22)(23). They can be identified in a dental office if only oral and some extraoral manifestations associated with this disease are known (1,3,6,9,(21)(22)(23). ...
... Prevalence of dental caries and periodontal diseases among AN remains unclear (21)(22)(23). They can be identified in a dental office if only oral and some extraoral manifestations associated with this disease are known (1,3,6,9,(21)(22)(23). The dentist's key role is to be the first health care practitioner to recognize, evaluate the oral effects of AN, and make a critical referral of this patient to the appropriate physicians. ...
... The highest incidence of AN is between 17.1 and 20.8 years of age. In all, 90-95% of anorexics are under 25 years of age (21). This phenomenon may be explained by the greater influence of the media on young women, who show a higher level of internalization of cultural patterns in the body shape than men. ...
Background: Anorexia nervosa is a psychosomatic disorder and is commonly associated with impaired oral health. Dentists can play a relevant role in the early diagnosis of anorexia nervosa. With the help of intra- and extraoral examinations and anamnesis, the dentist can detect characteristic signs and symptoms of this eating disorder. The purpose of this study was to determine the knowledge regarding the oral and physical manifestations of anorexia nervosa among general dental practitioners and specialist dentists of Poland.
Material and Methods: A pretested online questionnaire consisting of a first part asking for the characteristics of the participant and a second part with 22 specific questions on their general knowledge of anorexia nervosa and knowledge of physical and oral manifestations of this eating disorder was used.
Results: A total of 369 dentists completed the questionnaire. The Polish dentists in this study reported sufficient knowledge regarding anorexia nervosa. However, younger dentists and general dental practitioners had relatively lower knowledge scores than other groups. The dentists mainly had difficulties with the oral symptoms of anorexia nervosa.
Conclusion: Despite Polish dentists having sufficient knowledge about anorexia nervosa in relation to the general symptoms of anorexia, there are deficits with regard to oral manifestations. Therefore, there is a need to increase continuing education in this field, which can improve early diagnosis of this disease by dental practitioners and referral to specialists for treatment.
... In particular, patients who have suffered from bulimia for a moderate period of time (months/a few years) have severe erosion on the lingual surfaces of the maxillary anterior teeth, whereas lingual and occlusal surfaces of the upper molars have moderate erosion. Instead, long-term bulimic patients show generalized erosion of teeth, an unsightly appearance, and a moderate-to-severe sensitivity [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . ...
... The cause of these eating disorders, As for psychiatric factors, disorders might start in response to inadequate or destructive interpersonal relationships in families who are goal oriented and highly achieving [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . cise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas) . ...
... Tab. I Diagnostic criteria for bulimia nervosa [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: -eating, in a discrete period of time (eg, within any 2-hour period), a large amount of food; -a sense of lack of control over eating during the episode Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise ...
... Among the consequences of ED in the scientific literature several oral and dental manifestations involving the oral mucosa, teeth, periodontium and salivary glands are reported. Often, these signs appear in the early stages of ED and allow an early diagnosis of the disease [Little, 2002;Debate et al., 2006;Misra et al., 2010;Antonelli and Seltzer;Tolkachjov and Bruce, 2017;Bassiouny, 2017;Panico et al., 2018]. The dentist, especially the paediatric dentist, collecting a complete history, performing a detailed extra/intra-oral examination and interacting with the patient, may be the first professional to detect the clinical signs of ED [Kavitha et al., 2011]. ...
Aim:
To evaluate the effects of tongue frenulectomy performed with two therapeutic approaches: Laser frenulectomy and combined laser and speech-language therapy.
Materials and methods:
The study involved 180 patients (90 males and 90 females) aged between 6 and 12 years. After examination and data collection, the patients were stratified according to three degrees of severity: mild, moderate and severe. After treatment, the test group (laser frenulectomy and combined laser and speech-language therapy) was compared with the control group (laser frenulectomy) in the pre-surgical phase, at one week, 1 month, 3 months, 6 months and 12 months after surgery.
Results:
Statistical analysis showed statistically significant differences between the pre-surgical and post-surgical values at 3 months, 6 months and 12 months after surgery (p<0,05).
Conclusions:
It is essential to establish diagnosis criteria to which the clinician should refer in order to decide the treatment plan. This study shows that combined laser and speech- language therapy leads to better results than the resection treatment of the frenulum with laser technique alone.
... 4 EDs as a non-communicable disorder 5 could possibly co-occur with many other abnormal conditions and have been seen in different classes and races of the world: recently the prevalence was observed in drug addicted people. 6 Bulimia nervosa is linked with gastric ulcer and gastric dilation in many studies 7,8 . EDs generally affect gastrointestinal system in two ways: mechanical and paralytic events; mechanically it could be due to duodenal compression whereas paralytic ally it could be because of atrophy of intestinal smooth muscles, delayed intestinal transit or delayed gastric emptying. ...
Background: Eating disorders (EDs) are very common disorders in the society, nonetheless, underestimated. It is a group of heterogeneous diseases/disorders associated with abnormal eating habits/eating behaviours found in all ages, race and sexes, and are more common in females than males. EDs could possibly be more common in diabetic patients. This study aims to examine the prevalence of eating disorders (using SCOFF questionnaire) in diabetics type I/II and its association with anthropometric indices. Methodology: A cross sectional study was conducted with the known cases of diabetes I or II. Subjects suffering from any other disease are excluded from the study. A self designed questionnaire indicating the anthropometric indices and a well-known SCOFF questionnaire for the purpose of screening of EDs was used. SPSS-21 was used to analyze the data. Fisher’s exact test was employed as an appropriate for qualitative data. Results: The overall prevalence of likelihood of EDs was reported highest (99%), the frequency of EDs in diabetic type II groups was 66.6% and Type I was 32.4% respectively, The prevalence of EDs was significantly more in type II (p=0.03) as compared to type I. Conclusion: High prevalence of eating disorders was observed in diabetics, more common in Type II diabetic patients. Non-significant fluctuated anthropometric indicators were seen in diabetics type I and II and patients with eating disorders.
Keywords: Eating disorders, Diabetes, Anthropometric indicators
... Hypoestrogenia can be a trigger for the development of osteopenia and osteoporosis, which leads to a decrease in bone mineral density (29,30,31). Emerging hypogonadism and secondary hyperparathyroidism, as a result of disorganizing eating behavior in AN, low calcium intake, and vitamin D deficiency and hypercorticism, may also be one of the important components that predispose GPD in patients with AN (32,33,34,35,36,37). ...
Introduction. Diseases of parodontal tissues occupy a leading place in the structure of dental diseases. Early diagnosis of the initial degree of generalized parodontitis (GP) is an effective way of secondary prevention. This is due to the complexity of understanding the etio-pathogenetic mechanisms of the development generalized parodontal diseases (GPD) and the high association of them with a number of diseases of the internal organs and systems with common points of contact between interdependence and mutual influence, in particular with anorexia nervosa (AN). Recently, the incidence of AN has increased significantly and poses a serious state, social, psychological and medical problem. There are serious changes on the axis hypothalamus - pituitary - amygdala, genital and thyroid glands, which cause a decrease in thyroid hormone metabolism, cause hypoestrogenia, hypogonadism, secondary hyperparathyroidism due to AN. The detection of tissue sensitization to bone antigen can be an adequate specific reaction for early diagnosis of GP. Objective. To establish the features of configuration of generalized pаrodontal diseases and their clinical manifestations in the format of basic characteristics of anorexia nervosa. Material and methods. Clinico-radiological, immunological, analytical and statistical methods were used. Objects were 75 patients with AN, aged 18-36 years (average age 26 ± 3.8) - the main group (M), and 60 patients with GPD without signs of anorexia of the same age - comparison group (C). For a detailed analysis of the clinical manifestations of clinical manifestations of GPD in patients with AN, all patients in the main (M) and comparative (C) groups were divided into several subgroups. M1 subgroup - patients with various forms of gingivitis. The M2 subgroup was presented with patients with generalized parodontitis (GP) with AN as the basic pathology. The comparative (C) group consisted of two subgroups (C1), (C2) with different forms of gingivitis and GP, respectively. The control group consisted of 30 people similar to the age and sex without clinical signs of periodontal disease. Diseases of internal organs and systems, including the osteoarticular apparatus, in these examined people were excluded. Results. A high incidence of GPD up to 100% was diagnosed, including both independent parodontal soft tissue disease and all components of the paroodontal complex, which had characteristic of all age groups and varied with patient age, duration of AN and its stages. Among the independent forms of gingivitis, the most common was chronic catarrhal marginal gingivitis (86.7 ± 8.8%), with some cases of exacerbation on the background of the overwhelming absence of complaints with single manifestations of agrarian, complexity of psychological alliance. GP was predominantly I-II degree, with chronic course prevailing over other forms of GPD (80 ± 4.6%). Radiographically, in all patients, regardless of the severity of GP, there was an extension of the parodontal cleft and osteoporosis of the bone component of the parodontal complex, horizontal type of resorption. Advantages and priorities of different segments of parodontal complex lesions in patients with AN were not observed. For all patients with GP, a high degree of tissue sensitization to the bone antigen, characterizing significant changes in the bone component of the parodontal complex with AN, was finalized. Conclusions. Thus, direct correlation and interdependence of generalized parodontal diseases in the format of basic characteristics of anorexia nervosa were established.
A hipersensibilidade dentinária é caracterizada por dor aguda de curta duração, afetada pela exposição da dentina, resultante de vários estímulos (térmicos, químicos, táteis e osmóticos) sem envolvimento bacteriano. A hipersensibilidade dentinária pode ser desencadeada pelo consumo excessivo de bebidas ácidas, escovação inadequada, idade, doenças gengivais e periodontais, estresse, trincas dentárias por bruxismo, práticas esportivas e certas profissões que expõem os trabalhadores a produtos químicos que corroem o esmalte e o cemento do dente. O objetivo deste trabalho é investigar estudos existentes em artigos sobre a relação entre hipersensibilidade dentinária e estilo de vida, buscando correlacionar hábitos alimentares e ocupacionais entre atletas profissionais, amadores de esportes, estudantes e pessoas com transtornos alimentares. O estilo de vida também pode ser um fator de risco; muitos hábitos considerados saudáveis no estilo de vida atual são realmente potencializadores para o desenvolvimento da hipersensibilidade dentinária. Como comer frutas cítricas, molhos, vinagre e refrigerantes. O consumo de frutas ácidas, bebidas energéticas ácidas e bebidas com baixo teor de açúcar leva ao aumento da hipersensibilidade dentinária. A hipersensibilidade dentinária pode causar desconforto oral, causando danos psicossociais à vida do indivíduo, levando a restrições alimentares e sociais e comprometendo seu bem-estar geral. Conclui-se que este trabalho é uma contribuição essencial, no sentido de orientar os profissionais a intervir nos fatores que levam ao aparecimento e agravamento destas condições ao nível individual, nas diferentes causas de hipersensibilidade dentinária e nas condições que realmente impactam na vida das pessoas.
People with eating disorders suffer from a mental disorder that negatively affects their physical and/or mental health. The three most frequent eating disorders are binge eating disorder, bulimia nervosa, and anorexia nervosa. Environmental and genetic factors are involved in the pathogenesis of eating disorders in vulnerable persons. Although treatment varies among different types of eating disorders, nutrition, medical care combined with psychotherapy and medications are standard of care. The aim of this review is to give an overview of the oral health impact of eating disorders with a special emphasis on the periodontium. Oral health professionals have a unique role to play in the early diagnosis of eating disorders because of the important impact that eating disorders have on the oral cavity. In vomiting-associated eating disorders, the risk of erosive tooth wear is mainly localized to the palatal surfaces of the incisors. Emerging evidence also indicates a high frequency of gingivitis and gingival recessions associated with compulsive toothbrushing. A holistic approach, including oral health and functional rehabilitation, should be promoted by physicians, psychiatrists, and dentists for people with eating disorders.
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