EATING DISORDERS

Shahnaz CRI

ORAL MANIFESTATIONSOF

Eating disorders are conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health.

Anorexia nervosa

Bulimia nervosa

Binge eating disorder

OSFEDDSM IV 2009

Etiology

Prevalence• The mean age of onset is between 17.1 and

20.8 years• Most anorexics (90% to 95%) are young

(under 25years), affluent white woman of at least normal intelligence

• Most bulimic patients are women in late adolescent or early adult years.

• Athletes, dancers, or models, showed higher risk for the development of eating disorders

• female:male – 3:1

ANOREXIA NERVOSA Anorexia nervosa is characterized by • Intentional loss of weight due to an

extreme aversion to food,• strict diet in an unchecked pursuit of

slenderness,• obsessive fear of getting fat,• a grossly distorted self-image of the

body, • and alterations in the menstrual cycle

ICD 9 code 307.1

SUBTYPES(DSM-IV)

RESTRICTIVE

BINGE & PURGE

•Malnutrition and vitamin deficiencies • Obsessive and/or self-injurious behaviors • Abnormal blood counts • Irregular heart rhythms • Fatigue, dizziness, or fainting • Low blood pressure • Amenorrhea • Dry skin and brittle nails • Dehydration • Bone loss • Others: increased body hair, thin appearance,

constipation

Clinical Manifestations

BULIMIA NERVOSA• An eating disorder characterized

by binge eating and purging,• or consuming a large amount of food

in a short amount of time • followed by an attempt to rid oneself

of the food consumed (purging), • typically by vomiting, taking a 

laxative, diuretic, or stimulant, and/or excessive exercise, because of an extensive concern for body weight ICD 9 code 307.51

CLINICAL MANIFESTATIONS • Irregular heartbeat • Dehydration, dry skin • Fatigue • Bloating • Abnormal bowel functioning • Sores, scars, or calluses on the knuckles

or back of hands (Russell’s sign) Chronically inflamed & sore throat Electrolyte imbalance

ORAL MANIFESTATIONS

Bulimia nervosaAnorexia nervosa

GINIGIVITISPERIODONTITIS

CHANGES IN SALIVA

XEROSTOMIA

CARIESCHANGES IN

ORAL MICROFLORA

ENLARGED SALIVARY GLANDS

DENTAL EROSION

Effects on teeth structure• chronic regurgitation of gastric

contents causes enamel erosion and demineralization

• PERIMYLOLYSIS• Erosion: #lingual- smooth and

glossy #facial- dished out • Dentin hypersensitivity• Increased risk of dental caries

Lingual erosion

Facial/ buccal erosion

Effect on soft tissues• Increased risk of periodontal disease,

gingival bleeding and delayed healing• Gingival erythema• Burning sensation• Traumatized oral mucosa• Angular chelitis• Oral candidiasis• Altered taste sensation

Effect on salivary glands

• Xerostomia• Low salivary flow,

decreased buffering capacity

• Sialadenosis• Enlargement of

parotid gland

Dental treatment and prevention• Monitor dental erosion• Fluoride gel to induce remineralization• Avoid use of abrasives during restoration• Potassium oxalates, strontium chloride and

desensitization pastes.• Instruct patients not to brush within 1 hr of

vomiting• Use of xylitol gums to increase salivary flow• Encourage use of antacids after purging

episodes

TREATMENT• COGNITIVE BEHAVIORAL THERAPY

• DIETARY COUNSELLING

• FAMILY THERAPY

• ANTIDEPRESSANTS

CONCLUSION

• Eating disorders present unique psychological, medical, nutritional, and dental pattern

• The dentist may be the first healthcare provider to detect, diagnose, and lead the patient to medical treatment, there by, providing multidisciplinary treatment with a favorable prognosis.

References• Aranha, Eduardo,cordas; psychiatric and dental implications of

eating disorders;The Journal of Contemporary Dental Practice, Volume 9, No. 6, September 1, 2008

• Walter bretz, J evid based dent prac 2002,dec ;2(4) 262-272• Carranza’s clinical periodontology, 10th edition• Yagi, Ueda, Asakawa et al,; role of ghrelin, salivary secretions

in eating disorders; Nutrients 2012, 4, 967-989; doi:10.3390/nu4080967