oral manifestations of eating disorders
TRANSCRIPT
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