Bulimia-

The Implica/ons of Relevance for the Den/st.

What is bulimia? - Bulimia is a physiological disorder stemming from distorted perceptions of shape and weight. It is associated with a persistent preoccupation of eating (binge eating) and compensatory behavior or reducing caloric intake (purging) (Frydrych, Davies et al. 2005). Etiology- There are many proposed predisposing and etiological factors both psychological and biological. The attributes that tend to predispose an individual to develop and retain an eating disorder are: the strive for perfection, admiration of being thin, distorted views of weight gain, cultural/social pressures, family pressures and individual factors (Burke, Bell et al. 1996) Who is at risk? - Teenage girls to mid 30s (Pyle, Mitchell et al. 1983) - Elite Athetes (Frydrych, Davies et al. 2005) - Performing arts students (Frydrych, Davies et al. 2005) - 35% of American college students (Pyle, Mitchell et al. 1983) Dental Implications Classically, the most common and dramatic commonly observed manifestation is acid erosion due to vomiting. Dentists are recongized as one of the Tirst health practictioners to dignose eating disorders (Frydrych, Davies et al. 2005), and therefore should be aware of all the oral signs to begin treatment since erosion takes 2 years to become apparent (Brownridge 1994).
Enamel Erosion Palatal / occlusal

sensitivity

loss of gag reex

Sialadenosis

DMFT

vomiting binge eating - Acid / sugar food initiation of gagging Reduced saliva rate / bicarbonate

Enamel erosion buccal / occlusal

increased caries

periodontal disease. (manifests in later life)

reduced peak bone mass

osteopenia/ osteoporosis

ulcers, glossitis and tissue lesions

Bulimia

antidepressants

impaired tissue repair

angular chelitis

lack of nutrition

candida infection

UNDER DEBATE

Dental Management- Emergency care to treat pain (desnesitization, temporary / denitive restorations), patient education, antacid mouth rinse, uoride mouth rinse, and a magnesium hydroxide lined bite splint (Burke, Bell et al. 1996).

Bibliography Brownridge, E. (1994). "Eating disorders and oral health. How the dentist can help." Ont Dent 71(6): 15-18. ! Burke, F. J., T. J. Bell, et al. (1996). "Bulimia: implications for the practising dentist." Br Dent J 180(11): 421-426. ! Frydrych, A. M., G. R. Davies, et al. (2005). "Eating disorders and oral health: a review of the literature." Aust Dent J 50(1): 6-15; quiz 56. ! Pyle, R. L., J. E. Mitchell, et al. (1983). "The incidence of bulimia in freshman college students." International Journal of Eating Disorders 2(3): 75-85. !