Oral Health and Bone Density in Adolescents and Young Women with Anorexia Nervosa

Abstract

Purpose-To evaluate the dental and periodontal health of adolescents and young women with restrictive anorexia nervosa (AN), and relationship between bone mineral density (BMD) assessed by dual energy X-ray absorptiometry (DXA) and dental radiographs.Study Design-Twenty-three young women, median age 17.6 years (range 14.4-27.2), were studied within three months of entering a clinical trial. DXA BMD measurements were obtained and subjects underwent a comprehensive dental examination, including panoramic and bitewing dental radiographs. Three observers assessed mandibular cortical width (MCW) in the mental foramen region on panoramic radiographs.Results-Dental findings included very good to excellent oral hygiene. Gingival recession was evident in 10 participants (43%). Dental erosion was not seen and the mean decayed missing or filled teeth (DMFT) was 8.6. There was a weak positive correlation between BMD by DXA and MCW on radiographs.Conclusions-We report dental manifestations associated with restrictive AN, and the association between bone assessments by DXA and dental radiographs in this patient group. Despite subnormal DXA measurements in most patients, essentially all adolescents had a normal dental examination. Dental providers should be cognizant of the fact that many patients with eating disorders may not display the "classic" findings reported in the literature.

Tooth Erosion and Eating Disorders: A Systematic Review and Meta-Analysis

“…Twenty papers were published in English [4]–[6], [9], [18]–[26], [28], [30]–[32], [34]–[36], and there were also publications in Portuguese [29], Spanish [27] and Italian [33]. The search presented papers published from 1977 [25], [26] to 2013 [6].…”

“…It also did not mention if the patients were referred from hospitals [25]. Only a few studies reported the criteria used to identify TE or if the examiners had been trained and calibrated [6], [9], [25], [36].…”

“…Therefore, they may be the first health professionals to suspect EDs, due to their oral implications, contributing to the patient's early referral to specific treatment [3], [9]. Nevertheless, even with the increasing prevalence of EDs, the causal effect between these EDs and TE has not been thoroughly discussed in literature.…”

Causes of Dental Erosion: Intrinsic Factors

“…It should be pointed out that in this study, 26 % of the participants had history of binge eating/vomiting activity [ 45 ]. A recent systematic review showed that patients with eating disorders who have a self-induced vomiting habit showed 19.6 times more risk for erosion than patients without vomiting habits [ 28 ].…”

Eating disorders in children and adolescents

“…The malnutrition and related medical complications resulting from ED such as AN, BN, and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The Workgroup for Classification of Eating Disorders in Children and Adolescents (2010) and The Society for Adolescent Medicine recommend that the diagnoses and treatment thresholds for pediatric ED should be lower than for adults due to the potentially irreversible effects of ED including pubertal delay, growth retardation, short stature, structural brain changes, low bone mineral density (6,7). In addition, it has been reported that in young women suffering from BN, unstimulated saliva flow rate was decreased, with frequent complaints of dry mouth (8).…”