Oral profiles of bulimic women: Diagnosis and management. What is the evidence?

Abstract

This article is a critical appraisal of the literature on the oral complications of bulimia. The MEDLINE database yielded a total of 82 English-language reports published between 1966 and 2002 that were pertinent to the topic of oral manifestations and treatment of bulimia. The literature is composed primarily of reviews, letters, case reports with or without restorative management, and descriptive studies of small sample sizes. At present, retrospective case-control studies are the only studies available with levels of evidence in the vicinity of 3 to 4. From these studies it is apparent that bulimic women present with a variety of oral and pharyngeal signs and symptoms, including dental caries and tooth erosion, dental pain, increased levels of cariogenic bacteria, orthodontic abnormalities, xerostomia (the subjective complaint of a dry-mouth) and decreased saliva secretion (the objective measure), decreased salivary pH, decreased periodontal disease, parotid enlargement, and swallowing impairments. Dental erosion is the major finding associated with bulimia. Case reports describe restoration of damaged surfaces with porcelain-laminated veneers, dentin-bonded crowns with minimal tooth preparation, composites, and completecoverage restorations. However, what is really needed is identification of oral markers of bulimic behavior for early detection of bulimic patients by dentists and by physicians that can prevent the deleterious effects of frequent vomiting on the oral/dental tissues.Bulimia nervosa is a constellation of nutritional and psychological disorders that is characterized by uncontrollable eating binges usually followed by periods of fasting, purging, or vomiting. These bingeing/vomiting episodes presumably affect oral health. Oral symptoms related to bulimia nervosa that have been described in case reports, descriptive studies, and case-control studies include enamel erosion, dental caries, dental pain, orthodontic abnormalities, xerostomia, reduced saliva secretion, parotid enlargement and dysphagia, among others. All but 2 of the oral symptoms can be reversed: dental caries and tooth erosion. The dental profession can promptly diagnose these pathoses. However, this diagnosis reflects an established condition that leaves the professional with no other option than repair of damaged dental surfaces. Although it is important to diagnose erosion of the teeth in order to advise patients to seek medical treatment, the diagnosis of an established pathosis fails to anticipate its development and progression and does not permit the professional to implement interceptive and preventive strategies. EPIDEMIOLOGY OF BULIMIA NERVOSAThe eating disorders anorexia nervosa, bulimia nervosa, and their variants affect an estimated 5 million Americans yearly. 22 Although the prevalence of bulimia nervosa is unknown, the prevalence of dieting is very high. Modern women are bombarded with unrealistic images of what they should look like and what they should achieve. A recent survey of the San Francisco Bay area r...

No Mental Health without Oral Health

“…Dental erosion or pathological wear on tooth surfaces is defined as loss of dental tissue without the involvement of bacteria. 22 This loss can be due to attrition (the action of one tooth grinding upon another, such as in bruxism), abrasion (where the surface is worn by another agent, such as a toothbrush), or erosion (where there is chemical dissolution of the tooth). 14 Risk factors for the latter include the consumption of large amounts of citrus fruit, soft drinks, and sports drinks as well as the presence of gastric reflux or frequent vomiting.…”

“…By contrast, dental caries is the result of bacterial action. 22 Organic acids produced by microorganisms in dental plaque cause demineralisation of enamel and dentin with cavitation of specific sites on the tooth surface. Caries is assessed by the number of decayed, missing, and filled teeth or surfaces (DMFT or DMFS).…”

“…29 Patients with self-induced vomiting (SIV) are most at risk, and wear is greatest on palatal surfaces (Figure 1). 22,30 In a meta-analysis of 10 studies ( N = 1112), patients with eating disorders had 5 times the odds of dental erosion compared with controls. In patients with SIV, the erosion rate was 7 times higher.…”

“…21 Finally, xerostomia may be a side effect of commonly used psychotropic medications, particularly those with anticholinergic effects. 21 –23…”

Neutralizing salivary pH by mouthwashes after an acidic challenge

“…1,4 Dental erosion due to chronic stomach acid exposure is the most frequent oral manifestation of bulimia nervosa. 5 Although the frequency of associated dental erosion is not known, the lifetime prevalence of bulimia nervosa among women has been reported to be 2%. 6 According to the National Eating Disorders Association, 20 million women and 10 million men in the USA suffer from eating disorders sometime in their lifetime.…”