Periodontal condition, changes in salivary biochemical parameters, and oral health‐related quality of life in patients with anorexia and bulimia nervosa

Abstract

Background Anorexia and bulimia nervosa can have significant effects on oral health. Assessment of enzyme concentrations in saliva can be useful for obtaining information on molecular biomarkers for the prevention, monitoring, and diagnosis of oral diseases. This study investigated the periodontal condition, changes in salivary biochemical parameters, and oral health‐related quality of life (OHRQoL) in patients with anorexia and bulimia nervosa. Methods The study comprised 60 women patients who attended a Brazilian medical school. Participants were divided into two groups: patients with anorexia and bulimia nervosa (ABN; n = 30) and control patients (CN; n = 30). Oral clinical examinations were carried out to evaluate the periodontal condition by Community Periodontal Index, and interviews using the Oral Health Impact Profile (OHIP‐14) were conducted to assess OHRQoL. Saliva samples were collected for the evaluation of salivary concentrations of total protein, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and thiobarbituric acid reactive substance (TBARS), and salivary flow rate. Results Periodontal condition in the ABN group was significantly worse than that in the CN group. The ABN group showed significantly higher salivary concentrations of total protein, AST, ALT, and LDH than the CN group. There was no significant difference in the salivary concentrations of TBARS among the groups. The OHIP‐14 score was higher in the ABN group than in the CN group. Conclusion Anorexia and bulimia nervosa are associated with poor periodontal condition, elevated salivary concentrations of total protein, AST, ALT, and LDH, decreased salivary flow rate and a significant adverse impact on OHRQoL.

Eating disorders through the periodontal lens

“…However, a high frequency of toothbrushing (ie, three times or more per day) has been repeatedly reported in people with eating disorders 34,37,57 . Findings regarding the occurrence of periodontal pockets of more than 3 mm reveal no difference between the anorexia nervosa/bulimia nervosa population and the general population 58 . However, a higher percentage of sites with a clinical attachment level of 3 mm or more have been repeatedly shown in people with eating disorders, particularly in those suffering from anorexia nervosa.…”

“…In addition, the repeated vomiting episodes promote gastrointestinal reflux, which aggravates dental erosion and initiates gingival recession on the palatal surfaces of the maxillary teeth (Figure 7). 58,60 It should be highlighted that in people with eating disorders the cervical erosive tooth wear often prevents use of the…”

“…In addition, the repeated vomiting episodes promote gastrointestinal reflux, which aggravates dental erosion and initiates gingival recession on the palatal surfaces of the maxillary teeth (Figure 7). 58,60 …”

“…Anterior lingual and occlusal localizations of the erosive tooth wear are typical of vomitingassociated eating disorders F I G U R E 2 Early stage of erosive tooth wear in a woman (25 years old) with anorexia nervosa periodontal pockets of more than 3 mm reveal no difference between the anorexia nervosa/bulimia nervosa population and the general population. 58 However, a higher percentage of sites with a clinical attachment level of 3 mm or more have been repeatedly…”

“…In addition, the repeated vomiting episodes promote gastrointestinal reflux, which aggravates dental erosion and initiates gingival recession on the palatal surfaces of the maxillary teeth (Figure 7). 58,60 It should be highlighted that in people with eating disorders the cervical erosive tooth wear often prevents use of the cemento-enamel junction for measuring the height of the recession and for calculating the clinical attachment level. Any other reference point used should be clearly identified in the periodontal chart.…”