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DENTAL ASPECTS OF BULIMIA

Bulimia can cause severe health problems

Many people suffering from bulimia are able to hide the disorder from others but it is more difficult to keep it a secret from their dentists. Changes inside the mouth of a bulimic  can be detected during the course of a routine dental examination.

     The oral manifestations of bulimia are:

  1. Smooth outer surface (enamel) erosion which is a major sign of bulimic behavior.  This is the most common effect of vomiting.   This lose of enamel and dentin usually occurs on the upper,  front inside  surfaces of their teeth.  These teeth will have a smooth glassy appearance that are void of stains or lines.  If the back teeth are affected there is often a loss of the biting surfaces of these teeth and they become highly susceptible to decay and more serious infections of the nerves within these teeth.  
    These signs often appear after the bulimic has been binging an purging for at least two years.  There is a relationship between tooth erosion and frequency and degree of vomiting as well as oral hygiene habits. If they have excellent hygiene practices these symptoms may not be present.
    They symptoms could progress to the point of causing:

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The nerve of the tooth to be exposed leading to temperature
 sensitivity.

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Margins of fillings on the back teeth may appear higher than the
surfaces around the filling

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Their bite can change causing an open bite due to loose of
tooth structure.

  2.   Parotid gland swelling.  Swelling is common in bulimics.  
        The occurrence of enlargement is related to the duration and
        severity of vomiting.

  3.   Dry mouth.  The amount of saliva is effected by abuse of laxatives, 
        diuretics, dehydration from fasting and vomiting.

  4,   Gum tissue trauma.  This condition is due to ingesting 
         large amounts of food and by the force of vomiting.  
         If objects are used to force vomiting they can injury 
         the soft pallet.  Dehydration will effect gum tissue.  

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   Suggestions for detection:

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Include a general screening with questions regarding eating and
maintaining weight.

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Bring the symptoms you observe to their attention.  "You have
loss of enamel.  This is often seen in individuals who vomit.
Have you ever vomited or purged in this way?

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Be gentle and understanding about the problem while trying to 
encourage the bulimic at their appointments. 

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Refer them to a mental health professional who is experienced in 
eating disorders.

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Look for irritated areas or callus on the top surface of right or left forefinger,
caused by rubbing the finger on the incisal edges of the upper anterior teeth 
while inducing vomiting.

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Dental Treatments Protocol

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Start with rigorous hygiene and home care.

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Regular professional dental cleanings

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In-office fluoride applications to prevent further erosion and decrease dentin sensitivity.

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Daily home application of fluoride in custom trays to promote remineralization of the enamel.

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Use of artificial saliva.

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Rinsing their mouth with water immediately after vomiting to decrease the acidity in the mouth.

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Use  a fluoride rinse to neutralize acids and protect and remineralize
the tooth surfaces. 

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Do NOT brush teeth after vomiting, it will lead to excessive enamel erosion.

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Commitment to professional treatment.

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Use desensitizing toothpaste to decrease dentinal sensitivity. 

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Esthetic treatment should not be done during the active phase of this disorder.  Restoring esthetics can be done  in the recovery stage.

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When treating during RECOVERY their teeth may need to be restored to normal appearance.

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Recommend 1,200-1,500 mg of calcium per day, in addition to eating a healthy variety of al foods.**

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Frequent dental visits to monitor condition of the mouth.

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Bulimic News Updates

Oral profiles of bulimic women

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. 
From these studies it is apparent that bulimic women present with a variety of oral and pharyngeal signs and symptoms, including:

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dental caries 

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tooth erosion

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dental pain

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increased levels of cariogenic bacteria

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orthodontic abnormalities

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xerostomia ( dry-mouth)

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decreased saliva secretion 

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decreased salivary pH

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decreased periodontal disease

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parotid enlargement

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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 complete-coverage restorations. 

**Source: Women Dentist Journal, Female Athlete Triad Spell Triple Trouble, Dr. Doniger, pgs. 63-67, Jan/Feb 2003
Source.  Dental Products Report.  Dr. Steinburg.  March 2001, pg 88-90.

Diagnosis and management. What is the evidence? Walter A. Bretz , Journal of Evidence Based Dentistry 2002; 2(4)
Oral Care for Patients with Bulimia, Dr Christensen, JADA, Vol 133, pgs 1681-1691,December 2002.

For more on: Bulimia or Anorexia

http://www.msu.edu/user/nigg/424eatingdisorder.htm

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February 06, 2008

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          If you have any questions please e-mail me at: drdpeterson@scottsbluff.net
                                                                                 308-436-3491 Office number

PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
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