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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:
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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.
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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
Women's
Dental Health Eating
Disorders Women's Health Index
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