The need for psychiatric-dental liaison in the treatment of bulimia

Eating Disorders and Dental Erosion: A Systematic Review

Both eating disorders and dental erosion are increasingly affecting adolescents and young adults. Thus, our systematic review was designed to answer the question: "Is there a relationship between dental erosion and eating disorders?" Following the inclusion and exclusion criteria, 31 studies were included in this systematic review (according to the PRISMA statement guidelines). Based on the meta-analysis, 54.4% of patients with bulimia nervosa and 26.7% with anorexia nervosa experienced tooth erosion. For the whole group of 1699 patients with eating disorders, erosive lesions were observed in 42.1% of patients. Bulimics were more than 10 times more likely to experience dental erosion compared to healthy individuals (OR = 10.383 [95%CI: 4.882-22.086]). Similarly, more than 16 times increased odds of tooth erosion were found in patients with self-induced vomiting (OR = 16.176 [95%CI: 1.438-181.918]). In conclusion, eating disorders are associated with an increased risk of developing erosive lesions, especially in patients with bulimia nervosa.

Occupational Therapy in Bulimia

In this second article on bulimia, the role of occupational therapy is discussed. Some approaches examined Include psychoeducational groups and the use of projective techniques. The area of body image is explored. The complications and outcome of the condition are reviewed since they form an important part of the educational groups.

Tooth erosion and eating disorders: a systematic review and meta-analysis

Background

Eating disorders are associated with the highest rates of morbidity and mortality of any mental disorders among adolescents. The failure to recognize their early signs can compromise a patient's recovery and long-term prognosis. Tooth erosion has been reported as an oral manifestation that might help in the early detection of eating disorders.

Objectives

The aim of this systematic review and meta-analysis was to search for scientific evidence regarding the following clinical question: Do eating disorders increase the risk of tooth erosion?

Methods

An electronic search addressing eating disorders and tooth erosion was conducted in eight databases. Two independent reviewers selected studies, abstracted information and assessed its quality. Data were abstracted for meta-analysis comparing tooth erosion in control patients (without eating disorders) vs. patients with eating disorders; and patients with eating disorder risk behavior vs. patients without such risk behavior. Combined odds ratios (ORs) and a 95% confidence interval (CI) were obtained.

Results

Twenty-three papers were included in the qualitative synthesis and assessed by a modified version of the Newcastle-Ottawa Scale. Fourteen papers were included in the meta-analysis. Patients with eating disorders had more risk of tooth erosion (OR = 12.4, 95%CI = 4.1–37.5). Patients with eating disorders who self-induced vomiting had more risk of tooth erosion than those patients who did not self-induce vomiting (OR = 19.6, 95%CI = 5.6–68.8). Patients with risk behavior of eating disorder had more risk of tooth erosion than patients without such risk behavior (Summary OR = 11.6, 95%CI = 3.2–41.7).

Conclusion

The scientific evidence suggests a causal relationship between tooth erosion and eating disorders and purging practices. Nevertheless, there is a lack of scientific evidence to fulfill the basic criteria of causation between the risk behavior for eating disorders and tooth erosion.

The psychology of tooth wear

AIM

To review the main psychological and mental conditions that are manifested dentally in the form of tooth wear. These conditions include depression, eating disorders, and alcohol and drug use disorders. The paper will also review the comorbidity of these conditions and the relevance of other medical conditions and lifestyle factors, such as gastroesophageal reflux disorder, smoking and diet, in the expression of tooth wear.

CONCLUSION

A holistic, multidisciplinary, healthcare approach is required in management of tooth wear patients with underlying mental health disorders. Dentists and Dental Care Professionals can have an important role in identifying these mental disorders through the observed tooth wear. They can also play a key role in monitoring patients' response and compliance to medical treatment through the monitoring of tooth wear progression and expression.

Stomatologic complications of eating disorders

Since the 1990s numerous international experts have reported about the somatic complications of eating disorders including those having a dental and stomatological nature. Several reports emphasised that deformations in the oral cavity resulting from this grave nutritional disease typical of the young generation could already appear in the early stage and, therefore, dentists are among the first to diagnose them. Dentists are still often unaware of the importance of their role in multidisciplinary treatment. Even if they knew what the disease was about and recognised it on the basis of deformations in the oral cavity in time, their advice that their patients should brush their teeth more often would fail to eliminate the root cause of the problem. Not only the earliest possible treatment of the complications of the bingeing-purging mechanism and the maintenance of oral hygiene are important, but controlling and curing pathological habits with active participation of psychiatrists are also required to ensure full recovery. Due to the multidisciplinary nature of the disease, manifold communication is required. For this reason, publishing the dental ramifications of organic and systemic diseases at dental conferences and in technical journals, as well as providing information about oral complications of eating disorders for general practitioners and specialists are particularly important. Orv. Hetil., 2012, 153, 1779–1786.

Sex differences among dentists regarding eating disorders and secondary prevention practices

BACKGROUND

The purpose of this cross-sectional study was to assess sex differences among dentists pertaining to current behaviors and behavioral beliefs with regard to eating disorders.

METHODS

The authors collected data via a self-administered paper-and-pencil questionnaire from a randomized sample of 350 practicing male and female dentists.

RESULTS

The results showed a low level of practice regarding secondary prevention (that is, measures leading to early diagnosis and prompt intervention) of eating disorders. The authors found statistically significant differences, with more female than male dentists reporting that they assessed patients for oral cues (P < .001), more female dentists reporting that they provided specific dental care instructions (P = .038) and more female dentists referring patients who have oral signs of eating disorders (P = .028). They also found sex differences with regard to mediating factors. Female dentists had greater knowledge of oral manifestations of eating disorders (P = .001), greater knowledge of physical cues of anorexia nervosa (P < .001), greater perception of the severity of anorexia nervosa (P = .007) and greater knowledge of physical cues of bulimia nervosa (P < .001).

CONCLUSIONS

Although the dentist may be the first health care provider to assess oral effects of eating disorders, his or her involvement may be influenced in part by sex and sex-related health beliefs.

CLINICAL IMPLICATIONS

Female dentists may be more sensitive to oral cues related to women's health issues. Further research is warranted to explore the mediating factors regarding secondary prevention of eating disorders.

Communicating effectively with patients suspected of having bulimia nervosa

BACKGROUND

The dental team often is confronted with the clinical appearance of erosion affecting the hard and soft oral tissues. An investigative process often is needed to determine the cause of such erosion, because factors other than eating disorders may be involved. The authors present a protocol that should be considered in the assessment of dental erosion. Guidelines provide direction for the clinician toward opening a dialogue with a patient when the suspected cause of erosion is an eating disorder.

TYPES OF STUDIES REVIEWED

The authors review publications related to the causes of dental erosion and the patterns that are involved with both chemical and mechanical destruction of oral tissues. They also discuss the oral-tissue effects related to eating disorders. The authors stress the importance of assisting parents in obtaining adequate treatment for pediatric patients.

RESULTS

Cases of eating disorders among female college students, athletes, preadolescent children and men are well-documented. However, dental staff members often do not feel comfortable beginning a dialogue with patients who are suspected of having an eating disorder. This article focuses on the proper protocol for approaching such patients and beginning a dialogue. In addition, the authors provide suggestions for limiting further erosive damage to the tissues. They also discuss other causes of erosion that should be considered when assessing any type of oral erosion.

CLINICAL IMPLICATIONS

The dental team is in a prime position to assist patients who have eating disorders. Timely treatment by mental health and other medical professionals is crucial. The authors suggest a dialogue for approaching these patients and offer educational material to reduce further tissue destruction.

Bulimia Nervosa: A Primary Care Review

Bulimia nervosa is a psychiatric condition that affects many adolescent and young adult women. The disorder is characterized by bingeing and purging behavior and can lead to medical complications. Thus, patients with bulimia nervosa commonly present in the primary care setting. Physical and laboratory examinations reveal markers of bulimia nervosa that are useful in making the diagnosis. Treatment is beneficial, and outcomes of early intervention are good. This article discusses the history, presentation, and tools needed for recognizing and treating bulimia nervosa in primary care.

Pharmacotherapy and medical complications of eating disorders in children and adolescents

In this article, the authors cover two areas of interest regarding eating disorders in childhood and adolescence: (1) the detection of eating disorders in medical practice and their medical complications and (2) the psychopharmacologic treatment of patients with eating disorders.

Eating disorders: a guide for the primary care physician

The diagnostic criteria for eating disorders are described, including assessment of complications related to semi-starvation, binge eating, and purging. The key components of treatment are presented, including normalization of eating, individual and family therapy, and cognitive behavioral therapy. The role of the primary care physician in diagnosis and treatment is outlined.

The role of third molar surgery in the exacerbation of eating disorders

PURPOSE

Eating disorders are a major public health problem. This study was undertaken to investigate the role of dental surgery in the etiology and clinical course of these serious and occasionally life-threatening disorders.

METHODS

Three questions concerning dental therapy were included in a pretreatment assessment of 97 consecutive patients entering an eating disorder therapy program during a 22-month period. These questions were designed to determine the influence of dental surgery, including frequency and severity, on eating disorders.

RESULTS

All 97 patients, of which 96 were female, complied with the questionnaire. Seventy-five of 97 were 25 years or younger, and 53 of 97 were diagnosed as having anorexia nervosa. Sixteen patients (16.5%) reported having had orthodontic therapy, and 21 (21.6%) had undergone third molar surgery. Nine patients (9.3%) (1 orthodontic, 8 third molar surgery) indicated that dental procedures had caused exacerbation or relapse of their eating disorders; 8 of 21 (38%) who had undergone third molar surgery were positive respondents. None of the patients linked dental care to the initial onset of their eating disorders.

CONCLUSIONS

These data reveal that dental procedures, specifically third molar surgery, can significantly alter the course of eating disorders, causing exacerbation or relapse. No patient indicated that dental therapy was the primary cause of these multifactorial psychonutritional disorders. A history of eating disorder should alert the practitioner to the risks of performing third molar surgery without a medical or psychotherapy consultation unless there is documentation of remission. Delay of surgical intervention is recommended if third molars are asymptomatic. If surgery is necessary, the surgeon and other members of the psychotherapy team should establish clear guidelines regarding behavior and postoperative nutrition and should monitor the patient's nutritional status.

Bulimia: a primary care approach

More common than anorexia and less easily detected, bulimia typically begins as an effort to control weight. Although the prognosis is better than that for anorexia nervosa, a number of medical complications can arise related to the mode of purging. Some of these complications can have profound deleterious sequelae if not diagnosed and treated.

Eating disorders. Guide to medical evaluation and complications

Eating disorders lead to numerous physical complaints with signs and symptoms affecting nearly every organ system of the body. We review the presentation of a patient with eating disorder to the primary care giver or general psychiatrist, focusing on the physical manifestations of the underlying illness. Specific complications related to laboratory findings, the gastrointestinal tract, and the endocrine system are reviewed. Algorithms for medical evaluation of these patients are also presented.

Anorexia and bulimia nervosa (the eating disorders): conditions of interest to the dental practitioner

OBJECTIVES

This paper aims to give the dental practitioner an insight into the impact of the eating disorders on sufferers.

METHODS

A review of the psychiatric literature on the diagnosis, aetiology and treatment of these conditions is given.

CONCLUSIONS

The dental practitioner is in an ideal position to identify the warning signs of these conditions before they have attracted medical attention.

Oral symptoms in bulimia nervosa. A survey of 34 cases

Bulimia nervosa is increasingly recognized as an eating disorder with significant medical and dental complications, including increased caries rate, thermal hypersensitivity, enamel erosion, xerostomia, and parotid gland hypertrophy. This article reviews the oral manifestations in bulimia nervosa and presents a questionnaire study of oral symptoms in 34 women with bulimia nervosa. Twenty-three (68%) of the subjects reported dental symptoms, such as hypersensitive teeth (47%), tooth pain (18%), dental fractures (6%), and subjectively increased caries rate (29%). Twelve women (35%) reported dry mouth or dry eyes as a daily experience, and 10 (29%) reported intermittent parotid gland swelling. To the author's knowledge, this is the first report that evaluates the frequency of subjectively experienced oral symptoms in bulimia nervosa.

Dental erosion secondary to ethanol-induced emesis

Case reports within the dental literature have attributed dental erosion to many factors. Severe dental erosion from chronic vomiting, induced by ethanol abuse, has not been previously documented. This article reports such a history and reviews appropriate intervention by the dental practitioner.

Oral findings in anorexia nervosa and bulimia nervosa: a study of 47 cases

These two clinically oriented articles deal with problems dentists are seeing more frequently. One hospital dental service sees an average of four to five patients weekly with eating disorders. The first article is a research study discussing problems found in 47 study participants with the eating disorders anorexia nervosa and bulimia nervosa. The second article describes a helpful technique for oral rehabilitation.