Eating disorders part II: Clinical strategies for dental treatment

Department of Restorative Dentistry, School of Dentistry, University of São Paulo, SP, Brazil.
The journal of contemporary dental practice 02/2008; 9(7):89-96.
Source: PubMed


To present the strategies of treatment for dental implications of eating disorders.
A comprehensive review of the literature was conducted with special emphasis on the treatment of the oral implications of anorexia nervosa and bulimia nervosa, dividing the treatment into different parts.
Oral manifestations of eating disorders represent a challenge to the dental practitioner. Dental erosion, caries, xerostomia, enlargement of parotide glands, traumatized oral mucosa, and other oral manifestations may present in anorexic and bulimic patients.
Often the dentist is the first healthcare provider to observe the clinical symptoms of an eating disorder. Dental treatment should be carried out simultaneously with the medical treatment. However, dentists are not aware of the fundamental importance of the dentist's participation in the multidisciplinary treatment and no training is provided with regard to the strategies involved in the dental treatment.
Oral complications of eating disorders are a major concern. The difficulties of recognizing the oral manifestations, and the failure to do so, may lead to serious systemic problems in addition to progressive and irreversible damage to the oral hard tissues. Considering the increasing incidence and prevalence rates of eating disorders, the dentist's participation and dental treatment should be discussed.

39 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to analyze the effect of CO(2) laser (10.6 μm) irradiation with 5-μs pulse width in prevention of enamel erosion due to citric acid exposure in vitro. One hundred forty-four bovine enamel samples were cut into 5 × 5 × 2-mm-size slabs and polished to obtain plane surfaces. Enamel surfaces were covered with acid-resistant varnish, except for a central area of 2.5 mm in diameter. The samples were divided into four groups (n = 12/group/day): C-control, no treatment; L-CO(2) laser irradiation (0.3 J/cm(2), 5 μs, 226 Hz); F-topical fluoride treatment, 1.25%F(-) (AmF/NaF) for 3 min; and FL-fluoride treatment + CO(2) laser. For erosive demineralization, samples were immersed in 40 ml of citric acid (0.05 M, pH 2.3) for 20 min two times per day during 5 days. After 1, 3, and 5 days, surface loss was measured by digital profilometer. According to the repeated measure ANOVA and post hoc comparisons, all the treatments showed statistically significant reduction of enamel loss as compared to control group, in all investigated times (p < 0.0001): L (52%,31%,37%); F (28%,24%,29%); FL (73%,55%,57%). Both CO(2) laser irradiation alone (L) and the combined laser-fluoride treatment (FL) caused less enamel loss than the fluoride group (F) in all days (p < 0.0001 for L in all times; and p < 0.0001, p = 0.0220 and p = 0.0051 for F, respectively, at days 1, 3, and 5). Under the conditions of this study, CO(2) laser irradiation (0.3 J/cm(2), 5 μs, 226 Hz) could effectively reduce enamel surface loss due to citric acid exposure, in vitro. This effect was still observed after 5 days of repeated acid exposures.
    Lasers in Medical Science 02/2012; 28(1). DOI:10.1007/s10103-012-1071-x · 2.49 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Bariatric surgery may cause frequent vomiting episodes and gastroesophageal reflux, which promote the contact of gastric acids with the teeth leading to irreversible loss of tooth structure. The aim of this study was to assess prevalence of tooth wear in bariatric patients. One hundred and twenty-five patients were examined at a Public Hospital in São Luis, MA, Brazil, between July and October 2010, being patients who had already been submitted to the bariatric surgery at least 6 months previously (Bariatric group), morbidly obese patients who were on the waiting list for this surgery (Obese group) and patients who were waiting for ambulatory medical care in other sectors (Control group). The patients answered an investigative questionnaire and were clinically examined using the Basic Erosive Wear Examination (BEWE) scoring system, which allows the classification of the severity of noncarious dental lesions (NCDL) and evaluation of risk. All patients presented some degree of tooth wear at different levels. However, the presence of NCDL was associated with the group to which the patient belonged. The bariatric patients showed higher prevalence and a statistically significant level of risk with regard to NCDLs when compared with the other patients, followed by the obese and control groups. Reflux and vomiting did not seem to influence NCDL positively.
    Brazilian dental journal 04/2012; 23(2):160-6. DOI:10.1590/S0103-64402012000200012
  • [Show abstract] [Hide abstract]
    ABSTRACT: Eating disorders (EDs) are life-threatening conditions that mainly affect women and can be diagnosed early by dental professionals. The aims of this study were to examine the oral radiographic status of ED patients and compare the performances of dental professionals from different backgrounds in interpreting these findings.Materials and methodsIn total, 72 women with EDs and healthy controls matched by age, sex, educational status, and smoking status were included in the project. Standardized full-mouth intraoral periapical radiography with a bisecting-angle technique and digital panoramic imaging were performed in all participants. Five observers independently interpreted the tooth status, the condition of the periapical tissues, and the third molars.ResultsScores for intra- and interobserver consistency were acceptable and were 0.76 and 0.92, respectively. The ED group consumed a larger daily amount of acidic beverages (P < 0.05) than the controls, and a significant positive correlation was observed between the daily acidic-beverage intake and the frequency of vomiting (P < 0.05). In the ED group, the mean number of teeth with untreated carious lesions (P < 0. 01), particularly in the posterior mandibular region (P < 0.05) and periapical pathologies requiring treatment (P < 0.05), were significantly higher compared with healthy individuals. However, the radiographic depth-progression pattern of the carious lesions was similar in the two groups.Conclusion The presence of radiographically detectable caries and periapical lesions makes ED patients more susceptible to the risk of losing their functional teeth over time, especially when considered together with their inadequate oral hygiene practices and acidic-beverage consumption. Nonetheless, dental professionals with different backgrounds can interpret such radiographic findings with similar efficiency.
    Journal of dental sciences 06/2012; 7(2):190-198. DOI:10.1016/j.jds.2011.10.001 · 0.56 Impact Factor
Show more