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Abstract

Eating disorders are potentially life-threatening disorders. In this article, we discuss the oral manifestations of eating disorders so as to enable dental practitioners to recognize the effects of eating disorders and to manage the patients with eating disorders.
Journal of Indian Academy of Oral Medicine and Radiology, October-December 2010;22(4):S19-22
Oral Manifestations of Eating Disorders
S19
REVIEW ARTICLE
Oral Manifestations of Eating Disorders
1Neeta Misra, 2Anshul Mehra, 3Pradyuman Misra, 4Jaya Mehra
1Professor, Department of Oral Medicine and Radiology, UP Dental College and Research Center, Faizabad Road, Lucknow
Uttar Pradesh, India
2Reader, Department of Oral Medicine and Radiology, UP Dental College and Research Center, Faizabad Road, Lucknow
Uttar Pradesh, India
3Professor, Department of Conservative Dentistry, UP Dental College and Research Center, Faizabad Road, Lucknow
Uttar Pradesh, India
4Private Practitioner, Lucknow, Uttar Pradesh, India
Correspondence: Neeta Misra, Professor, Department of Oral Medicine and Radiology, UP Dental College and Research Center
301, Sapphire Apartment, 3A Jopling Road, Lucknow, Uttar Pradesh, India, e-mail: neeta4lko@gmail.com
JIAOMR
INTRODUCTION
Eating disorders are a serious concern in one’s health and a clinical
challenge to dental professionals. Eating disorders are a group of
psychopathological disorders affecting patient’s relationship with
food and his/her own body, which is manifested by distorted or
bizarre eating behavior. They include anorexia nervosa, bulimia
nervosa and eating disorder not otherwise specified. Eating
disorders represent a vain attempt to cope with or to suppress
personal conflicts and problems through preoccupation with food
intake and body weight. The role of dentist, as case finder, is
important because by obtaining a comprehensive medical history,
measuring vital signs, performing a head and neck examination
and complete intraoral examination and interacting with the patient,
the dentist may be the first professional to detect clinical findings
involving oral mucosa, teeth, peridontium, salivary glands and
perioral tissues. It is, therefore, desirable that dental practitioners
should have comprehensive knowledge of oral manifestation of
eating disorders to diagnose and influence progress of the medical
and psychological management by providing support and dental
care.
ETIOPATHOGENESIS AND PREVALENCE
The cause of these eating disorders is unknown. Genetic, cultural
and psychiatric factors appear to play a role in the etiology of
these disorders. Some nonspecific risk factors that increase
vulnerability to psychological disturbance which leads to eating
disorders, are sexual or physical abuse and a family history of
mood disturbance. The prevalence of psychosomatic eating
disorder is very high in industrialized countries and has increased
in recent years. Women account for the vast majority of cases
about 90%, fewer than 10% are men with total prevalence of 0.5
to 1%.1,2 The prevalence of bulimia is approximately 1 to 5% for
the most populations. Approximately 40 to 50% of patients
suffering from anorexia are also bulimic.3
ABSTRACT
Eating disorders are potentially life-threatening disorders. In this article, we discuss the oral manifestations of eating disorders so as to enable dental
practitioners to recognize the effects of eating disorders and to manage the patients with eating disorders.
Keywords: Anorexia nervosa, Bulimia nervosa, oral manifestations.
DIAGNOSTIC CRITERIA
The diagnostic criteria of anorexia nervosa are:1
a. Refusal to maintain body weight at or above a minimally
normal weight for age and height.
b. Intense fear of gaining weight or becoming fat, even though
underweight.
c. Disturbance in the way in which one’s body weight or shape
is experienced, undue influence of body weight or shape on
self evaluation, or denial of the seriousness of current low
body weight.
d. In postmenarcheal female amenorrhea, i.e. the absence of
atleast three consecutive menstrual cycles.
The diagnostic criteria of bulimia nervosa are:1
a. Recurrent episodes of binge eating. An episode of binge eating
is characterized by the following:
i. Eating, in a discrete period of time (e.g. within any
2-hour period), an amount of food that is definitely larger
than most people would eat during a similar period of time
and under similar circumstances.
ii. A sense of lack of control over eating during the episode
(e.g. a feeling that one cannot stop eating or control what
or how much one is eating).
b. Recurrent inappropriate compensatory behavior in order to
prevent weight gain, such as self-induced vomiting; misuse
of laxatives, diuretics, enemas, or other medications; fasting;
or excessive exercise.
c. The binge eating and inappropriate compensatory behaviors
both occur, on average, atleast twice a week for three months.
CLINICAL FEATURES
Anorexia nervosa and bulimia nervosa are eating disorders usually
found in young, previously healthy women of age group
15 to 25 years who develop a paralyzing fear of becoming fat. The
onset of the illness usually begins in early adolescence then goes
10.5005/jp-journals-10011-1062
Neeta Misra et al
JAYPEE
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to remission, only to reappear in early adulthood. The driving force
is the pursuit of thinness; all other aspects of life are secondary.
Anorexia nervosa may be defined as aversion to food resulting
from a complex interaction between biological, social, individual
and family factors leading to severe weight loss.4 Anorexic
behavior is characterized by fasting. Despite severe weight loss,
patients deny hunger, thinness, or fatigue. They are often physically
active, and ritualized exercise is common. Constipation is common.
Bulimia patients have a strong fear of putting on weight but initially
have occasional episodes of binge eating, which represents a form
of expression of anxiety, depression and loneliness, the perceived
loss of control over food intake, so patient eliminates the food
that has just been eaten by self-induced vomiting or by means of
laxatives.5 Bulimia nervosa patient has episodes of uncontrolled
eating until they start feeling uncomfortable. They eat alone
because of embarrassment and feel guilty after overeating. In order
to prevent weight gain, they exhibit inappropriate compensatory
behaviors like induced vomiting, excessive use of laxative or use
of enema followed by massive binge eating.6-8
MEDICAL COMPLICATIONS
In both anorexia nervosa and bulimia nervosa, the disturbed eating
pattern leads to medical complications, which are wide ranged
like bradycardia, hypothermia and hypotensions. In anorexic
patients, there is little or no body fat, menstrual irregularities
coupled with ovarian changes, amenorrhea stunting of growth,
alopecia xerosi. In case of bulimic patients aspiration, esophageal
or gastric rupture, hypokalemia with cardiac arrhythmias,
pancreatitis, drug induced myopathy or cardiomyopathy. The use
of finger to induce vomiting leads to the “Russel’s Sign”, i.e. callus
on the back of hand and fingers due to trauma from maxillary
incisors.7,9
ORAL MANIFESTATION
Oral manifestation of ED can occur in any phase of disease
progression and they play a significant role in assessment,
characterization and prognosis of ED. Dentist examines the patients
at frequent intervals and may be the first health care provider to
identity the problem and refer the patient for medical management.
Oral and dental complications can also be managed by the dentist.
So, the dentist should enhance the ability to recognize, diagnose
and provide dental treatment to these patients.8,10 The impact of
eating disorders on the oral soft and hard tissues depends upon
the diet as well as the duration and frequency of binge-purge
behavior. Oral manifestations occurring in ED are mainly caused
by nutritional deficiencies and consequent metabolic impairment.
Dental Erosion
The impact of eating disorder upon oral health was initially reported
by Hellstrom and Hurst et al.11,12 The specific type of enamel
erosion seen in these patients is termed as perimyolysis, which is
secondary to vomiting, gastric reflux and regurgitation. When case
control studies were undertaken, patients with anorexia nervosa
and bulimia nervosa demonstrated higher levels of tooth wear than
the controls, but the frequency, duration and a total number of
vomiting episodes were not linearly associated.8,9 In addition, it
may develop secondary to the frequent use of acidic sports drinks
during physical activity, abnormal use of some caffeinated and D
or carbonated drinks used to boost energy levels or to decrease
the reflex hunger stimulus by increasing dilation of the stomach,
consumption of alcoholic beverages for energy and stimulation
and it may be a cofactor for purging and the use of vinegar and
lemon juice eliminates the gustatory phase of mechanism regulating
hunger.10 Severe erosion can cause increased tooth sensitivity to
touch and cold temperature, the incisal edges of the anterior teeth
become eroded and shorten the clinical crowns of teeth. The erosion
may progress to the posterior region resulting in a decreased vertical
dimension.
Dental Caries
Prevalence of dental caries among eating disorder patients and
normal population remains unclear. Caries experience was no
different between vomiters and non-vomiters. In one study there
was no statistically significant difference between control and
bulimic group. The DMFS scores for control; the bulimic group
were significantly higher in the study done by Rolf and Ohm. The
number of decayed untreated surfaces was significantly higher
among the patients with eating disorder indicating their reluctance
to seek dental care.2 Dental caries may be more prevalent in these
patients because of high carbohydrate diet, sweetened fruits and
carbonated health drinks. Dental caries should be assessed for each
patient according to patient’s oral hygiene, diet, malnutrition,
genetic predisposition, ingestion of certain types of medication.13
Periodontal Disease
The evidence on periodontal status is conflicting. Gingival index
scores were not statistically different between groups of anorexics,
bulimics and controls.9,13 Patients with eating disorder may have
poor oral hygiene, which may lead to gingival inflammation and
potentially predispose to periodontitis. Nutritional deficiencies
especially in vitamin C may also affect marginal periodontium
predisposing to gingivitis. The dehydration of oral soft tissues due
to salivary gland impairment in addition to dietary deficiencies
and poor oral hygiene can adversely impact the health of
periodontal tissues and oral mucosa.10,14
Mucosal Lesions
Nutritional deficiencies in eating disorders can lead to angular
cheilitis, candidiasis, glossitis and oral mucosal ulceration.
Reduced intake of vitamins, iron deficiency anemia may lead to
generalized mucosal atrophy, which may also cause diffuse oral
burning sensation which can be more intense on tongue.9
Erythematous mucosal lesions are more commonly seen in patients
who engage in binge eating and self-induced vomiting. The soft
palate may be injured by objects used to induced vomiting;
epithelial erosion may be related to the direct offending action of
acid during vomiting.
Salivary Manifestations
Patients with eating disorders frequently have enlarged parotid
glands. The onset of swelling usually follows a binge-purge
episode. In early stages of eating disorder, the enlargement may
Journal of Indian Academy of Oral Medicine and Radiology, October-December 2010;22(4):S19-22
Oral Manifestations of Eating Disorders
S21
appear and disappear but later on it becomes more persistent. It is
because of sialadenosis, a noninflammatory enlargement of the
salivary glands caused by a peripheral autonomic neuropathy,
which is responsible for disordered metabolism and secretion,
resulting in acinar enlargement and functional impairment. It is
noteworthy that sialadenosis may also involve minor salivary
glands.8,10,15 Salivary flow may also decrease and changes in
salivary secretion may be secondary to structural change within
the gland. Xerostomia is a common side effect of many
psychotropic medications that may be prescribed to treat patients
with eating disorders. Fluid imbalance results because of excessive
use of diuretics and laxative to prevent weight gain and by
persistent vomiting. Lowering of the pH of mucosal surfaces in
palate region may be considered reason for minor salivary gland
pathologies in the hard palate. Necrotizing sialometaplasia has
also been reported in association with bulimia.16
Other Oral Complications
In addition to above-mentioned oral manifestation, some oral
manifestations can also be seen like oral burning sensation,
dygeusia, unexplained pain, and xerostomia. These can be
independent and disconnected from the oral signs commonly seen.
These could be psychogenic in origin or may be due to multiple
nutritional deficiencies, which can be the predisposing factor for
candidiasis, angular cheilitis fissured tongue. In patients with
anorexia nervosa osteopenia and later osteoporosis is common
and this bone loss can make them susceptible to bone fracture and
make the jaws more susceptible to accelerated alveolar bone loss.17
DENTAL MANAGEMENT
Oral manifestations of eating disorder may appear in different
stages of disease progression. Some oral manifestations may occur
very early during the disease onset like sialadenosis, palatal
erythema, etc., so early detection will be valuable in identifying
these patients. As these patients often try to keep their food related
problems a secret and do not visit medical practitioner for their
systemic health, a dentist may be the first physician to notice the
aberrant behavior.
While taking history, a dentist should ask additional questions
related to eating disorders like duration and severity of the disorder,
frequency of bingeing or purging, current status of medical
treatment. The dentist should avoid judgment and pressure, observe
the patient’s body language and remain calm. This is important in
both diagnostic and therapeutic, as the dentist may suggest referring
the patient to a psychiatrist, psychologists, or another medical
professional expert. In case the patients is younger than 18 years
of age, the dentist should discuss his or her findings with the
patient’s parents and refer the patient to physician for expert
opinion and management. In patients whose diet is rich in
carbohydrate and use carbonated drinks juices too much, chances
of dental caries and additional erosion of the teeth is present. In
these patients, the instructions should be given for self care,
maintaining proper oral hygiene, use of dental floss and topical
fluoride application can be done. Some researchers recommend
custom made trays and 1.1% neutral fluoride gel. The patient
should use the tray for 5 min daily. The patient should not brush
the teeth within one hour of vomiting or chances of tooth wear
increases.8,17,18 Patients need to be educated to reduce intake of
acidic drinks and drink alternatives, such as low calorie beverages
which still have erosive potential. Patients should be advised to
reduce consumption of fresh fruit especially citrus fruit.18
Restoration of dental health is an important part of regaining a
normal appearance and may influence the patient’s recovery. But
it is recommended to delay all definitive dental treatment until
there is control of eating disorder.8,14 Restorative care depends on
the severity of hard tissue destruction. Composite restorative
procedure can done to reduce sensitivity. Porcelain veneers can
be used in anterior region and in severe cases full mouth
reconstruction and occlusal rehabilitation are appropriate
options.8,9 But extensive oral rehabilitation should be postponed
until the psychiatric components of eating disorder are atleast
stabilized. Regular dental checkups should be encouraged and
using recall system will prevent individual dropout.
CONCLUSION
The oral manifestations of eating disorders are well reported but
failure to diagnose the dental component may lead to more serious
systemic problems in addition to progressive, irreversible damage
to the hard tissues of the oral cavity. Appropriate dental manage-
ment is based on multidisciplinary facets of these conditions.
Coordination between the dental team, psychotherapist and
physician is important for managing the patient with eating disorder
holistically.
REFERENCES
1. American Psychiatric Association, Eating disorders In: Diagnostic and
statistical manual of mental disorders (DSM-IV TR) (4th ed).
Washington: American Psychiatric Association; 2000;583-97.
2. Rolf Ohrn, Karin Enzell, Bigit Angmar-Mansson B, Oral Status of 81
subjects with eating disorders. Eur J Oral Sci 1999;157-63.
3. Roberts W, Li SH. Oral findings in Oral findings in anorexia nervosa
and bulimia nervosa a study of 47 cases J Am Dent 1987;115:407-10.
4. Stege P. Visco-Dangler I, Rye L, Anorexia nervosa review including
oral and dental manifestations J. Am Dent Asso 1982;104:648-52.
5. Becker AE, Grinspoon SK, Klibanski A, et al. Eating disorders. N Eng
J Med 1999;390:1092-98.
6. James W. Little. Eating disorders: Dental implications. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 2002;93:138-43.
7. Braiwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, et al
(Eds). Harrison’s principles of internal medicine, (14th ed). New York:
Mc Graw Hill; 1998:462-72.
8. Deborah Studen Pavlovich, Magaret A. Elliott. Eating disorders in
Women’s Oral health. DCNA 2001;45(3):491-511.
9. Milosevic A. Eating disorders and the dentist. BDJ 1999;186(3):109-
13.
10. Russo L Lo, Gampisi O Di Fede G, Di Liberto C, V’Pana zarella, Muzio
L Lo. Oral Manifestations of eating disorders a critical review. Oral
Diseases 2008;14:479-84.
11. Hellstrom I. Oral complications in anorexia nervosa. Scand J Dent Res
1977;85:71-86.
12. Hurst PS, Lacey JH, Crisp AH. Teeth, vomiting and diet: A study of
the dental characteristics of seventeen anorexia nervosa patients.
Postgrad Med J 1977;53:298-305.
13. Roberts W, Li SH. Oral findings in Oral findings in anorexia nervosa
and bulimia nervosa a study of 47 cases. J Am Dent 1987;115:407-10.
14. Roberts MW, Tylenda CA. Dental aspects of anorexia and bulimia
nervosa Pediatrician 1989;16:178-84.
Neeta Misra et al
JAYPEE
S22
15. Mignogna MD, Fedele S, Lo Russo L. Anorexia/bulimia-related
sialadenosis of palatal minor salivary glands. J Oral Patho Med 2004;
33:441-42.
16. Solomon LW, Merizianw M, Sullivan M, et al. Necrotizing sialometa-
plasia associated with bulimia: Case report and Literature review. Oral
Surgery, Oral Med, Oral Patho, Oral Radio, Endo 103 e39-e42.
17. Jeffcoal MK, Chestnut CH. Systemic osteoporosis and oral bone loss :
Evidence shows increased risk factors. J Am Dent Asso 1993;124:49-
59.
18. Lifante-Oliva C, López-Jornet P, Camacho-Alonso F, Esteve-Salinas J.
Study of oral changes in patients with eating disorders. International
Journal of Dental Hygiene, 2008;6:119-22.
... Among the consequences of ED in the scientific literature several oral and dental manifestations involving the oral mucosa, teeth, periodontium and salivary glands are reported. Often, these signs appear in the early stages of ED and allow an early diagnosis of the disease [Little, 2002;Debate et al., 2006;Misra et al., 2010;Antonelli and Seltzer;Tolkachjov and Bruce, 2017;Bassiouny, 2017;Panico et al., 2018]. The dentist, especially the paediatric dentist, collecting a complete history, performing a detailed extra/intra-oral examination and interacting with the patient, may be the first professional to detect the clinical signs of ED [Kavitha et al., 2011]. ...
... The association between oral diseases and ED is particularly evident in cases with frequent self-induced vomiting, regardless of whether the diagnosis is AN or BN [Frydrych et al., 2005;Misra et al., 2010;Johansson et al., 2012;Mehler and Brown, 2015]. Oral signs directly related to vomiting include dental erosion, especially of the palatal surface of the teeth [Frydrych et al., 2005;Romanos et al., 2012] and mucous changes [Lo Russo et al., 2008]. ...
... Typical sign of self-induced vomiting is the "Russell's sign", a callosity present on the back of the hand and fingers caused by traumatism with the maxillary incisors during the manoeuvres to induce vomiting (Fig. 2) [Misra et al., 2010]. Loss of enamel, observed in these patients, mainly on the palatal surface of the upper teeth was defined by the term "perymolisis" in 1939 by Holst and Lange and is secondary to vomiting, gastric reflux, regurgitation and lack of protective saliva activity [Westmoreland et al., 2016]. ...
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Aim: To evaluate the effects of tongue frenulectomy performed with two therapeutic approaches: Laser frenulectomy and combined laser and speech-language therapy. Materials and methods: The study involved 180 patients (90 males and 90 females) aged between 6 and 12 years. After examination and data collection, the patients were stratified according to three degrees of severity: mild, moderate and severe. After treatment, the test group (laser frenulectomy and combined laser and speech-language therapy) was compared with the control group (laser frenulectomy) in the pre-surgical phase, at one week, 1 month, 3 months, 6 months and 12 months after surgery. Results: Statistical analysis showed statistically significant differences between the pre-surgical and post-surgical values at 3 months, 6 months and 12 months after surgery (p<0,05). Conclusions: It is essential to establish diagnosis criteria to which the clinician should refer in order to decide the treatment plan. This study shows that combined laser and speech- language therapy leads to better results than the resection treatment of the frenulum with laser technique alone.
... Other implications vary from disruption of normal lifestyle to generalized weaknesses to even life threatening complications. 1 The earliest manifestations of abnormal eating patterns and disorders have been shown to appear in the oral cavity first which include deterioration of oral aesthetics, discomfort and pain in oral and perioral structures and impairment of oral functions. 1,2 With the increasing numbers of these conditions, the possibility of a dental practitioner encountering an eating disordered individual is quite high. Hence oral health care practitioners should have a sound knowledge about the various general and oral manifestations of eating disorders. ...
... Genetic, cultural and psychological factors appear to play a vital role in the etiology of these disorders. 2 Gene expressions are altered by environmental factors without changing the underlying DNA sequence. Eating behav-ior is regulated by the hypothalamus-pituitary-adrenal axis and any defect in production, transmission of hormones and neurotransmitters such as serotonin, leptin and norepinephrine manifest in eating disorders. ...
... In a case control study it was proved that subjects with anorexia nervosa and bulimia nervosa had higher levels of tooth erosion than the controls and that there was no linear association between the frequency, duration and total number of vomiting episodes. 2 This may be attributed to difference in susceptibility to erosion between patients, differences in buffering capacity of saliva, flow rate, pH and tooth surface composition. 3 Cross-sectional study conducted by Robb on 122 eating disorder patients showed that subjects who suffered from anorexia nervosa had significantly more erosion than control group and the erosion was predominantly on the buccal and occlusal surfaces of posterior teeth. ...
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Dental practitioners have a crucial role in diagnosing patients with eating disorder and can be the first to notice the presence of previously undiagnosed eating disorders. The general dental practitioner should identify the subtle changes in the oral cavity which are early indicators of a serious underlying psychiatric condition. Identification of these minor signs will help in early diagnosis, appropriate referral and management of affected individuals in their early stages. This article is a review of the recent literature on eating disorders and their subsequent oral manifestations. The authors have made an attempt to create awareness and knowledge among dental practitioners about their role in the early diagnosis, intervention and management of affected individuals.
... A similar causal mechanism results in the appearance of erosions of traumatic etiology, found in 12.9% of our Group A individuals. Erosions and ulcers of the oral mucosa can arise in patients with eating disorders and be caused by various types of compensatory actions, mainly ones which arise during the mechanical stimulation of the back of the throat by individuals seeking to provoke vomiting [18,19]. Pallor of the skin and oral mucosa was observed in 29% of Group A individuals, which could suggest the possibility of an increased occurrence of anemia in anorexic individuals. ...
... An increase in the amount of deposits on the tongue we observed may have been caused by a decrease in salivary flow. The erethematous spots found on the palate of 12.9% of anorexic individuals, and the similar percentage of traumatic erosions, may have been caused by mechanical and chemical irritation and indicate atrophic processes in the mucous membrane of the oral cavity as suggested by Paradowska (2010) and Misra (2010), [11,18]. The angular cheilitis found in 12.9% of our AN individual suggests the possibility of coexisting deficiencies of microelements (mainly vitamins from groups A and B, as well as of iron) and a mixed bacterial-fungal infection [23]. ...
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Unlabelled: The aim of the study was to evaluate the status of the oral mucosa, to assess the prevalence of Candida in the oral cavity and to analyze the pH values of total saliva in patients with anorexia nervosa (AN) in comparison to the general population. Method: A controlled clinical trial was designed for two, age-matched, female groups: patients with AN (Group A, n=31) and healthy women (Group 0, n = 40). Total saliva was collected at rest and after stimulation by chewing paraffin wax. Salivary pH was measured and macroscopic evaluation of the oral mucosa was performed with a qualitative and quantitative mycological analysis. The smear layer was collected from three different areas in the oral cavity. Selected Candida broths were used for incubation. Results: Changes in the macroscopic structure of the oral mucosa due to multifactorial etiologies were observed. The prevalence of Candida in patients with AN was comparable to that in the general population. Salivary pH values were significantly lower in the AN patients than in the control group. Conclusions: The incidence of pathological changes in the oral mucosa is associated with the loss of the salivary protective barrier. This is shown by the significant reduction in the pH values of stimulated and non-stimulated saliva of the AN patients. In these patients, the monitoring of salivary parameters such as salivary flow rate and pH is indicated, and a regular dental checkup, together with soft tissue evaluation, is advised.
... Zbliżony mechanizm przyczynowy ma miejsce również w przypadku powstawania nadżerek o etiologii urazowej wykrytych u 12,9% badanych osób. Nadżerki i owrzodzenia błony śluzowej u pacjentów z zaburzeniami odżywiania się mogą powstawać na skutek różnego typu zachowań kompensacyjnych, głównie w trakcie mechanicznego drażnienia tylnej ściany gardła w celu prowokacji wymiotów [18,19]. Bladość błony śluzowej i skóry stwierdzana w naszym badaniu u 29% badanych może natomiast wskazywać na zwiększoną częstość występowania niedokrwistości u chorych na anoreksję. ...
... Zwiększenie ilości osadu na grzbiecie języka może być związane ze zmniejszeniem ilości wydzielanej śliny. Rumieniowe plamy na podniebieniu wykryte u 12,9% pacjentek z grupy A, podobnie jak nadżerki pourazowe, mogą być wywołane drażnieniem mechanicznym i chemicznym oraz wskazywać na procesy zanikowe błony śluzowej jamy ustnej [11,18]. Zapalenie kątowe warg stwierdzone u 12,9% badanych z jadłowstrętem psychicznym jest chorobą wskazującą na współwystępujące niedobory mikroskładników odżywczych (głównie witamin z grupy A i B oraz żelaza) i mieszane zakażenie bakteryjno-grzybicze [23]. ...
Data
1 Katedra Biomateriałów i Stomatologii Doświadczalnej UM w Poznaniu Kierownik: prof. UM dr hab. n. med. B. Czarnecka 2 Klinika Psychiatrii Dzieci i Młodzieży UM w Poznaniu Kierownik: prof. dr hab. med. A. Rajewski 3 Klinika Chorób Błony Śluzowej Jamy Ustnej UM w Poznaniu Kierownik: dr hab. n. med. B. Dorocka-Bobkowska 4 Zakład Genetyki w Psychiatrii, Katedra Psychiatrii UM w Poznaniu Kierownik: prof. dr hab. med. J. Twarowska-Hauser Summary The aim of the study was to evaluate the status of the oral mucosa, to assess the prevalen-ce of Candida in the oral cavity and to analyze the pH values of total saliva in patients with anorexia nervosa (AN) in comparison to the general population. Method. A controlled clinical trial was designed for two, age-matched, female groups: patients with AN (Group A, n=31) and healthy women (Group 0, n=40). Total saliva was collected at rest and after stimulation by chewing paraffin wax. Salivary pH was measured and macroscopic evaluation of the oral mucosa was performed with a qualitative and quantitative mycological analysis. The smear layer was collected from three different areas in the oral cavity. Selected Candida broths were used for incubation. Results. Changes in the macroscopic structure of the oral mucosa due to multifactorial etiologies were observed. The prevalence of Candida in patients with AN was comparable to that in the general population. Salivary pH values were significantly lower in the AN patients than in the control group. Conclusions. The incidence of pathological changes in the oral mucosa is associated with the loss of the salivary protective barrier. This is shown by the significant reduction in the pH values of stimulated and non-stimulated saliva of the AN patients. In these patients, the mo-nitoring of salivary parameters such as salivary flow rate and pH is indicated, and a regular dental checkup, together with soft tissue evaluation, is advised. Słowa klucze: jadłowstręt psychiczny, jama ustna Key words: anorexia nervosa, oral cavity
... Zbliżony mechanizm przyczynowy ma miejsce również w przypadku powstawania nadżerek o etiologii urazowej wykrytych u 12,9% badanych osób. Nadżerki i owrzodzenia błony śluzowej u pacjentów z zaburzeniami odżywiania się mogą powstawać na skutek różnego typu zachowań kompensacyjnych, głównie w trakcie mechanicznego drażnienia tylnej ściany gardła w celu prowokacji wymiotów [18,19]. Bladość błony śluzowej i skóry stwierdzana w naszym badaniu u 29% badanych może natomiast wskazywać na zwiększoną częstość występowania niedokrwistości u chorych na anoreksję. ...
... Zwiększenie ilości osadu na grzbiecie języka może być związane ze zmniejszeniem ilości wydzielanej śliny. Rumieniowe plamy na podniebieniu wykryte u 12,9% pacjentek z grupy A, podobnie jak nadżerki pourazowe, mogą być wywołane drażnieniem mechanicznym i chemicznym oraz wskazywać na procesy zanikowe błony śluzowej jamy ustnej [11,18]. Zapalenie kątowe warg stwierdzone u 12,9% badanych z jadłowstrętem psychicznym jest chorobą wskazującą na współwystępujące niedobory mikroskładników odżywczych (głównie witamin z grupy A i B oraz żelaza) i mieszane zakażenie bakteryjno-grzybicze [23]. ...
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