Oral manifestations of eating disorders

2. EATING DISORDERS
Shahnaz
CRI
ORAL MANIFESTATIONS
OF

3. Eating disorders are conditions defined
by abnormal eating habits that may
involve either insufficient or
excessive food intake to the detriment of
an
individual's physical and mental health.

4. Anorexia
nervosa
Bulimia
nervosa
Binge eating
disorder OSFED
DSM IV 2009

5. Etiology

6. Prevalence
• The mean age of onset is between 17.1
and 20.8 years
• Most anorexics (90% to 95%) are young
(under 25years), affluent white woman of
at least normal intelligence
• Most bulimic patients are women in late
adolescent or early adult years.
• Athletes, dancers, or models, showed
higher risk for the development of eating
disorders

7. ANOREXIA NERVOSA
Anorexia nervosa is characterized by
• Intentional loss of weight due to an
extreme aversion to food,
• strict diet in an unchecked pursuit of
slenderness,
• obsessive fear of getting fat,
• a grossly distorted self-image of the body,
• and alterations in the menstrual cycle
ICD 9 code 307.1

8. SUBTYPES(DSM-IV)
RESTRICTIVE
BINGE & PURGE

9. •Malnutrition and vitamin deficiencies
• Obsessive and/or self-injurious behaviors
• Abnormal blood counts
• Irregular heart rhythms
• Fatigue, dizziness, or fainting
• Low blood pressure
• Amenorrhea
• Dry skin and brittle nails
• Dehydration
• Bone loss
• Others: increased body hair, thin appearance,
constipation
Clinical Manifestations

10. BULIMIA NERVOSA
• An eating disorder characterized by binge
eating and purging,
• or consuming a large amount of food in a
short amount of time
• followed by an attempt to rid oneself of the
food consumed (purging),
• typically by vomiting, taking
a laxative, diuretic, or stimulant, and/or
excessive exercise, because of an
extensive concern for body weight
ICD 9 code 307.51

12. CLINICAL MANIFESTATIONS
• Irregular heartbeat
• Dehydration, dry skin
• Fatigue
• Bloating
• Abnormal bowel functioning
• Sores, scars, or calluses on the knuckles or
back of hands (Russell’s sign)
 Chronically inflamed & sore throat
 Electrolyte imbalance

18. ORAL MANIFESTATIONS
Bulimia nervosa
Anorexia nervosa
GINIGIVITIS
PERIODONTITIS
CHANGES IN
SALIVA
XEROSTOMIA
CARIES
CHANGES IN
ORAL
MICROFLORA
ENLARGED
SALIVARY
GLANDS
DENTAL
EROSION

19. Effects on teeth structure
• chronic regurgitation of gastric contents
causes enamel erosion and
demineralization
• PERIMYLOLYSIS
• Erosion: #lingual- smooth and glossy
#facial- dished out
• Dentin hypersensitivity
• Increased risk of dental caries

20. Lingual erosion
Facial/ buccal erosion

22. Effect on soft tissues
• Increased risk of periodontal disease,
gingival bleeding and delayed healing
• Gingival erythema
• Burning sensation
• Traumatized oral mucosa
• Angular chelitis
• Oral candidiasis
• Altered taste sensation

23. Effect on salivary glands
• Xerostomia
• Low salivary flow,
decreased buffering
capacity
• Sialadenosis
• Enlargement of parotid
gland

24. Dental treatment and prevention
• Monitor dental erosion
• Fluoride gel to induce remineralization
• Avoid use of abrasives during restoration
• Potassium oxalates, strontium chloride
and desensitization pastes.
• Instruct patients not to brush within 1 hr of
vomiting
• Use of xylitol gums to increase salivary
flow
• Encourage use of antacids after purging

25. TREATMENT
• COGNITIVE BEHAVIORAL
THERAPY
• DIETARY COUNSELLING

26. • FAMILY THERAPY
• ANTIDEPRESSANTS

27. CONCLUSION
• Eating disorders present unique
psychological, medical, nutritional, and
dental pattern
• The dentist may be the first healthcare
provider to detect, diagnose, and lead the
patient to medical treatment, there by,
providing multidisciplinary treatment with a
favorable prognosis.

29. References
• Aranha, Eduardo,cordas; psychiatric and dental implications of
eating disorders;The Journal of Contemporary Dental Practice,
Volume 9, No. 6, September 1, 2008
• Walter bretz, J evid based dent prac 2002,dec ;2(4) 262-272
• Carranza’s clinical periodontology, 10th edition
• Yagi, Ueda, Asakawa et al,; role of ghrelin, salivary secretions
in eating disorders; Nutrients 2012, 4, 967-989;
doi:10.3390/nu4080967