Parotid enlargement: a presenting sign in anorexia nervosa

Eating disorders and the orthodontist: Diagnosis, considerations and referral

BACKGROUND

Eating disorders are relatively common mental health disorders in Western European and North American populations. The peak incidence occurs within the adolescent years, which correlates with the largest orthodontic patient population. The morbidity associated with these psychological conditions is significant, and has a direct impact upon patient well-being, orthodontic outcomes and the success of treatment. Therefore, it is of relevance to the orthodontist to be aware of potential presenting features of these conditions, when and where to seek advice, and how such disorders may impact upon orthodontic outcomes.

METHODS

Articles published on PUBMED and MEDLINE relevant to orthodontics and eating disorders were reviewed. Key information was extracted, and the relevant evidence for the orthodontist summarised.

RESULTS

Eating disorders may present to the orthodontist in specialist or hospital practice, either undiagnosed or as a co-morbidity. Orthodontists may benefit from an appreciation of these potential diagnoses, the orthodontic implications and to have the confidence to refer their patients to the necessary services.

LIMITATIONS

There is little existing research in this area.

CONCLUSIONS

These conditions have a significant impact on patient morbidity and mortality. This cohort of patients is not suitable for orthodontic treatment while their disease is active. The impact of a developing eating disorder can adversely affect orthodontic treatment.

Rare medical manifestations of severe restricting and purging: "Zebras," missed diagnoses, and best practices

OBJECTIVE

Medical problems that arise due to severe restricting and/or purging may be misdiagnosed or suboptimally treated, from outpatient clinics to top medical hospitals. A symptom may be presumed to be a psychological manifestation of the eating disorder and inappropriately dismissed for further medical evaluation. Alternatively, a detailed medical workup may be performed, overlooking a classic relationship between starvation and a physical finding, which delays referral to eating disorder care. This review article focuses on rare medical issues (also called "zebras" in medical training), diagnoses that may be missed in patients with eating disorders, and best practices for management, organized by organ system.

METHOD

A PubMed search was performed, using search terms "eating disorder," "anorexia nervosa," and "bulimia nervosa" in combination with different words for each organ system and known medical manifestations of severe eating disorders, with high quality and relevant studies from the past 20 years cited.

DISCUSSION

Adults with eating disorders may present with extreme organ dysfunction and atypical signs and symptoms of typical medical problems. Timely diagnosis, risk awareness, appropriate treatment, and avoidance of harm are all vital. With judicious management and nutritional rehabilitation, most of these complications will significantly improve or resolve. ©

Gastrointestinal complications associated with anorexia nervosa: A systematic review

OBJECTIVE

A systematic review identifying gastrointestinal (GI) complications attributable to anorexia nervosa (AN) was completed.

METHOD

Studies of any design exploring the pathogenesis of complications and treatment strategies were included. The review was completed in accordance with PRISMA standards.

RESULTS

A total of 123 articles were retained, including one randomized control trial. The majority of included studies were case reports and case series. Controlled studies demonstrated that patients with AN were more likely to have delays in gastric motility, gastric emptying and intestinal transit than comparator groups although results were not uniform across all studies. Published reports suggest that complications can occur at any segment of the GI tract. These issues may derive as a consequence of severe malnourishment, from eating disorder related symptoms such as self-induced purging or from the refeeding process itself. Multiple studies noted that patients with AN report high rates of GI symptoms although in the few cases where medical testing was undertaken, correlations between self-reported symptoms and measurable pathology were not demonstrated.

DISCUSSION

GI complications may occur throughout the entire GI tract in patients with AN. It is recommended that clinicians use careful judgment when pursuing targeted investigation or introducing symptom specific treatments in response to GI complaints. Evidence suggests that most GI complications resolve with refeeding and cessation of ED symptoms.

Restoration of erosion associated with gastroesophageal reflux caused by anorexia nervosa using ceramic laminate veneers: a case report

Ceramic laminate veneers are useful to restore incisors suffering from severe erosion.

Atrophic change of rat salivary gland during adenovirus-induced hyperleptinemia

Sustained hyperleptinemia in normal rats induced by infusing a recombinant adenovirus containing the rat leptin cDNA (AdCMV-leptin) exhibited a remarkable reduction in food intake (AdCMV-leptin, 9.3 +/- 2.6 vs untreated, 20.6 +/- 1.0 g/day) and ablated body fat without any significant changes in wet weight of liver and left ventricle. In those hyperleptinemic rats, we found a 52% reduction in wet weight of salivary gland compared with that in the pair-fed AdCMV-beta-gal-treated rats, which received a recombinant virus containing the beta-galactosidase gene (AdCMV-beta-gal) and were fed on the same amount of food as had been consumed by the AdCMV-leptin-treated group on the previous day. Microscopic examination with hematoxylin-eosin staining revealed that atrophic change was induced in both serous and mucous gland only in the AdCMV-leptin-treated group, but not in the pair-fed controls. Thus, the atrophic changes in hyperleptinemic rats were due to neither a decrease of food intake nor disuse of the salivary gland related with anorexia. Our data suggested that size of the salivary gland was controlled, at lease in part, by "non-anorexic" effect of leptin.

Eating disorders and the dentist

Dentists are likely to encounter patients who have eating disorders. The paper explains the various types and considers both the risk factors, and the psychological and medical complications. The effect on oral health and the principles of dental management are outlined. Dentists have an important part to play in the overall care of these patients.

Sialadenosis: a presenting sign in bulimia

BACKGROUND

Sialadenosis refers to noninflammatory, often recurrent, enlargement of the salivary glands, most frequently the parotids, which is almost always associated with an underlying systemic disorder. These include diabetes, alcoholism, malnutrition, anorexia nervosa, and bulimia. It is thought that the various causes of sialadenosis all result in a common pathogenetic effect in that they produce a peripheral autonomic neuropathy which is responsible for disordered metabolism and secretion, resulting in acinar enlargement.

METHODS

This paper reports a case of sialadenosis as a presenting sign in bulimia and studies the histologic and electron microscopic features of this disease.

RESULTS

Light microscopy showed acini which appeared to be larger than normal and which were composed of plump pyramidal cells containing prominent zymogen granules. There was less interstitial fat, and the ducts were widely dispersed. Electron microscopy showed the acinar cells to be packed with membrane-limited, dark secretory granules some of which showed moulding of their outlines. Cellular organelles and nuclei were inconspicuous.

CONCLUSIONS

Management of sialadenosis depends upon identification of the underlying cause, which must then be corrected. In bulimia, the swellings may be refractory to standard treatment modalities, and parotidectomy may be considered as a last resort to improve the unacceptable aesthetics.

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 and dental complications in dieting disorders

This study investigated the oral status and dental complications in patients with both anorexia and bulimia nervosa. Results revealed that prolonged periods of dietary restraint in anorexic patients did not result in changes to bacteria associated in dental caries. Furthermore, patients did not have lower decay rates or salivary flow but did have more acidic saliva. Moreover, both groups of patients revealed changes indicative of gingivitis and gingival recession but not necessarily of periodontitis when compared to control subjects.

Clinical and microbiological investigations of anorexia nervosa

Several studies have examined the relationship between anorexia nervosa and oral status. However, none has used control subjects. Furthermore, none has examined bacteriological data in these subjects to determine whether dietary restrictions, particularly of carbohydrates, change the levels of Streptococcus mutans and Lactobacillus species. Fifteen female subjects recently hospitalized for anorexia were studied along with fifteen age- and sex-matched control subjects. The parameters examined included salivary pH and flow rate, levels of S. mutans and Lactobacillus spp., DMFT scores, facial and palatal plaque scores, periodontal pocketing, gingival recession and bleeding following gentle probing. Compared with control subjects, anorexics had significantly lower salivary pH (7.1 +/- 0.4 vs 7.6 +/- 0.3, p less than 0.01), more facial and lingual surfaces with plaque scores of 1 (facial plaque 38 per cent vs 18 per cent, p less than 0.01, lingual plaque 47 per cent vs 29 per cent, p less than 0.01), more surfaces with gingival recession (1 mm-7.9 per cent vs 1.8 per cent, p less than 0.001; 2 mm-1.7 per cent vs 0.2 per cent, p less than 0.001; greater than 2 mm-0.6 per cent vs 0.0 per cent, p less than 0.001), more surfaces with bleeding on probing (16.9 per cent vs 6.5 per cent, p less than 0.001) and fewer sextants with CPITN scores of 0 (1.9 +/- 1.5 vs 3.2 +/- 1.0, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Parotid gland enlargement and female reproductive performance in a Papua New Guinea highland population

Swelling of the parotid salivary glands is commonly observed among males and females of highland Papua New Guinea. Evidence suggests that the condition is related to the highlanders' high starch consumption in the form of sweet potato. In this paper we regard parotid enlargement as an indicator of high energy intake and test its association with two measures of reproductive performance, the number of live births and living offspring, in a sample of 274 women from Lufa in the Eastern Highlands District of Papua New Guinea. Multiple regression analysis including maternal age showed that parotid enlargement is positively correlated with both measures of reproductive performance. Given that parotid gland enlargement in this population is due to persistent starch consumption, and that the condition represents above average energy intake, these results suggest that increases in energy intake relate to increases in reproductive performance in this sample of highland females.

Pathology consultation. Sialadenosis

Sialadenosis, characterized by a uniform hypertrophy and hyperplasia of the acinar parenchyma of salivary glands, is associated with a variety of systemic diseases or functional disorders. Present evidence relates the clinical and morphologic changes in the salivary tissues to a neuropathic alteration of the autonomic innervation of the salivary acini.

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.

Anorexia nervosa and related conditions in schoolchildren

The clinical features of anorexia nervosa and the prevalence of the eating orders in different societies is described. The role of physiological, cultural and biological factors in the aetiology of eating are reviewed. Finally ways of preventing eating disorders are considered.