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

Ghrelin and oral diseases

Eating food is one of the most complicated behaviours in mammals, especially humans. The primary function of ghrelin is regulation of the appetite level and its stimulation. It is also responsible for the body's energy balance and glucose homeostasis. Ghrelin has been shown to affect many brain structures, which confirms the presence of ghrelin receptors in the brain. Studies are also conducted to assess the possible role of ghrelin in anxiety states and in memory disorders and motor dysfunctions. Ghrelin has been found in saliva and salivary glands, teeth and gums, and in the taste buds of the tongue epithelium; it is also secreted by mucosal cells and gingival fibroblasts. The presence of ghrelin in developmental enamel, especially in odontoblasts and ameloblasts, may suggest its regulatory role in the development of teeth. Patients with chronic periodontitis have significantly higher concentrations of ghrelin in the peripheral blood serum, as compared to the control group. Ghrelin plays a special role in the proliferation of cancer cells and in the development of neoplastic metastases. The abundant presence of ghrelin receptors in cancer cells is considered an important target in the treatment of neoplasms. Ghrelin is a hormone whose multidirectional mechanism of action has not yet been fully understood. However, its ubiquitous occurrence in the human body and its very diverse participation in metabolic processes may prove to be a significant obstacle in achieving the expected clinical effect of ghrelin as an effective drug in selected disease units.

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.

The role of ghrelin, salivary secretions, and dental care in eating disorders

Eating disorders, including anorexia and bulimia nervosa, are potentially life-threatening syndromes characterized by severe disturbances in eating behavior. An effective treatment strategy for these conditions remains to be established, as patients with eating disorders tend to suffer from multiple relapses. Because ghrelin was originally discovered in the stomach mucosa, it has been widely studied over the past decade in an effort to uncover its potential roles; these studies have shed light on the mechanism by which ghrelin regulates food intake. Thus, studying ghrelin in the context of eating disorders could improve our understanding of the pathogenesis of eating disorders, possibly resulting in a promising new pharmacological treatment strategy for these patients. In addition, early detection and treatment of eating disorders are critical for ensuring recovery of young patients. Oral symptoms, including mucosal, dental, and saliva abnormalities, are typically observed in the early stages of eating disorders. Although oral care is not directly related to the treatment of eating disorders, knowledge of the oral manifestations of eating disorder patients may aid in early detection, resulting in earlier treatment; thus, oral care might contribute to overall patient management and prognosis. Moreover, ghrelin has also been found in saliva, which may be responsible for oral hygiene and digestion-related functions. This review discusses the pharmacological potential of ghrelin in regulating food-intake and the role of saliva and oral care in young patients with eating disorders.

Medical complications of bulimia nervosa and their treatments

OBJECTIVE

To present a cogent and practical review of the medical complications and their treatment in patients with bulimia nervosa.

METHOD

Thorough review of the medical literature from 1990 to current in regards to the medical complications of bulimia nervosa and the therapeutic intervention that are effective to treat them.

RESULTS

Extensive and detailed review of the medical complications of bulimia nervosa.

Oral health and bone density in adolescents and young women with anorexia nervosa

PURPOSE

To evaluate the dental and periodontal health of adolescents and young women with restrictive anorexia nervosa (AN), and relationship between bone mineral density (BMD) assessed by dual energy Xray absorptiometry (DXA) and dental radiographs.

STUDY DESIGN

Twenty-three young women, median age 17.6 years (range 14.4-27.2), were studied within three months of entering a clinical trial. DXA BMD measurements were obtained and subjects underwent a comprehensive dental examination, including panoramic and bitewing dental radiographs. Three observers assessed mandibular cortical width (MCW) in the mental foramen region on panoramic radiographs.

RESULTS

Dental findings included very good to excellent oral hygiene. Gingival recession was evident in 10 participants (43%). Dental erosion was not seen and the mean decayed missing or filled teeth (DMFT) was 8.6. There was a weak positive correlation between BMD by DXA and MCW on radiographs.

CONCLUSIONS

We report dental manifestations associated with restrictive AN, and the association between bone assessments by DXA and dental radiographs in this patient group. Despite subnormal DXA measurements in most patients, essentially all adolescents had a normal dental examination. Dental providers should be cognizant of the fact that many patients with eating disorders may not display the "classic" findings reported in the literature.

Integration of oral health care and mental health services: Dental hygienists' readiness and capacity for secondary prevention of eating disorders

Often the first to observe overt health effects of eating disorders, dentists and dental hygienists play a fundamental role in the secondary prevention of eating disorders. The purpose of this study was to explore readiness and capacity for integration of oral health and mental health services. Employing a randomized cross-sectional study based upon the Transtheoretical and Health Belief Models, data were collected from 378 dental hygienists. Results reveal that the majority do not currently engage in secondary prevention practices. Only 18% of respondents indicated referring patients exhibiting oral manifestations of eating disorders to treatment. Significantly increasing the likelihood of assessment, referral, and case management included modifying factors regarding greater perceived self-efficacy, and knowledge of oral cues of disordered eating, as well as the individual's perception pertaining to severity of eating disorders. Implications for bridging dental care to mental health services include increasing behavioral capacity among dental hygienists via consciousness raising and improved self-efficacy.

Effects of Bartter's syndrome on dentition and dental treatment: A clinical report

Bartter's syndrome is an autosomal recessive form of severe volume depletion due to renal salt wasting. This clinical report describes the prosthodontic treatment for a 24-year-old man who suffers from Bartter's syndrome. The treatment plan included endodontic treatment of the maxillary anterior incisors and placement of cast dowel-and-core restorations because of reduced crown height. The patient's remaining teeth were restored with metal-ceramic crowns.

Oral manifestations in a group of young patients with anorexia nervosa

Anorexia nervosa (AN) is an eating disorder (ED) identified using DSM-IV criteria. Eating disorders are occurring increasingly earlier in childhood and can lead to a series of oral manifestations. The aim of this study was to evaluate the correlation between stomatognathic lesions and eating disorders in 80 young patients (76 females and 4 males aged 9-18 years) with restricting or binge-eating/purging AN. The results confirm the close correlation between ED and oral lesions, the most common of which were dental erosion, dentinal hypersensitivity, the extrusion of amalgam restorations and xerostomia. The authors conclude by emphasising the importance of involving dentists in the diagnosis and treatment of ED.

Recognition and management of eating disorders in the dental office

Extensive damage to the teeth may result from self-induced vomiting. Recognition of the oral signs of eating disorders is a responsibility of dental care providers. Young women with BN and AN may seek dental care before seeking medical treatment because they are concerned about their appearance. Early identification of oral changes by the dental practitioner and referral to medical and psychiatric therapists can reduce the risk of further physical damage to the body or greater loss of tooth surface enamel. Home care instructions will be followed when the reasons for timing of toothbrushing, rinsing after vomiting, and use of fluoride are explained. Careful selection of beverages and snacks will help reduce the risk of further erosion and dental caries. Comprehensive dental procedures should not be undertaken until significant improvement in vomiting behavior or complete recovery has occurred.

Oral profiles of bulimic women: Diagnosis and management. What is the evidence?

This article is a critical appraisal of the literature on the oral complications of bulimia. The MEDLINE database yielded a total of 82 English-language reports published between 1966 and 2002 that were pertinent to the topic of oral manifestations and treatment of bulimia. The literature is composed primarily of reviews, letters, case reports with or without restorative management, and descriptive studies of small sample sizes. At present, retrospective case-control studies are the only studies available with levels of evidence in the vicinity of 3 to 4. From these studies it is apparent that bulimic women present with a variety of oral and pharyngeal signs and symptoms, including dental caries and tooth erosion, dental pain, increased levels of cariogenic bacteria, orthodontic abnormalities, xerostomia (the subjective complaint of a dry-mouth) and decreased saliva secretion (the objective measure), decreased salivary pH, decreased periodontal disease, parotid enlargement, and swallowing impairments. Dental erosion is the major finding associated with bulimia. Case reports describe restoration of damaged surfaces with porcelain-laminated veneers, dentin-bonded crowns with minimal tooth preparation, composites, and complete-coverage restorations. However, what is really needed is identification of oral markers of bulimic behavior for early detection of bulimic patients by dentists and by physicians that can prevent the deleterious effects of frequent vomiting on the oral/dental tissues.

Oral health of children with gastro-esophageal reflux disease: a controlled study

BACKGROUND

The aim of this study was to compare the dental health of children with gastro-esophageal reflux disease (GERD) with a healthy control group.

METHODS

Dental examinations were conducted for 52 children (31 boys and 21 girls) with a definitive history of GERD. For every subject enrolled in the study, a healthy control sibling without the condition was recruited. Medical histories were obtained from medical records, and dental and dietary histories were obtained from parents. The teeth were examined for erosion, dental caries, and enamel hypoplasia, and sampled for Streptococcus mutans.

RESULTS

The prevalence of erosion by teeth was found to be statistically significant between GERD patients (14 per cent) and controls (10 per cent) (p<0.05). GERD patients had erosion in more permanent teeth compared to controls (4 per cent vs 0.8 per cent, p<0.05), and more severe erosion (p<0.05). Caries experience was also higher in GERD patients compared to controls (p<0.05). Although there were more subjects with Streptococcus mutans in the GERD group compared to the control group (42 per cent vs 25 per cent), the difference was not statistically significant.

CONCLUSIONS

Children with GERD have more erosion and dental caries compared to healthy controls and should be targeted for increased preventive and restorative care.

[Behavioral eating disorders and their effects on the oral health in adolescence]

Anorexia nervosa and bulimia nervosa are serious eating disorders that affect a significant number of adolescents and young adults. Individuals with anorexia nervosa tend to ignore or deny their excessive dieting and may present purging habits. The individual with bulimia nervosa spends great effort and time in compensating the effects of binge eating with dieting and fasting, self-inducing vomiting, utilization of laxatives or overexercising. The incidence of those behavioral disorders seems to be increasing, but there are no epidemiological data on that matter in Brazil. The dental practitioner has an important role in identifying these disorders since toothwear is very frequent due to the acidic oral environment caused by vomiting. The dentist can help to minimize the effects of anorexia and bulimia on the dentition. The objective of this study is to review the features of those behavioral eating disorders and to highlight the importance of being prepared to diagnose them and implement a comprehensive treatment of patients.

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.

The prevalence, etiology and management of tooth wear in the United Kingdom

STATEMENT OF PROBLEM

Recent epidemiologic evidence suggests that tooth wear is now a significant problem in both children and adults. There is growing evidence that a major cause of severe wear in patients is regurgitation erosion due to a variety of factors including gastroesophageal reflux disease.

PURPOSE

The purpose of this article is to discuss the prevalence of tooth wear in the United Kingdom. Emphasis in management should be on accurate diagnosis, and in some patients, long-term monitoring before embarking on any irreversible, interventive treatment. Even when treatment is necessary, a period of monitoring is helpful to assess the rate of progress of the wear, the effectiveness of preventive measures, and therefore the extent of the treatment necessary.