Eating disorders: dental implications

Anorexia and bulimia nervosa in the practice of the paediatric dentist

OBJECTIVE

This systematic review aimed to highlight the usefulness of the clinical examination of the oral cavity for the diagnostic suspicion of anorexia (AN) and bulimia nervosa (BN), being of main interest to the paediatric dentist and paediatrician due to the early onset of symptoms in Eating Disorders (EDs).

METHOD

A systematic search, applying PICO question, was carried out in biomedical and other electronic databases from 2005 to 2020. Both case reports and case series of patients under 65 years of age with AN and BN were included. Data were extracted and statistically analysed.

RESULTS

A sample of 111 studies was obtained (n = 192; 92.78% female). The most prevalent diagnosis was restrictive type AN (n = 110; 57.29%). Only 16 (8.33%) patients had been clinically examined at the oral cavity, indicating the presence or absence of oral manifestations (OM) and showing dental erosion (n = 10) as the most frequent.

CONCLUSION

There is a lack of information about the oral examination of anorexic and bulimic patients. Dental erosion and other oral manifestations can help us to make an early ED diagnosis. Clinical observation and basic erosive wear examination (BEWE) Index are necessary steps to detect and record any anomaly in oral cavity during the evaluation of these patients.

Relationship between Risk Factors Related to Eating Disorders and Subjective Health and Oral Health

This study examined the factors related to eating disorders (ED) and the relationship between ED and subjective health or subjective oral health in adolescents. The 46,146 adolescents (age 12–18 years) who participated in the Korea Youth Risk Behavior Web-based Survey were selected, including those who had attempted to lose weight within the past 30 days during the survey period. The variables included were eating behavior, BMI, body image subjective health, and subjective oral health. The weight-loss method was divided into two groups (regular exercise, RE, and eating disorder, ED). The data were analyzed using the Rao-Scott χ2 test and logistic regression analysis. The adolescents with an obese body image had a lower risk of ED (OR = 0.75, 95% CI 0.38–1.49) than adolescents with a very thin body image. Adolescents with ED had a higher risk of a poor subjective health assessment (OR = 2.32, 95% CI 1.85–2.91). On the other hand, they had a lower risk of a poor subjective oral health assessment (OR = 0.89, 95% CI 0.71–1.12). ED is closely associated with eating behavior, BMI, body image, oral health behavior, subjective health, and subjective oral health in Korean adolescents.

Knowledge of Oral and Physical Manifestations of Anorexia Nervosa Among Polish Dentists: A Cross-Sectional Study

Background: Anorexia nervosa is a psychosomatic disorder and is commonly associated with impaired oral health. Dentists can play a relevant role in the early diagnosis of anorexia nervosa. With the help of intra- and extraoral examinations and anamnesis, the dentist can detect characteristic signs and symptoms of this eating disorder. The purpose of this study was to determine the knowledge regarding the oral and physical manifestations of anorexia nervosa among general dental practitioners and specialist dentists of Poland. Material and Methods: A pretested online questionnaire consisting of a first part asking for the characteristics of the participant and a second part with 22 specific questions on their general knowledge of anorexia nervosa and knowledge of physical and oral manifestations of this eating disorder was used. Results: A total of 369 dentists completed the questionnaire. The Polish dentists in this study reported sufficient knowledge regarding anorexia nervosa. However, younger dentists and general dental practitioners had relatively lower knowledge scores than other groups. The dentists mainly had difficulties with the oral symptoms of anorexia nervosa. Conclusion: Despite Polish dentists having sufficient knowledge about anorexia nervosa in relation to the general symptoms of anorexia, there are deficits with regard to oral manifestations. Therefore, there is a need to increase continuing education in this field, which can improve early diagnosis of this disease by dental practitioners and referral to specialists for treatment.

Anorexia, Oral Health and Antioxidant Salivary System: A Clinical Study on Adult Female Subjects

The aim of this study was to compare the oral health status and salivary antioxidant system between patients diagnosed with anorexia nervosa (AN) and healthy controls. A total of 25 female AN patients and 25 matched healthy controls were enrolled. Clinical parameters and saliva samples were collected for each patient. Two questionnaires to investigate oral health and hygiene were administered. Superoxide Dismutase (SOD) activity and High Reactive Oxygen Species (hROS) were evaluated. Salivary concentration of SOD was significantly higher in subjects with AN compared with control group (1.010 ± 0.462 vs. 0.579 ± 0.296 U/mL; p = 0.0003). No significant differences between groups were identified for hROS (233.72 ± 88.27 vs. 199.49 ± 74.72; p = 0.15). Data from questionnaires indicated that, although most of the patients recognized the oral hygiene importance in maintaining a good oral health, more than half of them had poor oral hygiene. Altered biochemical composition of saliva in patients with AN could be interpreted as an effective defence mechanism against oxidative stress. Moreover, despite the discrepancy between clinical findings and perception of the oral health in AN population arose, the quality of life of these patients appears not to be significantly affected by their dental condition.

[E-Therapies for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder]

E-Therapies for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder Abstract. Eating disorders can often be treated with psychotherapy, but mostly due to a lack of trained clinicians, the majority of the persons concerned do not receive any treatment. In recent years, internet-based psychotherapy (e-therapy) was proposed and tested in several pilot projects as a novel possibility to offer a larger number of places on a treatment program with a constant number of available clinicians. Recent results are promising, but before an implementation into standard care can take place, more detailed knowledge must be provided as to which patients may be recommended this type of therapy as an equivalent alternative to traditional face-to-face therapy.

Barriers and enablers for oral health care for people affected by mental health disorders

BACKGROUND

People with mental health disorders are reported to have poorer access to dental services and poorer oral health outcomes. The aim of this paper is to analyze current published work regarding barriers and enablers for oral health outcomes and access to dental care for adults with mental health disorders which will be addressed from individual, organizational and systemic perspectives METHODS: A narrative review based on a search of the relevant published work regarding oral health for people with mental health disorders was undertaken using Medline, Web of Science, ERIC and Psychlit. Any relevant systematic reviews were highlighted in this process along with primary studies.

RESULTS

The published work repeatedly verified poorer oral health and inadequate access to dental services in people with mental health disorders. The published work identified barriers at individual, organizational and systemic levels. Much of the published work focused on barriers with less focus on enablers and interventions.

CONCLUSIONS

Considerable investigation of barriers had not elucidated options to improve care or outcomes.

Nonsuicidal Self-injury as a Risk Factor for Purging Onset: Negatively Reinforced Behaviours that Reduce Emotional Distress

Both nonsuicidal self-injury (NSSI) and purging behaviour are thought to involve harm to the self. The acquired capability for self-harm model holds that engaging in one self-harming behaviour increases the capability to tolerate harm to the self, thus increasing risk for engaging on other such behaviours. In addition, both behaviours are thought to serve the similar function of relief from distress. We thus tested whether engagement in one of these behaviours predicts the subsequent onset of the other. In a longitudinal design, 1158 first-year college women were assessed for purging and NSSI at two time points. Engagement in NSSI at time 1 predicted the college onset of purging behaviour 9 months later (OR = 2.20, p < .04, CI = 1.07-4.19) beyond prediction from time 1 binge behaviour, and purging behaviour at time 1 predicted the subsequent onset of NSSI (OR = 6.54, p < .01, CI = 1.71-25.04). These findings are consistent with the acquired capability for harm model and with the possibility that the two behaviours serve a similar function.

Deep carious lesions and other consequences of caries among 18-year-olds at Public Dental Health Service in Northern Norway: A cross-sectional age cohort study

OBJECTIVES

To document deep carious lesions and other consequences of caries (DCL-CC) in molars of 18-year olds leaving the free-of-charge Public Dental Health Service (PDHS). To explore the association between background factors and DCL-CC.

MATERIALS AND METHODS

The final study sample (n=1876) comprised 95% of individuals born in 1993 and registered in the PDHS in Troms County, Northern Norway. The most recent digital bitewing radiographs of each subject were examined for DCL-CC (deep untreated carious lesions, deep restorations, root canal obturations or extractions due to caries). Inter- and intra-observer kappa scores were 0.62 and 0.87, respectively. Information on background factors (gender, clinic location, history of medical problems, bitewing examination interval, DMFT score and planned recalls) were retrieved from dental records.

RESULTS

About one-quarter of subjects (488) had at least one molar with DCL-CC. There were 848 molars in total with DCL-CC; the majority were deep restorations (70%), but 4% were deep untreated carious lesions. More than a quarter of DCL-CC were either root canal obturations (14%) or extractions (12%). Multivariable logistic regression analyses showed that a 1-unit increase in DMFT score was associated with deep untreated carious lesions and extractions due to caries. There was no association between urban/rural clinic location, which indicated socio-economic status, and either DMFT score or DCL-CC.

CONCLUSIONS

Despite the existence of a free-of-charge dental service, more than one-quarter of the subjects in the present study had at least one molar with DCL-CC.

Bulimia Nervosa - medical complications

As with anorexia nervosa, there are many medical complications associated with bulimia nervosa. In bulimia nervosa, these complications are a direct result of both the mode and the frequency of purging behaviours. For the purposes of this article, we will review in detail the many complications of the two major modes of purging, namely, self-induced vomiting and laxative abuse; these two account for more than 90% of purging behaviours in bulimia nervosa. Some of these complications are potentially extremely dangerous and need to be well understood to effectively treat patients with bulimia nervosa. Other methods of purging, such as diuretic abuse, are much less frequently utilized and will only be mentioned briefly. In a subsequent article, the treatments of these medical complications will be presented.

Parotid gland flow activity and inorganic composition in purging bulimic patients treated with fluoxetine

OBJECTIVES

The purpose of this study was to establish whether vomiting bulimic and/or non-bulimic depressive patients, both treated with the serotonin reuptake inhibitor SI-5-HT (fluoxetine), have differing proportions of inorganic components (specifically, sodium, potassium and calcium) in their parotid salivary gland secretions, than in the average population.

METHODS

A controlled clinical trial was designed for three age-matched female groups: bulimic patients receiving fluoxetine 40 mg/day (n = 33), non-bulimic patients diagnosed with bipolar affective disorder (fluoxetine 20 mg/day, n = 25) and healthy controls (n = 51). Parotid saliva was collected using a Lashley cap while the subjects were at rest. Stimulation was obtained chemically using a 3% citric acid solution, and physically by instructing the subjects to chew on wax pellets. The concentrations of sodium, potassium and calcium ions were measured using the colorimetric photometry method.

RESULTS

The bulimic patients had a reduction in flow and sodium and potassium ions in the parotid saliva and non-bulimic patients had a reduction in flow. Deficits in certain components of saliva were shown to be directly related to salivary flow rate.

CONCLUSIONS

The data suggest that detection of inorganic deficits in parotid saliva might serve as a reliable confirmation of reduction in flow amongst purging bulimic patients treated with fluoxetine.

Evaluation of a theory-driven e-learning intervention for future oral healthcare providers on secondary prevention of disordered eating behaviors

Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.

Effects of eating disorders on oral fungal diversity

BACKGROUND

The eating disorders anorexia and bulimia nervosa can cause several systemic and oral alterations related to poor nutrition and induced vomiting; however, the oral microflora of these patients is poorly studied.

OBJECTIVE

The aim of this study was to evaluate fungal microflora in the oral cavity of these patients by culture-dependent and culture-independent methods.

STUDY DESIGN

Oral rinse samples were cultured to assess the prevalence of Candida species, and the isolates were identified by API system. Microorganism counts were compared by the Mann-Whitney test (5%). Ribotyping, a type of molecular analysis, was performed by sequencing the D1/D2 regions of 28S rRNA.

RESULTS

Our results demonstrated that the eating disorder group showed higher oral Candida spp. prevalence with culture-dependent methods and higher species diversity with culture-independent methods.

CONCLUSIONS

Eating disorders can lead to an increased oral Candida carriage. Culture-independent identification found greater fungal diversity than culture-dependent methods.

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.

Implementation and experience of a new method for posterior vertical bite reconstruction using direct resin composite restorations in the private practice--a survey

OBJECTIVE

The purpose of the present survey was to evaluate the implementation and experience of a new method for posterior vertical bite reconstruction using direct resin composite restorations by private practitioners who attended a hands-on continuing education course on this technique.

MATERIALS AND METHODS

In the years 2007 and 2008, 17 1-day continuing education courses on vertical bite reconstruction in the worn dentition by using direct resin composite restorations were attended by 310 participants. A 13-item questionnaire was posted to all course participants in April 2009 seeking information on the acceptance, implementation and experience of the presented technique in the private practice.

RESULTS

A total of 97 (31%) questionnaires were returned, whereas 67% of the respondents had used the presented technique. Analysis of the overall experience and satisfaction with the placed resin composite restorations using visual analog scale (VAS) revealed a mean VAS score of 7.2 ± 1.7 (0 = maximal unsatisfied, 10 = maximal satisfied). The direct resin composite restorations were predominantly rated 'good' within the assessed criteria surface texture, anatomical form, marginal integrity, marginal discoloration and color match. Ninety-eight percent of the private practitioners stated that they would continue to carry out vertical bite reconstructions according to this technique. The three most frequently observed clinical problems were related to marginal discolorations, bulk fractures and adhesive failures.

CONCLUSION

The presented restoration method was well accepted by private practitioners who used this treatment approach at least once after course participation, even though some clinical problems were observed.

Oro-facial manifestations in patients with eating disorders

Studies have reported that the oral health status is jeopardized in patients with eating disorders. The aim was to review the oro-facial manifestations in patients with eating disorders. The address the focused question was "What is the oro-dental health status in patients with eating disorders?" MEDLINE/PubMed and Google Scholar databases were searched from 1948 to March 2012 using the following terms in various combinations: "Anorexia nervosa", "bulimia nervosa", "eating disorders", "dental", "oral health status". Letters to the editor, unpublished data and articles published in languages other than English were excluded. Dry lips, burning tongue and parotid gland swelling are common manifestations in patients with eating disorders as compared to medically healthy controls. The association of dental caries and periodontal disease in patients with eating disorders remains debatable. Temporomandibular disorders have also been reported to be more prevalent in patients with eating disorders as compared to healthy controls. A critical oral-dental examination during routine dental check-ups may reveal valuable information regarding the presence or absence of eating disorders in routine dental patients. This may be important information, updating the medical history, supporting the role of the physician.

The adult suicide-prone patient: a review of the medical literature and implications for oral and maxillofacial surgeons

PURPOSE

Suicide is the 11th most common cause of death among American adults. Some individuals who commit suicide may have been treated by oral and maxillofacial surgeons in the days preceding the event. Because suicide often is preventable, in this report we review methods that are useful in identifying individuals at risk of imminent suicide and give suggestions for obtaining interventional assistance.

METHODS

A Medline search using the key terms "suicide," "adult," and "oral surgery" was conducted. Articles selected were published in peer-reviewed journals.

RESULTS

Individuals who have told their surgeon they have no further reason to live, have developed a suicide plan, have secured a lethal device, and have previously made such an attempt are at extreme risk and require immediate intervention. Additional risk factors include being white, aged older than 45 years, and unemployed; living alone, with poor social supports; having a current mental illness or history of mental illness, including substance abuse; and having a family history of suicide. Specialty-specific patients at highest risk are those treated for oral cancer and cosmetic issues and those with adverse surgical outcomes. With regard to assessment of these individuals, the modified SAD PERSONS acronym can assist surgeons in documenting the presence of major risk factors associated with adult suicide and in facilitating communication with emergency personnel.

CONCLUSIONS

Suicide is a potentially preventable public health problem. Oral and maxillofacial surgeons can be key in elucidating clinically significant suicide potential in their patients and referring them for timely intervention.

Flow rates and inorganic composition of whole saliva in purging bulimic patients treated with a fluoxetine

OBJECTIVES

The current study established whether vomiting bulimic and/or non-bulimic depressive patients, both treated with a serotonin reuptake inhibitor (fluoxetine), have changes in their whole salivary secretion and inorganic components: Na(+), K(+), Ca(2+).

METHODS

From 108 female subjects, namely bulimics (Group B) (fluoxetine: 40 mg/day) (n=33), non-bulimic depressives (Group D) (fluoxetine: 20 mg/day) (n=25) and a Group C of 50 healthy controls, unstimulated and stimulated saliva was collected. The concentrations of Na(+), K(+), Ca(2+) were determined by colorimetric photometry method (Effox 5053, Eppendorf, Germany).

RESULTS

The bulimic group reported significant lower output in salivary flow and sodium concentration. In the group (D) only flow was lower than in healthy controls but not significant.

CONCLUSION

This study supports the hypothesis that salivary flow is an unreliable indicator of bulimia, the lack of increase in sodium level in stimulated saliva in bulimic subjects could be a more reliable confirmation of the eating disorder.

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.

Study of oral changes in patients with eating disorders

BACKGROUND

The prevalence of eating disorders is very high in industrialized countries, especially in young women. The principal orodental manifestations are erosion of the dental enamel, caries and dental sensitivity.

OBJECTIVES

Our aim was to study oral complications in female with eating disorders.

METHODS

We study oral complications (dental, mucosal and salivary) in 17 female patients from the Hospitalized Patients Eating Disorders Unit.

RESULTS

We found alterations in salivary flow and pH, as well as salivary gland enlargement.

CONCLUSIONS

A significant alteration in oral tissue occurs; this has an adverse impact on oral health, producing an accumulation of local irritants which favour the appearance of oral diseases. Preventative measures are therefore recommended for this group of patients.

Oral manifestations of gastrointestinal diseases

The present paper offers a detailed review of the oral manifestations of various gastrointestinal diseases or conditions, with suggestions on how they may be relevant to the practice of gastroenterology. The review includes Crohn's disease, ulcerative colitis, Gardner syndrome, Peutz-Jeghers syndrome, malabsorption conditions related to hematopoesis, gastrointestinal malignancy metastatic to the jaws, jaundice and gastric reflux diseases.

Necrotizing sialometaplasia associated with bulimia: case report and literature review

Necrotizing sialometaplasia (NSM) is a self-limiting disorder affecting mainly the minor salivary glands. The significance of NSM resides in its clinical and histopathological resemblance to carcinoma. Few cases of NSM associated with eating disorders have been reported to date. We present here the clinical features and histomorphology of an additional case of bulimia-associated NSM closely mimicking an invasive carcinoma. A high index of suspicion and good communication between clinician and pathologist are essential in recognizing this entity and preventing unnecessary surgical therapy.

Sex differences among dentists regarding eating disorders and secondary prevention practices

BACKGROUND

The purpose of this cross-sectional study was to assess sex differences among dentists pertaining to current behaviors and behavioral beliefs with regard to eating disorders.

METHODS

The authors collected data via a self-administered paper-and-pencil questionnaire from a randomized sample of 350 practicing male and female dentists.

RESULTS

The results showed a low level of practice regarding secondary prevention (that is, measures leading to early diagnosis and prompt intervention) of eating disorders. The authors found statistically significant differences, with more female than male dentists reporting that they assessed patients for oral cues (P < .001), more female dentists reporting that they provided specific dental care instructions (P = .038) and more female dentists referring patients who have oral signs of eating disorders (P = .028). They also found sex differences with regard to mediating factors. Female dentists had greater knowledge of oral manifestations of eating disorders (P = .001), greater knowledge of physical cues of anorexia nervosa (P < .001), greater perception of the severity of anorexia nervosa (P = .007) and greater knowledge of physical cues of bulimia nervosa (P < .001).

CONCLUSIONS

Although the dentist may be the first health care provider to assess oral effects of eating disorders, his or her involvement may be influenced in part by sex and sex-related health beliefs.

CLINICAL IMPLICATIONS

Female dentists may be more sensitive to oral cues related to women's health issues. Further research is warranted to explore the mediating factors regarding secondary prevention of eating disorders.

The distribution of oral mucosal pH values in healthy saliva secretors

OBJECTIVES

To establish the normal range of oral mucosal pH and to correlate these measurements to salivary flow rate in healthy individuals according to age and gender.

SUBJECTS AND METHODS

Measurements of pH levels using a flat pH meter and salivary secretion rates were established in eight mucosal sites from a total of 50 healthy individuals.

RESULTS

The mean pH (+/-s.d.) of all sites was 6.78 +/- 0.04 with significant differences between mean pH values in the palate (7.34 +/- 0.38), the floor of the mouth (6.5 +/- 0.3), the buccal mucosa (6.28 +/- 0.36) and the tongue (6.8 +/- 0.26). A significant correlation was found between age and pH at palatal and tongue sites but no gender effects were noted.

CONCLUSIONS

This method is easy and relatively quick to manipulate, and may offer many diagnostic possibilities for oral related diseases and disorders such as oral malodour, mouth breathing, dysgeusia, acidic diet consumption and gastrointestinal disorders affecting the mouth.

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.

Communicating effectively with patients suspected of having bulimia nervosa

BACKGROUND

The dental team often is confronted with the clinical appearance of erosion affecting the hard and soft oral tissues. An investigative process often is needed to determine the cause of such erosion, because factors other than eating disorders may be involved. The authors present a protocol that should be considered in the assessment of dental erosion. Guidelines provide direction for the clinician toward opening a dialogue with a patient when the suspected cause of erosion is an eating disorder.

TYPES OF STUDIES REVIEWED

The authors review publications related to the causes of dental erosion and the patterns that are involved with both chemical and mechanical destruction of oral tissues. They also discuss the oral-tissue effects related to eating disorders. The authors stress the importance of assisting parents in obtaining adequate treatment for pediatric patients.

RESULTS

Cases of eating disorders among female college students, athletes, preadolescent children and men are well-documented. However, dental staff members often do not feel comfortable beginning a dialogue with patients who are suspected of having an eating disorder. This article focuses on the proper protocol for approaching such patients and beginning a dialogue. In addition, the authors provide suggestions for limiting further erosive damage to the tissues. They also discuss other causes of erosion that should be considered when assessing any type of oral erosion.

CLINICAL IMPLICATIONS

The dental team is in a prime position to assist patients who have eating disorders. Timely treatment by mental health and other medical professionals is crucial. The authors suggest a dialogue for approaching these patients and offer educational material to reduce further tissue destruction.

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.

Should dentists become 'oral physicians'? Yes, dentists should become 'oral physicians'

In summary, a new designation for the dental profession is warranted, not because paramedical professionals have done it, but because the new designation is appropriate for what they are able to do. Moreover, it can be done now with little resistance or fanfare. As has been suggested by others, changing the name "dentist" to the name "oral physician" would result in several benefits: dentists' being recognized as providers of services such as tobacco-use cessation, oral cancer screenings, nutritional counseling and, most recently, as a major health care resource for dealing with bioterrorism; the public's visiting dental professionals for services other than traditional dental procedures; the profession's being more likely to teach and provide services outside of traditional dental procedures; third-party payers' being more likely to pay for services other than traditional dental procedures; the improvement in the public's oral health that would result from patients' visiting "oral physicians" for services other than traditional dental procedures.

Position of the American Dietetic Association: Oral health and nutrition

It is the position of the American Dietetic Association (ADA) that nutrition is an integral component of oral health. The ADA supports the integration of oral health with nutrition services, education, and research. Collaboration between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between nutrition and the integrity of the oral cavity in health and disease. Oral health is an integral part of systemic and nutritional health. Two primary oral infectious diseases are directly influenced by diet and nutrition. Dental caries or tooth decay is modulated by numerous factors, including diet composition and frequency. Periodontal or gum disease is associated with malnutrition. Chronic diseases such as diabetes and cardiovascular disease that are modulated by diet and nutrition intervention have oral sequelae. As we advance in our discoveries of the links between oral and nutrition health, practitioners of both disciplines must learn to provide screening, baseline education, and referral to each other as part of comprehensive client/patient care. The future of dietetics practice requires dietetics professionals to provide medical nutrition therapy (MNT) that incorporates a person's total health needs, including oral health. Inclusion of both didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in both dental and dietetic education programs. Collaborative endeavors between dietetics and dentistry in research, education, and delineation of health provider practice roles are needed to ensure comprehensive health care to persons with oral infectious disease and/or oral manifestations of systemic diseases.

How can oral health care providers determine if patients have dry mouth?

BACKGROUND

Dentists recognize the importance of saliva in maintaining oral health and often are familiar with the clinical effects an insufficient salivary flow can have on oral tissues. A variety of medical conditions and medications can alter salivary secretion and composition. Typically, diagnosis of hyposalivation is made only after damage has occurred to the oral tissues.

OVERVIEW

The author describes a series of clinical steps that, if followed properly, may help in the early detection of salivary gland hypofunction and prevention of its severe complications. This four-step approach includes identifying a patient's chief complaint and the symptoms and duration of illness that brought the patient to the dentist, as well as any approaches the patient took to relieve symptoms; obtaining a medical history that includes a review of the body systems; performing a clinical evaluation that notes the patient's overall condition in addition to the health and functioning of the salivary glands and oral soft and hard tissues; and, when needed, conducting further diagnostic evaluations.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Oral health care providers will continue to face the challenges of treating new and recurrent carious lesions if the profession's approach to salivary hypofunction remains reactive rather than proactive. The recommendations in this article may enhance clinicians' awareness of the objective methods used to identify patients with salivary gland hypofunction or those at risk of developing it. It is hoped that early identification of asymptomatic patients at risk of developing hyposalivation, as well as symptomatic patients will lower the incidence and prevalence of dental caries and fungal infection in this population and ultimately enhance their quality of life.

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.