Study of Oral Changes in Patients with Eating Disorders
by Lifante-Oliva, C., López-Jornet, P., Camacho-Alonso,
F., & Esteve-Salinas, J. (2008).
A study was performed with 18 hospitalized patients suffering from either anorexia or bulimia from the Hospital de Albacete in Spain. Subjects were patients from an eating disorders uit of the hospital. The aim of the researchers was to document and study women with eating disorder and their oral manifestions due to their disorder.
Methods: Examination was performed by the same examiner and carried for 3 months. Oral and extra oral assessments were performed to note and establish baseline salivary flow, periodontal, dental and muscosal health. Caries and erosion were also recorded. Location as well of the erosions were noted. Indices that were used were the Silness and Loe hygiene index and DMF scoring.
Results: Looking at the subjects, their ages ranged between 13-32 years of age, and onset of their eating disorders were averaged between 9-21 years old. All 18 subjects reported to brush at least three or more times a day. These female subjects were all taking medications in which some side effects included xerostomia and alteration of salivary glands.
As far as oral findings, it was found that all subjects had dental erosion, Grade 1, which affected only the enamel. According to the researchers, these findings were consistent with the bulimic group. These subjects also had bilateral enalargement of the parotid gland. Looking at the results, both groups also exhibited a fair amount of labial dehydration, while some also exhibited commisural cheilitis. Intraoral examination of soft tissues reveal that a fair amount had tongue indentations and also exhibited gingival recession, while a very small number exhibited gingival hemorrhage.
Results also show that for the bulimic group, there are more incidences of dental erosions due to vomiting and more localized to the anterosuperior area, and a slight amount reaching more inferior. This group also showed signs of sialedonosis and most showed less than neutral saliva pH.
Discussion:
Researchers discussed how severe erosion of the teeth was one of the most significant findings in the bulimia nervosa subjects. As far as dental caries, the researchers believe their results were inconclusive due to many factors possibly causing the DMF score. Researchers believe that nutritional deficiency played the role in the results seen such as in cheilitis, labial dehydration and intraoral findings. Other oral findings such as candidiasis was also seen and attributed in part to the nutritional deficiency and in part by trauma. Altered pH was also seen and was attributed both to nutritional deficiency and mediciations taken by the subjects.
Researchers recommend that patients suffering from bulimia and anorexia be seen regularly for check-ups and to monitor these patients closely. They believe that it is important to educate the patients on how important recare appointments are and to provide fluoride treatment for eroded areas of teeth. In addition, proper OHI must be given regarding toothbrush care and food and drinks which can also cause added erosion.
Importance to the Dental Hygiene Profession:
This study helped to reinforce how as a dental professional it is important to aware of signs of bulimia or anorexia. Although subjects may be hesitant to admit they have an eating disorder, they should at least be cautioned about what consequences and signs are appearing in the mouth. As a dental professional it is important to understand what this type of patient need and what type of treatment they can benefit from. Fluoride for exposed areas due to erosion or recession is important as well as good oral hygiene instructions about the acid attack on teeth. Brushing frequency should be discussed in terms of how soon patients should brush after vomiting. Being able to recognize signs of nutritional deficiency is also important because it give clues on what is going on with the patient.
I believe mor importantly these patients do not want a lecture from their hygienist about how wrong they are because I believe that most are already embarrassed by what they are doing or are so sick that they cannot help their behavior. However, letting the patient know that you are seeing some signs, and hopefully being able to inform them properly of the side effects will benefit the patient.
Methods: Examination was performed by the same examiner and carried for 3 months. Oral and extra oral assessments were performed to note and establish baseline salivary flow, periodontal, dental and muscosal health. Caries and erosion were also recorded. Location as well of the erosions were noted. Indices that were used were the Silness and Loe hygiene index and DMF scoring.
Results: Looking at the subjects, their ages ranged between 13-32 years of age, and onset of their eating disorders were averaged between 9-21 years old. All 18 subjects reported to brush at least three or more times a day. These female subjects were all taking medications in which some side effects included xerostomia and alteration of salivary glands.
As far as oral findings, it was found that all subjects had dental erosion, Grade 1, which affected only the enamel. According to the researchers, these findings were consistent with the bulimic group. These subjects also had bilateral enalargement of the parotid gland. Looking at the results, both groups also exhibited a fair amount of labial dehydration, while some also exhibited commisural cheilitis. Intraoral examination of soft tissues reveal that a fair amount had tongue indentations and also exhibited gingival recession, while a very small number exhibited gingival hemorrhage.
Results also show that for the bulimic group, there are more incidences of dental erosions due to vomiting and more localized to the anterosuperior area, and a slight amount reaching more inferior. This group also showed signs of sialedonosis and most showed less than neutral saliva pH.
Discussion:
Researchers discussed how severe erosion of the teeth was one of the most significant findings in the bulimia nervosa subjects. As far as dental caries, the researchers believe their results were inconclusive due to many factors possibly causing the DMF score. Researchers believe that nutritional deficiency played the role in the results seen such as in cheilitis, labial dehydration and intraoral findings. Other oral findings such as candidiasis was also seen and attributed in part to the nutritional deficiency and in part by trauma. Altered pH was also seen and was attributed both to nutritional deficiency and mediciations taken by the subjects.
Researchers recommend that patients suffering from bulimia and anorexia be seen regularly for check-ups and to monitor these patients closely. They believe that it is important to educate the patients on how important recare appointments are and to provide fluoride treatment for eroded areas of teeth. In addition, proper OHI must be given regarding toothbrush care and food and drinks which can also cause added erosion.
Importance to the Dental Hygiene Profession:
This study helped to reinforce how as a dental professional it is important to aware of signs of bulimia or anorexia. Although subjects may be hesitant to admit they have an eating disorder, they should at least be cautioned about what consequences and signs are appearing in the mouth. As a dental professional it is important to understand what this type of patient need and what type of treatment they can benefit from. Fluoride for exposed areas due to erosion or recession is important as well as good oral hygiene instructions about the acid attack on teeth. Brushing frequency should be discussed in terms of how soon patients should brush after vomiting. Being able to recognize signs of nutritional deficiency is also important because it give clues on what is going on with the patient.
I believe mor importantly these patients do not want a lecture from their hygienist about how wrong they are because I believe that most are already embarrassed by what they are doing or are so sick that they cannot help their behavior. However, letting the patient know that you are seeing some signs, and hopefully being able to inform them properly of the side effects will benefit the patient.
Personal Reflection
Junior high was the first time I really remembered weighing myself and being conscious about the concept of weight and what it meant to pre-teen and teenage girls. They made us all fall in a line during Phys Ed and made each of us weigh ourselves. My classmate in line before me weighed herself and I remember seeing 130 lbs. I though to myself "Not bad." But then I noticed that my other classmates behind me started whispering and saying "oh my gosh, she's fat." Now that I think about it I remember her being taller than me, a little big boned in structure, but not looking overweight. She was a dancer and had been dancing since she was a little girl, so she was pretty active. But after hearing about how others commented, I began to feel self conscious about my own weight and it was then I realized that kids as young as I was that time were already thinking about these issues when I was still thinking about kiddie stuff.
I know that the reason why I am intrigued and chose this topic was that I realized for many, weight is an issue and for so some wanting to lose weight and not knowing when to stop is a sickness. It is a constant battle in their head and in their body. Every teenager goes through their moments of self doubt and insecurity. I remember another time in high school when I ate very little so that I could fit into my prom dress. I remember that it consumed me for one week and it was all I cared about- looking good for the prom picture.
I am curious to read about these articles and watching documentaries about this topic because when you are so focused on dieting and starving yourself, you lose track of the consequences because you are so focused on your goal to lose weight, that everything else doesn't matter. When you look deeper however, there are so many underlying issues that range from emotional to physical abuse, low self-esteem, pressures of work or school, athletics, etc. So many consequences of eating disorders occur that many aren't aware of, ranging from oral to gastrointestinal to overall body health. I believe that there are many women out there who think that they are in control of the situation and that they do not have an illness. Those that maybe do know, are ashamed to admit that they are suffering or are actually fine with this behavior. What I believe is sad is when these patients know what the consequences are, because they have been told, but they still are not able to stop their behavior. Whatever the reason may be for having an eating disorder, hopefully women out there know that there is support and a way to heal from this and that they can find a happy medium where they may feel satisfied with their weight and be healthy.
I know that the reason why I am intrigued and chose this topic was that I realized for many, weight is an issue and for so some wanting to lose weight and not knowing when to stop is a sickness. It is a constant battle in their head and in their body. Every teenager goes through their moments of self doubt and insecurity. I remember another time in high school when I ate very little so that I could fit into my prom dress. I remember that it consumed me for one week and it was all I cared about- looking good for the prom picture.
I am curious to read about these articles and watching documentaries about this topic because when you are so focused on dieting and starving yourself, you lose track of the consequences because you are so focused on your goal to lose weight, that everything else doesn't matter. When you look deeper however, there are so many underlying issues that range from emotional to physical abuse, low self-esteem, pressures of work or school, athletics, etc. So many consequences of eating disorders occur that many aren't aware of, ranging from oral to gastrointestinal to overall body health. I believe that there are many women out there who think that they are in control of the situation and that they do not have an illness. Those that maybe do know, are ashamed to admit that they are suffering or are actually fine with this behavior. What I believe is sad is when these patients know what the consequences are, because they have been told, but they still are not able to stop their behavior. Whatever the reason may be for having an eating disorder, hopefully women out there know that there is support and a way to heal from this and that they can find a happy medium where they may feel satisfied with their weight and be healthy.
REFERENCES
Lifante-Oliva, C., López-Jornet, P., Camacho-Alonso,
F., & Esteve-Salinas, J. (2008). Study of oral changes in patients with
eating disorders. International Journal Of Dental Hygiene, 6(2),
119-122.
F., & Esteve-Salinas, J. (2008). Study of oral changes in patients with
eating disorders. International Journal Of Dental Hygiene, 6(2),
119-122.
Additional Information
Websites for more information, treatment and support groups for eating disorders
All Photos Taken from Google Images