-Eating disorders are among most common psychiatric problems not only in the U.S. nearly 8 milion Americans suffer from them. They represent a complex spectrum of chronic illneses with medical and psychological complications that lead to the highset mortality of all psychiatric disorders. The rate of mortality without treatment is up to 20 %. With the propoer treatment the number drops to 2-3 %-says dr. Barbara J. Steinberg, DDS, Clinical Professor of Surgery during the latest webinar about eating disorders.
Etiology
Among the reasons you can find these connected with the occupation:
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atleths, particullary gimnastics, runners, skaters, and rowers,
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models,
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actors/actresses,
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flight attendatns,
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dancers,
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miIlitary personnel who must maintain a prticular weight,
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food-related professions, eg. chefs, caterers, waiters, etc.
Demographic risk factors
90 % of patients is female
Most prelevant are adolescent and young adults (16-25 % college students, 8-10 year old girls, women in middle and late life)
Cultural and social risc factors
White, Hispanic, native Americans slightly higher than African-American and Asian-American population.
The incidence appears to increase as the socioeconomic status increases, and in industralized nations.
The impossible standards of beauty and youthfulllness are promoted by certain products. In the U.S. 1 of 3, 8 commercials on TV sends an attractivenes message.
Family emotional problems like: overinvolvment, abandonment, sexual abuse, complicated bereavement, experience with a weight problem or obesity in childhood or adolescence, history of an eating disorder in the family, especially in 1 relatives of patients.
Comorbid psychiatric problems: depression, anxiety disorder, chemical dependency, physical or psychological trauma in childhood, rape, personality disorder.
Examples of eating disorders:
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anorexia nervosa (subtypes: restricting, and binge-eating and purging) and ortorectic anorexia nervosa,
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bulimia, and diabulimia.
Dentition symptoms
Perimylolysis-loss of enamel and dentine on the lingual surfaces of the teeth as a result of chemical and mechanical effects caused mainly by regurgitation of gastric contents and activated by movements of the tongue.
Depends of frequency and degree of regurgitation and oral hygiene habits. Usually clinically observable after purging for 2 years.
In early stages there are glassy apperance of teeth especially palatal surfaces of maxillary anterior teeth. In advanted stages anterior teeth became thin and chip, posterior ones-cupped ot, restorations protrude. Thermal sensitivity is observed. There is a loss of vertival dimention. Pulps may be exposed. Caries rate vary depending on: duration and frequency of binge/purge behaviour, diet, oral hygiene practises, medicalments involved in treating eating disorder. Traumatic injury to mucose and/or palate-injure from inducing vomiting by fingers, combs, pens, etc., rapid food ingestion, force of regurgitation. Angular chelitis-nutritional deficiences, dehydratation, loss of vertical dimension. Salivary glands-in 10-50 % of cases parotic gland enlargement, soft painless swelling uni- or bilateral which usually occurs within a few days of a vomiting cycle. It reverses with cessation of vomiting habit. Salivary glands-xerostomia-unstimulated salivary flow decreases, chronic dehydratation (vomiting, fasting, diuretics, laxatives, and the other medicines). A film on tongue from dehydratation can be observed.
In diabulimia (diabetics bulimia) not erosion, but decay, xerostomia, and peridental problems occur.
Dentition treatment
Rinsing, not brushing, just after vomiting (and acid reflux). It can be just regular tap water, but it is rather recommended to use warm water with magnesium or sodium bicarbonate. Brushing is allowed after 30-60 minutes. Otherwise it contributes to loss of enamel by erosion. Water rinse can be followed by 0, 05 % sodium fluoride rinse. It protects tooth surfaces and neutralizes acids. For xerostomia artificial salivas should be used. Reminalization of enamel should be also promoted-daily home application of 0, 1 % sodium fluoride in custom trays or applied with a toothbrush or daily aplication of 5 000 parts per million fluoride. You can also prescibe Minimally Invasive Paste from GC America. Regular professional prophylaxis-topical fluoride application o help prevent further erosion and reduce dentin hypersensitivity. Sialadenosis treatment options-abstinence from vomiting, warm compresses, sialogogues such as sour candies. If the above mentioned traditional treatment fails within a few weeks patient should be treated with pilocarpine 5, 0 mg PO TID.
Restorative dentistry-only pallative treatment and temporary cosmetic procedures provided until patient is stabilized emotionally. Depends on whitening agent (sensitivity like acids), but even frequent vomiting is not an absolute contrindication to whitening teeth.
Approach issue gently! Even oversized clothes can be a camouflage what a body looks like.
BARBARA J. STEINBERG received her D.D.S. from the University of Maryland School of Dentistry and completed a residency at the Medical College of Pennsylvania. She is Clinical Professor of Surgery at Drexel University College of Medicine, as well as Adjunct Associate Professor of Oral Medicine at the University of Pennsylvania School of Dental Medicine. She is a Diplomate of the American Board of Oral Medicine.
Dr. Barbara J. Steinberg specializes in the treatment of medically compromised patients. She is a nationally and internationally invited lecturer in the area of dental treatment of the medically compromised patient and women’s health, and has authored numerous articles and contributed to major textbooks on these subjects.
For the last nine years Dr. Steinberg has been named by Dentistry Today “One of the Top Clinicians in Continuing Education”. Dr. Steinberg is a former spokesperson for the American Dental Association on Women’s Oral Health Issues and has had numerous television appearances, including Good Morning America. She represented the American Dental Association at a congressional briefing on Women’s Oral Health Issues and presently serves on the Health, Nutrition and Fitness Board of Women’s Day Magazine.
Source: Lecture Eating Disoders: Medical and Dental Considerations given by dr. Barbara J. Steinberg, DDS, Clinical Professor of Surger.