Dental aspects of purging bulimia
Abstract
Background/Aim. Bulimia is in many cases followed by frequent vomiting, which in long term can result in irreversible loss of dental tissue, most commonly manifested as dental erosion. Frequent purging, xerostomia, lack of oral hygiene and acidic environment are also suitable for caries development. The aim of the research was to determine the presence, localization and degree of dental erosion using Basic Erosive Wear Examination (BEWE) index system, as well as to determine the Decayed, Missing and Filled Teeth (DMFT) index in purging bulimic patients. Methods. The study involved 30 purging bulimic patients and 30 healthy subjects. Used methods were survey (questionnaire) and clinical examination. The clinical examination included intraoral inspection and assessment of dental status using BEWE and DMFT index. Results. On the bases of conducted research, it has been found that dental erosion are significantly more often present in purging bulimics compared to the controls (χ2 = 5.963, p < 0.05), that eroded lesions are more severe in the bulimic group (t = 3.925, p < 0.05) and predominantly located on oral surfaces of the teeth (χ2 = 10.561, p < 0.05). DMFT index values showed no significant difference between bulimic patients and controls (t = 0.741, p = 0.461). Conclusion. Dental erosion are often encountered in patients suffering purging bulimia, especially on oral surfaces of anterior teeth that come into direct contact with gastric acid, so many bulimics exhibit high values of erosive tooth wear on mentioned surfaces. DMFT index score did not show significant differences compared to healthy participants, but due to complexity of carious process further investigation is necessary.
References
Culbert KM, Racine SE, Klump KL. Research Review: What we have learned about the causes of eating disorders - a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry 2015; 56(11): 1141–64.
Walsh BT, Attia E, Glasofer DR, Sysko R. Handbook of as-sessment and treatment of eating disorders. 1st ed. Arlington: American Psychiatric Association Publishing; 2016.
Lo Russo L, Campisi G, Di Fede O, Di Liberto C, Panzarella V, Lo Muzio L. Oral manifestations of eating disorders: a critical review. Oral Dis. 2008; 14(6): 479–84.
Dynesen AW, Bardow A, Pedersen AML, Nauntofte B. Oral find-ings in anorexia nervosa and bulimia nervosa with special ref-erence to salivary changes. Oral Biosci Med. 2004; 1(3): 151–69.
Frydrych AM, Davies GR, McDermott BM. Eating disorders and oral health: A Review of literature. Aust Dent J 2005; 50(1): 6–15; quiz 56.
Rosten A, Newton T. The impact of bulimia nervosa on oral health: a review of the literature. Br Dent J 2017; 223(7): 533–9.
West N, Joiner A. Enamel mineral loss. J Dent 2014; 42(Suppl 1): S2–11.
Li X, Wang J, Joiner A, Chang J. The remineralisation of enam-el: a review of the literature. J Dent 2014; 42(Suppl 1): S12–20.
Kitasako Y, Sasaki Y, Takagaki T, Sadr A, Tagami J. Age-specific prevalence of erosive tooth wear by acidic diet and gastroesophageal reflux in Japan. J Dent 2015; 43(4): 418–23.
Kargul B, Bakkal M. Prevalence, Etiology, Risk Factors, Diag-nosis, and Preventive Strategies of Dental Erosion: Literature review (Part I & Part II). Acta Stomatol Croat 2009, 43(3): 165–87.
Clark DB. Patients with eating disorders: Challenges for the oral health professional. Can J Dent Hygiene 2010; 44(4): 163–70.
Romanos GE, Javed F, Romanos EB, Williams RC. Oro-facial manifestations in patients with eating disorders. Appetite 2012; 59(2): 499–504.
Mehler PS, Rylander M. Bulimia nervosa - medical complica-tions. J Eat Disord 2015; 3: 12.
Kisely S, Baghaie H, Lalloo R, Johnson NW. Association between poor oral health and eating disorders: systematic review and meta-analysis. Br J Psychiatry 2015; 207(4): 299–305.
Bartlett D, Ganss C, Lussi A. Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs. Clin Oral Invest 2008; 12(Suppl 1): S65–8.
Larmas M. Has dental caries prevalence some connection with caries index values in adults? Caries Res 2010; 44(1): 81–4.
Cappelli DP, Mobley CC. Prevention in Clinical Oral Health Care. Philadelphia, Pa: Mosby Elsevier; 2007.
Sales-Peres SHC, Araujo JJ, Marsicano JA, Santos JE, Bastos JRM. Prevalence, sevirity and etiology of dental wear in pa-tients with eating disorders. Eur J Dent 2014; 8(1): 68–73.
Uhlen MM, Tveit AB, Stenhagen KR, Mulic A. Self-induced vomiting and dental erosion - a clinical study. BMC Oral Health 2014; 14: 92.
Paszynska E, Jurga-Krokowicz J, Shaw H. The use of parotid gland activity analysis in patients with gastro-esophageal reflux disease (GERD) and bulimia nervosa. Adv Med Sci 2006; 51: 208–13.
Paszynska E, Slopien A, Weglarz M, Linden RWA. Parotid sali-vary parameters in bulimic patients – a controlled clinical trial. Psychiatr Pol 2015; 49(4): 709–20.
Schlueter N, Ganss C, Pötschke S, Klimek J, Hannig C. Enzyme activities in the oral fluids of patients suffering from bulimia: a controlled clinical trial. Caries Res 2012; 46(2): 130–9.
Damle SG, Patil A, Jain S, Damle D, Chopal N. Effectiveness of supervised toothbrushing and oral health education in im-proving oral hygiene status and practices of urban and rural school children: a comparative study. J Int Soc Prev Commu-nity Dent 2014; 4(3): 175–81.
Otsu M, Hamura A, Ishikawa Y, Karibe H, Ichijyo T, Yoshinaga Y. Factors affecting the dental erosion severity of patients with eating disorders.Biopsychosoc Med. 2014 Nov 19;8:25.
Voronets J, Lussi A. Thickness of softened human enamel re-moved by toothbrush abrasion: an in vitro study. Clin Oral Investig 2010; 14(3): 251–6.
Al-Zarea BK. Tooth surface loss and associated risk factors in northern Saudi Arabia ISRN Dent. 2012; 2012: 161565.
Yoshizawa S, Suganuma T, Takaba M, Ono Y, Saki T, Yoshizawa A et al. Phasic jaw motor episodes in healthy subjects with or without clinical signs and symptoms of sleep bruxism: a pilot study. Sleep Breath 2014; 18(1): 187–93.
Hara AT, Lussi A, Zero A. Biological factors. In: Lussi A, edi-tor. Dental Erosion: From Diagnosis to Therapy. Monogr Oral Sci. Basel: Karger, 2006. p. 88–99. Chapter 7.
Dynesen AW, Bardow A, Petersson B, Nielsen LR, Nauntofte B. Salivary changes and dental erosion in bulimia nervosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106(5): 696–707.
Johansson AK, Norring C, Unell L, Johansson A. Eating disorders and oral health: a matched case - control study. Eur J Oral Sci 2012; 120(1): 61–8.
Conviser JH, Fisher SD, Mitchell KB. Oral care behavior after purging in a sample of women with bulimia nervosa. J Am Dent Assoc 2014; 145(4): 352–4.
Eisenburger M, Addy M. Evaluation of pH and erosion time on demineralization. Clin Oral Invest 2001; 5(2): 108–11.
Berar AM, Lasserre JF, d’Incau E, des Varannes SB, Picos A, Chira A et al. Factors associated with localization of dental erosion in patients from two French medical centres. HVM Bioflux 2015; 7(2): 55–9.
Ximenes R, Couto G, Sougey E. Eating disorders in adolescents and their repercussions in oral health. Int J Eat Disord 2010; 43: 59–64.
Milosevic A. Eating disorders and the dentist. Br Dent J 1999; 186(3): 109–13.
Mazurek M, Szyszkowska A, Mazurek A, Szymanska J. Selected issues concerning oral health in female patients with eating disorders: a survey study. Curr Issues Pharm Med Sci 2016; 29(3): 139–41.