Presentation by: Jeffrey P. Davis ANOREXIA AND BULIMIA Presentation by: Jeffrey P. Davis

EATING DISORDERS AND TEETH ACID EROSION OF THE TEETH OF THE BULIMIC PATIENT

Definitions ANOREXIA BULIMIA: described as a nervous, morbid disease characterized by loss of appetite and severe wasting. Patients are preoccupied with food and the constant struggle to over come hunger to achieve the desired goal of thinness. BULIMIA: recognized in those instances where patients primarily binge and purge themselves rather than just fast. Those afflicted characteristically have episodes of overeating (binges), followed by acts to ’undo’ the possible weight gain.

EATING DISORDERS 1. Anorexia 2. Bulimia 3. EDNOS

EDNOS (Eating Disorders Not Other Specified) Those who have a eating disorder of clinical severity yet do not meet diagnostic criteria for anorexia nervosa or bulimia nervosa. Ex: Binge Eating Disorder

INCIDENCE The prevalence of anorexia nervosa is reported to be anywhere from 0.5 to 1.0%. The prevalence of bulimia nervosa is reported to be from 1.0 to 1.5%

DEMOGRAPHICS Socioeconomic status white females affluent well educated

3 MAIN CHARACTERISTICS OF ANOREXIA NERVOSA 1) active maintenance of an abnormally low weight 2) amenorrhea (absence of 3 consecutive menstrual cycles) 3) presence of concerns about shape and weight (similar to bulimia nervosa)

3 MAIN FEATURES OF BULIMIA 1) recurrent episodes of binge eating 2) regular practice of extreme behavior designated to control body shape and weight 3) presence of a characteristic form of over concern with shape and weight

BULEMIA Binging usually occurs episodically, secretly and nocturnally The individual binges with high calorie food that requires little chewing. Bulimics have a less distorted body image, maintain normal body weight and menstruation cycles. The pre-bulimic is usually a high achiever, with marked parental dependence, who is socially anxious and has had difficulty establishing personal relationships.

ANOREXIA NERVOSA DIAGNOSIS HISTORY Differential Diagnosis: Endocrine disorders Gastrointestinal Diseases Chronic infections (tuberculosis) Neoplastic disorders (lymphoma) Possible CNS disorders

Clues to the Presence of Bulimia Preoccupation with weight and food History of frequent weight fluctuation Dizziness, thirst, syncope (complain complaints of to patient that purge and become dehydrated) PHYSICAL EXAM

EATING DISORDERS AND TEETH Teeth should be examined for erosion, discoloration due to stomach acid Purging behaviors can result in an acidic and dry mouth. irreversible enamel erosion, xerostomia, oral mucosa irritation, cheilosis, and salivary gland enlargement. Periodontal disease

TOUYZ, LIEW et al. Carbohydrates (g) Protein (g) Fat (g) Anorexics 89.7 21.9 17.3 Bulimics 237.9 70.4 87.5 National average 196.5 77.0 93.0 Anorexics Bulimics Controls Pockets 4 mm or more 1.1 .4 .6 Recession 1-3 mm 10.2 3.0 2.0 Bleeding Sites 16.9 9.4 6.5

TREATMENT

DRUG THERAPY Tricyclic antidepressants Monoamine Oxidase Inhibitors Serotonin Re-uptake inhibitors

“I wish I was running”

Garden of the Gods

TEETH Patient who sucks on lemons (affects anterior teeth (buccal)

EATING DISORDERS AND TEETH Bulimic Patient with acid erosion of the posterior teeth

“Drinking may cause purging “ The Coors Brewery “Drinking may cause purging “

“I am the king of the world”

EATING DISORDERS AND TEETH

EATING DISORDERS and TEETH

EATING DISORDERS AND TEETH

Eating Disorders and Teeth

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