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

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

3. 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.

4. EATING DISORDERS
1. Anorexia
2. Bulimia
3. EDNOS

5. 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

6. 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%

7. DEMOGRAPHICS
Socioeconomic status
white females
affluent
well educated

8. 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)

9. 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

10. 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.

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

12. 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

13. 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

14. TOUYZ, LIEW et al. Carbohydrates (g) Protein (g) Fat (g)
Anorexics
Bulimics
National average
Anorexics Bulimics Controls
Pockets 4 mm or more
Recession 1-3 mm
Bleeding Sites

15. TREATMENT

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

17. “I wish I was running”

18. Garden of the Gods

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

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

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

22. “I am the king of the world”

23. EATING DISORDERS AND TEETH

24. EATING DISORDERS and TEETH

25. EATING DISORDERS AND TEETH

26. Eating Disorders and Teeth

27. THE END