Anorexia and Bulimia: Medical and Dental Management

CAITLIN IS O.K. !!   Last Summer my neighbor asked me to examine her 17 year old daughter who had dental pain. Caitlin had labial tooth erosion, dental caries and parotitis, among other findings, and was preoccupied with her diet. I was concerned that Caitlin might have bulimia nervosa and suggested she see her physician as well. Caitlin is now under medical care and is doing well.

The eating disorders anorexia nervosa and bulimia nervosa are associated with serious morbidity in women. The cause is unknown, but may involve a variety of genetic, cultural and psychiatric factors. Dentists play an important role in recognizing cases of eating disorders and managing the oral manifestations and complications.

Clinical Findings and Medical Treatments—For women with anorexia and bulimia, being thin is the major objective of life. Those with anorexia achieve this goal by radically restricting their food intake, whereas patients with bulimia have binge eating followed by vomiting, excessive laxative use, or enemas.
 

Dental Complications and Treatment-Both eating disorders, but especially bulimia can have serious complications. Patients with bulimia may have caries develop as a result of the types of food they eat and dental erosion caused by vomiting. Recognition of this dental erosion by the dentist may prompt initial referral and diagnosis of an eating disorder. Bulimic patients with dental caries need to improve oral hygiene, prevent further erosion, and reduce tooth sensitivity. Anorexia may be more difficult to identify in a dental practice.