Gerald S. Fine, D.D.S.

   Oral and Maxillofacial Surgery

Brookline Office
Tel: 617-731-6060

Our commitment is to provide you the highest standard of oral and maxillofacial surgery in a professional manner.

Have You Treated These Patients? (Complicated Patient Diagnoses)

In the past three months I have seen and treated among many others, three unusual patients. One was a 71 year old female being evaluated for painful palatal ulcerations. This patient had a history of reflux esophagitis. The other two patients were college students who were referred to my office, one for the treatment of temporomandibular joint pain, the second for a biopsy. Both of these students were female and both demonstrated mucosal irritation and cheilosis. A thorough review of the students' medical history revealed a recent history of Anorexia nervosa. Although the underlying medical issues and concerns are different for the students than for the older patient. all presented with a component of regurgitation.

Esophageal diverticulitis, the reflux of gastric or duodenal contents through an incompetent lower esophageal sphincter may result in mucosal inflammation, ulcerations, and hemorrhage. Anorexia nervosa and bulemia nervosa are serious eating disorders which affect a significant number of young adults. Both disease states result in various degrees of dental destruction.

Anorexia nervosa and bulemia nervosa affect about 7.5 million Americans. These disorders are psychophysiologic conditions which start in adolescence and occur more often in young females than males. There is considerable overlap between the two eating disorders. Esophageal diverticulitisis is relatively common among patients of older age groups.

Oral symptoms suggestive of an eating disorder include asymptomatic parotid gland enlargement, xerostomia, oral mucosa irritation, dental thermal sensitivity, root surface caries and anterior open occlusion. Reflux esophagitis often times has a metallic taste or mucosal inflammation associated with its condition.

‍The first student with temporomandibular joint pain had restricted opening because of her habit of eating followed by her intentional regurgitation to purge herself of the ingested food. Her efforts were so dramatic and prolonged that she repeatedly overextended her normal opening and caused anterior disc displacement. The other two patients suffered from mucosal irritation secondary to acidity stomach regurgitation.

Often times it is the dentist or hygienist who may first detect signs and symptoms of anorexia or bulemia since denial is a significant component of these disease states. Patients suffering from reflux esophagitis may not appreciate the severity of their condition since it may be slowly progressive. Early diagnosis is beneficial to the dentition and overall health of patients with these clinical findings.

‍Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery‍