Dental Treatment For Patients With Eating Disorders

Basic Information About Eating Disorders

Eating disorders are characterized by severe disturbances in eating behavior. The practice of an eating disorder can be viewed as a survival mechanism. Just as an alcoholic uses alcohol to cope, a person with an eating disorder can use eating, purging or restricting to deal with their problems. Some of the underlying issues that are associated with an eating disorder include low self-esteem, depression, feelings of loss of control, feelings of worthlessness, identity concerns, family communication problems and an inability to cope with emotions. The practice of an eating disorder may be an expression of something that the individual has found no other way of expressing. Eating disorders are usually divided into three categories: Anorexia Nervosa, Bulimia Nervosa and Compulsive Overeating.

Each of these disorders robs the body of adequate minerals, vitamins, proteins and other nutrients needed for good health causing potential injury to teeth, muscles and major organs.

Anorexia Nervosa

Anorexia is characterized by a significant weight loss resulting from excessive dieting. Most women and an increasing number of men are motivated by the strong desire to be thin and a fear of becoming obese. Anorexics consider themselves to be fat, no matter what their actual weight is. Often anorexics do not recognize they are underweight and may still "feel fat" at 80 lbs. Anorexics close to death will show you on their bodies where they feel they need to lose weight. In their attempts to become even thinner, the anorexic will avoid food and taking in calories at all costs, which can result in death. An estimated 10 to 20% will eventually die from complications related to it.

Anorexics usually strive for perfection. They set very high standards for themselves and feel they always have to prove their competence. They usually put the needs of others ahead of their own needs. A person with anorexia may also feel the only control they have in their lives is in the area of food and weight. If they can't control what is happening around them, they can control their weight. Each morning the number on the scale will determine whether or not they have succeeded or failed in their goal for thinness. They feel powerful and in control when they can make themselves lose weight. Sometimes focusing on calories and losing weight is their way of blocking out feelings and emotions. For them, it's easier to diet then it is to deal with their problems directly. Anorexics usually have low self-esteem and sometimes feel they don't deserve to eat. They usually deny that anything is wrong. Hunger is strongly denied. They usually resist any attempts to help them because the idea of therapy is seen only as a way to force them to eat. Once they admit they have a problem and are willing to seek help, they can be treated effectively through a combination of psychological, nutritional and medical care.

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Signs and Symptoms

Statistics:

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Bulimia Nervosa

Bulimia Nervosa is an eating disorder that harms overall health and is particularly destructive to teeth. It involves secret repeated binge eating followed by purging—self-induced vomiting, use of laxatives, fasting, diuretics or diet pills.

The digestive system contains strong acids that break down food. When vomiting is used to purge food from the body, these acids attack tooth enamel. Repeated vomiting can severely erode tooth enamel and over time, teeth will become worn and translucent. The mouth, throat and salivary glands may become swollen and tender and bad breath may result.

Bulimics are caught in the devastating and addictive binge-purge cycle. Bulimics eat compulsively then purge through self-induced vomiting, use of laxatives or diuretics. Diet pills, ipecac, strict diets, fasts, chew-spitting, vigorous exercise, or other compensatory behaviors are used to prevent weight gain. Binges usually consist of the consumption of large amounts of food in a short period of time. Binge eating disorders usually occur in secret. Bulimics, like Anorexics, are obsessively involved with their body shape and weight. The medical complications of bulimia nervosa or binge-purge cycle can be severe and like Anorexia can be fatal.

Bulimia is characterized by a cycle of binge eating followed by purging to try and rid the body of unwanted calories. A binge is different for all individuals. For one person a binge may range from 1000 to 10000 calories, for another, one cookie may be considered a binge. Purging methods usually involve vomiting and laxative abuse. Other forms of purging can involve excessive exercise, fasting, use of diuretics, diet pills and enemas.
Bulimics are usually people that do not feel secure about their own self worth. They usually strive for the approval of others. They tend to do whatever they can to please others, while hiding their own feelings. Food becomes their only source of comfort. Bulimia also serves as a function for blocking or letting out feelings. Unlike anorexics, bulimics do realize they have a problem and are more likely to seek help.

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Signs and Symptoms

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Physical Complications of Eating Disorders

Anorexia: Signs and Symptoms

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Bulimia:

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How Eating Disorders Affect Teeth

Anorexia is an eating disorder that, in addition to damaging overall health, can harm teeth and reduce bone in the mouth. This can cause teeth to loosen and fall out. This deterioration of the patient's dental condition can cause further anxiety for the anorexic patient and make eating and mascitatory function more difficult. A healthy dentition is a critical component in the overall perception of one's self-image.

Bulimia Nervosa is an eating disorder that harms overall health and is particularly destructive to teeth. It involves secret repeated binge eating followed by purging—self-induced vomiting, use of laxatives, fasting, diuretics or diet pills. The digestive system contains strong acids that break down food. When vomiting is used to purge food from the body, these acids attack tooth enamel. Repeated vomiting can severely erode tooth enamel and over time, teeth will become worn and translucent. The mouth, throat and salivary glands may become swollen and tender and bad breath may result.

Repeated vomiting exposes teeth to gastric acids which erode tooth enamel, the hard protective covering of the tooth. Teeth may become rounded and soft and/or amalgam fillings may start to protrude above a tooth’s surface. The teeth weaken and become susceptible to the worst possible invasiveness. Decay, crumbling, fracturing, falling out – all occur with this insidious disease.

Widespread cavities over a short period of time are a significant problem for anorexic/bulimic patients. The problem is two-fold: those patients that binge on high-calorie, high-carbohydrate foods and then purge run the greatest risk of decay. The sugar in the foods set up an acid-attack on the enamel, while the act of purging bathes the teeth in hydrochloric acid from the stomach. This acid not only contributes to decay, but can also erode the teeth and fillings. The chronic bulimic patient will need numerous fillings over and over again, and have eroded enamel on the tongue-side of the teeth.

Dental Treatment for Patients With Eating Disorders

With the intervention of eating disorder specialists and our professional dental team, individuals can be helped to prevent further damage to their teeth and to have damaged and worn teeth replaced. It is essential that the patient is physically able to consume a proper diet. An appropriate means of restorative management is necessary to help meet this goal.

In bulimic patients, a durable, restorative technique that minimizes the corrosive effects of acidic materials is needed to address immediate, esthetic, psychological and functional demands. The Teeth In A Day® protocol is a predictable treatment to consider.

It is very important that the patient cooperate fully throughout the maintenance phase of treatment. Patients must also continue their pyschological treatment. We would be happy to evaluate your mouth and discuss your dental needs at Pi Dental Center.

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Research about Eating Disorders:

The Full Mouth Rehabilitation and Psychometric Assessment of a Patient with Bulimia Nervosa Following the Teeth in a Day™ Immediate Loading Protocol. Balshi TJ, Wolfinger GJ, Della Croce JN, Balshi SF (Not yet published)

Full Mouth Rehabilitation of a Patient with Bulimia Nervosa Following the Teeth in a Day Immediate Loading Protocol. Balshi TJ, Wolfinger GJ --A poster presentation.

Tips to overcome eating problems

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