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Eatting Disorders Effects on Oral Health

Terms in this set (81)

RDH and eating disorders: Purpose
The NIH and NIDCR granted monies to gather data regarding the oral care provider's knowledge about anorexia and bulimia nervosa
Methods
576 DDS and RDH knowledge of the oral and physical cues to identify anorexia and bulimia nervosa patients was randomly surveyed.
Results
Overall scores were low concerning the knowledge of oral and physical cues of anorexia and bulimia nervosa. RDH scored higher than DDS in recognizing the signs and symptoms of anorexia and bulimia nervosa
Conclusion
The oral health care provider is often the 1st to identify anorexia and bulimia nervosa through the patient's oral manifestation. Upon recognition of the oral cues of anorexia and bulimia nervosa, the 1st task of the dental care provider should be to help the patient seek treatment for the disease.
Conclusion continued
Dentists and dental hygienists need to be educated about treatment modularity, referral for tx, tx procedures, and curriculums for patient w/ eating disorders. How to communicate to the patient the etiology of the disease, the oral complications, physical complications and need for tx is fundamental to successful tx of the anorexic and bulimic patient.
Dental Community Obligations
Dentists (DDS) are often the 1st health care providers to see the undiagnosed ED patient; therefore more research should be done regarding the relationship of eating disorders, nutrition and the oral tissues.
Responsibility of Educators?
Eating Disorders in the Oral Health Curriculum: Statistically DH better than DDS however communication skills are similar (56-58%)
Pretest Questions
1) What role does the RDH have in the care of a patient w/ an eating disorder?
2) What are the physical and oral manifestations of the eating disorders?
3) What factors may lead to an eating disorder?
4) What are the standards of care for patients w/ eating disorders?
The Facts.....
1) EDs in adolescents are associated with the highest rate of morbidity and mortality in mental health.
2) 10 million female and 1 million males (BN and AN)
3) 25 million with BEN
Societal Factors
"Genteel women are literally speaking, slaves to their bodies" 1792 Mary Wollstonecraft
Beauty Pageants
1) Beauty Pageants
2) Women tie self esteem to physical appearance
Weight Loss Industry
1) Weight loss industry is thriving
2) Magazines just about weight.....shape
Superwoman
1) Superwoman complex....
2) Must maintain control
3) Young women have been lead to believe they can do it all
4) Peer pressure to be the best
Emotional Dynamics
1) Family
2) Mirror
3) Perfectionism
4) Chemical imbalances
Family influences
1) Abusive personalities
2) Depression
3) Parent modeling of body dissatisfaction and dieting
4) Conflicted families
5) Undo pressure for status
6) Body image disturbances
7) Self-hatred
Thinspiration
1) Any form of media, print, online, pictures, video, etc that are utilized in an unhealthy manner to promote continued weight loss.
2) Images of slim celebrities, individuals afflicted with an eating disorder or emaciated models
3) Often exchanged amongst members of online pro-eating disorder communities (pro-mia)
Thinspiration continued
4) Reverse thinspiration can include posting pictures of oneself at a high weight on mirrors or in the kitchen in attempts to induce guilt and prevent eating or pictures of morbidly obese individuals to facilitate disgust and motivate weight loss.
Thinspiration.... more
5) Also include poems, music lyrics, quotes, sayings, etc. that encourage weight loss, promote the eating of disorder and endorse it as being a life style and choice rather than illness.
Bulimia Nervosa (BM)
1) Bulimia nervosa (BN) is a serious, potentially fatal, brain disorder characterized by frequent binge eating followed by inappropriate compensatory behaviors, and diagnosed when occurring on average at least twice a week for at least 3 months.
BM continued
BN is classified into two subtypes:
-Purging subtype is characterized by the use of self-induced vomiting, laxatives, enemas, or diuretics
-Non-purging subtype, fasting or excessive exercising is used to compensate for binge eating
3) Absence of Anorexia Nervosa
BN Stats
1) 11% of dentists would refer an erosion
patient to a primary care physician
2) 38% of hospitalized bulimics have oral manifestations; only 25% had a dentist tell them about it.
BN Epidemiology
1) Lifetime prevalence of BN is 3%
2) BN affects about 6% of adolescent girls and 5% of college women
3) Up to 40% of college women have had isolated episodes of bingeing and purging
4) Most (90-95%) patients with BN are women.
BN epidemiology cont
5) Men with ED have increase in psychiatric illness, substance abuse, homosexuality, and bisexuality
6) Men with ED more frequently in men who participate in sports with a weight requirement (eg, wrestling, horse racing) or a low body fat requirement (eg, bodybuilders)
7) Age: Peak onset of BN occurs at 18 years.
BN Etiology is Multifactorial
1) Female gender
2) Familial Obesity
3) Dieting ( Bulimia almost always develops during or after an attempt to lose weight
4) Recurrent binge eating
-Habit
-Triggered by feeling of anger, anxiety or depression.....guilt is common after binge but also may be soothing
BN etiology continued
5) Compensatory behaviors to avoid weight gain
6) Cultural attitudes toward standards of physical attractiveness
7) Mounting evidence shows that genetics play a role .
8) Familial history of depressive disorders, alcoholism, or obesity
More on BN etiology
9) Interpersonal dynamics between parent and child
10) Sense of personal helplessness
11) Fear of losing control
12) Self-esteem highly dependent on the opinions of others
13) An all-or-nothing style of thinking
Etiology
14) Interpersonal conflict and achievement challenge may be perceived as particularly stressful by individuals with bulimia
15) History of abuse
16) Evidence is mounting to support the role of serotonin in bulimia
Etiology continued
Other theories being proposed have to do with endocrine imbalances that influence weight regulation and satiety
BN Medical Complications
1) Although the act of self-induced vomiting may occur only occasionally and may be of little consequence, a long-term pattern may develop
Complications are
-Cardiovascular -Esophageal ulcers
-Reproductive -Muscoskelatel
-CNS -Renal
-Gastrointestinal
Most deaths related to bulimia probably result from cardiac arrhythmia
BN oral manifestations
-Tooth erosions -Palatal lesions
-Russell's sign -Soft tissue lesions
-Caries (?) -Parotid enlargement
Anorexia Nervosa (AN)
1) A psychiatric disorder
2) A body weight 15% below what is expected
3) An intense fear of gaining weight
4) A distorted body image
AN continued
In females, amenorrhea for 3 consecutive months
-Restricting type: during the current episode of AN, the person has not regularly engaged in binge
-Binge-Eating/purging type: during the current episode of AN, the person has regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or the misue of laxatives, diuretics, or enemas)
AN Epidemiology
1) AN, meeting full DSM-IV criteria, 1 out of 100-200 females in late adolescence and early adulthood
2) Individuals who are subthreshold for the disorder are encountered more commonly
3) Incidence rates have increased in recent years
4) A familial pattern has been noted
AN epidemiology continued
5) 6-20% of patients eventually succumb to AN. Death usually is secondary to starvation or suicide
6) Race: significantly higher in white
7) Sex: almost 90% female
8) Age 12-18
More on Etiology
9) Genetic: Specific genetic factors appear likely to be important in the etiology of AN; however, what this trait may be is unclear
10) Neuroendocrine: A substantial number of abnormalities of hormone regulation have been described in AN patients
AN etiology continued
11) Physiological: Some physiological features have been proposed to act to sustain fasting in AN patients
12) Psychological: A variety of psychological, sociological, and family influences have been hypothesized to influence the development of AN
Medical conditions
-Cardiovascular, Gastrointestinal, Endocrine and Metabolic, Renal, Reproductive, Integumentary, Neurologic, Hematologic
Med. complications with Anorexia/Binge/Purge
Combination of symptoms and signs which ultimately if not treated leads to patient's demise.
Oral Manifestations
1) Tooth enamel erosion
2) Salivary dysfunction (Enlarged parotid gland, Xerostomia)
3) Soft Tissue Lesions (Angular chelitis, Candidiasis, Glossitis, Mucosal ulcerations)
4) Caries
Eating Disorder not otherwise Specified
1) ED classification for individual who don't meet the DSM-IV-TR criteria for anorexia nervosa or bulimia nervosa yet display severe eating disordered symptoms
2) Includes Binge Eating Disorder (BED), where the individual meets the diagnostic criteria for anorexia nervosa and continues to have monthly menses or the individual engages in daily self-induced vomiting, with an absence of binging and is not severely underweight
EDNOS
3) EDNOS symptoms can be more lethal than those associated with anorexia nervosa or bulimia nervosa
Binge Eating Disorder
1) Most have both of the following:
a. Eating in a discrete amount of time (within a 2-hour period), an amount that is definitely larger than most people would eat during a similar time period.
b. Sense of lack of control over eating during an episode
BED
2) Binge eating episodes are associated with three (or more) of the following:
a. Eating much more rapidly than normal
b. Eating until uncomfortably full
c. Eating large amount of food when not hungry
d. eating alone because of being embarrassed by how much one is eating
e. Feeling disgust with oneself, depressed, or guilty after overeating
BED continued
3. Marked distress regarding binge eating is present
4. The binge eating occurs, on average, at least 2 days a week for 6 months
5. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (eg. purging, fasting, compulsive exercising)
Epidemiology
1) Most common
2) 3% of all AMericans
3) Mostly aged 46-55
4) 3 females/2 males
5) Caucasian= African American....Others unknown
Clinical Features
1) Usually overweight or obese
2) More common in severely obsess however may see in normal weight
3) Obese at young age
4) Yo-yo dieters/weight cycling
BED etiology
"Experts generally agree most people with serious binge eating problems often eat an unusually large amount of food and feel their eating is out of control"
BED causes
-Depression
-History of dieting
-Emotional troubles
-Abusive personality
-Brain Chemicals
Medical Complications
1) Health....aches, digestive problems, menstrual issues
2) Stress
3) Sleep
4) Suicidal
5) Feel bad about selves....miss work and social activities
BED weight gain risks
1) Type 2 Diabetes 6) Certain cancers
2) Hypertension
3) High cholesterol levels
4) Gallbladder Disease
5) Cardiovascular disease
BED Treatments
1) Overweight......try to lose weight
2) Normal weight....Do not diet
3) Cognitive Therapy
4) Interpersonal Psychotherapy
5) Drugs
BED Oral manifestations
1) Caries
2) Periodontal disease
3) Malnourished
4) Oral risks associated with medical consequences of obesity
Night Eating Syndrome
A. The daily pattern of eating demonstrates a significantly increase intake in the evening and/or nighttime, as manifested by one or both of the following:
1. At least 25% of food intake is consumed after the evening meal
2. At least two episodes of nocturnal eating per week
NES
B. Awareness and recall of evening and nocturnal eating episodes are present
NES continued
C. The clinical picture is characterized by at least three of the following features:
1. Lack of desire to eat in the AM and/or breakfast as omitted on 4 or more morning per week
2. Presence of a strong urge to eat between dinner and going to sleep and/or during the night
C continued
3. Going to sleep and/or staying asleep insomnia are present 4 or more nights per week
4. Presence of a belief that one must eat in order to go to or fall back to sleep
5. Mood is frequently depressed and/or mood worsens in the evening
More on NES
D. NES is associated with significant distress and/or impairment in functioning
E. The disordered pattern of eating has been maintained for at least 3 months
F. The disorder is not secondary to substance abuse or dependence, medical disorder, medication, or another psychiatric disorder
Epidemiology- ENS
1) Perhaps only 1-2%, of adults in the general population, have this problem
2) Research at the University of Pennsylvania School of Medicine suggests that about 6% of people who seek tx for obesity have NES
3) Another study suggests that more than a quarter (27%) of people who are overweight by at least 100 pounds have the problem
Clinical Features/Etiology
1) Thought to be stress related and is often accompanied by depression
2) Foods ingested are often carbohydrates: sugary and starch
3) Night-eating syndrome involves continual eating throughout evening hrs. NOT BED
4) Eating produces guilt and shame, not enjoyment
NES medical complications
1) Possible Sleep Disorder
2) Same as obesity if unchecked
NES oral manifestations
1) High caries risk
2) Oral manifestations of other obesity related diseases
Pica clinical features
Compulsive eating of non-nutritive substance for a period of at least once month at an age for which this behavior is developmentally inappropriate and not a culturally sanctioned practice
Pica Etiology
1) Unknown....hypotheses:
-Nutritional deficiencies; Sensory enjoyment, Family stress, OCD disorder, Pregnancy, psychopathy, family dysfunction, epilepsy, brain damage, mental retardation and developmental disorders
Pica epidemiology
Ritual in some countries
Pica medical conditions
1) Toxicity
2) Bowel obstruction
3) Excessive caloric intake
4) Nutritional derivation
5) Infection
6) Injury
Pica oral manifestations
1) Self-reporting
2) Glossitis
3) Xerostomia
4) Dysphagia
Female Triad
-Disordered eating, Osteoporosis, Amenorrhea
Diabulimia
ED in which people with Type 1 diabetes deliberately reduce insulin treatment for the purpose of weight loss. The body goes into a starvation state, resulting in breakdown of muscle and fat into ketone bodies and subsequently ketoacids.
More on Diabulima
The body is unable to process sugars that have been consumed, so the sugars are excreted rather than being used by the body for energy or stored as fat. This typically results in significant weight loss but also places the patient at risk of a life-threatening condition known as diabetic ketoacidosis.
Bigorexia
1) Muscle dysmorphia ( also called Reverse anorexia or Bigorexia)
2) a form of body dysmorphic disorder that affects males and females
3) A pathological preoccupation with their muscularity, believing themselves to be small and weak, no matter how large their muscles
Bigorexia continued
4) Like AN, they may also see themselves as fat and develop a range of eating rituals
Orthorexia
An obsession with eating healthy food and avoiding unhealthy food. It is not recognized as a clinical eating disorder in the DSM-IV, but left untreated and/or combined with other risk factors, orthorexia can progress into a full clinical eating disorder
Rumination Disorder
1) Rumination disorder is characterized by effortless and repeated regurgitation of small amount of food, which is then partially or completely re-chewed, re-swallowed, or expelled
2) Relatively common in infants and mentally handicapped persons, but also occurs in persons with normal intelligence
Rumination Disorder Continued
3) Confused with bulimia nervosa , GERD, and upper gastrointestinal motility disorders such as gastroparesis or chronic intestinal pseudo-obstruction
PANDAS- Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus
AN in children believed to be linked to streptococcus. Clinical and research observations support the hypothesis that postinfectious process, similar to that in rheumatic fever, may cause or exacerbate certain cases of anorexia nervosa. When the pathogen is group A beta-hemolytic streptococcus these disorders are called PANDAS
RDH role in eating disorders and oral health
1) Screen for risk factors
2) Address comprehensive needs of those with eating disorder
3) Provide support and referral for therapy
4) Educate about oral and physical health consequences
5) Establish treatment plan and provide dental hygiene care
RDH role
1) Often times the OHCP/RDH is the first health care provider that a person with an eating disorder will present to.....
2) See RDH more frequently than MD
3) Educate, Integrate, Communicate, Empathize
Complementary approach to Dental Hygiene Care
1) Nutrition
2) Psychology
3) Medical Knowledge
4) Oral Care
Think about
1) Difficulty in patient admitting to an eating disorder given signs/symptoms
2) Patient non-compliance in dental tx because of fear of being "found out"
3) OFten times, oral health is a bigger indicator of an eating disorder than overall appearance
Think about it continued
4) Delaying dental tx until after therapy completion is not always beneficial to the patient
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