Research from the NHS information centre suggests that up to 6.4% of adults display signs of an eating disorder and, of those, 40% are bulimic.
The extended periods of intentional vomiting instigated by bulimics have considerable impact on a patient’s dentition and can result in substantial oral health complications, including:
• The teeth become rounded, smooth and shiny and lose their surface characteristics
• Incisal edges appear translucent
• Cupping forms in the dentine
• Cervical lesions are shallow and rounded
• Restorations tend to be unaffected by erosion and will therefore stand proud of the surrounding tooth tissue.
Alongside beat (www.b-eat.co.uk), which helps sufferers in the UK beat their eating disorders and runs Eating Disorders Awareness Week (23 February – 1 March 2015) with the aim of raising awareness of the health implications of these disorders, practices like the London Tooth Wear Centre are working hard to tackle this increasingly prevalent oral health problem.
Advice rather than treatment features heavily during the initial stage of helping a patient suffering with bulimia. Diet analysis and general guidance on how to reduce the effect of acidic foodstuffs should be given and include:
• Drinking water or low fat milk in preference to other liquids
• Using a straw positioned toward the back of the mouth when drinking acidic beverages
• Avoiding swishing drinks around the mouth
• Rinsing the mouth with water or fluoridated mouthwash after consuming acidic foodstuffs.
Oral health advice for a patient whose dentition is compromised by bulimia includes:
• Issuing a fluoride rinse or gel and prescribing a high-fluoride toothpaste for daily use
• Not brushing immediately after vomiting or consuming acidic foodstuffs, but rinsing with a fluoridated mouthwash and chewing sugar-free, xylitol-sweetened gum afterwards.
Extra protection can be provided via calcium and phosphate ions, such as those found in GC Tooth Mousse, helping to restore the mineral balance, neutralise acidic challenges and stimulate salivary flow.
Compliance may be difficult to achieve and restorative treatment in the presence of ongoing tooth wear is considered unwise but, irrespective of this, the damage caused by erosion means it may be necessary to take action to protect and conserve the remaining tooth structure, for example:
• Direct application of a glass ionomer or composite to sensitive areas may be indicated
• An occlusal guard can protect the teeth during vomiting
• An alkali or fluoride gel placed within the fitting surface of the guard to neutralise any acid pooling may be helpful.