The Food Disorders and the Health´s Mouth
According to studies, usually the first eating disorder´s clinical signs appear in the mouth. A specialist in pediatric dentistry and vice - coordinator of the Oral Health Group of the Society of Pediatrics of São Paulo, Dr. Lucy Coutinho, explains that eating disorders can cause oral changes such as increased caries, dental erosion, restorations projection (amalgam "islands"), bruxism, dental hypersensitivity, mucositis and gingivitis. "Although some of them are common dental problems, which usually require simple treatment, the professional must be attentive to what may be behind them, approaching the patient and his health in a comprehensive and systemic way," she says.
Dr. Lucia makes clear that among the symptoms more easily detected in patients with eating disorders, are the oral manifestations. Those with eating disorders tend to hide the disease from friends and family, and these symptoms are evident to the dentist. "The dentist is able to identify these changes in a simple routine clinical examination, which gives the dental professional an important role in the disease clinical diagnosis."
Supplementing the information provided by expert , Dr. Liliana Takaoka , Attention Group coordinator Transdisciplinary Mother and Child - ATRAMI explains that in the case of bulimia evidence , there are a variety of treatment options for each bulimic . " The dentist works with mental health professionals to design a fusion of treatments that fit all their behaviors and concerns. Common treatments for bulimia include therapy and counseling - individual and family - performed by psychiatrists and / or psychologists and counseling and nutritional planning by nutritional experts and / or nutritionists. Rarely, it is used as a medication for treating bulimia, unless otherwise prescribed for treating conditions that are associated therewith , such as depression . "
It is importante to have in mind that the dentist is often the first professional to detect the possible disturbances presence, and plays a key role in the early diagnosis of these eating disorders, prevention and oral health promotion in such patients.
Dr. Liliana remember that the carrier eating disorders tends to neglect oral hygiene , which leads to an increase in the occurrence of caries caused by increased intake of carbohydrates by patients, that during the binge times ingest large amount of cariogenic food, and decreased salivary pH, due to vomiting.
According to the expert, who also serves as NGO Live and Smiling vice president: Premature Support Group, compulsive food intake followed by vomiting induction usually develops dental erosion, especially in the palatal surfaces of the anterior teeth, caused by acidic substances consumption and the regurgitation of gastric juice. This fact would increase the erosion rate 31 times higher than in normal individuals. In these patients may also occur amalgam ' islands ', produced by the enamel adjacent to restoration decay.
"Antidepressant medications may also contribute to this increase in oral diseases therefore cause xerostomia. This decrease in saliva may hinder the emulsification of the bolus during the oral phase of swallowing and a dramatic increase in dental cavities, once the saliva´s protective effect is not present", says Dr. Liliana.
Keep in mind that the regurgitated stomach acidity causes dentin hypersensitivity, worsened by vigorous brushing, then the episodes of regurgitation; mucositis, also associated with the trauma caused by rapid eating, and vomiting by the act, and cheilitis. The latter is favored by malnutrition and vitamin deficiencies, leading to a decrease in salivary flow, gingivitis and other changes in the gingiva and periodontium.
Linked to the life quality
The oral health professional, as well as all necessary technical, still need to have a certain 'feel' when addressing the person who suffer with eating disorders.
The pediatric dentist Dr. Lucy Coutinho, the book coordinator 'Dentistry for the pediatrician', explains that it is fundamentally important that the dentist has knowledge of these disorders, and that these professionals be prepared to guide and conduct clinical monitoring of quality and efficiency for patients and their families, with emphasis on creating bonds of trust, emotional support and guidance on the disease and its consequences for the organism.
"As far as anorexia, bulimia are caused by a disruption in how individuals affected by these eating disorders construct their reality, that is, in the way they see their own body and their body image.
The dentist's relationship with the bulimic aims to maximize positive interactions with the environment on the other, promote a satisfactory level of well-being and strengthen the degree of autonomy of patients, "he explains.
Dentistry for Pediatrician: a specialized service
The specific dental care and proper to young people requires more than technical and scientific knowledge, because it is a public passing by great biological, psychological and social changes.
The dental surgeon, Dr. Lucy Coutinho, points out that the various stages of organic development, physiological and emotional adolescents do not always follow the chronological age, so the approach should take into account their stage of development. "It's always guaranteed adolescents secrecy about the issues that are addressed with any professional team. It is recommended that parents or guardians be heard without the presence of the patient, and any discussion on it should be made in his presence. The diagnosis of eating disorders should be done by a psychiatrist and the patient should be referred to this professional, if there is suspicion of this diagnosis. The discussion of this referral should be made with the teenager in the presence of those responsible," she says.
In addition to diagnosing and controlling oral effects of eating disorders, the dentist must also act in maintaining the patient's general health, including mental, considering that such disorders are associated with a high rate of suicide. "The professional oral health, as health professional all, we need to treat the patient holistically, and that implies being attentive to the signs of general and mental disturbances. The mortality rate in eating disorders, specifically anorexia nervosa, is among the highest in mental disorders, 15-20 %. Therefore, the referral of patients with suspected eating disorders to qualified professionals can be instrumental in saving the patient's life", argues the expert in pediatric dentistry, Dr. Lucy Coutinho.
Although eating disorders appear to be focused on body image, food and weight, they are often related to many other issues. Dr. Liliana Takaoka explains that eating disorders should be treated by psychiatrists, and the dentist may be the first professional to detect the problem, both by dental erosion, as frequent inflammation of the oropharyngeal mucosa. "All information to be exchanged on the patient, among professionals, should be with the patient's consent and her legal guardian. These disorders are related, often, depression, low self-esteem, obsessive compulsive personalities are therefore difficult to treat. "
Remember that the injury should be treated for that give relief to symptoms, reducing hypersensitivity, controlling the evolution of the lesions. However, the definitive restorative treatment should be performed when the purging process by vomiting is controlled, in the case of bulimia. "This should be explained to patients and responsible. With the patient's consent and responsible, information on disease control can be exchanged between professionals, since it is important data for the treatment to be successful, "concludes the also expert Odontohebiatria, Dr. Lúcia Coutinho.
Source : Dental Magazine. Access 02/09/2015 . Available in : goo.gl/c1kNJg