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Dental Tribune United Kingdom Edition | 1/201524 According to the US National Institute of DentalandCraniofacialResearch,28percent ofpatientswithbulimiaarefirstdiagnosedat a dental appointment. Although dentists are in an ideal position to detect the warning signs of eating disorders, research has found thatknowledgeoftheoralandphysicalsigns of these conditions is often limited.1 Nevertheless,wehaveanethicalobligation to increase our knowledge and participate in secondary prevention of eating disorders, as itcouldimproveprognosisandevenbealife- saver for some patients. Research has shown that such disorders have the highest mortal- ityrateofallpsychiatricillnesses.2 Weneedto initiate timely interventions, to minimise damage to the oral hard and soft tissue, and instigate medical referral for access to spe- cialists in treating eating disorders. An overview of eating disorders Eating disorders are psychiatric illnesses characterised by disordered eating and dis- turbed attitudes to eating and body image. They are often accompanied by inappropri- ate, dangerous methods of weight control. Thethreemostcommoneatingdisordersare bulimia nervosa (binge–purge), anorexia nervosa (starvation) and binge-eating disor- der (bingeing without purging).3 There are variations of disordered eating, including eating disorders not otherwise specified.4 Theseincludediabulimia,5 whereindividuals intentionally take insufficient insulin in or- der to lose weight; anorexia athletica, which isobsessive,excessiveexercisingtothepoint of being detrimental to health; and big- orexia, or muscle dysmorphia, where the in- dividual perceives his or her body to be underdeveloped, despite having a large, muscularphysique.Orthorexianervosaisan obsession with the quantity and quality of the food consumed. The compulsive, exces- siveintakeoffoodduring thehoursnormally reserved for sleep—often getting up multi- ple times during the night to eat—is called night eating syndrome. Finally, there is pica, thepersistenteatingofnon-foodsubstances, and various food-related phobias. TheUKhasthehighestrateofeatingdisor- ders in Europe. Recent figures suggest that onein100Britishwomenhaveaclinicallydi- agnosedeatingdisorder.6 IntheUS,anorexia nervosa is the third most common chronic illness among adolescents.7 Eating disorders occur mostly in females aged 15–25, but also occurinmales,inchildrenasyoungas7years of age, and in people aged over 50. As one of the most common eating disor- ders, bulimia nervosa is characterised by a patternofconsumptionofmassiveamounts offood(bingeeating)andrecurrentinappro- priate weight control behaviours. These in- clude purging through self-induced vomit- ing, abuse of laxatives and other substances, aswellasbehaviourssuchasfasting(noteat- TRENDS & APPLICATIONS Knowledge can save lives Understanding and treating patients with eating disorders By Linda Douglas,Canada Heart and major organs • Cardiac arrhythmias, and cardiac arrest related to electrolyte imbalance (especially low potassium), dehydration, or starvation-induced atrophy of the myocardium • Slow pulse rate • Low blood pressure • Impaired capacity to think, due to starvation-related brain changes • Kidney damage • Liver damage due to starvation or substance abuse14 • Hypothyroidism • Infertility related to amenorrhoea Digestive system • Abdominal pain • Chronic constipation • Poor muscle tone of the colon, and incontinence related to misuse of laxatives • Ruptured oesophagus, or Mallory–Weiss lesions (gastro-oesophageal laceration syndrome), due to vomiting • Gastric bleeding • Stomach might rupture during bingeing • Swollen parotid glands and sore throat related to purging General • Dehydration, malnutrition • Fatigue • Electrolyte imbalance • Hypoglycaemia • Anaemia • Low white blood cell count, and impaired immunity • Slow metabolism • Osteoporosis • Loss of muscle mass, causing stick-like limbs Skin (especially with anorexia) • Extremely dry, scaly, itchy skin with a grey cast15 • Decreased scalp hair, which is short and brittle • Increased lanugo hair—fine hair on the body and arms (the body’s attempt to retain heat after excessive loss of body fat) • Bloodshot eyes and broken capillaries (petechiae) of the skin around the eyes, related to forced vomiting Extremities • Clubbed fingers16 related to cardiac complications or overuse of laxatives • Cold hands and feet related to peripheral vasoconstriction • Russell’s sign: calluses, scars or abrasions on the knuckles of the dominant hand, related to inserting the fingers in the mouth to induce vomiting • Carotenoderma, orange pigmentation of skin, especially on the palms of the hands, related to excessive intake of foods containing carotene Table 1: Medical complications of eating disorders.12,13 © Kzenon DTUK0115_24-27_Douglas 09.04.15 15:37 Seite 24 DTUK0115_24-27_Douglas 09.04.1515:37 Seite 24