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Dental Tribune United Kingdom Edition | 1/201526 Vomit has a pH of about 3.8. During purg- ing, the vomit hits the palatal aspects of the maxillary anterior teeth. Dental erosion due to purging by vomiting becomes apparent about six months after onset.18 It eventually underminesthepalatalsurfacesandleadsto incisal fractures and chipping, and over- eruption of the mandibular anterior teeth. Erosion also occurs in the posterior teeth, causing perimolysis: tooth tissue surround- ing restorations is eroded, leaving the restorationswitharaised,island-likeappear- ance. Eroded occlusal contacts also lead to loss of vertical dimension. Bulimicstendtoconsumefoodshighinre- fined carbohydrates, and individuals with eating disorders often consume acidic diet beverages. Therefore, they have a high caries risk and impaired salivary buffering capac- ity. Dental hypersensitivity is also common. The loss of bone density increases the risk of jaw fracture during extractions. Dental management of patients with eating disorders19,20 Medical treatment21 of eating disorders in- cludes nutritional therapy to treat the med- icalcomplicationsandthestarvation-related brain changes that perpetuate the illness. This is combined with psychotherapy and medication, such as antidepressants. Individuals with eating disorders also need regular dental visits in a supportive environ- ment, for continuing care. They must be re- garded as medically compromised, owing to the risk of grave medical complications, par- ticularly cardiac arrest due to electrolyte im- balance. Thorough clinical assessment includes general appraisal, which begins the moment we greet our patient. We should tactfully ob- servehisorhergeneraldemeanour,gait,and facial symmetry. The skin should also be ob- served for lesions and pallor, and the hands for Russell’s sign or clubbed fingers. A com- prehensivemedicalhistoryisneeded,aswell as monitoring of the vital signs. Extra-oral and intra-oral examination, as well as exam- ination of the oral hard and soft tissue, is needed, plus comprehensive documenta- tion that includes detailed clinical notes, pe- riodontalcharts,radiographs,intra-oralpho- tographs and study models to monitor dam- age. When an eating disorder is suspected, this sensitive topic needs to be approached in a non-judgemental, non-threatening manner. Itisbeyondourscopeofpracticetodiagnose eatingdisorders,butwecanpresentthefind- ings of our examination to the patient.22 For example, if there is dental erosion, we could mention some possible causes, like acidic drinks,acidrefluxorfrequentvomiting.This gives the patient an opportunity for disclo- sure. If he or she discloses his or her eating disordertous,heorsheshouldbereferredto hisorherphysician.Ifheorsheisnotreadyto tell us, we can still be supportive and initiate • Depression, anxiety • Perfectionist, overachiever • Low self-esteem • Mood swings • Guilt, shame • Alienation, loneliness • Social isolation • Eating alone • Compulsive behaviours • Misperception of hunger and satiation • Obsessive thoughts about food, calories and weight often weighing themselves several times per day. • Secrecy and denial of their illness: individuals with anorexia nervosa often dress to hide their body shape, and they might put coins in their pockets when being weighed. • They often claim to have food allergies in order to justify their restrictive diet. Table2:Psychologicalaspectsofeatingdisorders.17 © jazzikov TRENDS & APPLICATIONS AD DTUK0115_24-27_Douglas 09.04.15 15:37 Seite 26 DTUK0115_24-27_Douglas 09.04.1515:37 Seite 26