Download binge eating disorer and its effects on the oral cavity

Running head: BINGE EATING DISORDER AND ITS EFFECTS ON THE ORAL CAVITY 1
Binge Eating Disorder and its Effects on the Oral Cavity
Laci Page
Missouri Southern State University
BINGE EATING DISORER AND ITS EFFECTS ON THE ORAL CAVITY
2
Binge Eating Disorder and Its Effect on the Oral Cavity
Eating disorders, such as Binge Eating, create damaging effects on the human body and
in turn, can greatly harm the oral cavity. Eating disorders effect many people today and are
typically associated with an underlying psychological disorder. In many cases a dental
professional may be the first person to learn of a person’s eating disorder (DeBate, Tedesco, &
Kerschbaum, 2005). This gives those professionals an opportunity to introduce some sort of
health intervention, whether it be presenting the patient with resources to turn to, or simply
educating the patient further on the effects of their disorder. While patient education aids in the
prevention of further damage that eating disorders can have on oral tissues, education among
caregivers, such as dental professionals, is essential. The further educated the caregiver, the
better the signs of these eating disorders can be spotted and the patient can then be educated on
the detrimental effects their conditions can have on their overall health.
Eating disorders often share similarities, however each one can be characterized
differently. Anorexia Nervosa includes an intense fear of gaining weight and can include either
“restricting” and limiting food consumption or a “binge-purge” type of anorexia where the
person will restrict food intake for a period of time and then purge or vomit after eating
(Steinberg, 2012). Anorexia is also increasing regularly all over the world and, unfortunately, has
the highest death rate of any psychiatric disease (Szalay, 2010). Bulimia Nervosa is often
characterized by binging. It often includes a fixation with eating and then a form of
compensation for overeating, either by purging or the overuse of laxatives (Frydrych, Davies, &
McDermott, 2005). The repeated vomiting of bulimia exposes teeth to more stomach acid than
the saliva can manage. This enables the acid to dissolve the tooth enamel which can lead to tooth
decay (How eating disorders affect your oral health, 2014). This is also true for Binge Eating.
BINGE EATING DISORER AND ITS EFFECTS ON THE ORAL CAVITY
3
Binge Eating Disorder, or BED, is when a person consumes a large amount of food over a short
amount of time (Chambers, 2009) and can be associate with Night Eating Syndrome and
elevated body mass index scores (Adrian Meule, 2014). While anorexia typically comes to mind
when thinking of eating disorders, BED is the most common eating disorder in the U.S.
(BingeEatingDisorderAssociation, 2014).
Binge Eating Disorder can incorporate the habits of bulimia and can overall be
detrimental to the human body. Along with other eating disorders, BED can have both systemic
and oral effects. As a health care professional, it is important to be able to spot the signs of BED,
and understand the underlying psychological reasons behind this disorder. Having a good
understanding of BED can aid in patient education, so they can better understand all of the
effects of their eating disorder and can ultimately lead to prevention. Binge eating disorder is the
most common eating disorder and consists of episodes of uncontrollable overeating. Sufferers of
this disease tend to hide their binge eating episodes from other people and feel ashamed or even
depressed about their overeating episodes (Chambers, 2009).
BED can have many systemic effects on the body. Many complications of BED can
include, gallbladder disease, type 2 diabetes, heart disease, high blood pressure, osteoarthritis,
high cholesterol and even some cancers. Other systemic complications include gastrointestinal
problems, depression, anxiety, polycystic ovary syndrome, joint and muscle pain as well as sleep
apnea (BingeEatingDisorderAssociation, 2014). Binge-and-purge cycles can affect the body’s
entire digestive system. This can lead to electrolyte and chemical imbalances which affect the
heart and other major organs. The mere appearance of one or more of these signs of malnutrition
does not necessarily diagnose an eating disorder, but they can present as clues so that further
BINGE EATING DISORER AND ITS EFFECTS ON THE ORAL CAVITY
4
questioning and investigating can begin along with possible referral to their general doctor
(Cynthia A. Stegeman & Lynne H. Slim, 2011).
Oral manifestations can also develop due to Binge Eating Disorder. “The intraoral effects
of eating disorders include signs of malnutrition, dental erosion, traumatized oral mucosal
membranes and pharynx, dental caries, dentinal sensitivity, enlargement of the parotid glands,
gingival and periodontal diseases, and soft tissue lesions.” Xerostomia, or dry mouth, often
occurs due to antidepressant or antianxiety medications often prescribed to those with eating
disorders (Cynthia A. Stegeman & Lynne H. Slim, 2011). Dental erosion can occur on both the
front and back sides of the teeth, also known as labial (lip side) and lingual (tongue side). The
lingual side of the top front teeth (or palatal surface) will commonly be eroded with a smooth
and glossy appearance to them (Cynthia A. Stegeman & Lynne H. Slim, 2011). “Once the palatal
surface of anterior teeth is depleted, unsupported enamel tends to crack easily and is exacerbated
if the patient has parafunctional habits. Erosion can also cause hypersensitivity to touch and cold
temperatures.” Also, “once cracked teeth cause inverted smiles, individuals with eating disorders
may seek dental care for aesthetic reason” (Cynthia A. Stegeman & Lynne H. Slim, 2011).
It is important for a dental professional, such as a dental hygienist, to be able to spot and
look for oral manifestations and other signs of eating disorders. “Enlargement of the parotid
glands and occasionally of the sublingual and submandibular glands are frequent oral
manifestations of the binge-purge cycle in patients with eating disorders” (Steinberg, 2012).
Patients who binge and purge may have reduced salivary flow. The oral mucosa and the pharynx
may also be damaged by binging and purging, due to rapid ingestion of large amounts of food
and forced vomiting. The soft palate may be injured by objects used to induce vomiting.
Dryness, erythema and angular cheilitis have also been documented in these cases (Steinberg,
BINGE EATING DISORER AND ITS EFFECTS ON THE ORAL CAVITY
5
2012). Oral ulcerations and glossitis of the tongue can also manifest. These can be signs of
vitamin deficiencies, such as iron and B12. Such deficiencies need to be recognized due to their
likelihood of underlying problems (Frydrych, Davies, & McDermott, 2005).
Eating disorders are often accompanied by mental disorders such as depression. In fact,
eating disorders, like BED, are often times one of many different symptoms of depression. Many
other psychological complications are associated with eating disorders such as anxiety, selfdoubt, mood swings, distorted body image, denial of problem and feelings of alienation among
others (Cynthia A. Stegeman & Lynne H. Slim, 2011). Eating disorders can also develop due to
physiological changes, shame or isolation. Studies show that individuals with eating disorders
tend to have higher rates of mental disorders, other compulsions and even substance abuse.
These patients also often lack motivation. (Cynthia A. Stegeman & Lynne H. Slim, 2011). Eating
disorders are often observed in people obsessed with not gaining weight, this is where binge
eating can differ from other eating disorders. “Binge Eating is most often thought of as a
maladaptive behavior associated with bulimia nervosa. However, this behavior is also noted in
patients with obesity, making it of interest to study within the context of the rapidly-spreading
obesity epidemic. It has been suggested that some individuals may develop addictive-like
behaviors when consuming palatable foods in a binge pattern, which can lead to overeating and
subsequent weight gain” (Chambers, 2009).
BED can be linked to obesity. In fact, “BED is the most common eating disorder found in
obese people” (Annagur, 2015). A study published in the Bulletin of Clinical
Psychopharmacology compared certain test results between 149 obese study participants and 151
non-obese healthy controls. The tests assessed included a Structured Clinical Interview (SCIDI), Eating Attitudes Test (EAT), Beck Depression Inventory (BDI), and Barratt Impulsiveness
BINGE EATING DISORER AND ITS EFFECTS ON THE ORAL CAVITY
6
Scale-11 (BIS-11). The results of these studies conclude that “the prevalence of BED ranges
from approximately 0.3 to 7% in community samples to between 9% and 30% in obesity clinics.
Most studies have found significantly higher levels of eating related and general psychiatric
symptomatology in obese patients with binge eating than those without binge eating” (Annagur,
2015). These studies have shown that there is a positive correlation between BED and depression
as well as a long history of affective disorders. Conditions such as paranoid ideas, psychoticism,
and obsessive-compulsive disorders appear to be strongly linked to BED. The results of these
studies also show that the risk of obesity is elevated among women who have BED. Binge Eating
is also more prevalent in overweight women who are pursuing treatment. (Annagur, 2015)
While developing different prevention outlets, internet-based “guided self-help”
programs have been explored. One approach included a 12 week program of online coaching
along with the self-help book Overcoming Binge Eating in a study of patients with bulimia
nervosa and binge eating disorder. These guided programs showed to be far better than symptom
reduction (Bauer, 2013). It is important for dental professionals to realize that it is their job to
advise prevention of further damage to the patients hard and soft tissues, even in the midst of
their disorder. This is true whether or not the patient is in control of their disorder. It is also
important for those dental professionals to understand that these recommendations will no delay
treatment sought by the patient for their eating disorder. The dental professional should
adamantly stress that damage to their teeth, or hard tissue, is permanent and that the suggestions
given are only short term solutions to minimized further enamel loss. (Cynthia A. Stegeman &
Lynne H. Slim, 2011)
Recommendations that can be made by dental professionals may include wearing a
mouth guard during purging episodes, rinse with baking soda and water right after vomiting to
BINGE EATING DISORER AND ITS EFFECTS ON THE ORAL CAVITY
7
help neutralized the saliva pH, not just tap water. It can also be recommended to avoid brushing
the teeth right after vomiting because it can cause further damage to the enamel. Dental
hygienists should use polish with fluoride and not a coarse grit prophylaxis paste. When a dental
professional suspects purging behavior in a patient, intraoral photographs, radiographs and study
models will be beneficial in order to chart, or monitor progression. (Cynthia A. Stegeman &
Lynne H. Slim, 2011)
In terms of permanent dental care, it is urged to postpone complex restorative care until
the patient is psychologically stabilized with very few exceptions. “Members of the dental team
play critical roles for identifying undiagnosed eating disorders. In fact, because of the visibility
of oro-facial manifestations, oral health care professionals may be the first to encounter such
patients and to play the important role of making appropriate referrals for further diagnostic
work-up and treatment” (Steinberg, 2012). It needs to be understood that eating disorders are
“silent killers” and should not be taken lightly or overlooked. If a patient is suspected of an
eating disorder, they should be gently confronted, informed of the many possible complications
and manifestations of their condition, and highly encouraged to pursue professional help both
medically and psychologically. In regards to eating disorders, early detection and intervention is
key. (Steinberg, 2012)
Addressing a patient will signs of eating disorders can be a difficult task. Studies show
that while dentists do feel obligated to partake in secondary prevention in patients with eating
disorders, they fear misdiagnosing or offending their patients (DeBate, Tedesco, & Kerschbaum,
2005). Studies also show that these dentists are admittedly not well education on local referrals,
how to approach patients on sensitive subject matter, or the oral and physical manifestations in
regards to eating disorders. (Steinberg, 2012) Studies such as these help outline the need for
BINGE EATING DISORER AND ITS EFFECTS ON THE ORAL CAVITY
8
dental professionals to be well educated on eating disorders such as BED, and develop office
protocols for such patients. “Approaching the topic of eating disorders with a patient is difficult
and requires a non-threatening, non-judgmental, and non-clinical environment to reduce anxiety
in revealing a well kept secret” (Cynthia A. Stegeman & Lynne H. Slim, 2011).
Dental professionals should thoroughly document all physical findings during the oral
exam. It’s important to keep in mind that not all patients may be ready to open up about their
condition, but those that are ready may need support. (Cynthia A. Stegeman & Lynne H. Slim,
2011) “All dental professionals should be aware of community resources for eating disorders in
their area, such as an eating disorder program and provide contact information. Providing a list
of reliable Internet sources may be helpful” (Cynthia A. Stegeman & Lynne H. Slim, 2011).
Binge Eating Disorder is a medical condition that can cause great harm to the body and
the oral cavity such as xerostomia, enlargement of the parotid, sublingual, and submandibular
glands, dental erosion, sensitivity and oral lesions. Binge eating can also cause damage to the
soft palate, the oropharynx and oral mucosa. This eating disorder usually has underlying
psychological origin like anxiety, depression and distorted body image that can both contribute
to and trigger this condition. “The recognition of disordered eating behavior requires specific
knowledge about oro-dental and physical cues of disordered eating behaviors. Increasing the
number of dental and dental hygiene programs that include eating disorders in the curriculum
along with allocation of didactic and clinical instruction time is greatly needed” (Cynthia A.
Stegeman & Lynne H. Slim, 2011).
Eating disorders are increasing in the U.S. and worldwide, predominantly among
adolescent and adult women. Early detection, referral, and treatment of eating disorders are
essential. It is important for dental professionals like the dental hygienist to be able to recognize,
BINGE EATING DISORER AND ITS EFFECTS ON THE ORAL CAVITY
9
help stop, and prevent further damage to the oral cavity. Recognition of disordered eating
behavior requires continued education of the dental and physical signs of eating disorders
(Cynthia A. Stegeman & Lynne H. Slim, 2011). Eating disorders, like binge eating disorder, are
serious conditions. People with such conditions need help and interventions and dental
professionals such as a dental hygienist may be the first step in their aid to recovery.
BINGE EATING DISORER AND ITS EFFECTS ON THE ORAL CAVITY
10
References
Adrian Meule, K. C. (2014). Emotional Eating Moderates the Relationship of Night Eating with.
European Eating Disorders Review.
Annagur, B. B. (2015). The effects of depression and impulsivity on obesity and binge eating
disorder. Klinik Psikofarmakoloji Bulteni, 162-170.
Bauer, S. (2013). Harnessing the Power of Technology for the Treatment and Prevention of
Eating Disorders. The International Journal of Eating Disorders, 508-515.
BingeEatingDisorderAssociation. (2014). Retrieved from http://bedaonline.com/:
http://bedaonline.com/understanding-binge-eating-disorder/what-is-bed/
Chambers, N. (2009). Binge Eating : Psychological Factors, Symptoms and Treatment.
Cynthia A. Stegeman, R. E., & Lynne H. Slim, R. M. (2011, September 8). Recognizing and
Managing Eating Disorders in Dental Patients. Retrieved from DentalCare.com:
http://www.dentalcare.com/media/en-US/education/ce321/ce321.pdf
DeBate, R., Tedesco, L., & Kerschbaum, W. (2005). Oral Health Providers and Secondary
Prevention of Disordered Eating: An Application of the Transtheoretical Model. Journal
of Dental Hygiene, 79(4), 1-9.
Frydrych, A., Davies, G., & McDermott, B. (2005). Eating disorders and oral health: A review of
the literature. Australian Dental Journal, 6-10.
How eating disorders affect your oral health. (2014). Mississauga News.
Steinberg, B. (2012). Medical and Dental Implications of Eating Disorders. Journal of Dental
Hygiene, 1-4.
Szalay, C. (2010). Taste reactivity deficit in anorexia nervosa. Psychiatry and Clinical
Neurosciences, 403-407.