Medical complications of bulimia nervosa.

Bulimia nervosa, a mental illness 4 times more common than anorexia nervosa, is characterized by binge-eating followed by compensatory purging behaviors, which include self-induced vomiting, diuretic abuse, laxative abuse, and misuse of insulin. Patients with bulimia nervosa are at risk of developing medical complications that affect all body systems, especially the renal and electrolyte systems. Behavior cessation can reverse some, but not all, medical complications.

Oral yeast colonization in patients with eating disorders: commensal acquisition or due to purgative habits?

Oral problems are common in patients diagnosed with Eating Disorders (ED) and still require better elucidation. We aimed to analyze the prevalence of oral Candida spp in individuals with ED. The sample of the study was comprised of 30 women with purgative habits and 15 without purgative habits. Samples of the oral cavity were collected by sterile cotton swab rubbed on soft tissues and teeth. Yeasts were isolated on Sabouraud dextrose agar. Yeasts were isolated from the oral cavity of 53% of the patients yielding 75 yeast isolates; of these, 43 were identified by conventional mycological methods: C. parapsilosis (n=19), C. glabrata (n=16), Rhodotorula sp (n= 6), C. famata (n=2). The remaining 32 isolates were presumptively identified as C. albicans or C. dubliniensis and required mass spectrometry for the final differentiation: 28 isolates were confirmed as C. albicans and four as C. dubliniensis. Among the control group, only four subjects (26.7%) were found to harbor C. albicans. The four C. dubliniensis isolates were from two patients, one that was only colonized and the other, with severe ED, was diagnosed with an oral candidiasis as demonstrated by the presence of pseudohyphae on the direct mycological exam from different sites. The increased rate of isolation of non-albicans species, such as C. glabrata, C. parapsilosis, and C. dubliniensis in the oral cavity from ED patients with nutritional deficiency may suggest that purgative habits of these patients can lead to changes in normal flora and predispose to oral candidiasis.

Comportamento de risco para bulimia nervosa, hábitos alimentares e de higiene bucal como fatores associados ao desgaste dentário erosivo e cárie dentária em adolescentes / Bulimia nervosa risk behavior, dietary habits and oral hygiene practices as associated factors for erosive tooth wear and dental caries among adolescents

Os distúrbios alimentares possuem uma etiologia multifatorial, composta de predisposições socioculturais, genéticas e vulnerabilidades biológicas e psicológicas. Entre os fatores predisponentes, destacam-se os padrões de interação presentes no ambiente familiar e o contexto sociocultural, caracterizado pela extrema valorização do corpo. A presença de algumas condições bucais, como o desgaste dentário erosivo e a cárie dentária, pode estar relacionada à ocorrência de distúrbios alimentares, como a bulimia nervosa (BN). Pesquisas sobre fatores de risco favorecem a análise oportuna de possíveis sinais e sintomas e, consequentemente, o estabelecimento de condutas preventivas. Este trabalho objetivou comparar a ocorrência do desgaste dentário erosivo e da cárie dentária em adolescentes com e sem comportamento de risco para BN, e investigar a influência de hábitos alimentares e de higiene bucal na ocorrência de desgaste dentário erosivo e da cárie dentária. Aprovação ética e termos de consentimento foram obtidos. A amostra foi composta por 225 escolares do sexo feminino, na faixa etária de 15 a 18 anos, oriundas de escolas das redes pública e particular de ensino de Belo Horizonte, no sudeste do Brasil. O comportamento de risco para BN foi avaliado segundo as subescalas de sintomas e gravidade dos sintomas da versão brasileira do Teste de Investigação Bulímica de Edinburgh (BITE) sendo categorizado em: hábito alimentar normal, comportamento de risco clinicamente significante e grave comportamento de risco. Os hábitos alimentares e de higiene bucal foram avaliados através de questionários autoaplicáveis. O desgaste dentário erosivo e a cárie dentária foram avaliados através dos índices de O'Sullivan e ICDAS II, respectivamente, por uma examinadora previamente calibrada (Kappa intra-examinador: 0,90 e 0,81; Kappa inter-examinadores: 0,88 e 0,83, referentes à erosão e à cárie dentária). Os dados foram analisados de forma descritiva e inferencial, através do software SPSS 18.0 (p<0,05). Através do modelo de regressão logística constatou-se que o grave comportamento de risco para a BN foi associado com o desgaste dentário erosivo (OR = 8,31; IC 95% = 3,91-16,91), e com adolescentes provenientes de escolas privadas (OR = 3,11 IC 95% = 1,44-6,45), mas não com a cárie dentária (OR = 1,13, IC 95% = 0,72-1,73). O comportamento de risco clinicamente significante para bulimia não foi associado às condições bucais avaliadas (p>0,05). Com relação aos hábitos alimentares, o desgaste dentário erosivo foi associado ao consumo diário de frutas cítricas (p<0,009) e refrigerantes com açúcar (p<0,046), enquanto a cárie dentária foi associada ao consumo diário de biscoitos recheados (p<0,049). O hábito de escovar os dentes imediatamente após as refeições foi estatisticamente associado à ocorrência de desgaste dentário erosivo no grupo com grave comportamento de risco para BN (p=0,047). O comportamento de risco para BN, caracterizado como clinicamente significante, não foi associado com implicações dentárias, mas o grave comportamento de risco para BN foi associado com a ocorrência de desgaste dentário erosivo. Hábitos alimentares e de higiene bucal foram associados à presença de desgaste dentário erosivo e cárie dentária

Eating disorders have a multifactorial etiology, composed of sociocultural and genetic predispositions as well as biological and psychological vulnerabilities. Among the predisposing factors, it is important to highlight the interaction patterns present in the family environment and the sociocultural context characterized by the overvaluation of the body and beauty standards. The presence of some dental implications such as erosive tooth wear and dental caries may be related to the occurrence of eating disorders such as bulimia nervosa (BN). Research on eating disorders' risk factors favors the timely analysis of possible signs and symptoms and, consequently, the establishment of preventive measures. This study aimed to compare the occurrence of erosive tooth wear and dental caries in adolescents with and without risk factor for BN, and investigate the influence of dietary habits and oral hygiene practices with the occurrence of erosive tooth wear and dental caries. Ethical approval and written consent forms were obtained. The sample consisted of female students, aged 15-18 years, from private and public schools in Belo Horizonte, southeastern Brazil. Risk behavior for BN was evaluated according to the subscales of symptoms and severity of the Brazilian version of the Bulimic Investigatory Test of Edinburgh (BITE) and classified in normal eaten behavior, clinically significant bulimic risk behavior and severe bulimic risk behavior. Eating habits and oral hygiene practices were assessed using validated self-report questionnaires. Erosive tooth wear and dental caries were evaluated by the O'Sullivan index and the ICDAS-II index, respectively, by a previously calibrated examiner (intraexaminer Kappa: 0.90 and 0.81, Kappa inter-examiner: 0.88 and 0.83, related to tooth erosion and dental caries). The data were analyzed descriptively and inferentially, using SPSS 18.0 software (p <0.05). Through the logistic regression model it was found that the severe risk behavior for BN was associated with erosive tooth wear (OR = 8.31; 95% CI = 3.91-16.91), and adolescents from private schools (OR = 3.11 95% CI = 1.44- 6.45), but not with dental caries (OR = 1.13, 95% CI = 0.72-1.73). The clinically significant risk behavior for BN was not associated with the assessed oral conditions (p> 0.05). With regard to eating habits, erosive tooth wear was associated with daily consumption of citric fruits (p<0.009), and soft drinks with sugar (p<0.046), while dental caries was associated with the daily consumption of cream biscuits (p<0.049). The habit of brushing the teeth shortly after eating was statistically associated with the occurrence of erosive tooth wear in the group with severe risk behavior for BN (p = 0.047). The risk behavior for BN, classified as clinically significant, was not associated with dental implications, but the severe risk behavior for BN was associated with the occurrence of erosive tooth wear. Dietary and oral hygiene habits were associated with the presence of erosive tooth wear and dental caries.

Erosão dentária causada por ácidos intrínsecos / Dental erosion caused by intrinsic acids

Lesões não cariosas caracterizam-se pela perda irreversível de tecido dental duro, sem envolvimento bacteriano, e compreendem: abfração, atrição, abrasão e erosão. No caso da erosão dentária, essa perda de tecido ocorre por ação de ácidos de origem extrínseca – dieta – e/ou intrínseca – distúrbios somáticos, psicossomáticos. Por ser uma condição cada vez mais frequente na população, este trabalho visa discutir a etiologia, o diagnóstico e as características da erosão dentária intrínseca, salientando a importância do cirurgião-dentista em seu diagnóstico. Sendo assim, o profissional deve estar apto a identificar tais lesões, correlacionando-as com as informações obtidas na anamnese para assistir seu cliente da melhor maneira possível, ou seja, encaminhando-o a um especialista e/ou através de intervenções odontológicas.

Bulimia: manifestações bucais e atenção odontológica / Bulimia: oral manifestations and dental care

O padrão estético de beleza do corpo imposto pela sociedade contemporânea tem sido o responsável pelo aumento do número de casos de bulimia nervosa. Essa doença comportamental que leva a transtornos alimentares acarreta danos fisiológicos que, se não erradicados precocemente, podem se tornar irreparáveis. Dentre esses danos, destacam-se àqueles relacionados à saúde bucal, caracterizados pela perimólise, aumento nos índices de lesões cariosas, intumescimento das glândulas salivares, sobretudo as parótidas, alterações na quantidade e qualidade da saliva, xerostomia, queilite e mucosite, bruxismo e alterações ortodônticas. As manifestações bucais são causadas por higiene bucal insatisfatória, deficiências de vitaminas, pela ingestão crônica de carboidratos, pela compulsão alimentar, pouca salivação (xerostomia), ansiedade e, também, pela acidificação da saliva causada pelos vômitos. O cirurgião-dentista, a partir do conhecimento dos sinais e sintomas dessa doença, é potencialmente um dos primeiros profissionais de saúde a identificá-la, podendo oferecer tratamento odontológico adequado.

The aesthetic beauty standard imposed by contemporary society has been responsible for the increasing bulimia rates. This behavioral disease that leads to eating disorders results in physiological damages that can become permanent if not treated early. These damages may affect oral health and include perimolysis, more caries lesions, swelling of the salivary glands, especially the parotid glands, changes in the amount and quality of the saliva, xerostomia, cheilitis and mucositis, bruxism and orthodontic changes. The oral manifestations are caused by poor oral hygiene, vitamin deficiencies, chronic carbohydrate intake, binge eating, xerostomia, anxiety, and also because of the acidification of the saliva due to vomiting. Based on the signs and symptoms of this disease, the dental surgeon is potentially one of the first health professionals to identify it and can provide proper dental treatment.

Bulimia nervosa as a risk factor for voice disorders--literature review.

UNLABELLED: Bulimia nervosa (BN) is a type of feeding disorder that starts in adolescence and presents a variety of symptoms, recurrent vomiting in the oral cavity that may reach down to the larynx - similarly to gastro-esophageal reflux, causing laryngeal and voice disorder alterations. AIM: These studies aimed at surveying the literature and investigate the studies that considered BN a risk factor for voice disorders. RESULTS: of the ninety three papers we found, twenty-three were used as a basis for this review, among them, only three discuss BN as an etiology factor associated with voice changes in adult women, and we did not find any paper associating this with bulimic teenagers. CONCLUSION: It is necessary to observe laryngeal and vocal signs and symptoms associated with BN, especially in teenagers whose voices are going through a period of change.

A bulimia nervosa como fator de risco para distúrbios da voz: artigo de revisão / Bulimia nervosa as a risk factor for voice disorders: literature review

A bulimia nervosa é um tipo de transtorno alimentar que tem início na adolescência e que apresenta uma variedade de sintomas, dentre estes, os episódios recorrentes de vômitos que acometem a cavidade oral, podendo alcançar a laringe de forma semelhante ao refluxo gastroesofágico, ocasionando alterações laríngeas e distúrbios na voz. OBJETIVO: Este trabalho teve como objetivo investigar através da revista da literatura os estudos que relacionassem a BN como fator de risco para os distúrbios da voz. RESULTADOS: Dos noventa e três artigos levantados, vinte e três foram usados como base para esta revisão, dentre os quais, apenas três referem-se à BN com fator etiológico de alterações na voz em mulheres adultas, não sendo encontrado nenhum trabalho referindo esta relação em adolescentes bulímicos. CONCLUSÃO: Faz-se necessária a observância de sinais e sintomas laríngeos e vocais que possam estar relacionados à BN, em especial nos adolescentes cuja voz passa por significativas mudanças quando do período da muda vocal.

Bulimia nervosa (BN) is a type of feeding disorder that starts in adolescence and presents a variety of symptoms, recurrent vomiting in the oral cavity that may reach down to the larynx - similarly to gastro-esophageal reflux, causing laryngeal and voice disorder alterations. AIM: These studies aimed at surveying the literature and investigate the studies that considered BN a risk factor for voice disorders. RESULTS: of the ninety three papers we found, twenty-three were used as a basis for this review, among them, only three discuss BN as an etiology factor associated with voice changes in adult women, and we did not find any paper associating this with bulimic teenagers. CONCLUSION: It is necessary to observe laryngeal and vocal signs and symptoms associated with BN, especially in teenagers whose voices are going through a period of change.

[Oral symptoms and signs in patients with bulimia and anorexia nervosa]. / Sintomas y signos bucales en pacientes con bulimia y anorexia nerviosa.

There are numerous general clinical manifestations in eating disorders, such as anorexia and nervous bulimia, which are fully described in the reading material. The objective of this study is to demonstrate that patients suffering from anorexia and nervous bulimia present manifestations in the oral mucosa and a proper anamnesis can lead to an early disease diagnosis. The clinical cases presented show some of the oral manifestations in patients suffering from these disorders. Abrasion of teeth enamel is a typical sign of this disease, specially in patients with nervous bulimia, caused by self-induced vomit acids. However, this sign does not help to make an early disease diagnosis, since the acid takes a long time to produce demineralization.

Síntomas y signos bucales en pacientes con bulimia y anorexia nerviosa / Oral symptoms and signs in patients with bulimia and anorexia nervosa

Las manifestaciones clínicas generales en los trastornos alimentarios, como la anorexia y la bulimia nerviosa son múltiples y están bien descriptas en la literatura. El objetivo de este trabajo es demostrar que las pacientes que padecen de bulimia y anorexia nerviosa presentan manifestaciones en la mucosa bucal y que junto a una correcta anamnesis nos pueden orientar hacia un diagnóstico temprano de la enfermedad. Los casos clínicos presentados muestran algunas de las manifestaciones bucales en los pacientes con estos trastornos. Un signo característico de esta enfermedad son las abrasiones que sufre el esmalte de los dientes, en especial en los pacientes con bulimia nerviosa, causado por los ácidos del vómito autoinducido. Sin embargo el tiempo que necesita el ácido para producir la desmineralización es largo, por lo que no es un signo que nOs ayude a realizar un diagnóstico temprano de la enfermedad.(AU)

There are numerous general clinical manifestations in eating disorders, such as anorexia and nervous bulimia, which are fully described in the reading material. The objective of this study is to demonstrate that patients suffering from anorexia and nervous bulimia present manifestations in the oral mucosa and a proper anamnesis can lead to an early disease diagnosis. The clinical cases presented show some of the oral manifestations in patients suffering from these disorders.Abrasion of teeth enamel is a typical sign of this disease, specially in patients with nervous bulimia, caused by self-induced vomit acids. However, this sign does not help to make an early disease diagnosis, since the acid takes a long time to produce demineralization.(AU)

Síntomas y signos bucales en pacientes con bulimia y anorexia nerviosa / Oral symptoms and signs in patients with bulimia and anorexia nervosa

Las manifestaciones clínicas generales en los trastornos alimentarios, como la anorexia y la bulimia nerviosa son múltiples y están bien descriptas en la literatura. El objetivo de este trabajo es demostrar que las pacientes que padecen de bulimia y anorexia nerviosa presentan manifestaciones en la mucosa bucal y que junto a una correcta anamnesis nos pueden orientar hacia un diagnóstico temprano de la enfermedad. Los casos clínicos presentados muestran algunas de las manifestaciones bucales en los pacientes con estos trastornos. Un signo característico de esta enfermedad son las abrasiones que sufre el esmalte de los dientes, en especial en los pacientes con bulimia nerviosa, causado por los ácidos del vómito autoinducido. Sin embargo el tiempo que necesita el ácido para producir la desmineralización es largo, por lo que no es un signo que nOs ayude a realizar un diagnóstico temprano de la enfermedad.

There are numerous general clinical manifestations in eating disorders, such as anorexia and nervous bulimia, which are fully described in the reading material. The objective of this study is to demonstrate that patients suffering from anorexia and nervous bulimia present manifestations in the oral mucosa and a proper anamnesis can lead to an early disease diagnosis. The clinical cases presented show some of the oral manifestations in patients suffering from these disorders.Abrasion of teeth enamel is a typical sign of this disease, specially in patients with nervous bulimia, caused by self-induced vomit acids. However, this sign does not help to make an early disease diagnosis, since the acid takes a long time to produce demineralization.