Sunday, July 23, 2017

Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name:   Olga Raptis                                                                                         Date: 07/23/17
Article Title: Eating Disorders and oral health: a matched case- control study
Author(s): Johansson et al.
Journal: European Journal of Oral Sciences
Date: 2012
Major Topic: Eating disorders and oral health
Type of Article: Case-control study 
Main Purpose: The comparison in “oral health status of patient with eating disorders (EDs) with sex- and age- matched controls, with a view to identify self-reported and clinical parameters that might alert the dental professional to the possibility of EDs”
Key Points: (2 lines Max): Main conclusion or the most interesting

·       3 types of eating disorders:
o   Anorexia nervosa (AN): underweight and food restriction
o   Bulimia nervosa (BN): binge eating and inappropriate compensatory behaviors; self-induced vomiting (VOM), laxatives use, and excessive exercise.
o   Eating disorder not otherwise specified (EDNOS): mix of AN- and BN- like atypical EDs
·       Previous studies on Oral health in ED have showed that correlation of EDs and dental caries are contradictory but are more consistent regarding dental erosion and bulimic behavior.
·       Some symptoms are permanent (i.e. dental erosion and caries) others reflect the expression and intensity of the disease (i.e. gingivitis, mucosal lesions, enlargement of salivary glands and xerostomia)

·       Dental and other healthcare providers often prefer to not pursue suspicions of EDs due to fear of losing the patient or insufficient confidence in their suspicion. Patients with EDs often avoid healthcare professionals and conceal the true origin of their problem due to guilt, shame, and self-denial of the disease.
·       Study summary:
o   54 patients: 50 females and 4 males in clinical for EDs treatment and the control group of 54 subjects matched for sex and age was selected from the ordinary recall patients at a Public Dental Health Clinic.
o   Given a 91-item questionnaire which was used to exclude patients with a risk of having EDs from the control. Same investigator recorded:
§  EOE (dry/cracked lips and enlargement of parotid gland)
§  IOE (Visible plaque index, gingival bleeding, dental caries and grading of dental erosion and assessment of intraoral tissue; gingival trauma, ulcers, blisters, and/or esophagitis)
·       Study Results:
o   Mean age of onset :16 y/o and the mean duration of the disease was 4.4 years
o   Signs of dry and/or cracked lips or parotid gland swelling, were significantly more common in ED patients than in controls. Esophagitis and the severity of dental erosion was also more common in patients with EDs. Similar DMFT, DMFS, IP caries, and Lower Gingival Bleeding Index ( due to obsessive hygiene) 
Dental team should look out for symptoms and signs such as present dental problems indicative of EDs: 
Burning mouth, dry/cracked lips, good oral hygiene, parotid gland swelling, and dental erosion

1- According to the study: “only a few dentists inform patients/parents about their suspicion of EDs, and/or report insufficient knowledge of EDs and their clinical diagnosis.
2- Therefore, an increased knowledge of EDs and their effect on oral health is likely to increase the probability of intervention by the dentist” and lead to early detection and intervention for ED patients.

Assessment of Article:  Level of Evidence/Comments:   II-3 Case-Control Study

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