eating disorders

Question 1

What is an eating disorder?

Answer 1

Complex mental illness

Often underlying issue

Question 2

What is the screening tool for some eating disorders?

Answer 2

SCOFF
do you make yourself SICK because you feel uncomfortably full?
do you worry you have lost CONTROL over how much you eat?
have you recently lost more than ONE stone in a three month period?
do you believe yourself to be FAT when others say you are too thin?
would you say that FOOD dominates your life?

Question 3

What causes an eating disorder?

Answer 3

Eg.
High achievers
Previous bullying relating to appearance
Broken families
Genetic
Hobbies/sports
Physical/sexual/drug abuse

Question 4

What is a healthy weight?

Answer 4

Body Mass Index - kg/m2
Categories- underweight, healthy weight, overweight, obese, severely obese, morbidly obese

Age and gender percentiles for children

Question 5

What is orthorexia nervosa?

Answer 5

Not an eating disorder
Obsession w eating ‘pure’ and ‘clean’ foods
Extreme guilt w unhealthy eating
Judging others
Behaviour to cope w negative thoughts and to feel in control
Clinical features- fatigue, poor immune response, angular chelitis, recurrent aphthous ulceration
Management- therapies to tackle underlying disorder

Question 6

What is anorexia nervosa?

Answer 6

Body image disorder
Believe they’re fat even when they’re underweight
Concerns about weight gain from oral contraceptive pill
Rapid weight loss
Secretive behaviours and social withdrawal
Clinical features- muscle wasting, lanugo, bone density problems, hair loss
Consequences-
~faltering growth
~delayed puberty (amennorrhea, infertility)
~dehydration so kidney failure
~cardiac (heart) failure

Question 7

How is anorexia nervosa managed?

Answer 7

Complex and long term
Psychoeducation
Therapy (family, group, CBT)
Monitoring health (weight gain, meal planning, supplements, check ins, no blame)
Pharmacological interventions (TCA/SSRI)
Family counselling
Inpatient care (not force fed unless no capacity)

Question 8

What are dental considerations for anorexia?

Answer 8

Halitosis- pear drops (ketosis)
Dry mouth (esp. TCAs)
Drug doses (weight consideration)
Reduced immune response (perio, angular chelitis)
Emergencies (vasovagal syncope, cardiac arrest)

Question 9

What is bulimia nervosa?

Answer 9

Cyclical binge eating (no control, painfully full), purging behaviours
~self induced vomiting, obsessive exercising, use of laxatives, enemas, diuretics
Often history of anorexia/obesity
Clinical features- Russell’s sign, bloating, melanosis coli, Barrett’s oesophagus
Consequences
~normal/slight overweight
~laxative abuse so lazy colon, cancer risk, dehydration/electrolyte imbalance
~Barrett’s oesophagus
~diabulimia (hyperglycaemia)
~cardiac arrhythmias and health failure or death

Question 10

How is bulimia nervosa managed?

Answer 10

Complex and long term
Psychoeducation
Therapy (family, group, CBT)
Monitoring health (meal planning, supplements, no blame)
Family counselling

Question 11

What are dental considerations of bulimia?

Answer 11

Regular dental review
orofacial features (parotid gland enlargement, acne, oral ulceration)
Emergencies- vasovagal syncope, cardiac event
Dentition- erosion (vomit pH 3.8) palatal surfaces of incisors, perimylolysis, caries
Management- specialist care, prevention (education), 2800ppm/5000ppm fluoride toothpaste, fluoride varnish 4x a year, fissure sealants, saliva substitutes, don’t brush for an hour after vomit, monitor, restore when stable, multidisciplinary approach

Question 12

What is binge eating disorder?

Answer 12

Secretive eating
Rapid eating til over full
Social withdrawal
Buy lots of food and hoard
More common in adults
Linked w other eating disorders
Clinical features- weight gain, bad skin, bloating, constipation, stomach rupture, obesity, type 2 diabetes, sleep apnoea, heart disease

Question 13

How is binge eating managed?

Answer 13

Therapy (CBT, group)
Outpatient care unless self harm/suicide
Monitor- meal planning, avoid dieting, weight monitoring

Question 14

What are dental considerations of binge eating?

Answer 14

Caries
Dental chair (127kg)
General anaesthetic airway risks
Emergencies- hypoglycaemia, myocardial infarction, cardiac arrest

Question 15

What is obesity?

Answer 15

BMI 30 or over
Not eating disorder
Similar clinical features and dental considerations to BED
Management- exercise on prescription, healthy living classes, therapy, CBT

Question 16

How to communicate and avoid stereotypes?

Answer 16

Ask general qs
Ask sensitively
Be aware of confidentiality (private room, use x-ray opportunity to avoid family)
Avoid commenting on appearance
Don’t focus on weight
Don’t ignore family/support/siblings