Oral Symptoms in Eating Disorder (Bulimia Nervosa) : The Result of a Preliminary Study

There are reports regarding the patients with bulimia nervosa in whom due to continuous vomiting, chronic regurgitaion of acid gastric contents erodes and demineralizes their teeth. This study included an investigation of oral manifestations of the patients with bulimia nervosa, and a questionnaire on oral hygiene and eating disorder presented to them. The subjects consisted of 12 patients with bulimia nervosa (25±7 years old ; 1 male and 11 females) who were under the care of Dr.Yasuda at the Department of Psychosomatic Medicine, Kita-Kyushu Municipal Medical Center. The following results were obtained : 1) Hyperesthesia and toothache were noted in half of the subjects. The average number of decayed, missing and filled teeth (DMFT) in the subjects was 45.5 ± 21.6. This is 4.4 higher than the number of DMFT described in a report on the survey of dental diseases by the Medical Affairs Bureau, Ministry of Health and Welfare of Japan in 1993. White spots on maxillary anterior teeth region were noticed in 2 subjects, and parotid gland swelling was seen in one subject. 2) Nine subjects (75%) were conscious of an increase in decayed tooth count after contracting eating disorder, 5 subjects (42%) were anxious about acid eroshio of teeth and 5 subjects (42%) were conscious of acid erosion of teeth. Eight subjects (67%) were under the care of dentists, but only 2 subjects (17%) were pointed out to have a change in oral state. Five subjects (42%) were anxious about the care of the dentists in charge. Seven subjects (58%) were reluctant to tell their dentists about eating disorder and 9 subjects (75%) expected dentists to be informed of eating disorder. 3) The average number of DMFT found in the grope with vomiting for 4 years of less (n=8) was close to the number described in the report on the survey of dental diseases by the Medical Affairs Bureau, Ministry of Health and Welfare of Japan in 1993, but the average number of DMFT found in the groupe with vomiting for more 4 years (n=4) was 15.9 higher than that of the report. The number of DMFT found in the grope with vomiting for 4 years or less was lower than the number found in the groupe with vomiting for more 4 years, but no significant oral manifestations of acid erosion of the teeth were found. A relationship between vomiting and erosion was not found either. The reply to the questionnaire that they were reluctant to tell dentists about eating disorder suggested the patients' mental states of desiring to make a secret of eating disorder. Although only few subjects were pointed out by dentists to have a change in oral state, dentists play an important role in diagnosing the disorder. It is important that both medical doctors and dentists notice this problem and its treatment.