Roberts M W, Tylenda C A
National Institute of Dental Research, Bethesda, Md.
Pediatrician. 1989;16(3-4):178-84.
Anorexia nervosa and bulimia nervosa are both psychosocial pathological eating disorders. An intense preoccupation with food, weight and a distorted body image coupled with a morbid fear of becoming obese are common elements in both syndromes. Self-starvation with extreme weight loss is associated with anorexia nervosa. Bulimia nervosa is characterized by unrestrained eating sprees followed by purging, fasting or vomiting. Approximately 50% of anorexia nervosa patients also practice bulimia. The impact of eating disorders on the oral soft and hard tissues depends upon the diet as well as the duration and frequency of binge-purge behavior. Erosion of the teeth due to frequent regurgitation of highly acidic stomach contents is a common finding. Dental caries development is less predictable and appears to be diet- and oral hygiene-dependent. Painless enlargement of the parotid salivary glands is a common sequela of chronic vomiting but the pathophysiological cause has not been firmly established. The dehydration of the oral soft tissues due to salivary gland impairment in addition to dietary deficiencies and poor oral hygiene can adversely impact the health of the periodontal tissues and oral mucosa. Initial dental care is focused on discouraging behavior that is destructive to the oral tissues. Improved oral hygiene, the use of gastric acid-neutralizing antacid rinses and the daily application of topical fluorides can be useful in reducing enamel erosion. Extensive restorative oral rehabilitation should be postponed until the underlying psychiatric components of the disorder are stabilized.
神经性厌食症和神经性贪食症都是社会心理性病理性饮食失调症。对食物、体重的过度关注以及扭曲的身体形象,再加上对肥胖的病态恐惧,是这两种综合征的常见特征。自我饥饿并伴有极度体重减轻与神经性厌食症有关。神经性贪食症的特征是无节制地暴饮暴食,随后进行催吐、禁食或呕吐。大约50%的神经性厌食症患者也会出现神经性贪食的症状。饮食失调对口腔软硬组织的影响取决于饮食以及暴饮暴食-催吐行为的持续时间和频率。由于高酸性胃内容物频繁反流导致的牙齿侵蚀是常见现象。龋齿的发展较难预测,似乎取决于饮食和口腔卫生情况。腮腺无痛性肿大是慢性呕吐的常见后遗症,但病理生理原因尚未完全明确。除了饮食缺乏和口腔卫生不良外,唾液腺功能受损导致的口腔软组织脱水会对牙周组织和口腔黏膜的健康产生不利影响。最初的牙科护理重点是劝阻对口腔组织有破坏作用的行为。改善口腔卫生、使用中和胃酸的抗酸漱口水以及每日局部应用氟化物有助于减少牙釉质侵蚀。在该疾病潜在的精神因素稳定之前,应推迟进行广泛的口腔修复康复治疗。