Eating Disorders Part One
Condition defined by marked weight loss, fear of gaining weight, body image distortion, and either loss of appetite or self-induced starvation
What is anorexia nervosa?
Condition defined at least by 2 binges and purges per week for three months
What is bulimia nervosa?
Reviewed health conditions that may indirectly or directly result in a change of taste and smell
What is: neoplasia (itself or radiation), epilepsy (medications), Parkinson, renal disease, diabetes mellitus (itself or medications), hyperlipidemia (medications), malabsorptive conditions, xerostomia, iron-deficiency anemia, megaloblastic anemia, other taste and smell disorders?
Characteristics of Gastroparesis as they relate to diet/nutrition
What is the partial paralysis of the stomach can cause nausea, vomiting, early satiety, and weight loss. Strict diet modifications must be made involving avoidance of high fat and high fiber foods. Dehydration and malnutrition are common.
Characteristics of skeletal conditions that relate to diet/nutrition
Ensure calcium and vitamin D in diet
Resorption can impact bite and denture fit
Fine body hair that may appear in those with anorexia nervosa due to the body's attempt at regulating temperature.
What is lanugo?
Physical (non intraoral) signs and symptoms of bulimia nervosa
What is normal or slightly overweight, calluses on fingers, broken blood vessels in eyes, higher tobacco and alcohol use?
Reviewed health conditions that may indirectly and/or directly cause xerostomia
Note: several prescription medications can cause xerostomia
Those reviewed include:
What is neoplasm (radiation), Parkinson (medications), AIDS, mental illness (medications), Gastroparesis (if dehydrated), renal disease, diabetes (itself and medications), iron-deficiency anemia, epilepsy (medications), GERD (medications) and hypertension (medications)?
What is:
tumor location can directly impact normal digestive processes (saliva, chewing, etc.)
treatment for neoplasia can cause loss of appetite, loss of taste, xerostomia (difficulty chewing), burning mouth, food aversions
psychological factors can also impact appetite
Characteristics of hyperlipidemia that relate to diet/nutrition
Related to high blood cholesterol levels - diets typically revolve around decreasing saturated fats, trans fats, and limiting cholesterol
If on coumadin or warfarin, must limit vitamin K (why?)
When recommending noncariogenic snacks, consider low fat or non-fat options (low fat cheese, nonfat yogurt, skim milk)
Two subtypes of anorexia nervosa
What is restricting subtype and binge/purge subtype?
What are SSRIs and atypical antipsychotics (these can cause xerostomia and taste disturbances)
Reviewed health conditions that may directly and/or indirectly cause difficulty with chewing and swallowing or cause intraoral effects that may impact diet
What is neoplasia (itself, radiation, and surgery), Kaposi sarcoma, AIDS, developmental disabilities, Parkinson, renal disease, hypothyroidism (macroglossia), Cushing syndrome (muscles of mastication and tongue), skeletal disease, hyperparathyroidism (brown tumors), malabsorptive conditions, GERD, iron deficiency anemia, diabetes (xerostomia), xerostomia, hypertension meds (xerostomia), stroke
Characteristics of epilepsy as they relate to diet/nutrition
What is:
Phenytoin impacts metabolism of vitamins D, K, and folate. However, supplementing with folate is risky since it decreases the bioavailability of phenytoin in the body.
Characteristics of GERD that relate to diet/nutrition
Patient may be trying to avoid fatty foods, mints, citrus, tomato products, and carbonated beverages
Typically small, frequent meals help symptoms
Consider antacids - think caries risk!
Anticholinergic meds interfere with B12 and folate absorption
Physical signs and symptoms of anorexia nervosa
What is emaciated appearance, cyanosis of hands and feet, lanugo, LOW blood pressure, LOW body temperature, death (cardiac arrest, multi-organ failure, electrolyte imbalance, suicide)
Oral signs and symptoms of an eating disorder that involves purging
Reviewed health conditions that may indirectly and/or directly influence appetite
What is cancer, Gastroparesis, Parkinson, Renal disease, hypopituitarism, xerostomia?
Characteristics of Parkinson Disease as they relate to diet/nutrition
What is:
Some research suggests that a healthy diet may protect against Parkinson disease.
Vitamin B6, protein, and fat may interfere with effectiveness of the medication.
Medications cause xerostomia, nausea, and poor appetite
Individual may not be able to obtain groceries, cook, feed self, and have difficulty chewing and swallowing
Characteristics of malabsorptive conditions (Celiac, Chrons, ulcerative colitis, cystic fibrosis, AIDS, etc.) that relate to diet/nutrition
Consider what dietary modifications control their flare ups
Nutrient deficiencies possible despite consuming the appropriate nutrients (know why!)
Psychological factors of anorexia nervosa
What is depression, fear of growing up, perfectionism, need for attention, low self-esteem, high family expectations, and dysfunctional family?
How patients with a suspected eating disorder are managed
What is rule out other potential causes (GERD, deficiencies, other systemic conditions), talk to person in private, relate oral findings to chief complaint, state that the findings may suggest an eating disorder, refer to medical doctor and RDN.
If patient denies eating disorder, refer to rule out other dietary causes.
NO BRUSHING AFTER VOMITING - what can we recommend?
Characteristics of AIDS as they relate to diet/nutrition
Characteristics of Diabetes Mellitus that relate to diet/nutrition
What is:
Being able to control diabetes greatly relies on the patient's diet. Therefore, we do not counsel patients on what to eat and what to avoid. You can discuss the relationship between diet/nutrition and oral health, but state that any changes should be discussed with the patient's doctor.
Oral considerations that can impact diet: xerostomia and altered taste
Characteristics of cerebrovascular accident (stroke) that relate to diet/nutrition
Effects from stroke may limit chewing, swallowing, and caring for oneself (can they prepare their own foods? grocery shop?). Patients may deny difficulty.
Consider how diet may be modified given these circumstances
After eating, check mouth for pocketed/retained foods.