eating disorders Flashcards
What is an eating disorder?
Complex mental illness
Often underlying issue
What is the screening tool for some eating disorders?
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?
What causes an eating disorder?
Eg. High achievers Previous bullying relating to appearance Broken families Genetic Hobbies/sports Physical/sexual/drug abuse
What is a healthy weight?
Body Mass Index - kg/m2
Categories- underweight, healthy weight, overweight, obese, severely obese, morbidly obese
Age and gender percentiles for children
What is orthorexia nervosa?
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
What is anorexia nervosa?
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
How is anorexia nervosa managed?
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)
What are dental considerations for anorexia?
Halitosis- pear drops (ketosis)
Dry mouth (esp. TCAs)
Drug doses (weight consideration)
Reduced immune response (perio, angular chelitis)
Emergencies (vasovagal syncope, cardiac arrest)
What is bulimia nervosa?
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
How is bulimia nervosa managed?
Complex and long term Psychoeducation Therapy (family, group, CBT) Monitoring health (meal planning, supplements, no blame) Family counselling
What are dental considerations of bulimia?
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
What is binge eating disorder?
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
How is binge eating managed?
Therapy (CBT, group)
Outpatient care unless self harm/suicide
Monitor- meal planning, avoid dieting, weight monitoring
What are dental considerations of binge eating?
Caries
Dental chair (127kg)
General anaesthetic airway risks
Emergencies- hypoglycaemia, myocardial infarction, cardiac arrest
What is obesity?
BMI 30 or over
Not eating disorder
Similar clinical features and dental considerations to BED
Management- exercise on prescription, healthy living classes, therapy, CBT
