Management of a patient with bulimia
CASE STORY
A 42-year-old female patient presents with the chief complaint of “I’m not happy with the way my teeth look.” The patient reports that she has neglected her teeth for the past 20 years and has not received dental treatment other than emergency dental care. The patient exhibits poor oral hygiene and reports that she brushes only occasionally.
Figure 1: Preoperative presentation..
Figure 2: Preoperative right side.
Figure 3: Preoperative left side.
LEARNING GOALS AND OBJECTIVES
- Identify signs of bulimia.
- Understand treatment limitations in patients with bulimia.
- Provide appropriate dental interventions to control future damage.
Medical History
- Bulimia: from 1982-1990
Medications and Allergies
- Methadone 30 mg: for management of previous drug addiction
Social History
- Smoking: one pack of cigarettes per day, for the past 30 years
- Alcohol: drinks alcohol occasionally
- Recreational drugs: previous drug addiction and currently in drug rehabilitation program
Charting
(See Fig. 4 .)
Clinical Findings/Problem List
- Generalized gingivitis, moderate localized calculus, mild localized periodontitis
- Evidence of erosion
- Caries: extensive decay in all four quadrants
- Maxillary right second molar (2) DOL
- Maxillary right first molar (3) MOD
- Maxillary right canine (6) L
- Maxillary lateral incisors (7-10) MD
- Maxillary left canine (11) B, L
- Maxillary left first premolar (12) MOD
- Maxillary left second premolar (13) MOD
- Maxillary left first molar (14) MODL
- Mandibular left first molar (19) MO
- Mandibular left second premolar (20) MOD
- Mandibular left first premolar (21) MOD
Figure 4: Dental charting.
- Mandibular right first premolar (28) B
- Mandibular right second premolar (29) B
- Mandibular right first molar (30) B, DO
- Mandibular right second molar (31) B, DO o Mandibular right third molar (32) B, MOD
- Missing teeth: Maxillary third molars (1, 16), maxillary left second molar (15), mandibular left second and third molars (17, 18)
- Nonrestorable: Maxillary right second premolar (5)
- Apical periodontitis: Maxillary right second premolar and canine (5, 6)
Radiographic Findings
(See Figs. 5 and 6 .)
Diagnosis
- Generalized gingivitis, moderate localized calculus, mild localized periodontitis
- Partial edentulism
- Caries
- Inadequate restorations
- Apical periodontitis
- Erosion
Clinical Decision-Making Determining Factors
- Bulimia is an eating disorder in which the patient, typically female, is preoccupied with her weight and body image. The patient often goes through periods of consuming large amounts of food (bingeing) and then trying to rid herself of the food through self- induced vomiting or the use of laxatives (purging). The chronic exposure of the teeth to the gastrointestinal acid may result in damage, the severity of which depends on the />
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