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Bulimia (‘ox hunger’) is a serious, potentially dangerous, eating disorder that is often associated with anxiety about weight and body shape. People with bulimia ‘binge’, meaning that they eat large amounts of food, and then vomit afterwards to ‘purge themselves’ in order to get rid of those recently ingested calories. Frequent vomiting of the stomach hydrochloric acid and other ingested acids (pH 1–2) produces variable, but often catastrophic, erosion of the palatal aspects of the upper teeth in particular.
‘Satisficing’ is a word made from combining ‘sufficient’ and ‘satisfactory’. It means seeking an outcome that meets the essential requirements for it to be ‘sufficient to be satisfactory for that situation’.
These authors recommend pragmatic early additive direct resin composite bonding as being a ‘satisficing’ approach to help manage tooth surface loss in bulimic patients, and the article provides clinical examples of some dental problems caused by bulimia being solved in that way.
CPD/Clinical Relevance: This article addresses a number of controversial issues in the dental management of patients with bulimia nervosa (‘bulimia’).
Article
Bulimia nervosa (commonly abbreviated to ‘bulimia’) is a psychological disorder characterized by compulsive overeating followed by vomiting. It has been known about for centuries in different cultures, but in 1979, Gerard Russell, a psychiatrist practising in South London, described it as an ominous variant of anorexia.1
Teeth dissolve below a pH of 5.5.2 During vomiting, the regurgitated stomach contents, which have a pH of about 1–2, due to the hydrochloric acid in the stomach, often mixed with variable recently ingested acidic foods and drinks, passing over the top of the protruded tongue before contacting the palatal aspects of the upper teeth, thereby eroding the upper front teeth primarily. The lower anterior teeth are usually protected by the various protruded movements of the tongue lying on top of them during the violent expulsion of the stomach contents.
Pragmatic direct resin composite bonding is a clinically proven, effective, and efficient approach for managing various problems, including tooth surface loss (TSL).3–5
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