EATING DISORDERS

A. CRITERIA FOR ANOREXIA NERVOSAAccording to the latest Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria:

• Refusal to maintain body at or above a minimally normal weight for age and height.

• Intense fear of gaining weight• The central concern of weight and shape in the evaluation of the self, in

addition to a reference to the denial of the serious consequence of weight loss.

• Amenorrhea.

SUBTYPES:• The restrictor type • The binge purger type

B. CRITERIA FOR BULIMIA NERVOSADiagnostic criteria for Bulimia Nervosa:• Recurrent episodes of binge eating . • Recurrent inappropriate compensatory behavior to prevent weight gain.• The binge eating and inappropriate compensatory behaviors both occur,

on average, at least twice a week for 3 months.• Self evaluation is unduly influenced by body shape and weight.• The disturbance does not occur exclusively during episodes of anorexia

nervosa.• SUBTYPES:• Purging• Non purging

C. ORAL MANIFESTATIONS

• Severe erosion of the enamel on the lingual surfaces of the maxillary teeth - cardinal oral

manifestation of eating disorders, due to acids from chronic vomiting.

• Parotid enlargement - as a result of starvation• Mandibular teeth may be affected.• Palatal ulcerations

D. Management

• Refer to other practitioners.• Support of the patient physically, by treatment

of tooth desensitization and esthetics.• Support of the patient psychologically, by

demonstrating a caring and compassionate attitude.

PLASMA CELL NEOPLASIA

• I. DEFINITION • Is a group of related malignant disorders of terminally differentiated B

lymphocytes (plasma cells), of which plasma cell myeloma or multiple myeloma is the most common (90% of cases).

• This condition is characterized by bone marrow multifocal infiltration by malignant plasma cells. There are typically multiple destructive lesions or diffuse demineralization of bone. The tumour cells secrete a homogenous, complete or partial, immunoglobulin molecule, an M component or para protein, most commonly IgG or IgA.

II. ETIOLOGY• Genetic predisposition• Ionizing radiation • Chronic antigenic

III. ORAL MANIFESTATION

• Maxillary or mandibular lesions • Root resorption and loss of lamina dura may

be found.• Amyloid like deposition in the gingiva and

tongue.

IV. DENTAL MANAGEMENT

• Patients are prone to postoperative hemorrhage due to thrombocytopenia.

• Development of dental amyloidosis.• Dental hygiene care should focus on controlling infections

associated with a compromised immune system.• Patients being treated with bisphophonates must be

monitored closely for the development of osteonecrosis of the jaw.

• Educate patient about the necessity of reporting unusual sores or painful areas in the mouth.