According to the National Comorbidity Survey Replication, the median age of onset of bulimia is 18 (1), so specific inclusion of oral health research on bulimic patients would be wise. A recent systematic review identified several oral health manifestations of bulimia. In particular, specific patterns of tooth erosion can be the first visible indicators of bulimia, so dentists and hygienists can have a crucial role in detecting this problem and arranging for referral. There is also evidence of increased risk of dental caries, reduced salivary flow, parotid gland enlargement, dry mouth either associated with antidepressants used for treatment or the underlying condition itself and differential behaviors, such as oral health care or dietary habits, compared to patients without bulimia. However, the systematic review points to several evidence gaps in these studies, specifically the need to stratify bulimics based on treatment type and eating disorder type as some studies mix all eating disorder or bulimia types; for longitudinal studies to understand long-term oral health effects; and for research on men who suffer from bulimia.(2) NIDCR should collaborate with the National Institute of Mental Health on this research topic. References 1. Hudson JI, Hiripi E, Pope HG, Jr., Kessler RC. 2007. The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry. 61(3):348-358. 2. Rosten A, Newton T. 2017. The impact of bulimia nervosa on oral health: A review of the literature. Bdj. 223:533.
Comment No. 360