Diagnosis of anorexia nervosa and bulimia nervosa is mainly based on self-reports and is complicated because patients, especially those in the initial stages of anorexia and bulimics, present a normal body appearance and have a predisposition to hide their disease and avoid professional help. Dental erosions caused by self-induced vomiting and/or intake of acidic foodstuffs are common in this patient group as well as major salivary gland enlargement. However, dental caries and gingivitis do not seem to be related to anorexia and bulimia per se. Paraclinical findings suggest that Streptococcus sobrinus and other aciduric microorganisms are possible candidate biomarkers of bulimia. Oral dryness, impaired salivary flow and compositional changes including increased activity of the salivary alpha-amylase isoenzymes may qualify as biomarkers of anorexia and bulimia. Additionally, body water, electrolyte- and acid-base disturbances of these patients may be mirrored in saliva.
The dentist may be the first clinician to suspect the presence of an eating disorder, as patients often attend the dental clinic for regular dental checks. Despite clinical signs, diagnosis is often complicated. Although there are no well established pathognomic changes in saliva that relate to anorexia and bulimia there is some evidence to suggest that saliva may play a role in the oral changes observed in eating disorders, or that a number of clinical and laboratory salivary findings may provide biomarkers of these disease entities. Future research will prove if some of these markers could be helpful as screening tools in the dental clinic.
eating disorders, salivary glands, xerostomia, amylase, dental erosion