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Efficient prosthodontic treatment in a young patient with long-standing bulimia nervosa: A clinical report
Efficient prosthodontic treatment in a young patient with long-standing bulimia nervosa: A clinical report Stefanie Schwarz, Dr med dent,a Alexander Kreuter,b and Peter Rammelsberg, Prof Dr med dentc University of Heidelberg, Heidelberg, Germany Time-saving, efficient dental treatment is essential for patients in poor dental condition. This clinical report describes a systematic technique for restoration of the visibly-destroyed dentition of a long-term bulimia nervosa patient, including occlusal vertical dimension increase, with composite resin core foundations and prosthetic rehabilitation with ceramic crowns, in only a few treatment sessions. The efficiency of this procedure is gained from composite resin core restorations that establish the new occlusal vertical dimension (OVD) and replace and form the foundation for the subsequent crown preparation. (J Prosthet Dent 2011;106:6-11) The term ‘eating disorder’ includes bulimia nervosa and anorexia nervosa, and is defined as a persistent disturbance of eating behavior or behavior intended to control weight, which significantly impairs physical health or psychosocial functioning.1 Eating disorders are potentially life-threatening, and their relatively poor prognosis has not improved in recent decades. Although some patients improve symptomatically over time, a substantial proportion continues to have body-image disturbances, disordered eating, and other psychiatric difficulties.2-4 Oral manifestations of eating disorders are a concern.5 The greatest impact on the oral cavity results from the presence of stomach acids in the mouth, caused by chronic and frequent self-induced vomiting. Typical orodental findings associated with bulimia nervosa or anorexia nervosa are dental erosion,6,7 caries,6 and parotid gland hypertrophy.8 It is known that relatively few patients with eating disorders seek treatment,9 so the dentist who is aware of the signs and characteristic presentation of eating disorders may be the first health professional to detect an undiagnosed patient.10 Nevertheless, even when
the disease is known, treatment of the dental findings is often a challenge to the dentist because of its complexity. This is especially true in situations of long-term eating disorders of the purging type with extensive lesions of all teeth, especially those in the maxilla. Furthermore, the general condition of affected patients is reduced in many situations, so that long-standing treatment sessions can place a strain both on medical staff performing the treatment and on the patient. Depending on the extent of the lesions, different therapeutic options are possible. Limited erosion and caries can be treated by placement of composite resin restorations. Rinsing the mouth with a neutral fluoride and brushing regularly with a high fluoride concentration gel is recommended.5 For extensive lesions with subgingival loss of substance, however, composite resin restorations may no longer be an adequate therapeutic option. Foundations and prosthetic treatment with crowns, veneers, or onlays to restore the dentition may then be indicated. For these options it has been suggested starting, preferably, only when the patient’s eating disorder is under control 11 or, at least, not
before a thorough period of evaluation has been completed.12,13 This clinical report describes a systematic technique for restoration of the visibly destroyed dentition of a long-term bulimia nervosa patient. This technique, performed in just a few clinical sessions, used composite resin foundations to create an occlusal vertical dimension (OVD) increase followed by prosthetic rehabilitation with ceramic crowns. The efficiency of this procedure is gained from composite resin restorations, which simulate planned OVD and replace lost tooth structure, yet are also the basis of the later prosthetic treatment.
CLINICAL REPORT In 2010, a 26-year-old female patient was hospitalized for 5 months at the Medical Clinic of the University of Heidelberg, Department for Psychosomatics, because of her long-term bulimia nervosa. Her general condition had worsened, so ambulant treatment was no longer adequate. At the time of inpatient admission, she had a weight of only 33.8 kg for a body height of 169 cm. During her stay she was referred by the ward physician to
Assistant Professor, Department of Prosthodontics. Dental Technician, Zahntechnik Alexander Kreuter (ZAK), Weilbach, Germany. c Director, Department of Prosthodontics. a
b
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July 2011
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E 1 Pretreatment dentition. A, Frontal view. B, Right side. C, Left side. D, Maxillary view. E, Mandibular view. the Department for Prosthodontics of the Dental School of the University of Heidelberg, because of marked pain in the region of the left and right maxillary posterior teeth, with particular sensitivity to hot and cold during food intake. Furthermore, the patient desired rehabilitation of her teeth. The clinical examination showed visible destruction of all maxillary teeth; loss of tooth structure from the palatal cusps was particularly prevalent, and extended to the gingiva. The
Schwarz et al
pulp chambers of the anterior teeth were extensively penetrated by caries. The carious lesions of the posterior teeth were smaller, with pinpoint pulpal exposures. The loss of tooth structure in the mandible was less pronounced and affected the occlusal, cervical, and lingual areas. The vitality test was negative for the anterior teeth, but positive for all others. Periodontal screening resulted in no pathological findings; the probing depths were 2 to 3 mm in general, the
Periodontal Screening Index (PSI) was 0 in all sextants, and there were no furcation involvement. The patient’s oral hygiene was good. She had no signs or symptoms of temporomandibular disorders, although it was apparent from injuries to the palatal soft tissues from the mandibular incisors that the occlusal vertical dimension was reduced (Fig.1). The patient requested that the restorations be modeled similarly to her original tooth contours, and there-
8
Volume 106 Issue 1
A
B
C
D
E
F
G 2 A, Maxillary posterior teeth marked with caries detector. B, Provisional restoration of posterior teeth after removal of hard splint. C, Restoration of posterior teeth with foundations resulting in anterior open occlusion, preserving sufficient space for restoration of incisors. D, Anterior teeth after endodontic therapy and removal of caries. E, Foundation restorations placed on anterior teeth. F, Composite resin foundations (right side). G, Composite resin foundations (left side).
The Journal of Prosthetic Dentistry
Schwarz et al
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July 2011
A
B
C 3 A, Cast of prepared anterior teeth. B, Anterior ceramic crowns on cast. C, Posterior ceramic crowns on cast. fore, provided photographs of her smile before the tooth destruction. The smaller defects of the mandibular teeth could have been restored with inlays and partial veneer crowns or direct composite resin restorations. Direct composite resin restorations were chosen considering the patient’s age and the need to reduce the cost of treatment. For the extensive lesions in the maxilla, however, direct restorative treatment was not an adequate therapeutic option. Foundations and prosthetic treatment with crowns to restore the occlusion and to long-term secure the dentition from possible self-induced vomiting were indicated. Metal-free crowns were planned for esthetic reasons. The treatment plan first included diagnostic impressions and mounted casts, and a diagnostic waxing for the maxilla. The dental technician fabricated a hard splint (Erkodur 2 mm; Erkodent, Pfalzgrafenweiler, Germany) on the duplicated cast of the
Schwarz et al
waxing, which served as an index for adhesive restorations. The index enabled the wax to be transferred to the patient and develop the new contours clinically. Another resilient splint (Ercolen 1 mm; Erkodent) was made for the latter, chairside fabrication of the provisional restorations to protect the abutment teeth after preparation. The pulp chambers of the anterior teeth were extensively penetrated by caries, so endodontic treatment after removal of the carious lesions was necessary. All teeth were obturated by cold lateral condensation. The carious lesions in the posterior teeth were marked by a caries detector (Voco GmbH, Cuxhaven, Germany) and then removed by mechanical excavation with a slow-speed bur (H1SE, Komet; Gebr Brasseler GmbH, Lemgo, Germany). Sterile cotton pellets soaked in 0.1% chlorhexidine solution (GlaxoSmithKline Consumer Healthcare GmbH, Bühl, Germany) were then placed on the exposed pulp.
Mineral trioxide aggregate (MTA) cement (ProRoot MTA; DentsplyMaillefer, Ballaigues, Switzerland) was applied to the area of exposed pulp in small portions and then carefully compressed into the pulp wounds. Thereafter, the MTA was covered with a thin protective layer of resinmodified glass ionomer cement (Vitrebond; 3M ESPE, St Paul, Minn), to ensure that the capping material was not removed during subsequent treatment. The cavities of the posterior teeth were then immediately and systematically restored with composite resin foundations using the hard splint. The bonding surfaces of the teeth were, therefore, cleaned and roughened with abrasive disks (SofLex Contouring and Polishing Discs; 3M ESPE GmbH, Neuss, Germany). Because of the palatal gingival loss of substance, it was not possible to apply a rubber dam. To ensure optimum adhesive bonding, a 3-step adhesive system, which included etching
10
Volume 106 Issue 1 with phosphoric acid (Ultraetch; UP Dental GmbH, Cologne, Germany) and separate applications of primer and adhesive (Optibond FL; Kerr, Orange, Calif ), was used. The foundations (Rebilda DC; Voco GmbH) were then placed side-ways using the hard splint as a mold. The splint was placed precisely on the palate and the vestibule to ensure its exact position. On completion of the restorations, the occlusion was monitored and the foundations were separated and pol-
ished with abrasive discs (3M ESPE GmbH) and silicone polishers (9608 and 9618, Komet; Gebr. Brasseler GmbH). The defects of the mandibular teeth were restored with direct composite resin restorations (Fig. 2). After 3 months without any pain or functional problems, and consultation with the treating physician, prosthetic treatment followed. Reevaluation of the pretreatment resulted in no further need for operative or endodontic therapy; vitality test-
ing was positive for all teeth without root canal treatment, and no tooth was sensitive on percussion. The general condition of the patient was also improved with a weight gain of 20 kg and a successful period of observation and evaluation. For esthetic reasons, 14 lithium disilicate ceramic crowns (IPS e.maxPress; Ivoclar Vivadent GmbH, Ellwangen, Germany) were planned for the maxilla. The posterior teeth, except for the second molars left and right, were treated first
A
B
C
D
E 4 Post treatment dentition. A, Right side. B, Left side. C, Frontal. D, Maxillary view, E, Close-up of patient smile.
The Journal of Prosthetic Dentistry
Schwarz et al
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July 2011 to retain the newly established occlusal vertical dimension for the restorations. Treatment of the second molars and the anterior teeth followed (Fig. 3). The composite resin foundations were prepared incorporating a ferrule of at least 2 mm. Provisional restorations made of bisacrylate composite resin (Luxatemp-Solar; DMG, Hamburg, Germany) were then fabricated chairside using the resilient splint to protect the prepared teeth. All impressions were made with polyether (Impregum Penta DuoSoft HB; 3M ESPE GmbH ; Permadyne Penta L; 3M ESPE GmbH), 1 week after tooth preparation. After monitoring the fit, all crowns were luted using self-adhesive resin cement (RelyXUnicem, 3M ESPE) (Fig. 4). The treatment sessions ended with a final evaluation of the occlusion, and oral hygiene instructions and techniques. In the follow-up period of 6 months no complications occurred.
SUMMARY Time-saving, efficient dental treatment is essential for patients with a generalized poor dentition. This clinical report described a systematic technique with composite resin foundations, using a hard splint as an index, for restoration of the occlusal vertical dimension and loss of tooth structure in the dentition of a young
patient. The primary advantage of this procedure is the rapid restoration of the form, size, and occlusion of the teeth in 2 treatment sessions. Another advantage is that the foundations function as the provisional restorations, to evaluate the new occlusal vertical dimension, and as the basis of the prosthetic treatment, because they are prepared starting from anotomical tooth contour. Prosthetic treatment with 14 lithium disilicate ceramic single crowns after a period of functional and esthetic evaluation completed the process of rehabilitation for the patient.
REFERENCES 1. Fairburn CG, Walsh BT. Atypical eating disorders (eating disorder not otherwise specified). In: Fairburn CG, Brownell KD, eds. Eating Disorders and Obesity: A Comprehensive Handbook. London: The Guilford Press;2002:171-7. 2. Steinhausen HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 2002; 159: 1284-93. 3. Herzog DB, Nussbaum KM, Marmor AK. Comorbidity and outcome in eating disorders. Psychiatr Clin North Am 1996;19:843-59. 4. Herpertz-Dahlmann B, Müller B, Herpertz S, Heussen N, Hebebrand J, Remschmidt H. Prospective 10-year follow-up in adolescent anorexia nervosa-course, outcome, psychiatric comorbidity, and psychosocial adaptation. J Child Psychol Psychiatry 2001;42:603-12. 5. de Moor RJ. Eating disorder-induced dental complications: a case report. J Oral Rehabil 2004;31:725-32.
6. Wolcott RB, Yager J, Gordon G. Dental sequelae to the binge-purge syndrome (bulimia): report of cases. J Am Dent Assoc 1984;109:723-25. 7. Ruff JC, Koch MO, Perkins S. Bulimia: dentomedical complications. Gen Dent 1992;40:22-5. 8. Mandel L, Kaynar A. Bulimia and parotid swelling: a review and case report. J Oral Maxillofac Surg 1992;50:1122-5. 9. Bulik CM, Sullivan PF, Kendler KS. An empirical study of the classification of eating disorders. Am J Psychiatry 2000;157:886-95. 10.Milosevic A. Eating disorders and the dentist. Br Dent J 1999;186:109-13. 11.Shaw L, Smith AJ. Dental erosion--the problem and some practical solutions. Br Dent J 1999;186:115-18. 12.Cowan RD, Sabates CR, Gross KB, Elledge DA. Integrating dental and medical care for the chronic bulimia nervosa patient: a case report. Quintessence Int 1991;22:553-7. 13.Bidwell HL, Dent CD, Sharp JG. Bulimiainduced dental erosion in a male patient. Quintessence Int 1999;30:135-8. Corresponding author: Dr Stefanie Schwarz Department of Prosthodontics University of Heidelberg Im Neuenheimer Feld 400 69120 Heidelberg GERMANY Fax: +49-06221-565371 E-mail: [email protected] Acknowledgments The authors thank Ian Davies, copy editor, for language revision. Copyright © 2011 by the Editorial Council for The Journal of Prosthetic Dentistry.
Availability of Journal Back Issues As a service to our subscribers, copies of back issues of The Journal of Prosthetic Dentistry for the preceding 5 years are maintained and are available for purchase from Elsevier, Inc until inventory is depleted. Please write to Elsevier, Inc, Subscription Customer Service, 6277 Sea Harbor Dr, Orlando, FL 32887, or call 800-654-2452 or 407-345-4000 for information on availability of particular issues and prices.
Schwarz et al
the disease is known, treatment of the dental findings is often a challenge to the dentist because of its complexity. This is especially true in situations of long-term eating disorders of the purging type with extensive lesions of all teeth, especially those in the maxilla. Furthermore, the general condition of affected patients is reduced in many situations, so that long-standing treatment sessions can place a strain both on medical staff performing the treatment and on the patient. Depending on the extent of the lesions, different therapeutic options are possible. Limited erosion and caries can be treated by placement of composite resin restorations. Rinsing the mouth with a neutral fluoride and brushing regularly with a high fluoride concentration gel is recommended.5 For extensive lesions with subgingival loss of substance, however, composite resin restorations may no longer be an adequate therapeutic option. Foundations and prosthetic treatment with crowns, veneers, or onlays to restore the dentition may then be indicated. For these options it has been suggested starting, preferably, only when the patient’s eating disorder is under control 11 or, at least, not
before a thorough period of evaluation has been completed.12,13 This clinical report describes a systematic technique for restoration of the visibly destroyed dentition of a long-term bulimia nervosa patient. This technique, performed in just a few clinical sessions, used composite resin foundations to create an occlusal vertical dimension (OVD) increase followed by prosthetic rehabilitation with ceramic crowns. The efficiency of this procedure is gained from composite resin restorations, which simulate planned OVD and replace lost tooth structure, yet are also the basis of the later prosthetic treatment.
CLINICAL REPORT In 2010, a 26-year-old female patient was hospitalized for 5 months at the Medical Clinic of the University of Heidelberg, Department for Psychosomatics, because of her long-term bulimia nervosa. Her general condition had worsened, so ambulant treatment was no longer adequate. At the time of inpatient admission, she had a weight of only 33.8 kg for a body height of 169 cm. During her stay she was referred by the ward physician to
Assistant Professor, Department of Prosthodontics. Dental Technician, Zahntechnik Alexander Kreuter (ZAK), Weilbach, Germany. c Director, Department of Prosthodontics. a
b
The Journal of Prosthetic Dentistry
Schwarz et al
7
July 2011
A
B
C
D
E 1 Pretreatment dentition. A, Frontal view. B, Right side. C, Left side. D, Maxillary view. E, Mandibular view. the Department for Prosthodontics of the Dental School of the University of Heidelberg, because of marked pain in the region of the left and right maxillary posterior teeth, with particular sensitivity to hot and cold during food intake. Furthermore, the patient desired rehabilitation of her teeth. The clinical examination showed visible destruction of all maxillary teeth; loss of tooth structure from the palatal cusps was particularly prevalent, and extended to the gingiva. The
Schwarz et al
pulp chambers of the anterior teeth were extensively penetrated by caries. The carious lesions of the posterior teeth were smaller, with pinpoint pulpal exposures. The loss of tooth structure in the mandible was less pronounced and affected the occlusal, cervical, and lingual areas. The vitality test was negative for the anterior teeth, but positive for all others. Periodontal screening resulted in no pathological findings; the probing depths were 2 to 3 mm in general, the
Periodontal Screening Index (PSI) was 0 in all sextants, and there were no furcation involvement. The patient’s oral hygiene was good. She had no signs or symptoms of temporomandibular disorders, although it was apparent from injuries to the palatal soft tissues from the mandibular incisors that the occlusal vertical dimension was reduced (Fig.1). The patient requested that the restorations be modeled similarly to her original tooth contours, and there-
8
Volume 106 Issue 1
A
B
C
D
E
F
G 2 A, Maxillary posterior teeth marked with caries detector. B, Provisional restoration of posterior teeth after removal of hard splint. C, Restoration of posterior teeth with foundations resulting in anterior open occlusion, preserving sufficient space for restoration of incisors. D, Anterior teeth after endodontic therapy and removal of caries. E, Foundation restorations placed on anterior teeth. F, Composite resin foundations (right side). G, Composite resin foundations (left side).
The Journal of Prosthetic Dentistry
Schwarz et al
9
July 2011
A
B
C 3 A, Cast of prepared anterior teeth. B, Anterior ceramic crowns on cast. C, Posterior ceramic crowns on cast. fore, provided photographs of her smile before the tooth destruction. The smaller defects of the mandibular teeth could have been restored with inlays and partial veneer crowns or direct composite resin restorations. Direct composite resin restorations were chosen considering the patient’s age and the need to reduce the cost of treatment. For the extensive lesions in the maxilla, however, direct restorative treatment was not an adequate therapeutic option. Foundations and prosthetic treatment with crowns to restore the occlusion and to long-term secure the dentition from possible self-induced vomiting were indicated. Metal-free crowns were planned for esthetic reasons. The treatment plan first included diagnostic impressions and mounted casts, and a diagnostic waxing for the maxilla. The dental technician fabricated a hard splint (Erkodur 2 mm; Erkodent, Pfalzgrafenweiler, Germany) on the duplicated cast of the
Schwarz et al
waxing, which served as an index for adhesive restorations. The index enabled the wax to be transferred to the patient and develop the new contours clinically. Another resilient splint (Ercolen 1 mm; Erkodent) was made for the latter, chairside fabrication of the provisional restorations to protect the abutment teeth after preparation. The pulp chambers of the anterior teeth were extensively penetrated by caries, so endodontic treatment after removal of the carious lesions was necessary. All teeth were obturated by cold lateral condensation. The carious lesions in the posterior teeth were marked by a caries detector (Voco GmbH, Cuxhaven, Germany) and then removed by mechanical excavation with a slow-speed bur (H1SE, Komet; Gebr Brasseler GmbH, Lemgo, Germany). Sterile cotton pellets soaked in 0.1% chlorhexidine solution (GlaxoSmithKline Consumer Healthcare GmbH, Bühl, Germany) were then placed on the exposed pulp.
Mineral trioxide aggregate (MTA) cement (ProRoot MTA; DentsplyMaillefer, Ballaigues, Switzerland) was applied to the area of exposed pulp in small portions and then carefully compressed into the pulp wounds. Thereafter, the MTA was covered with a thin protective layer of resinmodified glass ionomer cement (Vitrebond; 3M ESPE, St Paul, Minn), to ensure that the capping material was not removed during subsequent treatment. The cavities of the posterior teeth were then immediately and systematically restored with composite resin foundations using the hard splint. The bonding surfaces of the teeth were, therefore, cleaned and roughened with abrasive disks (SofLex Contouring and Polishing Discs; 3M ESPE GmbH, Neuss, Germany). Because of the palatal gingival loss of substance, it was not possible to apply a rubber dam. To ensure optimum adhesive bonding, a 3-step adhesive system, which included etching
10
Volume 106 Issue 1 with phosphoric acid (Ultraetch; UP Dental GmbH, Cologne, Germany) and separate applications of primer and adhesive (Optibond FL; Kerr, Orange, Calif ), was used. The foundations (Rebilda DC; Voco GmbH) were then placed side-ways using the hard splint as a mold. The splint was placed precisely on the palate and the vestibule to ensure its exact position. On completion of the restorations, the occlusion was monitored and the foundations were separated and pol-
ished with abrasive discs (3M ESPE GmbH) and silicone polishers (9608 and 9618, Komet; Gebr. Brasseler GmbH). The defects of the mandibular teeth were restored with direct composite resin restorations (Fig. 2). After 3 months without any pain or functional problems, and consultation with the treating physician, prosthetic treatment followed. Reevaluation of the pretreatment resulted in no further need for operative or endodontic therapy; vitality test-
ing was positive for all teeth without root canal treatment, and no tooth was sensitive on percussion. The general condition of the patient was also improved with a weight gain of 20 kg and a successful period of observation and evaluation. For esthetic reasons, 14 lithium disilicate ceramic crowns (IPS e.maxPress; Ivoclar Vivadent GmbH, Ellwangen, Germany) were planned for the maxilla. The posterior teeth, except for the second molars left and right, were treated first
A
B
C
D
E 4 Post treatment dentition. A, Right side. B, Left side. C, Frontal. D, Maxillary view, E, Close-up of patient smile.
The Journal of Prosthetic Dentistry
Schwarz et al
11
July 2011 to retain the newly established occlusal vertical dimension for the restorations. Treatment of the second molars and the anterior teeth followed (Fig. 3). The composite resin foundations were prepared incorporating a ferrule of at least 2 mm. Provisional restorations made of bisacrylate composite resin (Luxatemp-Solar; DMG, Hamburg, Germany) were then fabricated chairside using the resilient splint to protect the prepared teeth. All impressions were made with polyether (Impregum Penta DuoSoft HB; 3M ESPE GmbH ; Permadyne Penta L; 3M ESPE GmbH), 1 week after tooth preparation. After monitoring the fit, all crowns were luted using self-adhesive resin cement (RelyXUnicem, 3M ESPE) (Fig. 4). The treatment sessions ended with a final evaluation of the occlusion, and oral hygiene instructions and techniques. In the follow-up period of 6 months no complications occurred.
SUMMARY Time-saving, efficient dental treatment is essential for patients with a generalized poor dentition. This clinical report described a systematic technique with composite resin foundations, using a hard splint as an index, for restoration of the occlusal vertical dimension and loss of tooth structure in the dentition of a young
patient. The primary advantage of this procedure is the rapid restoration of the form, size, and occlusion of the teeth in 2 treatment sessions. Another advantage is that the foundations function as the provisional restorations, to evaluate the new occlusal vertical dimension, and as the basis of the prosthetic treatment, because they are prepared starting from anotomical tooth contour. Prosthetic treatment with 14 lithium disilicate ceramic single crowns after a period of functional and esthetic evaluation completed the process of rehabilitation for the patient.
REFERENCES 1. Fairburn CG, Walsh BT. Atypical eating disorders (eating disorder not otherwise specified). In: Fairburn CG, Brownell KD, eds. Eating Disorders and Obesity: A Comprehensive Handbook. London: The Guilford Press;2002:171-7. 2. Steinhausen HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 2002; 159: 1284-93. 3. Herzog DB, Nussbaum KM, Marmor AK. Comorbidity and outcome in eating disorders. Psychiatr Clin North Am 1996;19:843-59. 4. Herpertz-Dahlmann B, Müller B, Herpertz S, Heussen N, Hebebrand J, Remschmidt H. Prospective 10-year follow-up in adolescent anorexia nervosa-course, outcome, psychiatric comorbidity, and psychosocial adaptation. J Child Psychol Psychiatry 2001;42:603-12. 5. de Moor RJ. Eating disorder-induced dental complications: a case report. J Oral Rehabil 2004;31:725-32.
6. Wolcott RB, Yager J, Gordon G. Dental sequelae to the binge-purge syndrome (bulimia): report of cases. J Am Dent Assoc 1984;109:723-25. 7. Ruff JC, Koch MO, Perkins S. Bulimia: dentomedical complications. Gen Dent 1992;40:22-5. 8. Mandel L, Kaynar A. Bulimia and parotid swelling: a review and case report. J Oral Maxillofac Surg 1992;50:1122-5. 9. Bulik CM, Sullivan PF, Kendler KS. An empirical study of the classification of eating disorders. Am J Psychiatry 2000;157:886-95. 10.Milosevic A. Eating disorders and the dentist. Br Dent J 1999;186:109-13. 11.Shaw L, Smith AJ. Dental erosion--the problem and some practical solutions. Br Dent J 1999;186:115-18. 12.Cowan RD, Sabates CR, Gross KB, Elledge DA. Integrating dental and medical care for the chronic bulimia nervosa patient: a case report. Quintessence Int 1991;22:553-7. 13.Bidwell HL, Dent CD, Sharp JG. Bulimiainduced dental erosion in a male patient. Quintessence Int 1999;30:135-8. Corresponding author: Dr Stefanie Schwarz Department of Prosthodontics University of Heidelberg Im Neuenheimer Feld 400 69120 Heidelberg GERMANY Fax: +49-06221-565371 E-mail: [email protected] Acknowledgments The authors thank Ian Davies, copy editor, for language revision. Copyright © 2011 by the Editorial Council for The Journal of Prosthetic Dentistry.
Availability of Journal Back Issues As a service to our subscribers, copies of back issues of The Journal of Prosthetic Dentistry for the preceding 5 years are maintained and are available for purchase from Elsevier, Inc until inventory is depleted. Please write to Elsevier, Inc, Subscription Customer Service, 6277 Sea Harbor Dr, Orlando, FL 32887, or call 800-654-2452 or 407-345-4000 for information on availability of particular issues and prices.
Schwarz et al