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Bulimia Dental Management — ORE Part 1 MCQ

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HardRestorative DentistryBulimia Dental ManagementORE Part 1

A 22-year-old patient with bulimia nervosa presents with severe palatal erosive tooth wear affecting the maxillary anterior teeth. The palatal enamel is almost completely lost and dentine is widely exposed. The patient reports ongoing self-induced vomiting and is not currently engaged with an eating-disorder service. What is the most appropriate overall management approach?

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Correct answer: B — Discuss the condition empathetically, arrange appropriate medical signposting, institute preventive stabilisation and postpone definitive rehabilitation

**A is correct.** Ongoing vomiting creates continuing intrinsic acid exposure, so care should be empathetic and non-judgemental, with appropriate signposting to the GP/eating-disorder service. Dental management should immediately stabilise disease—for example, preventive advice after vomiting, fluoride-based prevention, sensitivity control and minimally invasive interim care where needed—while avoiding irreversible definitive rehabilitation until the disease process and prognosis are more stable. **B** risks failure of extensive restorations during ongoing erosion. **C** includes prevention but uses an inappropriate, confrontational approach and does not facilitate access to eating-disorder care. **D** does not address self-induced vomiting or provide the required multidisciplinary pathway; a PPI is not routine dental management for bulimia. **E** is wrong because dental prevention and supportive care must not be withheld pending recovery.

Reference: Anderson S, Gopi-Firth S. Eating disorders and the role of the dental team. British Dental Journal. 2023;234(6):445-449. https://pubmed.ncbi.nlm.nih.gov/36964374/