Bulimia nervosa and its consequences on dental tissue

Uvod: Bulimija nervoza je motnja hranjenja, pri kateri oseba v zelo kratkem času zaužije ogromne količine hrane, nato sledijo občutki krivde zaradi zaužite hrane, nakar poskušajo to hrano izločiti z bruhanjem ali jemanjem odvajal. Ena izmed posledic bulimije nervoze je erozija zobne sklenine zaradi pogostega bruhanja, pri katerem želodčna kislina pride v stik z zobmi. Z razvojem keramičnih in kompozitnih materialov ter adhezivov je zobno erozijo mogoče oskrbeti. Namen: Namen diplomskega dela je predstaviti značilnosti bulimije nervoze, njene negativne posledice na zobna tkiva, preprečevanje le-teh (z zaščitno folijo) in oskrbo poškodovanih zob. Za prikaz obstojnosti različnih materialov v primerjavi z zobnimi tkivi, smo izdelke in zob izpostavili klorovodikovi kislini katere pH je bil 1,8 ter opazovali spremembe na njih v obdobju 14ih dneh. Spremembe na izdelkih smo opazovali s svetlobnim mikroskopom pri povečavi 25x. Z elektronskim mikroskopom smo opazovali strukturo površine glaziranega izdelka in dokončno spoliranega. Hipoteza 1: Zaščitna folija iz plastičnega materiala je najbolj občutljiva na delovanje klorovodikove kisline, cirkonij pa najmanj. Hipoteza 2: Glazura na cirkonijevi in litijevi disilikatni keramiki ter kompozitni luski vpliva na obstojnost površine nadomestkov. Metode dela: Za teoretični del smo uporabili deskriptivno metodo dela s kritičnim pregledom strokovne in znanstvene literature v fizični obliki (knjige pridobljene v mestni knjižnici Ljubljana, članki v revijah – Zobozdravstveni vestnik pridobljen na Zdravstveni fakulteti…), spletnih brskalnikih in strokovnih bazah (Google, Google učenjak, PubMed, ScienceDirect, MEDLINE). Za raziskovalni del diplomske naloge smo uporabili eksperimentalno – kavzalno metodo, kjer smo s svetlobnim mikroskopom pri povečavi 25x ter vrstičnim elektronskim mikroskopom ugotavljali spremembe na površini nadomestkov iz različnih materialov, izpostavljenih 14 dni klorovodikovi kislini pri pH 1,8. Rezultati: Na izdelanih palatinalnih luskah iz cirkonijeve oksidne in litijeve disilikatne keramike ter kompozita in zaščitni foliji ni bilo vidnih znakov razlike pred poskusom in po. Zdrav človeški zob je kislina razžrla v roku 24ur. Razprava in zaključek: Pri majhnih lezijah obsega zdravljenje premazovanje lezij s fluoridi, pri velikih erozijah naredimo plombe, pri zelo obsežnih pa obnavljamo zobe izključno z uporabo aditivnega lepila, fasetami, onleji in prevlekami. Cirkonijeva oksidna keramika ima najvišjo trdnost, izjemne estetske lastnosti ter zelo dobro biokompatibilnost. Litijeva disilikatna keramika ima manjšo trdnost, vendar prav tako zelo dobre estetske lastnosti in biokompatibilnost, medtem ko so ključne lastnosti kompozita, njegova nizka abrazivnost antagonističnih zob ter nizek elastični modul kateri omogoča večjo absorpcijo napetosti. Prav zaradi tega je kompozitni material veliko bolj priporočljiv pri rekonstrukciji erozivnega zoba kot keramika.Introduction: Bulimia nervosa is an eating disorder in which a person consumes huge amounts of food in a very short period of time, followed by feelings of guilt over the ingested food, to which they try to eliminate this food by vomiting or taking laxatives. One of the consequences of bulimia nervosa is erosion of the tooth enamel due to frequent vomiting in which the stomach acid comes in contact with the teeth. With the development of ceramic and composite materials and adhesives, dental erosion can be managed. Purpose: The purpose of the diploma thesis is to present the characteristics of bulimia nervosa, its negative effects on dental tissues, prevention of them (with protective film) and care of damaged teeth. To demonstrate the persistence of different materials in comparison to dental tissues, dental substitutes and a tooth were exposed to hydrochloric acid wich pH was 1,8 and observed changes on them over a 14-day period. Changes on the substitutes were observed with a light microscope at magnification 25x. An electron microscope was used to observe the structure of the surface of the glazed scale and finally polished. Hypothesis 1: The protective film from a plastic material is most sensitive to hydrochloric acid and zirconium oxide ceramics the least. Hypothesis 2: Glazing on zirconium and lithium disilicate ceramics and composite substitutes affect the stability of the substitute surface. Methods: For the theoretical part, we used a descriptive method of working with a critical review of the professional and scientific literature in physical form (books obtained at the Ljubljana City Library, journal articles - Dental Journal acquired at the Faculty of Health…), web browsers and professional bases (Google, Google Scholar, PubMed, ScienceDirect, MEDLINE). For the research part of the thesis we used the experimental - causal method, where by using a light microscope at 25x magnification and an electron microscope we determined changes on the surface of substitutes made of different materials, exposed for 14 days with hydrochloric acid at pH 1.8. Results: There were no visible differences in the palatinal substitutes and the protective film produced before and after the experiment. A healthy human tooth was burned with acid within 24 hours. Discussion and conclusion: For small lesions, treatment involves coating lesions with fluoride, for large erosive lesions fillings are made and for very large lesions, restoration is performed exclusively with the use of additive adhesive, veneers, onlays and coatings. Zirconium oxide ceramics have the highest strength, outstanding aesthetic properties and very good biocompatibility. Lithium disilicate ceramics have lower strength, but also very good aesthetic properties and biocompatibility, while the key properties of the composite are its low abrasiveness of antagonistic teeth and its low elastic modul which allows greater absorption of tension. This is why composite material is much more recommended in the reconstruction of erosive tooth than ceramic