title: The role of third molar surgery in the exacerbation of eating disorders.
abstract: OBJECTIVE
  Eating disorders are a major public health problem. This study was undertaken to investigate the role of dental surgery in the etiology and clinical course of these serious and occasionally life-threatening disorders.
  
  
  METHODS
  Three questions concerning dental therapy were included in a pretreatment assessment of 97 consecutive patients entering an eating disorder therapy program during a 22-month period. These questions were designed to determine the influence of dental surgery, including frequency and severity, on eating disorders.
  
  
  RESULTS
  All 97 patients, of which 96 were female, complied with the questionnaire. Seventy-five of 97 were 25 years or younger, and 53 of 97 were diagnosed as having anorexia nervosa. Sixteen patients (16.5%) reported having had orthodontic therapy, and 21 (21.6%) had undergone third molar surgery. Nine patients (9.3%) (1 orthodontic, 8 third molar surgery) indicated that dental procedures had caused exacerbation or relapse of their eating disorders; 8 of 21 (38%) who had undergone third molar surgery were positive respondents. None of the patients linked dental care to the initial onset of their eating disorders.
  
  
  CONCLUSIONS
  These data reveal that dental procedures, specifically third molar surgery, can significantly alter the course of eating disorders, causing exacerbation or relapse. No patient indicated that dental therapy was the primary cause of these multifactorial psychonutritional disorders. A history of eating disorder should alert the practitioner to the risks of performing third molar surgery without a medical or psychotherapy consultation unless there is documentation of remission. Delay of surgical intervention is recommended if third molars are asymptomatic. If surgery is necessary, the surgeon and other members of the psychotherapy team should establish clear guidelines regarding behavior and postoperative nutrition and should monitor the patient's nutritional status.
authors.affiliation: Department of Psychiatry, University of Connecticut, Hartford Hospital, Hartford, CT, USA.
authors.forename: M
authors.initials: M
authors.lastname: Maine
authors.forename: M H
authors.initials: MH
authors.lastname: Goldberg
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D018450:Disease Progression; D001068:Feeding and Eating Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery*; D012008:Recurrence; D014081:Tooth Extraction / Q000009:adverse effects* / Q000523:psychology*