The role of third molar surgery in the exacerbation of eating disorders

Purpose: Eating disorders are a major public health problem. This study was undertaken to investigate the role of dental surgery in the etiology and c linical course of these serious and occasionally life-threatening disorders . Methods: Three questions concerning dental therapy were included in a pretr eatment assessment of 97 consecutive patients entering an eating disorder t herapy program during a 22-month period. These questions were designed to d etermine the influence of dental surgery, including frequency and severity, on eating disorders. Results: All 97 patients, of which 96 were female, complied with the questi onnaire. Seventy-five of 97 were 25 years or younger, and 53 of 97 were dia gnosed 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 disor ders; 8 of 21 (38%) who had undergone third molar surgery were positive res pondents. None of the patients linked dental care to the initial onset of t heir eating disorders. Conclusions: These data reveal that dental procedures, specifically third m olar surgery, can significantly alter the course of eating disorders, causi ng exacerbation or relapse. No patient indicated that dental therapy was th e primary cause of these multifactorial psychonutritional disorders. A hist ory of eating disorder should alert the practitioner to the risks of perfor ming third molar surgery without a medical or psychotherapy consultation un less 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 monit or the patient's nutritional status. (C) 2001 American Association of Oral and Maxillofacial Surgeons.