Hello,

I am looking for feedback and advice on how to approach this case. This is my first post so please let me know any additional info you would like :)

The patient is a 39 yr. old female who has been with the practice for about 10 years, I have been seeing her for about 4 years now. She present with a dentition that I would consider textbook for bulimia. She has denied any history of bulimia over the years. I have asked her and the hygienist has talked with her about it. She denies any reflux symptoms. Recently, she has become very concerned with the appearance of her teeth and wants to "fix her front teeth." We took photos and mounted study models. I told her that I have concerns with the rate of breakdown and I wanted to reach out to her physician to see if there is any medical condition they are aware of that may be contributed to her severe erosion. Pt was ok with me reaching out. I told her physician my findings and sent the intraoral photos so she could see exactly what I am concerned with. The physician was not aware of any conditions but sent patient for endoscopy which came back negative for GERD. Pt also denies bulimia with her physician. Pt is returning in a few weeks for a consult but I am unsure how to proceed. Full coverage restorations with subgingival margins? Something more conservative? I am concerned about longevity of restorations. Thoughts? Also of note, pt has been wearing an occlusal gaurd for the approx 3 years.

Thanks!

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