Eating disorder risk behavior and dental implications among adolescents

Diet Traps during Eating Disorders among Dentate Patients at an Oral Health Glance

Persons suffering from eating disorders (ED) may often experience a recurrence/persistence symptoms despite the completion of psychiatric therapy. In most cases, their general health status is linked to current nutritional behaviors. Medical professionals, general practitioners (GPs), dieticians, and dentists may see those patients in their practices. At the same time, due to low sense of illness, some patients may delay or never seek professional medical care. The aim of this article is to analyze the main ED types according to dietary behaviors causing oral health problems and discuss oral health complications in affected dentate patients. The second objective is to update oral preventive measures and technological innovations together with active agents for oral hygiene care that might effectively support oral health maintenance during the presence of long-term symptoms. The research method involved a review of clinical reports as a synthesis of the electronic research in the Pubmed, Web of Science, and Google Scholar databases. Based on the research, ED patients were found to present related incidences of oral complications. Studies have reported that the possible course of an ED and comorbidities may be an imbalance in the oral environment. The results showed an association between biological (malnutrition, etc.), behavioral (binge eating episodes, vomiting, acidic diet, poor oral hygiene), and pharmacotherapeutic (addiction, hyposalivation) factors that may threaten oral health. Early diagnosis of the past and present symptoms is essential to eliminate and take control of destructive behaviors. Oral changes need to be tackled with medical insight, and additionally, the perception of dietary interactions is recommended.

Eating Disorders and Dental Erosion: A Systematic Review

Both eating disorders and dental erosion are increasingly affecting adolescents and young adults. Thus, our systematic review was designed to answer the question: "Is there a relationship between dental erosion and eating disorders?" Following the inclusion and exclusion criteria, 31 studies were included in this systematic review (according to the PRISMA statement guidelines). Based on the meta-analysis, 54.4% of patients with bulimia nervosa and 26.7% with anorexia nervosa experienced tooth erosion. For the whole group of 1699 patients with eating disorders, erosive lesions were observed in 42.1% of patients. Bulimics were more than 10 times more likely to experience dental erosion compared to healthy individuals (OR = 10.383 [95%CI: 4.882-22.086]). Similarly, more than 16 times increased odds of tooth erosion were found in patients with self-induced vomiting (OR = 16.176 [95%CI: 1.438-181.918]). In conclusion, eating disorders are associated with an increased risk of developing erosive lesions, especially in patients with bulimia nervosa.

Eating disorders and oral health: a scoping review

BACKGROUND

Screening and treatment guidance for somatic sequalae of eating disorders typically include specifics such as laboratory testing, observable physical signs, and treatment interventions. Oral health guidance is notably sparse or absent from many guidelines. Often, the only mention of oral health is the potential erosion caused by self-induced vomiting and suggests a referral to an oral health professional. The guidelines generally do not include information about education and training of oral health professionals.

OBJECTIVE

The objective of this research was to explore the literature on eating disorders and oral health including the effects of eating disordered behaviors on oral health and training of oral health professionals to increase their capacity to recognize and appropriately address clinical care needs of individuals with eating disorders.

METHODS

A comprehensive scoping review was conducted to investigate what is known about the relationship between eating disorders and oral health and training provided to oral health professionals in recognition and treatment of individuals with eating disorders. The search was completed using PubMed, Embase, Science Direct, Google Scholar, and the Journal of the American Dental Association.

RESULTS

Of 178 articles returned in the initial search, 72 full texts were read, and 44 were included based on eligibility criteria. The retained articles were categorized thematically into articles related to (1) oral health professional education and training, (2) the oral health effects of eating disorders, and (3) patient experiences of oral health care.

CONCLUSION

Most of the research on the relationship between eating disorders and oral health examines the impact of eating disordered behaviors. There is a significantly smaller literature on the knowledge and training of oral health professionals related to eating disorders and individuals with eating disorders' experiences of oral health care. Research on education and training of oral health professionals should be expanded globally, taking into consideration the suitability of interventions for diverse models of oral health education and service delivery. Further, there is an opportunity for eating disorder professionals and professional organizations to improve understanding and care of eating disorders by building relationships with oral health providers and professional organizations in their local communities.

Epidemiology, aetiology and prevention of tooth wear

Tooth wear is a commonly reported finding globally; however, many patients are unaware of having tooth wear. Identifying early signs of erosion, abrasion or attrition and determining the risk factors contributing to a patient's tooth wear may help to prevent further loss of enamel and dentine in the future. Appropriate prevention should be instigated, or appropriate referral made to other health professionals, when conditions such as gastroesophageal reflux or eating disorders are suspected. This paper presents the epidemiology and aetiological factors for tooth wear, as well as identifying the common clinical presentations of tooth wear. Patient perspectives on tooth wear and preventive techniques that can be utilised are also discussed.

Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

BACKGROUND

Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders.

METHODS

This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised.

RESULTS

A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED.

CONCLUSIONS

This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.

Assessment of the eating disorders and relationship with dental caries, age, gender, and body mass index in a sample of Turkish adolescents aged 9 through 15

Background and Aims

Eating disorders (ED) are an important public health problem for adolescents due to changing eating attitudes. Using the Eating Attitude Test (EAT-26) with a sample of Turkish adolescents aged 9-15 years, this study evaluated the behavioral risk of ED and its association with dental caries, age, body mass index (BMI), and gender.

Subjects and Methods

The EAT-26 scoring system was used, and variables examined included demographic, familial, sociocultural, social, and clinical features. Data were analyzed using SPSS® Statistics for Windows, version 20.0. (IBM, New York, NY, USA).

Results

A total of 112 adolescents, 46 (41.1%) boys, and 66 (58.9%) girls (mean age 11.46 ± 1.91 years), were evaluated. EAT-26 mean scores were 16.0 (10.0-21.0) for girls and 14.0 (12.0-23.0) for boys (Mann Whitney U test; P = 0.509). There was no statistically significant difference between the mean BMI scores and the mean EAT-26 scores for girls and boys (Mann Whitney U test) (P = 0.509) (P = 0.636). The mean DMFT decay-missing-filled and total) was higher in EAT-26 >20 than in EAT-26 <20, and the difference was statistically significant (Mann Whitney U test; P = 0.008). BMI was not correlated with EAT-26 (Spearman rank correlation test, r = -0.013, P = 0.156), but there was a statistically significant positive correlation between the development of caries and age (Spearman rank correlation test, r = 0.405, P < 0.05).

Conclusion

Early diagnosis of ED is crucial because it primarily starts during childhood and adolescence. It is responsible for the dft of the deciduous teeth. BMI is related to decay,missed,filled,total (DMFT), decay, filled, total (dft), and age in adolescents aged 9-15 years. Furthermore, we searched subgroups of EAT-26 for dental caries. Dieting score may be a significant factor for dental caries for ED. However, observing ability is an important factor for dentists because they can inform parents and provide information on preventing ED.

Acidic food choice among adolescents with bulimic symptomatology: a major risk factor for erosive tooth wear?

PURPOSE

Evaluate dietary habits and the presence of erosive tooth wear (ETW) among female adolescents with varying severity of bulimic symptomatology.

METHODS

An explanatory study was conducted with 72 female school adolescents with bulimic symptomatology, aged 15-18 years in Southeastern Brazil. Dietary habits were evaluated through a food frequency questionnaire. Bulimic symptomatology was evaluated and classified (mild, moderate and severe) according to the Bulimic Investigatory Test of Edinburgh. ETW examinations were performed. Data analysis involved descriptive statistics, bivariate analysis, Kruskal-Wallis/Mann-Whitney tests and Poisson regression. Ethical approval and informed consents were obtained.

RESULTS

The final population consisted of 62 participants. The prevalence of ETW differed among adolescents with mild, moderate and severe bulimic symptomatology (p = 0.001), corresponding to 5.9%, 8.0% and 45.0%, respectively. Adolescents with severe bulimic symptomatology presented higher daily consumption of acidic food: citric fruits (p < 0.005), diet soda (p < 0.009) and ketchup (p = 0.004). No difference related to vomiting practices was observed between groups (p = 0.060). The adjusted regression model showed that a higher prevalence of ETW was associated with self-induced vomit at least once a week (PR = 2.42, 95% CI = 1.00-5.86, p = 0.05) and higher frequencies of consumption of citric fruits (PR = 7.96, 95% CI = 1.50-42.11, p = 0.015) and diet soda (PR = 2.32, 95% CI = 1.09-4.91, p = 0.029).

CONCLUSION

It was the food choices (acidic food) and not purging practices that differed among adolescents with varying severity of bulimic symptomology. Likewise, higher consumption of citric fruits was the main factor associated with higher prevalence of ETW.

LEVEL OF EVIDENCE

III case-control analytic study.

Risk Behaviors for Eating Disorders Among Brazilian Female Adolescents

Background:

Eating disorders are complex conditions that cause serious emotional and physical problems.

Aim:

The aim of the study was to evaluate the behavioral risk for eating disorders in Brazilian female adolescents and their association with dental caries and erosion.

Materials and Methods:

This cross-sectional study included 200 students from public and private schools aged 15-18 years divided into two groups according to behavioral risk: Group 1 - adolescents without risk and Group 2 - adolescents at risk / disorder situation. Sociodemographic information (age and type of school), use of dental services, eating habits, and Body Mass Index (BMI) was obtained. The Bulimic Investigatory Test of Edinburgh (BITE) was used to identify behavioral risk. Caries experience was assessed using the DMFT index, while dental erosion was evaluated using the O'Sullivan index. Data were analyzed using descriptive and inferential statistics, with a significance level of 5%.

Results:

The highest overweight and obesity percentages were verified among adolescents at risk / disorder, respectively, 33% and 16%. There was a statistically significant association between behavioral risk and variables standard dietary pattern (p<0.001), strict diet (p<0.001), fasting for 24 hours (p<0.001), self-induced vomiting (p<0.001), and BMI (p<0.001). There was also a statistically significant difference between behavioral risk and the presence of dental caries (p<0.05) and erosion (p<0.001).

Conclusion:

Behavioral risk for eating disorders in female adolescents was associated with standard dietary patterns, strict diet and, self-induced vomiting. Adolescents at risk / eating disorders for bulimia were related to dental caries and erosion.

Diet and behavioral habits related to oral health in eating disorder patients: a matched case-control study

BACKGROUND

Patients suffering from eating disorders (ED) have a substantially increased risk for developing poor oral health. In this regard, dietary habits in combination with obsessive behavior as well as the expression and intensity of the disease are of utmost importance. This study aimed to investigate diet and behavioral habits in patients with ED compared to healthy controls.

METHODS

All patients who initiated treatment in an ED clinic during 1 year were invited to participate in the study. Sixty-five patients were admitted out of which 54 agreed to participate: 50 women and 4 men, mean age 21.5 years, range 10-50 years. From a public dental health clinic, 54 sex-and age-matched controls where selected. In all participants a comprehensive questionnaire was completed. ED patients were analyzed with respect to their self-perceived disease state: when they felt "relatively good" (ED-good) and "bad" (ED-bad) as well as if they reported vomiting or not.

RESULTS

The ED-good patients reported significantly higher intake of caffeine-containing and cola light soft drinks and both study groups reported a lower intake of regularly sweetened carbonated drinks compared to controls. ED-bad reported significantly lower intake of number of meal and sweet intake while both study groups brushed their teeth more frequently than controls. As regards awareness of detrimental dietary intake and the possible risk for oral health complications did not differ between patients and controls except that the ED groups were more aware that vomiting and brushing thereafter could damage their teeth. ED patients went less often to the dentist for regular checkups than controls. Vomiting ED patients differed in several of the parameters related to dietary and other behaviors compared to no vomiting subjects. According to regression analyses and compared to healthy controls, predictive variables for ED-good were: higher intake of caffeine containing drinks (OR 1.34, CI 1.10-1.64) and lower intake of regular soft drinks (OR 0.57, CI 0.35-0.94). For ED-bad, lower frequency intake of lunch meals (OR 0.59, CI 0.39-0.88) and sweet biscuits were predictive (OR 0.15, CI 0.05-0.48).

CONCLUSIONS

ED patients present a number of dietary and other types of behavior that are potentially harmful for oral health. It is important to retrieve reports on the ED behaviors in both relatively good and bad disease state in order for the medical team to prescribe adequate advice and treatment.

Oral and dental health status in patients with eating disorders in Madrid, Spain

Background

The aim of the present study was to describe and compare the oral and dental health status of two groups, one diagnosed with eating disorders (EDs), and another group without this pathology, assessing the following oral manifestations: dental alterations, periodontal disorders, soft tissue disorders, non-stimulated salivary flow, and oral pH.

Material and Methods

This comparative transversal epidemiological study included 179 participants, of whom 59 were diagnosed with EDs (Eating Disorder Group: EDG) and 120 had no antecedents of EDs (No Eating Disorder Group: NEDG). All patients fulfilled the following inclusion criteria: women aged over 18 years, diagnosed with an ED by a specialist, patients who had undergone at least 1 year monitoring by the Clinical Nutrition Unit, and had not received any periodontal treatment during the previous 6 months. Both groups were homogeneous in terms of sex, age, education, and socioeconomic level. Oral exploration was performed, registering clinical variables, as well as sociodemographic and socioeconomic data, oral hygiene habits, and smoking. Statistical significance was established as p<0.05 (confidence level > 95%).

Results

The dental erosion (DE) was the most significative feature of dental alterations. The degree of DE was significantly greater in the EDG (p<0.001). A significant association between soft tissue lesions and EDs was found (p<0.001) A notable difference in non-stimulated salivary flow was found between the groups (p<0.001). No significant differences between the groups were found for periodontal status, dental caries, or oral hygiene practices.

Conclusions

On the basis of the results obtained, it is necessary to carry out oral/dental examination as soon as an ED is diagnosed with regular check-ups thereafter.

Key words:Eating disorders, anorexia nervosa, bulimia nervosa, oral health, dental erosion.

RISK BEHAVIOR FOR BULIMIA AMONG ADOLESCENTS

Objective:

To analyze the risk behavior for bulimia among female adolescents from public and private high schools.

Methods:

A cross-sectional study with a random sample of 850 female students aged 15-18 years was carried out in a city in northeastern Brazil, using the Bulimic Investigatory Test of Edinburgh (BITE) to assess the risk behavior for bulimia. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software and the Pearson’s chi-square , Fisher’s exact and robust Poisson regression tests, adopting the significance level of 5%.

Results:

Less than half of the sample (42.0%) showed standards of dietary risk and weight control practices; in 1.4% of the sample, bulimia signs were already installed. Fear of gaining weight was reported by 62.8% of the subjects. Risk practices were lower among students from public schools; (Odds Ratio - OR - 0.82; confidence interval of 95% - 95%CI - 0.69-0.97). Among restrictive practices, fasting for a whole day was the most applied (29.9% of the students). Among individuals who were at risk situation, almost half believed to have normal eating habits (prevalence ratio - PR - 0.42; 95%CI 0.36-0.49). Individuals who consider their eating habits normal, who are afraid of gaining weight, those who seek emotional comfort in food and follow strict diets had higher risk for bulimia (p<0.05).

Conclusions:

The number of female adolescent students with risk behavior practices for bulimia is high, and the frequency of those unaware of this situation is also very high. Risk situations emerge as a collective health problem, and individuals from private schools were more likely to be in this situation.

[Tooth Erosions Associated with Gastroesophageal Reflux: Cause, Prevention and Restorative Therapy]

Tooth Erosions Associated with Gastroesophageal Reflux: Cause, Prevention and Restorative Therapy Abstract. Dental erosions are caused by the recurring contact of solutions which are unsaturated in tooth minerals,ith hard tooth substances. This initially leads to softening and later to an irreversible loss of hard tooth substance. Erosion is observed particularly with excessive consumption of acidic foods (e.g. soft drinks or citrus fruits) but also in connection with gastrointestinal (gastroesophageal reflux disease) or psychosomatic diseases (anorexia nervosa or bulimia nervosa). The aim of this article is to define dental erosions, their causes, prevalence and consequences as well as possible preventive measures. Based on a clinical example of a patient with reflux-related erosions, a therapy option with direct composite tooth build-up is presented.

The impact of bulimia nervosa on oral health: A review of the literature

Eating disorders are a potentially life-threatening group of mental disorders, which affect a patient's relationship with food and their body. This manifests itself through chaotic and disordered eating habits. One such eating disorder is bulimia nervosa, which has a lifetime prevalence of 1%. While there is consensus that bulimic behaviour directly causes dental erosion due to vomiting and acidic food choices, there is less clear evidence for a direct link between bulimia nervosa and dental caries, although there does still appear to be an association. Reduced salivary flow rate is a common feature among bulimics, but this is often due to anti-depressant medication rather than dietary habits or vomiting, and the effects are largely limited to unstimulated whole salivary flow rate and don't affect stimulated whole salivary flow rate. Parotid enlargement is present in a number of cases but this tends to be a minority. Further research is required given the limitations of current studies, especially gender imbalances among the populations studied and a lack of clear focus on bulimia nervosa.

Reducing the burden of suffering from eating disorders: Unmet treatment needs, cost of illness, and the quest for cost-effectiveness

Eating disorders are serious mental disorders as reflected in significant impairments in health and psychosocial functioning and excess mortality. Despite the clear evidence of clinical significance and despite availability of evidence-based, effective treatments, research has shown a paradox of elevated health services use and, yet, infrequent treatment specifically targeting the eating disorder (i.e., high unmet treatment need). This review paper summarizes key studies conducted in collaboration with G. Terence Wilson and offers an update of the research literature published since 2011 in three research areas that undergirded our collaborative research project: unmet treatment needs, cost of illness, and cost-effectiveness of treatments. In regards to unmet treatment needs, epidemiological studies find that the number of individuals with an eating disorder who do not receive disorder-specific treatment continues to remain high. Cost-of-illness show that eating disorders are associated with substantial financial burdens for individuals, their family, and society, yet comprehensive examination of costs across public sectors is lacking. Cost measures vary widely, making it difficult to draw firm conclusions. Hospitalization is a major driver of medical costs incurred by individuals with an eating disorder. Only a handful of cost-effectiveness studies have been conducted, leaving policy makers with little information on which to base decisions about allocation of resources to help reduce the burden of suffering attributable to eating disorders.

Risk behaviors related to eating disorders in adolescents and its association with dental erosion

Abstract Introduction The overvaluation of thinness as a standard of beauty has contributed to the development of eating disorders and has mainly affected adolescents and young adults. Objective To evaluate the prevalence of risk behaviors for eating disorders and their association with dental erosion in adolescents. Material and method This is a cross-sectional observational epidemiological study. The sample consisted of 278 adolescents aged 12 to 19 years, enrolled in a State School in Campinas - SP. Two questionnaires were used for the data collection on eating disorders: Bulimic Investigatory Test of Edinburgh and Eating Attitudes Test -26. The presence of erosion was evaluated by calibrated examiners. Result The mean age of the sample was 14.8 years. The prevalence of mean risk for bulimia in the sample was 43.2% (95% CI: 37.3%-49.0%) and the prevalence of adolescents with a probability of developing bulimia was 53.2% (95% CI: 47.4%-59.1%). Of the total, 11.9% (95% CI: 8.1%-15.7%) showed results suggestive of anorexia. Among women, 66.9% were classified as probability developing bulimia, whereas in men the prevalence was 39.0%. As for dental erosion, only 1.1% of the sample presented erosion. Conclusion The study pointed to large number of adolescents with risk behaviors for eating disorders but no association was found with dental erosion due to low prevalence.

Relationship between Risk Behavior for Eating Disorders and Dental Caries and Dental Erosion

The aim of this study was to evaluate whether there is an association between risk behavior for eating disorders (EDs) and dental erosion and caries. A controlled cross-sectional study was conducted in Brazil, involving 850 randomly selected female adolescents. After evaluating risk behavior for eating disorders through the Bulimic Investigatory Test of Edinburgh, 12 adolescents were identified with severe risk behavior for EDs and matched to 48 adolescents without such risk. Dental examinations, anthropometric measurements, and eating habits and oral hygiene were performed. Adolescents with high severity eating disorder condition were not more likely to show dental caries (p = 0.329; OR = 2.2, 95% CI: 0.35–13.72) or dental erosion (p = 0.590; OR = 2.33; 95% CI: 0.56–9.70). Adolescents with high body mass index (BMI) were five times more likely to have high severity eating disorder condition (p = 0.031; OR = 5.1; 95% CI: 1.61–23.07). Therefore, high severity risk behavior for EDs was not significantly associated with dental caries and dental erosion. However, high BMI was a risk factor for developing eating disorders and should be an alert for individuals with this condition.

Consensus statement: Oral health and elite sport performance

While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.

Eating disorders - knowledge, attitudes, management and clinical experience of Norwegian dentists

Background

The purpose of this study was to investigate knowledge, attitudes and clinical experience with regard to patients with eating disorders (ED) among Norwegian dentists.

Methods

In 2010, a questionnaire was sent to all dentists in Norway (N = 4282) comprising 33 questions related to demographics of the participating dentists, their knowledge of ED (general and oral health aspects), clinical experience, attitudes and perceived management preferences.

Results

The participation rate was 40 % (47 % women and 53 % men). Their knowledge about ED was often retrieved from common media sources and the greater part of the participants reported they had seen very few patients with ED during their professional career. Female dentists reported superior knowledge about ED compared to males, but the former experienced greater difficulties to inform about the condition. Referrals of the patient to other health facilities were significantly more common among female compared to male dentists. The majority of dentists (76 %) reported a need of more education related to ED management.

Conclusions

The Norwegian dentists in this study reported limited clinical experience and insufficient knowledge regarding ED. There is therefore a need to increase both undergraduate and continuing education in this field, which can improve preventive and management measures that a dentist can provide for ED patients.

Enamel formation genes associated with dental erosive wear

Dental erosive wear is a multifactorial condition that is greatly affected by environmental factors. So far, no study has investigated how dental erosive wear is influenced by variations in enamel formation genes. The aim of the present study was to investigate polymorphisms in genes involved in enamel formation and their influence on enamel susceptibility to dental erosion. DNA samples were collected from 795 Norwegian adolescents aged 16-18 years. Five single-nucleotide polymorphism markers were genotyped in selected candidate genes (ameloblastin, amelogenin, enamelin, tuftelin 1 and tuftelin interacting protein 11), reported to influence enamel formation. Allele and genotype frequencies were compared within two patient groups with dental erosions; all participants with dental erosion and only those with severe dental erosion (erosion extending into dentine). Overrepresentation of the G allele of the enamelin marker was seen in the erosion group compared to the unaffected group (p = 0.047). When erosion severity was considered, statistical significant difference in allele frequency was observed for amelogenin, with the C allele suggesting a protective role (p = 0.02). A suggestive overrepresentation of the TT genotype of the amelogenin marker was also seen in cases with severe erosion (p = 0.049) when compared to cases with no dentine erosion. Amelogenin was also associated with severe erosion in the recessive model; the TT genotype was significantly more frequent in the affected group than in the unaffected group (p = 0.01). The present study suggests that polymorphisms in enamel formation genes are statistically associated with an individual's susceptibility to dental erosive wear.

Eating disorders and biochemical composition of saliva: a retrospective matched case-control study

This study aimed to compare the biochemical composition of saliva from patients with eating disorders (EDs) with saliva from control subjects with no ED. All patients who initiated outpatient treatment in an ED clinic during a 12‐month period were invited to participate. Of the 65 patients who started treatment during the period, 54 (50 female patients/four male patients; mean age: 21.5 yr) agreed to participate. The controls were 54 sex‐ and age‐matched patients from a dental health clinic. All participants completed a questionnaire and underwent dental clinical examinations, including laboratory analyses of saliva. The proportion of subjects with unstimulated salivary hyposalivation was lower in the ED group and not correlated with intake of xerogenic drugs. Significant differences in the biochemical composition of saliva were found almost exclusively in the unstimulated state, with albumin, inorganic phosphate, aspartate aminotransferase (ASAT), chloride, magnesium, and total protein all being significantly higher in the ED group. Conditional logistic regression showed that higher ASAT and total protein concentrations were relatively good predictors of ED, with sensitivity and specificity of 65% and 67%, respectively. In conclusion, elevated salivary concentrations of ASAT and total protein may serve as indicators of ED as well as of disease severity. Future studies are needed to corroborate these initial findings.

Factors affecting the dental erosion severity of patients with eating disorders

BACKGROUND

Intraoral disease is a common occurrence in patients with eating disorders, particularly dental erosion, which frequently becomes severe and may hinder daily life. The severity varies from patient to patient. Understanding the underlying mechanisms may help prevent dental erosion in these patients. Accordingly, we investigated the relationship between the severity of erosion and the behavior of patients with eating disorders, with a focus on daily diet and vomiting behavior.

METHODS

A total 71 female eating disorder outpatients from the Clinical Center of Psychosomatic Dentistry of Nippon Dental University Hospital and the Psychosomatic Internal Medicine Department of Kudanzaka Hospital or who were hospitalized at Hasegawa Hospital were enrolled. Dental erosion severity and location were determined by oral examination. Patients who induced vomiting were queried on their behavior during vomiting and on routine diet habits. Patients with dental erosion were further divided into mild and severe groups based on the lesion severity and the groups compared.

RESULTS

Dental erosion was observed in 43 of 50 subjects who induced vomiting. Dental erosion was most frequent on the palatal side of the anterior maxillary teeth, occurring in 81.3% of the subjects. There were significant differences observed between the mild and severe groups according to post-vomiting oral hygiene. Significantly more subjects in the mild group consumed large amounts of water before vomiting, and significantly more subjects in the severe group routinely consumed carbonated beverages or sweetened food.

CONCLUSIONS

While self-induced vomiting is the main cause of dental erosion in eating disorder patients, the erosion severity may be affected by behavior when inducing vomiting or by routine consumption of certain foods and beverages. Addressing these factors may help prevent severe dental erosion in patients who chronically induce vomiting.

Tooth erosion and eating disorders: a systematic review and meta-analysis

Background

Eating disorders are associated with the highest rates of morbidity and mortality of any mental disorders among adolescents. The failure to recognize their early signs can compromise a patient's recovery and long-term prognosis. Tooth erosion has been reported as an oral manifestation that might help in the early detection of eating disorders.

Objectives

The aim of this systematic review and meta-analysis was to search for scientific evidence regarding the following clinical question: Do eating disorders increase the risk of tooth erosion?

Methods

An electronic search addressing eating disorders and tooth erosion was conducted in eight databases. Two independent reviewers selected studies, abstracted information and assessed its quality. Data were abstracted for meta-analysis comparing tooth erosion in control patients (without eating disorders) vs. patients with eating disorders; and patients with eating disorder risk behavior vs. patients without such risk behavior. Combined odds ratios (ORs) and a 95% confidence interval (CI) were obtained.

Results

Twenty-three papers were included in the qualitative synthesis and assessed by a modified version of the Newcastle-Ottawa Scale. Fourteen papers were included in the meta-analysis. Patients with eating disorders had more risk of tooth erosion (OR = 12.4, 95%CI = 4.1–37.5). Patients with eating disorders who self-induced vomiting had more risk of tooth erosion than those patients who did not self-induce vomiting (OR = 19.6, 95%CI = 5.6–68.8). Patients with risk behavior of eating disorder had more risk of tooth erosion than patients without such risk behavior (Summary OR = 11.6, 95%CI = 3.2–41.7).

Conclusion

The scientific evidence suggests a causal relationship between tooth erosion and eating disorders and purging practices. Nevertheless, there is a lack of scientific evidence to fulfill the basic criteria of causation between the risk behavior for eating disorders and tooth erosion.

Oral health and elite sport performance

While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.