Eating disorders and oral health: a scoping review

Plain English summaryOral health professionals, including dentists and dental hygienists, are well positioned to observe signs of eating disordered behaviors during routine oral health care. To gain an understanding of what is known about the relationship between eating disorders and oral health, we reviewed research studies that discussed any aspect of this relationship. We identified 44 studies meeting our criteria. Most of the extant research focuses on the impact of eating disorders on oral health. Smaller portions of the literature discussed education and training of oral health professionals and patients' oral health behaviors (including routine oral health care). Educational interventions to increase oral health professionals' knowledge of eating disorders and confidence in raising concerns with patients are effective, but evidence about whether they are being implemented in training programs is lacking. Further, many studies indicated the need to connect oral health professionals to eating disorder treatment providers. Additional research is needed to develop guidance and best practices for collaboration between fields. BackgroundScreening 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.ObjectiveThe 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.MethodsA 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.ResultsOf 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.ConclusionMost 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.