Association between poor oral health and eating disorders: systematic review and meta-analysis

Background There is a well-established link between oral pathology and eating disorders in the presence of self-induced vomiting. There is less information concerning this relationship in the absence of self-induced vomiting, in spite of risk factors such as psychotropic-induced dry mouth, nutritional deficiency or acidic diet. Aims To determine the association between eating disorder and poor oral health, including any difference between patients with and without self-induced vomiting. Method A systematic search was made of Med line, PsycINFO, EMBASE and article bibliographies. Outcomes were dental erosion, salivary gland function and the mean number of decayed, missing and filled teeth or surfaces (DMFT/S). Results Ten studies had sufficient data for a random effects meta-analysis (psychiatric patients n=556, controls n=556). Patients with an eating disorder had five times the odds of dental erosion compared with controls (95% Cl 3.31-7.58); odds were highest in those with self-induced vomiting (odds ratio (OR)=7.32). Patients also had significantly higher DMFS scores (mean difference 3.07, 95% Cl 0.66-5.48) and reduced salivary flow (OR=2.24, 95% 01 1.44-3.51). Conclusions These findings highlight the importance of collaboration between dental and medical practitioners. Dentists may be the first clinicians to suspect an eating disorder given patients' reluctance to present for psychiatric treatment, whereas mental health clinicians should be aware of the oral consequences of inappropriate diet, psychotropic medication and self-induced vomiting.