Eating Disorders and Dental Erosion: A Systematic Review

Abstract

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.

Keywords: anorexia nervosa; bulimia nervosa; dental erosion; eating disorders; tooth erosion.

Figure 1

PRISMA flow diagram presenting search strategy.

Figure 2

Quality assessment, including the main potential risk of bias (risk level: green—low, yellow—unspecified, red—high; quality score: green—good, yellow—intermediate, red—poor) [32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62].

Figure 3

Forest plots presenting the summarised prevalence and odds ratio of dental erosion among patients with bulimia nervosa [32,33,38,41,43,44,49,52,53,55,57,60,62].

Figure 4

Forest plots presenting the summarised prevalence and odds ratio of dental erosion among patients with anorexia nervosa [37,39,43,46,49,51,53,56,60].

Figure 5

Forest plot presenting the odds ratio of dental erosion among patients with bulimia nervosa vs. anorexia nervosa [43,49,53,60].

Figure 6

Forest plots presenting the summarised prevalence and odds ratio of dental erosion among other patients with eating disorders (without divided diagnoses) [34,35,36,40,42,45,47,48,50,54,58,59,61,62].

Figure 7

Forest plot presenting the odds ratio of dental erosion among patients with self-induced vomiting [34,37,48].

Figure 8

Forest plots presenting the summarised prevalence and odds ratio of dental erosion among all patients with eating disorders [32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62].