The influence of anorexia nervosa on oral health and related parameters potentially relevant to orthodontic treatment: a systematic review and meta-analysis

Abstract

Objectives: Information on the oral health of patients with anorexia nervosa remains not satisfactory. The aim of this systematic review is to evaluate oral health parameters in anorexic patients compared to healthy individuals. Furthermore, potential clinical implications for orthodontic treatment are discussed from an orthodontic perspective.

Materials and methods: Electronic databases were searched for case-control and controlled clinical trial studies on dentofacial manifestations in anorexic patients up to 2/2024. Study selection, data extraction and risk of bias assessment was done independently by two authors. Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity analyses.

Results: Eleven out of 573 initially identified studies were included. They involved oral health analyses of general anorexic patients ≥ 12 years (mean age 18.4). The meta-analysis showed that anorexia nervosa was associated with a significantly increased caries experience (DMFT), plaque accumulation and gingival inflammation (BOP). PH and salivary flow rate were significantly altered in patients with anorexia nervosa, although no significant relationship between α-amylase levels and anorexia nervosa was demonstrated.

Conclusions: These data enabled us to formulate modalities for anorexia-specific orthodontic treatments. Based on the results, patients with anorexia nervosa exhibit an increased risk of caries and gingival inflammatory signs.

Clinical relevance: The systematic information on dentofacial manifestations obtained in this study should be considered to better manage the oral health of anorexia patients.

Keywords: Anorexia nervosa; Eating disorder; Oral health; Oral manifestation; Orthodontic therapy; Saliva.

Fig. 1

PRISMA flow chart describing the search strategy and study selection. Detailed information about exclusion reasons is shown in supplementary table I

Fig. 2

Forest plot for BOP meta-analysis

Fig. 3

Forest plot for DMFT meta-analysis

Fig. 4

Forest plot for salivary pH meta-analysis

Fig. 5

Forest plot for unstimulated salivary flow rate

Fig. 6

Forest plot α-amylase