Abstract
BackgroundEating 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.ObjectivesThe 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?MethodsAn 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.ResultsTwenty-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).ConclusionThe 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.
Highlights
The incidence of eating disorders (EDs) has increased over the past decade, both in males and females [1]
The following search strategy was used in the MEDLINE, Web of Science and Cochrane: ((non-carious cervical lesions odds ratios (ORs) noncarious cervical lesions OR non-carious cervical lesions OR tooth wear [Mesh] OR dental wear OR tooth erosion [Mesh] OR tooth erosion* OR dental erosion OR dental enamel [Mesh] OR dental enamel OR enamel erosion) AND NOT (‘‘animals’’[Mesh] NOT ‘‘humans’’[Mesh]))
23 studies were included in the qualitative synthesis of this systematic review (13 case-control and 10 cross-sectional) and 14 were included in the quantitative synthesis
Summary
The incidence of eating disorders (EDs) has increased over the past decade, both in males and females [1] These conditions are associated with significant functional impairment and serious physical and psychological consequences due to an excessive preoccupation with body weight or shape. TE is a complex and multifactorial condition characterized by a progressive and irreversible loss of tooth structure due to a chemical process without bacterial involvement. It is clinically detectable as thinner enamel with chamfered ridges, cupped cusp tips and grooved incisal edges, sometimes with dentine exposure [7,8]. Tooth erosion has been reported as an oral manifestation that might help in the early detection of eating disorders
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