Eating disorders: experiences of and attitudes toward oral health and oral health behavior

Self-Perceived Oral Health Related to Eating Disorders-A Cross-Sectional Questionnaire Study

OBJECTIVES

To investigate oral problems experienced by patients with eating disorder (ED).

METHODS

A cross-sectional study where ED patients (n = 48) at two Swedish specialised clinics filled out a questionnaire about perceived oral health problems and habits, and specific behaviours related to ED.

RESULTS

The majority exhibited poor eating and drinking habits, f.i. drinking light drinks (63%), and most of them were on medication (71%). The most common problems were hypersensitive teeth (three out of five) and perceived dryness of the mouth (almost four out of five). Likewise, pain in the teeth (38%) and the jaws (46%) was frequent. About one-third had been binge eating and/or vomiting in recent weeks and these behaviours were associated with pain in the teeth and snacking. Almost two out of three participants were concerned about informing their dentist or dental hygienist about their vomiting.

CONCLUSIONS

The ED patients in this study experienced oral problems and exhibited many risk behaviours regarding oral health. Both dental staff and ED staff who meet ED patients should be aware of the risk of oral health problems and preventive measures should be taken.

Oral health experience of individuals with eating disorders

BACKGROUND

Evidence on how persons with and in remission from an eating disorder experience their oral health is limited. Dental treatment in Sweden today is often postponed until medical rehabilitation has been completed, but this carries risks. For the patient, the risk is severely impaired oral health and additional suffering, and for both society and the patient, higher costs than might have been necessary.

METHODS

Ten female informants aged 21-51 years (mean age = 36.7, standard deviation 12.7) in remission from an eating disorder with a median duration of 12.5 (range 4-25) years of illness, were questioned in semi-structured interviews about their perceptions of oral health. All participants had been referred to a specialist dental clinic and needed oral rehabilitation. 10% of the patients had been diagnosed with anorexia nervosa and 90% with bulimia nervosa. All had been in remission from the eating disorder for at least one year. Transcripts of the interviews were analyzed with thematic analysis using an inductive approach.

RESULTS

One overarching theme emerged from the analysis: dental damage persisted as a visible, lingering scar during remission of the eating disorder, reminiscent of the disease and its consequences. The three major themes identified were (1) Physical impact, (2) Psychological impact, and (3) Impact on daily living. The first major theme included erosive tooth wear and impaired oral function and aesthetics. Interviewees described the second as feelings of stigma, guilt, shame, anxiety, and worry, in particular concerning self-inflicted dental damage through self-induced vomiting. The last major theme covered avoidance strategies such as limiting smiling and laughing and minimizing social situations such as eating with others, pursuing a wanted career, and meeting a partner.

CONCLUSIONS

The participants in this study expressed a profound negative impact on daily life and a two-fold burden of stigma of having suffered from both an eating disorder and poor oral health.

Oral health knowledge, attitudes and practices of dietitians in Australia: A national survey

AIM

Dietitians are a well-placed profession to be providing pre-emptive oral health promotion. Despite recommendations that oral health promotion should be routinely part of dietetic practice, there is limited data informing the current practices of clinical dietitians in this area across Australia. Hence, the aim of this study was to investigate the knowledge and practices of Australian dietitians and oral health promotion.

METHODS

A cross-sectional survey was undertaken involving registered clinical dietitians in Australia using purposive and snowballing sampling (social media/dietetic organisations/public databases). Data were analysed using descriptive and inferential statistics.

RESULTS

A total of 149 dietitians participated in the national survey. Overall, dietitians were knowledgeable about oral health risk factors and preventative measures across general health domains. Majority of dietitians agreed that oral health can affect nutrition interventions (95.5%) and dietitians should be discussing oral health (88.0%). However, nearly half were not confident in providing counselling or education and felt that undergraduate training for oral health promotion was inadequate (78.2%). A small proportion (6.0%) of dietitians were already providing oral health promotion regularly. Key barriers included a lack of clear guidelines for practice, limited training opportunities and indistinct referral pathways.

CONCLUSION

Dietitians have acknowledged that oral health promotion should be incorporated into their practice. However, they are challenged by a lack of resources and training to support this in clinical practice. SO WHAT?: Capacity building dietitians to promote oral health allows opportunity for improvement in the oral health, nutritional status and quality of life of priority population groups.

Determinants of dietary behaviors among dental professionals: insights across educational levels

BACKGROUND

Healthy dietary behaviors are fundamental for maintaining optimal health. Understanding the dietary behaviors of dentists is vital for designing effective interventions to foster healthier behaviors. However, investigations into dietary behaviors and their associations among dental professionals have been limited.

OBJECTIVE

To investigate the dietary behaviors of dental professionals, along with the associated factors influencing their dietary options.

MATERIALS AND METHODS

A self-administered online questionnaire was constructed to collect data from three groups of dental professionals: undergraduates (UG), postgraduates (PG), and practicing dentists (DT). The questionnaire encompassed inquiries regarding demographic characteristics, knowledge assessment, evaluation of attitudes, and examination of dietary behaviors. Data analysis procedures included descriptive statistics, Spearman's rank correlation, and multiple linear regression.

RESULTS

A total of 842 individuals participated in the study (UG: 264, PG: 247, DT: 331). Attitude emerged as the strongest association of healthy dietary behaviors across all groups (UG: ß=0.370, PG: ß=0.512, DT: ß=0.642; P < 0.001), while alcohol consumption showed a negative correlation with healthy dietary behaviors (UG: ß=-0.135, PG: ß=-0.220, DT: ß=-0.216; P < 0.001).

CONCLUSION

Significant variations in dietary behaviors across diverse educational levels of dental professionals were observed. Attitude emerged as the predominant factor influencing dietary behaviors, while knowledge was found to have a weak association. Tailored interventions addressing individual challenges at different career stages should be considered to enhance dietary behaviors and overall well-being in dental practice settings.

Undergraduate perspectives of the awareness, diagnosis and management of patients with eating disorders

Introduction Patients with eating disorders (EDs) may present with potentially life-threatening complications due to missed and late diagnoses. Dentists can play a fundamental role in the early identification and signposting of patients with suspected EDs.Aims To investigate the awareness of final-year dental students of the aetiology, diagnosis and management of EDs.Methods An anonymous electronic questionnaire was distributed to final-year dental students at the University of Manchester. Respondents reported their knowledge, confidence and education related to the management of patients with EDs.Results Over 50% of students felt they had an above average awareness of the clinical signs and oral manifestations of EDs. The majority of students lacked confidence in discussing a suspected ED diagnosis with patients (75%) and referring them to appropriate services (71%). Additionally, 58% were not confident in planning treatment for and treating a patient with an ED. In total, 100% of students reported that they would benefit from further teaching related to the management of patients with EDs.Conclusion Participants highlighted the need for further teaching related to the diagnosis and management of patients with EDs. This study supports the development of an educational resource of undergraduate dental students.

Oral health and individuals with a lived experience of an eating disorder: a qualitative study

BACKGROUND

Limited evidence exists describing the impact to oral health when living with an eating disorder and the availability of information or access to oral health services. This study investigated the perceptions of individuals with a lived experience of an eating disorder specifically to understand their needs and recommendations for improving access to early intervention and oral health promotion.

METHODS

Using purposive sampling a total of 12 semi-structured interviews were conducted with participants across Australia who had a lived experience of an eating disorder. A hybrid inductive and deductive approach to thematic analysis was used to construct salient themes and subthemes.

RESULTS

Most participants had experienced some oral health manifestation as part of their eating disorder hence, many felt quite knowledgeable on the topic. Following their eating disorder many participants felt confident in engaging with dental services, although, barriers including embarrassment, shame, and cost compromised access at times. Participants felt strongly that greater emphasis on oral health promotion during an eating disorder was important and this may be achieved by increasing the availability of resources and using trusted non-dental health professionals like dietitians.

CONCLUSIONS

The need for oral health promotion while experiencing an eating disorder was evident, however, dentists can often be a costly option. Non-dental health professionals like dietitians working with clients with an eating disorder may be an acceptable alternative for closing this gap.

Eating disorders and oral health: a scoping review

BACKGROUND

Screening 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.

OBJECTIVE

The 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.

METHODS

A 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.

RESULTS

Of 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.

CONCLUSION

Most 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.

Eating disorders and the role of the dental team

Although primarily classified as psychiatric disorders, eating disorders have a complex aetiology and presentation, with comorbidities spanning multiple disciplines, including dental complications. In some cases, general dental practitioners may be the first health professional to become aware that someone is struggling with an eating disorder. The dental team is in an ideal position to sensitively explore the presentation and signpost the patient to appropriate services while offering support and/or remedial management for dental complications of the eating disorder. Anyone from any background, gender or ethnicity may develop an eating disorder, of which the main diagnoses are anorexia nervosa, bulimia nervosa and binge eating disorder. Some of the frequently seen oral manifestations of these disorders include generalised dental erosion, caries, self-inflicted palatal or oropharyngeal trauma, atrophic mucosa, bilateral parotid gland enlargement, xerostomia and periodontal disease. The dentist's role is pivotal in recognising the possible implications of some of these findings, approaching the patient sensitively, and communicating empathetically to engage them in treatment, reducing the risk of further erosion and improving oral health and hygiene. The dental team may be able to signpost the patient to their general practitioner for onward referral or to a local eating disorder support network.

Epidemiology, aetiology and prevention of tooth wear

Tooth wear is a commonly reported finding globally; however, many patients are unaware of having tooth wear. Identifying early signs of erosion, abrasion or attrition and determining the risk factors contributing to a patient's tooth wear may help to prevent further loss of enamel and dentine in the future. Appropriate prevention should be instigated, or appropriate referral made to other health professionals, when conditions such as gastroesophageal reflux or eating disorders are suspected. This paper presents the epidemiology and aetiological factors for tooth wear, as well as identifying the common clinical presentations of tooth wear. Patient perspectives on tooth wear and preventive techniques that can be utilised are also discussed.

Anorexia and bulimia nervosa in the practice of the paediatric dentist

OBJECTIVE

This systematic review aimed to highlight the usefulness of the clinical examination of the oral cavity for the diagnostic suspicion of anorexia (AN) and bulimia nervosa (BN), being of main interest to the paediatric dentist and paediatrician due to the early onset of symptoms in Eating Disorders (EDs).

METHOD

A systematic search, applying PICO question, was carried out in biomedical and other electronic databases from 2005 to 2020. Both case reports and case series of patients under 65 years of age with AN and BN were included. Data were extracted and statistically analysed.

RESULTS

A sample of 111 studies was obtained (n = 192; 92.78% female). The most prevalent diagnosis was restrictive type AN (n = 110; 57.29%). Only 16 (8.33%) patients had been clinically examined at the oral cavity, indicating the presence or absence of oral manifestations (OM) and showing dental erosion (n = 10) as the most frequent.

CONCLUSION

There is a lack of information about the oral examination of anorexic and bulimic patients. Dental erosion and other oral manifestations can help us to make an early ED diagnosis. Clinical observation and basic erosive wear examination (BEWE) Index are necessary steps to detect and record any anomaly in oral cavity during the evaluation of these patients.

Dietitians' Experiences of Providing Oral Health Promotion to Clients with an Eating Disorder: A Qualitative Study

(1) Background: Eating disorders (EDs) can seriously impact oral health, leading to irreversible dental damage. Dietitians play a key role in the care of people with an ED and are well-placed to promote oral health. However, there is currently little understanding of how dietitians perceive their role in this space. This study aimed to explore the perceptions and role of dietitians in providing oral health promotion to their clients in an ED clinical setting. (2) Methods: This descriptive qualitative study used semi-structured interviews to explore the perceptions of 14 registered dietitians practicing across seven states in Australia. Participants were recruited using a combination of purposive and snowball sampling. A hybrid thematic analysis approach was undertaken to identify and describe the key themes generated from the data. (3) Results: Generally, dietitians were insightful and knowledgeable of the oral health issues that clients with an ED may be experiencing. However, dietitians' practices across education, screening, and referrals were inconsistent. Challenges such as inadequate training, unknown referral pathways, and clear guidelines were cited as significant barriers to practice. (4) Conclusions: The results reinforce the need for education and the development of targeted strategies that address challenges to oral health promotion in dietetic practice.

Risk of Dental Caries and Erosive Tooth Wear in 117 Children and Adolescents' Anorexia Nervosa Population-A Case-Control Study

Introduction

Restrictive type of anorexia nervosa (AN) is still one of the most severe eating disorders worldwide with an uncertain prognosis. Patients affected by AN should be encouraged to undertake psychiatric care and psychotherapy, but whether they should necessarily be included in careful dental care or not may still be questionable. Even though there is a constantly increasing number of AN studies, there are just a few data about the youngest group of AN children and adolescents aged < 18.

Methodology

This case-control study aimed to compare the dental health and gingival inflammation level in female adolescent inpatients affected by severe AN restrictive subtype vs. controls. Based on clinically confirmed 117 AN cases (hospitalized in years 2016-2020 in public Psychiatric Unit, BMI < 15 kg/m2, mean age 14.9 ± 1.8), the dental status has been examined regarding the occurrence of caries lesions using Decay Missing Filling Teeth (DMFT), erosive wear as Basic Erosive Wear Examination (BEWE), gingival condition as Bleeding on Probing (BOP) and plaque deposition as Plaque Control Record (PCR). The results were compared with age-matched 103 female dental patients (BMI 19.8 ± 2.3 kg/m2, age 15.0 ± 1.8, p = 0.746) treated in a public University dental clinic.

Results

AN patients were found to present a higher incidence of oral-related complications according to dental status (DMFT 3.8 ± 4.5 vs. 1.9 ± 2.1, p = 0.005), erosive tooth wear (BEWE 18.9 vs. 2.9%, p < 0.001), less efficient in controlling plaque (PCR 43.8 vs. 13.7%, p < 0.001) and gingival inflammation (BOP 20.0 vs. 3.9%, p < 0.001) compared with female adolescents. In the AN group, a significant correlation between BOP, BEWE, and duration of AN disease (p < 0.05), similarly to the number of decayed teeth D, filled teeth F and PCR were detected (p < 0.05).

Conclusions

Although the obtained results did not reveal any severe oral status, our findings indicated impaired dental and gingival conditions in young anorexics. Considering AN's potential role in oral health, it is essential to monitor dental treatment needs and oral hygiene levels in their present status to prevent forward complications in the future.

Eating Disorders: An Analysis of Self-Induced Vomiting, Binge Eating, and Oral Hygiene Behavior

BACKGROUND

Self-induced vomiting (SIV) is often present in patients with eating disorders (ED) and potentially damaging for oral health. Related behaviors, such as binge eating and oral hygiene habits, may equally increase the risk for dental damage. This study aimed to investigate behaviors and habits in patients with ED and SIV in relation to oral health.

METHODS

All patients enlisting for treatment in an ED clinic for 1 year were offered to take part in the study. Fifty-four of 65 patients were accepted to participate, and a questionnaire included questions on dietary and oral hygiene habits was included. A subgroup consisting of only those 17 ED patients who reported SIV during the previous six months comprised the sample for this study and received additional questions related to other compensatory behaviors and oral hygiene habits in relation to oral health.

RESULTS

Binge eating before SIV was common (14/17 patients). Time point for SIV after binge eating and the procedures performed after vomiting varied. Tooth brushing after vomiting was common (7/17). Food and drinks during binge eating included mainly items rich in calories (sugar/fat) or acid. All 17 patients believed that vomiting could damage their teeth, but only one of them had informed the dentist about having an ED. A number of oral symptoms were reported. Ten patients considered their oral health to be good/fairly good, while the remaining seven patients reported their oral health as not so good/bad/very bad. Information on how ED could affect their teeth was commonly received from the media.

CONCLUSIONS

The dental team should be made aware of the likely detrimental effects of binge eating and vomiting on oral health in patients with eating disorders. The team should also be aware of the cyclical nature of the disease and the similarities and diversities that exist within this group of ED patients. Since ED patients hide their disease from the dental team, this stresses the importance of open and trustful communication between patients and health workers. An organized collaboration between ED clinics and dental professionals is suggested as well as a development of avenues for information about ED and oral health.

Risk Factors for Oral Health in Anorexia Nervosa: Comparison of a Self-Report Questionnaire and a Face-to-Face Interview

Behavioral, nutritional, and local risk factors for oral health are frequent in people with anorexia nervosa. However no self-report questionnaire is available for screening in clinical practice or for research purposes. The objective of this study was to design a questionnaire to identify risk factors and symptoms of oral diseases and to test its reliability as a self-report form among people with anorexia nervosa. A 26-item questionnaire was designed based on a sound literature review performed by a group of dentists, psychiatrists, and epidemiologists specialized in the field of eating disorders. Sixty-nine anorexia nervosa inpatients (mean age 18.72 ± 5.1) were included from four specialized units. The questionnaire was first self-reported by the patients, then the same questionnaire was administrated by a dentist during a structured face-to-face interview as the gold standard. The concordance between the two forms was evaluated globally and item per item using Cohen’s kappa statistical tests. The overall concordance between the self-report questionnaire and the face-to-face structured interview was 55%. Of the 26 items, 19 showed significant concordance. Items relating to water intake, extracted teeth, gingival status, and oral hygiene had the best concordance (all kappa coefficients > 0.4). A questionnaire that identifies risk factors and symptoms of oral diseases in anorexia nervosa was developed and tested. The 26-item form of the questionnaire (long version) is moderately reliable as a self-reported form. A short version of the questionnaire, including the 10 most reliable items, is recommended for oral risk assessment in patients with anorexia nervosa. The clinical value of the self-administered questionnaire remains to be evaluated.

Association between dental fear and eating disorders and Body Mass Index among Finnish university students: a national survey

Background

Little is known about the association between eating disorders (ED) and dental fear. This study investigated the association between dental fear and EDs through body mass index (BMI), and SCOFF (sick, control, one stone, fat, food) questionnaire among Finnish university students. We hypothesised that dental fear is associated with EDs and BMI.

Methods

We used the latest data from the Finnish University Student Health Survey 2016. This survey targeted undergraduate Finnish students (n = 10,000) of academic universities and universities of applied sciences. We enquired about e.g. age, gender, height, weight, educational sector and perceived mental well-being. We used the SCOFF questionnaire to assess those at risk for developing EDs. The question ‘Do you feel scared about dental care?’ enquired about dental fear. We used the chi-square test and gender-specific logistic regression to analyse the associations between dental fear, EDs and BMI controlling for age, educational sector and mental well-being.

Results

In total, 3110 students participated in the study. Overall 7.2% of the students reported high dental fear and 9.2% scored SCOFF positive; more women than men reported high dental fear (11.2% vs. 3.8%, p < 0.001) and scored positive on SCOFF (14.2% vs. 3.6%, p < 0.001). Gender modified the association between dental fear and EDs and BMI. Among females, when controlling for educational sector and BMI, those with positive SCOFF score were more likely to have high dental fear than those with negative SCOFF score (OR = 1.6; CI = 1.0–2.4). After adding perceived mental well-being to the gender-specific regression analyses, overweight and obese males, BMI ≥ 25 (OR = 2.4; CI 1.3–4.4) and females with poor to moderate mental well-being (OR = 2.1; CI 1.4–2.9) were more likely than their counterparts to have high dental fear.

Conclusions

Among the Finnish university students BMI in males and problems of mental well-being in females were positively associated with high dental fear. The results of this study support possible common vulnerability factors that dental fear and other psychological disorders may share.

Knowledge of Oral and Physical Manifestations of Anorexia Nervosa Among Polish Dentists: A Cross-Sectional Study

Background: Anorexia nervosa is a psychosomatic disorder and is commonly associated with impaired oral health. Dentists can play a relevant role in the early diagnosis of anorexia nervosa. With the help of intra- and extraoral examinations and anamnesis, the dentist can detect characteristic signs and symptoms of this eating disorder. The purpose of this study was to determine the knowledge regarding the oral and physical manifestations of anorexia nervosa among general dental practitioners and specialist dentists of Poland. Material and Methods: A pretested online questionnaire consisting of a first part asking for the characteristics of the participant and a second part with 22 specific questions on their general knowledge of anorexia nervosa and knowledge of physical and oral manifestations of this eating disorder was used. Results: A total of 369 dentists completed the questionnaire. The Polish dentists in this study reported sufficient knowledge regarding anorexia nervosa. However, younger dentists and general dental practitioners had relatively lower knowledge scores than other groups. The dentists mainly had difficulties with the oral symptoms of anorexia nervosa. Conclusion: Despite Polish dentists having sufficient knowledge about anorexia nervosa in relation to the general symptoms of anorexia, there are deficits with regard to oral manifestations. Therefore, there is a need to increase continuing education in this field, which can improve early diagnosis of this disease by dental practitioners and referral to specialists for treatment.

Eating disorders and oral health: a scoping review on the role of dietitians

BACKGROUND

Compromised nutritional intake due to eating disorder related behaviors, such as binge eating and purging, can lead to multi-system medical complications, including an irreversible impact on oral health. However, dental anxiety, fear or embarrassment may hinder individuals with an eating disorder from seeking assistance for their oral health concerns. As key health professionals in eating disorder treatment, dietitians are well positioned to provide basic dental screening, however, their capacity to perform this role in practice has not been established. The aim of this review was to identify current evidence on the role of dietitians in promoting oral health among individuals with eating disorders.

METHODS

A comprehensive search of eight electronic databases and the grey literature was conducted to address the following three focus areas: 1) guidelines and recommendations on the role of dietitians in oral health 2) knowledge, attitudes and practices of dietitians regarding oral health promotion and; 3) current models of oral health care and resources for dietitians.

RESULTS

Twelve articles were included. The review indicated that current national and international position statements encourage dietitians to conduct basic oral health screening and promote oral health in high risk populations, such as those with an eating disorder. However, no evidence was found to indicate dietitians performed oral health screening or education in populations with an eating disorder. In other population settings, dietitians were found to play a role in oral health promotion, however, were noted to have mixed knowledge on oral health risk factors, prevention and treatment and generally were not providing referrals. Some oral health promotion resources existed for dietitians working in pediatric, HIV and geriatric clinical areas however no resources were identified for dietitians working in eating disorder settings.

CONCLUSION

Despite current evidence showing that dietitians can play a role in oral health care, no models of care exist where dietitians promote oral health among individuals with an eating disorder. There are also no training resources and screening tools for dietitians in this area. Further research is required to develop this model of care and assess its feasibility and acceptability.

Dental and periodontal health in adults with eating disorders: A case-control study

OBJECTIVES

This study evaluates dental and periodontal health in anorexia nervosa and bulimia nervosa patients.

METHODS

Seventy females with eating disorders (36 anorexia nervosa) attending a public hospital Psychiatry and Addiction unit were compared with age-matched controls (n = 70). Full-mouth examination and oral hygiene behaviours were recorded for all participants.

RESULTS

More frequent dental attendance and toothbrushing were observed in patients with eating disorders than in controls (p < 0.01), while lower plaque index and bleeding on probing were observed in controls than in patients (p ≤ 0.03). Percentages of sites with gingival recession >2 mm were higher in patients with eating disorders than in controls (2.3 ± 4.1 versus 0.0 ± 0.1, p < 0.01). The BEWE score >2 was significantly more frequent in bulimia nervosa patients than in anorexia nervosa patients (76.5% versus 41.7%, p < 0.01). Regarding periodontal parameters, mean plaque index, bleeding on probing and clinical attachment loss were increased in anorexia nervosa patients compared to bulimia nervosa patients.

CONCLUSIONS

The present data suggest different oral health approaches in eating disorder patients according to diagnosis type.

CLINICAL SIGNIFICANCE

Periodontal and dental health should be considered rigorously in patients with eating disorders. Personalized oral hygiene recommendations and treatments can be delivered according to the type of eating disorder.