Title	Eating Disorders Negatively Impact Oral Health
Clinical Question	Do eating disorders have a negative impact on oral health?
Clinical Bottom Line	Eating disorders negatively impact oral health. This is supported by a meta-analysis of studies included in a systematic review. The results show a significant increase in dental erosion and DMFT/S and significantly reduced salivary flow compared to that of the control group.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 26429686 Kisely/2015 10 studies for a random effect meta-analysis of 1,112 patients Meta-Analysis Key results Patients with self-induced vomiting had significantly higher odds of dental erosion (OR = 7.32) compared to that of the control patients. Patients with an eating disorder also had significantly higher decayed, missing, and filled teeth or surfaces (DMFT/S) (mean difference = 3.07, 95% CI 0.66-5.48) and reduced salivary flow (OR=2.24, 95% CI 1.44-3.51).
Evidence Search	(("Eat Disord"[Journal] OR ("eating"[All Fields] AND "disorders"[All Fields]) OR "eating disorders"[All Fields]) AND ("poverty"[MeSH Terms] OR "poverty"[All Fields] OR "poor"[All Fields]) AND ("oral health"[MeSH Terms] OR ("oral"[All Fields] AND "health"[All Fields]) OR "oral health"[All Fields]))
Comments on The Evidence	Validity: A systematic search of the literature was performed using using Medline, PsycINFO, EMBASE, and article bibliographies. Of the studies located through the search, “ten studies had sufficient data for a random effects meta-analysis.” The authors state, "All but two of the results had an I2 [I-squared] estimate of 50% or more, indicating possible heterogeneity." Furthermore, regarding the included studies, the authors state, "Study quality was not optimal." Taken together, this indicates that one should view the conclusions of the systematic review and meta-analysis with some skepticism. Perspective: This evidence suggests that eating disorders can negatively affect the oral health of a patient. The clinician may be able to identify the signs of a possible eating disorder and intervene by providing the patients with information on the effects of self-induced vomiting on the oral cavity.
Applicability	These results suggest that a patient may have an eating disorder when dental erosion, reduced salivary flow, higher DMFT/S are present. It should be noted that other factors can cause similar symptoms, like acid reflux or medications.
Specialty	(Public Health) (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords	Eating disorders, oral health, dental erosion, bulimia
ID#	3097
Date of submission	02/22/2017
E-mail	trevinoab@livemail.uthscsa.edu
Author	Anavel Trevino
Co-author(s)	Dayoung Yoo
Co-author(s) e-mail	YooD@livemail.uthscsa.edu
Faculty mentor	Carol Nguyen, RDH, MS
Faculty mentor e-mail	NGUYENC@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available