Tooth erosion and eating disorders: a systematic review and meta-analysis.

BACKGROUND: Eating 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. OBJECTIVES: The 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? METHODS: An 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. RESULTS: Twenty-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). CONCLUSION: The 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.

Tooth erosion awareness in a Brazilian dental school.

The aim of this cross-sectional study was to assess awareness and attitudes related to tooth erosion among dental students, patients, and faculty members in a Brazilian dental school. Data were collected by means of a self-applied questionnaire that was distributed among 298 participants. The response rate was 89.6 percent. Chi-square and Fisher's exact tests were used for statistical analysis (p<0.05). The majority of the participants had heard about erosion (72.9 percent), with lower percentages among the patients (p<0.001). In total, 74.9 percent believe that sugar can contribute to erosion (p=0.004). Almost 30 percent of the students did not know if they had had a patient with erosion, and 73.1 percent reported they were not advised by their clinical supervisor to examine their patients for tooth erosion (p=0.138). Concerning the faculty, 23.6 percent of them along with 61.5 percent of the students did not feel prepared to diagnose the condition (p<0.001). Reducing the consumption of acidic drinks was the practice most frequently mentioned as recommended to prevent erosion (89.6 percent). Knowledge about tooth erosion was not as widely evident as it should be in this sample, suggesting the need for better understanding and communication in this important area of oral health care.