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There is a well-established link between oral pathology and eating
disorders in the presence of self-induced vomiting. There is less
information concerning this relationship in the absence of self-induced
vomiting, in spite of risk factors such as psychotropic-induced dry
mouth, nutritional deficiency or acidic diet.
To determine the association between eating disorder and poor oral
health, including any difference between patients with and without
A systematic search was made of Medline, PsycINFO, EMBASE and article
bibliographies. Outcomes were dental erosion, salivary gland function and
the mean number of decayed, missing and filled teeth or surfaces
Ten studies had sufficient data for a random effects meta-analysis
(psychiatric patients n = 556, controls
n = 556). Patients with an eating disorder had five
times the odds of dental erosion compared with controls (95% CI
3.31–7.58); odds were highest in those with self-induced vomiting (odds
ratio (OR) = 7.32). Patients also had significantly higher DMFS scores
(mean difference 3.07, 95% CI 0.66–5.48) and reduced salivary flow (OR =
2.24, 95% CI 1.44–3.51).
These findings highlight the importance of collaboration between dental
and medical practitioners. Dentists may be the first clinicians to
suspect an eating disorder given patients' reluctance to present for
psychiatric treatment, whereas mental health clinicians should be aware
of the oral consequences of inappropriate diet, psychotropic medication
and self-induced vomiting.
Psychiatric patients have increased comorbid physical illness. There is
less information concerning dental disease in this population in spite of
risk factors including diet and psychotropic side-effects (such as
To compare the oral health of people with severe mental illness with that
of the general population.
A systematic search for studies from the past 20 years was conducted
using Medline, PsycINFO, Embase and article bibliographies. Papers were
independently assessed. The primary outcome was total tooth loss
(edentulousness), the end-stage of both untreated caries and periodontal
disease. We also assessed dental decay through standardised measures: the
mean number of decayed, missing and filled teeth (DMFT) or surfaces
(DMFS). For studies lacking a control group we used controls of similar
ages from a community survey within 10 years of the study.
We identified 21 papers of which 14 had sufficient data
(n = 2784 psychiatric patients) and suitable controls
(n = 31 084) for a random effects meta-analysis.
People with severe mental illness had 3.4 times the odds of having lost
all their teeth than the general community (95% CI 1.6–7.2). They also
had significantly higher scores for DMFT (mean difference 6.2, 95% CI
0.6–11.8) and DMFS (mean difference 14.6, 95% CI 4.1–25.1). Fluoridated
water reduced the gap in oral health between psychiatric patients and the
Psychiatric patients have not shared in the improving oral health of the
general population. Management should include oral health assessment
using standard checklists that can be completed by non-dental personnel.
Interventions include oral hygiene and management of xerostomia.
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