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

Abstract

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.

The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions

“…Nevertheless, the AN subgroups with purging episodes had worse dental erosion results [126]. Moreover, recent studies reported that 47.3% of AN patients declared suffering from bleeding gums after tooth brushing as the most prevalent oral health symptom, 37.5% of patients also regularly complained of tooth hypersensitivity [132].…”

Eating disorders and oral health: a scoping review

“…This indicates a partial adaptation of the organism to severe conditions during malnutrition Paszynska [ 49 ] Poland To establish the oral status regarding caries incidence, tooth wear, gingival inflammation, and oral hygiene levels among severely ill adolescent inpatients diagnosed with AN Case–control cross‐sectional survey, clinical examination of dental wear N = 220 AN Study findings indicate impaired dental and gingival conditions in young people with anorexia. 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 Rangé [ 51 ] France 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 AN Self-report questionnaire, face-to-face repeat questionnaire administered by dentist N = 69 AN The study authors developed and tested a questionnaire that identifies risk factors and symptoms of oral diseases in anorexia nervosa. The 26-item form of the questionnaire (long version) is moderately reliable as a self-reported form.…”

“…Eleven of the studies used case–control designs to compare oral health findings between people with/at risk for eating disorders and healthy controls/those not at risk. An additional six studies described oral health effects and risk behaviors in patients with diagnosed eating disorders [ 41 , 44 , 47 , 51 , 53 , 54 ]. Findings from these studies indicate negative effects of eating disorders on oral health including tooth erosion, increased size of salivary glands, and gingival recessions at higher rates than control groups.…”

“…A 26-item questionnaire was assessed and found have moderate reliability when administered as a self-report form. The ten most reliable items from the original questionnaire were recommended as a risk assessment in patients with anorexia nervosa [ 51 ].…”