Associations between self-reported problematic eating behaviors and oral health outcomes

Background

Disordered eating (DE) encompasses maladaptive eating-related symptoms that often fall below diagnostic thresholds yet are common among adult women. Although clinically diagnosed eating disorders are linked to poor oral health, population-based evidence on oral health outcomes associated with subclinical DE symptoms is limited. This study examined associations between DE symptom profiles and self-reported, quality-of-life, and clinical oral health outcomes.

Methods

Data were drawn from the Norwegian HUNT4 survey (2017–2019) and included 17,238 women aged 20–69 years. DE symptoms were assessed using the Eating Attitude Test-8 (EAT-8). Oral health outcomes included self-reported oral health, dental fear, dental attendance, dry mouth, oral health–related quality of life (OHIP-14; n = 2,745), and clinically assessed dental caries and periodontitis (n = 1,742). Associations were analyzed with Poisson and negative binomial regression models.

Results

Compared with women without DE symptoms, those reporting anorexia-related symptoms had a higher prevalence of poor self-reported oral health (22.1% vs 10.4%; adjusted prevalence ratio [PR] 1.56, 95% CI 1.28–1.89). Bulimia-related symptoms were associated with greater dental fear (25.1% vs 15.3%; PR 1.18, 95% CI 1.07–1.30). Oral health–related quality of life was substantially worse among women with anorexia-related symptoms (adjusted ratio of means 1.65, 95% CI 1.09–2.52) and with bulimia-related symptoms (1.28, 95% CI 1.02–1.59). No clear differences were observed in overall caries experience or untreated dentin caries across symptom categories.

Conclusions

Subclinical disordered eating symptoms are associated with clinically meaningful impairments in perceived oral health and oral health–related quality of life among adult women, whereas associations with dental caries are weak. Disordered eating should be considered an underrecognized determinant of oral health in population-based prevention and dental care.

Key messages

• Subclinical disordered eating is linked to poorer perceived oral health, greater dental fear, and reduced oral health–related quality of life among adult women.

• Disordered eating is an underrecognized public health determinant of oral well-being, supporting closer integration of mental health and oral health prevention and care.