Non-Cochrane · aetiology · PM39841278
The influence of anorexia nervosa on oral health and related parameters potentially relevant to orthodontic treatment: a systematic review and meta-analysis.
Niederau Christian, Alman Eda, Rizk Marta, et al. · Clinical oral investigations · 2025 · PubMed · doi:10.1007/s00784-024-05774-4
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
9
current version
GRADE rated
5
No studies
0
Included studies
19
linked below
No studies 0 · 0%Ungraded 4 · 44.4%Very low 0 · 0%Low 4 · 44.4%Moderate 1 · 11.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients >=12 years with anorexia nervosa (both sexes, all ethnicities, community-dwelling general population); retrospective and prospective studies (note: focused question mis-states '<12 years'; inclusion criteria state >=12 years) | 11 included studies (345 anorexia nervosa patients; entirely female in reported data; mean age 18.4-18.5 years); a 12th study (Milosevic 1989) contributes plaque data |
| Intervention | Anorexia nervosa (exposure) | Anorexia nervosa diagnosed by DSM-III/III-R/IV/V (most DSM-IV, 50%) |
| Comparison | Patients without anorexia nervosa (healthy controls) | Healthy age- and sex-matched controls without anorexia nervosa |
| Outcomes | Oral health parameters (PECO): bleeding on probing (BOP), DMFT index, salivary pH, salivary alpha-amylase, salivary flow rate | Meta-analyzed with GRADE (5 outcomes): BOP, DMFT, salivary pH, unstimulated salivary flow rate, alpha-amylase. Reported narratively/ungraded: plaque index, gingival recession, dental erosion, stimulated salivary flow rate |
| Study designs | Retrospective and prospective case-control and cohort studies (and controlled clinical trials); in vitro/animal, other eating disorders, and studies without a specified control group excluded | Case-control studies (75%) and controlled clinical trials (25%); NOS scores 4-7 (mean 6); 1/11 studies at high risk of bias (score <5) |
| Timing | Not specified | Not specified |
Search date: Up to February 2024 (Abstract); Methods states searched without time restriction up to April 2023. Databases: PubMed; Web of Science; ClinicalTrials.gov; Cochrane
Questions and results
Anorexia nervosa (as exposure; diagnosed by DSM-III/III-R/IV/V) vs Healthy individuals without anorexia nervosa (age- and sex-matched controls)
Population: Patients with anorexia nervosa aged >=12 years (mean age ~18.4; entirely female in reported data), general community-dwelling population
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bleeding on probing (BOP) Anorexia nervosa is associated with significantly increased bleeding on probing versus healthy controls (MD 16.57%, 95% CI 12.89 to 20.25; low certainty). Source: BOP - meta-analysis (Results); Fig. 2 (forest plot; MD 16.57 [12.89, 20.25], I2=0%, 2 studies, 326 participants); Table 7 (Summary of… · same question in other reviews | MD 16.57 [12.89, 20.25] 16.57 [12.89, 20.25] % of sites with BOP | 2 studies · 326 participants | Low |
Salivary pH Anorexia nervosa is associated with significantly lower salivary pH than healthy controls (MD -0.39, 95% CI -0.54 to -0.24; low certainty). Source: Salivary pH - meta-analysis (Results); Fig. 4 (forest plot; MD -0.39 [-0.54, -0.24], I2=40%, 3 studies, 180 participants); Table 7… · same question in other reviews | MD -0.39 [-0.54, -0.24] -0.39 [-0.54, -0.24] pH units | 3 studies · 180 participants | Low |
Stimulated salivary flow rate Stimulated salivary flow rate was significantly lower in anorexia nervosa patients than controls, but only unstimulated flow was meta-analyzed; this outcome is ungraded. Source: Salivary parameters (Results); Table 5 (stimulated flow rate, Paszynska 2015 Nov and 2018) · same question in other reviews | Stimulated salivary flow rate significantly lower in anorexic patients (Paszynska 2015 Nov 1.20 vs 1.57 ml/min, p=0.005; Paszynska 2018 0.99 vs 1.45 ml/min, p<0.00001); reported narratively, not meta-analyzed | 2 studies · 126 participants | Ungraded |
Salivary alpha-amylase There is no significant difference in salivary alpha-amylase between anorexia nervosa patients and healthy controls (MD 6.32 U/l, 95% CI -6.14 to 18.79; low certainty). Source: alpha-amylase - meta-analysis (Results); Fig. 6 (forest plot; MD 6.32 [-6.14, 18.79], I2=3%, 4 studies, 226 participants); Table 7… · same question in other reviews | MD 6.32 [-6.14, 18.79] 6.32 [-6.14, 18.79] U/l | 4 studies · 226 participants | Low |
Gingival (marginal) recession Gingival (marginal) recession was significantly higher in anorexia nervosa patients than controls in both reporting studies, but was not pooled or graded (ungraded). Source: Periodontal health (Results); Table 3 (REC %, Pallier and Touyz) · same question in other reviews | Marginal/gingival recession significantly higher in anorexia nervosa patients (Pallier 2.8% vs 0.0%, p<0.01; Touyz 10.2% vs 2.0%, p<0.001); not meta-analyzed | 2 studies · 136 participants | Ungraded |
Dental erosion Dental erosion was more prevalent in anorexia nervosa patients than controls (low erosive-wear severity), but was not pooled or graded (ungraded). Source: Discussion (dental erosion; studies [4,15]); Table 1 (BEWE parameter) · same question in other reviews | Significant prevalence of dental erosion in anorexic patients vs controls, though BEWE scores indicated low erosive-wear risk (Mascitti BEWE 5.2+/-4.5; Paszynska 16.2% at BEWE 3-8); not meta-analyzed | 2 studies · 270 participants | Ungraded |
Unstimulated salivary flow rate Anorexia nervosa probably reduces unstimulated salivary flow rate versus healthy controls (MD -0.27 ml/min, 95% CI -0.31 to -0.24; moderate certainty). Source: Unstimulated salivary flow rate - meta-analysis (Results); Fig. 5 (forest plot; MD -0.27 [-0.31, -0.24], I2=0%, 4 studies, 316… · same question in other reviews | MD -0.27 [-0.31, -0.24] -0.27 [-0.31, -0.24] ml/min | 4 studies · 316 participants | Moderate Downgraded: risk of bias |
Dental plaque accumulation (plaque index) Anorexia nervosa patients tended to have higher plaque accumulation than healthy controls (significant in 2 of 3 studies), but results were not pooled or graded (ungraded). Source: Plaque accumulation (Results); Table 6 (plaque index; 3 studies, 171 AN / 223 controls) · same question in other reviews | In 2 of 3 studies anorexic patients had significantly higher plaque accumulation than controls (Pallier 78.8% vs 53.0%, p<0.01; Paszynska 43.8% vs 13.7%, p<0.001; Milosevic 84% vs 72%, NS); not meta-analyzed | 3 studies · 394 participants | Ungraded |
Caries experience (DMFT index) Anorexia nervosa is associated with significantly higher caries experience (DMFT) than healthy controls (MD 2.00 teeth, 95% CI 0.87 to 3.13; low certainty). Source: DMFT - meta-analysis (Results); Fig. 3 (forest plot; MD 2.00 [0.87, 3.13], I2=35%, 4 studies, 406 participants); Table 7 (Summary of… · same question in other reviews | MD 2.00 [0.87, 3.13] 2.00 [0.87, 3.13] teeth (DMFT score) | 4 studies · 406 participants | Low |
Included primary studies 19
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Mascitti 2019 Anorexia, Oral Health and Antioxidant Salivary System: A Clinical Study on Adult Female Subjects. PMID:31159381 | this review only | Caries experience (DMFT index) | not extracted yet | not extracted yet |
| Mascitti et al. 2019 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Milosevic 1989 The orodental status of anorexics and bulimics DOI:10.1038/sj.bdj.4806915 | this review only | Dental plaque accumulation (plaque index) | not extracted yet | not extracted yet |
| Monteleone 2011 Abnormal diurnal patterns of salivary α-amylase and cortisol secretion in acute patients with anorexia nervosa DOI:10.3109/15622975.2011.590226 | this review only | Salivary alpha-amylase | not extracted yet | not extracted yet |
| Monteleone et al. 2011 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Pallier 2019 Dental and periodontal health in adults with eating disorders: A case-control study DOI:10.1016/j.jdent.2019.03.005 | this review only | Bleeding on probing (BOP); Caries experience (DMFT index); Dental plaque accumulation (plaque index) | not extracted yet | not extracted yet |
| Pallier et al. 2019 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Paszynska 2015 (Nov) Salivary enzyme activity in anorexic persons—a controlled clinical trial DOI:10.1007/s00784-015-1442-3 | this review only | Unstimulated salivary flow rate | not extracted yet | not extracted yet |
| Paszynska 2016 (Dec) Salivary alpha-amylase, secretory IgA and free cortisol as neurobiological components of the stress response in the acute phase of… DOI:10.3109/15622975.2016.1163419 | this review only | Salivary pH; Unstimulated salivary flow rate | not extracted yet | not extracted yet |
| Paszynska 2016 (June) Activation of human monocytes via their sIgA receptors. PMID:2016119 | this review only | Unstimulated salivary flow rate; Salivary alpha-amylase | not extracted yet | not extracted yet |
| Paszynska 2017 Enzyme activities in parotid saliva of patients with the restrictive type of anorexia nervosa DOI:10.1016/j.archoralbio.2016.12.012 | this review only | Salivary alpha-amylase | not extracted yet | not extracted yet |
| Paszynska 2018 Study of salivary and serum vaspin and total antioxidants in anorexia nervosa DOI:10.1007/s00784-018-2370-9 | this review only | Unstimulated salivary flow rate | not extracted yet | not extracted yet |
| Paszynska 2022 Risk of Dental Caries and Erosive Tooth Wear in 117 Children and Adolescents' Anorexia Nervosa Population-A Case-Control Study. PMID:35619622 | this review only | Bleeding on probing (BOP); Caries experience (DMFT index); Dental plaque accumulation (plaque index) | not extracted yet | not extracted yet |
| Paszynska et al. 2017 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Paszynska et al. 2018 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Paszynska et al. 2022 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Philipp 1991 matched by author and year (probable) | this review only | Salivary pH; Salivary alpha-amylase | not extracted yet | not extracted yet |
| Phillip et al. 1991 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Touyz 1993 matched by author and year (probable) | this review only | Caries experience (DMFT index); Salivary pH | not extracted yet | not extracted yet |