Feeding and Eating Disorders (FED) and Oral Manifestations

Feeding and eating disorders (FED) encompass a spectrum of psychiatric conditions that typically emerge from childhood through early adulthood. These include anorexia nervous (AN), bulimia nervous (BN), binge eating disorder (BED) and other specified feeding or eating disorder (OSFED), avoidance restrictive food intake disorder (ARFID), and pica.²¹

Epidemiological data show that;²¹

• 9% of the US populations will experience an eating disorder in their lifetime.

• 22% of children and adolescents will display disorder eating behaviors globally.

• Anorexia nervosa (AN) is among the highest mortality of any psychiatric disorder.

At the core of all FED’s is a disturbance of compensatory eating behaviors, often motivated by body image concerns and accompanied by co-occurring mood and anxiety disorders. Individuals with BN or BED are frequently overweight or obese and may suffer from serious metabolic complications.²¹

The COVID-19 pandemic significantly exacerbated the prevalence and severity of FED’s. Studies report a marked increase in new diagnosis, particular among adolescents and young adults with a higher rate of psychiatric comorbidity and hospitalizations.²¹

Dental professionals are in a unique position to identify early signs of FED during routine examinations. Common oral manifestations include;²¹

• Xerostomia

• Enamel erosion

• Tooth sensitivity

• Increased caries rate

• Mucosal irritation

A personalization and precision medical approach, one that considers biological, psychological, and social dimensions of FED’s can improve treatment outcome. Interprofessional collaboration, particularly with mental health providers offering cognitive behavioral therapy (CBT) is considered the gold standard of managing these complex conditions.

Figure 13. Erosion caused by chronic vomiting in bulimia.³¹

Figure 13. Erosion caused by chronic vomiting in bulimia.³¹

Image source: ©2003 Lippincott Williams & Wilkins.