Oral health experience of patients in remission from an eating disorder

Abstract Background Evidence on how persons in remission from an eating disorder experience their oral health is limited. Dental treatment in Sweden today is often postponed until medical rehabilitation has been completed, but this carries risks. For the patient, the risk is severely impaired oral health and additional suffering, and for both society and the patient, higher costs than might have been necessary. Methods Ten female informants (age 21–51 years; mean age = 36.7; standard deviation ± 12.7) in remission from an eating disorder (duration of illness: 4–25 years) were questioned in semi-structured interviews about their perceptions of oral health. All participants had been referred to a specialist dental clinic and needed oral rehabilitation. One patient had been diagnosed with anorexia nervosa and nine, bulimia nervosa. All had been in remission for at least 1 year. Transcripts of the interviews were analyzed with thematic analysis using an inductive approach. Results One overarching theme emerged from the analysis: dental damage persisted as “a visible, lingering scar” during remission of the eating disorder, reminiscent of the disease and its consequences. The three major themes identified were (1) Physical impact, (2) Psychological impact, and (3) Impact on daily living. The first major theme included erosive tooth wear and impaired oral function and aesthetics. Interviewees described the second as feelings of stigma, guilt, shame, anxiety, and worry, in particular concerning self-inflicted dental damage through self-induced vomiting. The last major theme covered avoidance strategies such as limiting smiling and laughing and minimizing social situations such as eating with others, pursuing a wanted career, and meeting a partner. Postponed dental rehabilitation led to anxiety and worry about future dental deterioration and inevitable extensive dental treatment and costs. Conclusions The participants in this study expressed a two-fold burden of stigma of having suffered from both an eating disorder and poor oral health. All participants expressed a profound negative impact on daily life caused by their poor oral health and their eating disorder.