Distúrbios alimentares em adolescentes em Belo Horizonte e sua associação com erosão e cárie dentária

Abstract

The dentist may be the first professional to suspect the occurrence of eating disorders, like bulimia, due to the signs and symptoms of tooth erosion and dental caries resulting from a chronically acidic oral environment and a diet rich in carbohydrates, respectively. Therefore, a controlled cross-sectional study was carried out in order to evaluate the occurrence of erosion and dental caries in adolescents at risk for being suffering from eating disorders and compare it to healthy adolescents. The target sample was composed by 1,287 female students, aged 15-18 years, from public and private schools in Belo Horizonte. The presence of risk for eating disorders was assessed using the Brazilian version of the Bulimic Investigatory Test of Edinburgh (BITE). Eating habits and oral hygiene were also investigated through a self-administered questionnaire. Data analysis of the BITE identified 20 adolescents with major risk behavior for eating disorders (case group), who were matched for age, school and classroom, with 80 adolescents without such risk (control group). All the 100 adolescents underwent dental examination for tooth erosion and dental caries diagnosis through the O'Sullivan index and the ICDAS-II index, respectively. The examiner, previously calibrated (Kappa: 0.88 and 0.83, relating to erosion and dental caries, respectively), was blinded regarding the case and control status of the participants. Data were analyzed using descriptive and inferential statistics by means of the statistical package SPSS 17.0. The association between the occurrence of tooth erosion, dental caries and dietary habits and oral hygiene was verified through a bivariate analysis process, using the Pearsons chi-square test, Fisher's exact test and linear association tests (p<0.05). A conditional logistic regression model was used to verify the association between the presence of risk behavior for eating disorders and the independent variables (p <0.05). The prevalence of risk behavior for eating disorders indicated by BITE in the study sample was 6%, while 1.7% were identified as a group with severe risk behavior. This group had a higher experience of tooth erosion and dental caries when compared to the control group (p <0.001 and p = 0.024, respectively) and had significantly higher chance of having tooth erosion when compared to thecontrol group (OR, 10.04, 95% CI 2.5 -39.4). Concerning those adolescents with tooth erosion, positive association was found between this dental condition and the consumption of citric fruits and the presence of the habit of brushing their teeth shortly after feeding (p=0.023 and p=0.049, respectively). It was concluded that the occurrence of tooth erosion was associated with risk behaviour for eating disorders, even relating to subclinical cases, which had not been diagnosed.