knowledge of eating disorders among dental professionals and students: a malaysian cross-sectional study
Abstract
Background: Eating disorders (EDs) are serious mental health conditions characterized by disordered eating behaviors and excessive concern about body weight, shape, or food intake, affecting an individual's psychological, physical, and oral health. Oral health professionals are often the first to recognize these signs and symptoms, thus playing a crucial role in early detection and timely intervention. Aim: To assess the knowledge of dental students and professionals regarding the psychological, physical, and oral health implications of EDs.
Material and Methods: A cross-sectional study was conducted using a structured and validated questionnaire among 193 clinical-year dental students (DS) and 40 practicing dental professionals (DP) in Malaysia, selected through a convenience sampling method. The questionnaire consisted of three sections: demographic data, and assessments of knowledge and awareness regarding the psychological, physical, and oral health manifestations of EDs. Differences in participants' knowledge was assessed using Fisher’s exact test and the Chi-square test. A p-value of <0.05 was considered statistically significant.
Results: Participants showed poor knowledge of certain EDs symptoms, including gender predilection (DS: 34.7%, DP: 35.0%), low body weight (DS: 41.5%, DP: 52.5%), parotid gland enlargement (DS: 28.5%, DP: 25.0%), and poor oral hygiene (DS: 36.3%, DP: 47.5%). Good level of knowledge was noted for associations with stress and anxiety (DS: 89.6%, DP: 90.0%), and mirror checking (DS: 78.2%, DP: 65.0%). Moderate knowledge was observed for social withdrawal (DS: 51.3%, DP: 50.0%), knuckle bruises, (DS: 51.3%, DP: 57.5%), low self-esteem (DS: 69.4%, DP: 72.5%), nail erosion, dental caries, hypersensitivity, angular cheilitis, and oral pain/burning(DS: 59.6%, DP: 55.0%). Significant differences between DS and DP were found for mirror checking (p<0.05), oral candidiasis (p<0.05), and symptoms such as burning sensation, taste changes, and unexplained oral pain (p<0.05).
Conclusions: DS and DP demonstrated varying levels of knowledge about EDs, with poor levels of knowledge on certain key physical and oral manifestations. Therefore, integrating education on EDs into dental training is essential to support early diagnosis and timely referral.
References
Presskreischer R, Prado MA, Kuraner SE, Arusilor IM, Pike K. Eating disorders and oral health: a scoping review. J Eat Disord. 2023;11(1):55. https://doi.org/10.1186/s40337-023-00778-z. PMID:3701 6387; PMCID: PMC10071677.
Garbin CAS, Martins RJ, de Melo Belila N, Garbin AJÍ. Oral manifestations in patients with anore-xia and bulimia nervosa: a systematic review. J Public Health. 2020;28:765–771. https://doi.org/10.1007/s10389-019-01080-6
Kim YR, Nakai Y, Thomas JJ. Introduction to a spe-cial issue on eating disorders in Asia. Int J Eat Disord. 2021;54(1):3-6. https://doi.org/10.1002/eat.23444. Epub 2020 Dec 19. PMID: 33340374.
Pengpid S, Peltzer K. Risk of disordered eating attitudes and its relation to mental health am-ong university students in ASEAN. Eat Weight Disord. 2018;23(3):349-355. https://doi.org/10.1007/s40519-018-0507-0. Epub 2018 Apr 21. PMID: 29681011.
Chan YL, Samy AL, Tong WT, Islam MA, Low WY. Eating Disorder Among Malaysian University Students and Its Associated Factors. Asia Pac J Public Health. 2020;32(6-7):334-339. https://doi.org/10.1177/1010539520947879. Epub 2020 Aug 13. PMID: 32787612.
Chua SN, Fitzsimmons-Craft EE, Austin SB, Wilfley DE, Taylor CB. Estimated prevalence of eating disorders in Malaysia based on a diag-nostic screen. Int J Eat Disord. 2022; 55(6):763-775. https://doi.org/10.1002/eat.23711. Epub 2022 Apr 2. PMID: 35366018; PMCID: PMC9167751.
Chua SN, Craddock N, Rodtanaporn W, Or F, Austin SB. Social media, traditional media, and other body image influences and disor-dered eating and cosmetic procedures in Malaysia, Singapore, Thailand, and Hong Kong. Body Image. 2023;45:265-272. https://doi.org/10.1016/j.bodyim.2023.03.010. Epub 2023 Apr 1. PMID: 37011471.
Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–93.
Romanos GE, Javed F, Romanos EB, Williams RC. Oro-facial manifestations in patients with eating disorders. Appetite. 2012;59(2):499-504. https://doi.org/10.1016/j.appet.2012.06.016. Epub 2012 Jun 29. PMID: 22750232.
Kavitha PR, Vivek P, Hegde AM. Eating disorders and their implications on oral health--role of dentists. J Clin Pediatr Dent. 2011; 36(2): 155-60. https://doi.org/10.17796/jcpd.36.2.3785414p68 2843wj. PMID: 22524077.
Dynesen AW, Gehrt CA, Klinker SE, Christensen LB. Eating disorders: experiences of and attitudes toward oral health and oral health behavior. Eur J Oral Sci. 2018;126(6):500-506. https://doi.org/10.1111/eos.12578. Epub 2018 Oct 19. PMID: 30341802.
Valeriani L, Frigerio F, Piciocchi C, Piana G, Montevecchi M, Donini LM, Mocini E. Oro-dental manifestations of eating disorders: a systematic review. J Eat Disord. 2024;12(1):87. https://doi.org/10.1186/s40337-024-01050-8. PMID:3891510 0; PMCID: PMC11197207.
Szupiany-Janeczek T, Rutkowski K, Pytko-Polończyk J. Oral Cavity Clinical Evaluation in Psychiatric Patients with Eating Disorders: A Case-Control Study. Int J Environ Res Public Health. 2023;20(6):4792. https://doi.org/10.3390/ijerph20064792. PMID:36981701; PMCID: PMC 10049687.
Johansson AK, Johansson A, Nohlert E, Norring C, Åstrøm AN, Tegelberg Å. Eating disorders- knowledge, attitudes, management and clini-cal experience of Norwegian dentists. BMC Oral Health. 2015;15(1):124. https://doi.org/10.1186/s12903-015-0114-7. PMID: 26463731; PMCID: PMC4604665.
Valeriani L, Frigerio F, Piciocchi C, Piana G, Montevecchi M, Donini LM, Mocini E. Oro-dental manifestations of eating disorders: a systematic review. J Eat Disord. 2024;12(1):87. https://doi.org/10.1186/s40337-024-01050-8. PMID: 38915100; PMCID: PMC11197207.
DeBate RD, Tedesco LA, Kerschbaum WE. Know-ledge of oral and physical manifestations of anorexia and bulimia nervosa among den-tists and dental hygienists. J Dent Educ. 2005; 69(3):346-54. PMID: 15749945.
Mohd Taib N, Abdul Khaiyom JH, Fauzaman J. Psychometric properties of the adapted Ma-lay Eating Disorder Examination-Questionnaire 6.0 (EDE-Q 6.0) among university students in Malaysia. Eat Behav. 2021;42:101533. https://doi.org/10.1016/j.eatbeh.2021.101533. Epub 20-21 Jun 10. PMID: 34182294.
Al-Rawajfah OM, Al-Mugeed KA, Alaloul F, Al-Rajaibi HM, Al Omari O. COVID-19 knowledge, attitude, and precautionary practices among health professional students in Oman. Nurse Educ Pract. 2021;52:103041. https://doi.org/10.1016/j.nepr.2021.103041. Epub 2021 Mar 25. PMID: 33866236; PMCID: PMC7993640.
Alhowaymel FM, Abdelmalik MA, Mohammed AM, Mohamaed MO, Alenezi A. Knowledge, Attitudes, and Practices of Hypertensive Patients Towards Stroke Prevention Among Rural Population in Saudi Arabia: A Cross-Sectional Study. SAGE Open Nurs. 2023;9:23779608221150717. https://doi.org/10.1177/23779 608221150717. PMID: 36643783; PMCID: PMC983 4414.
Jalal SM, Akhter F, Abdelhafez AI, Alrajeh AM. Assessment of Knowledge, Practice and Attitude about Biomedical Waste Management among Healthcare Professionals during COVID-19 Crises in Al-Ahsa. Healthcare. 2021;9(6):747. https://doi.org/10.3390/healthcare9060747. PMID: 34207056; PMCID: PMC8235679.
Pike KM, Dunne PE. The rise of eating disorders in Asia: a review. J Eat Disord. 2015;3:33. https://doi.org/10.1186/s40337-015-0070-2. PMID: 26388993; PMCID: PMC4574181.
Azman RI. Prevalence of Development of Ea-ting Disorders among Students in University of Cyberjaya. Asian J Med Health Sci. 2022; 5(1):125–39.
Mohd Taib N, Abdul Khaiyom JH, Fauzaman J. Psychometric properties of the adapted Malay Eating Disorder Examination-Questionnaire 6.0 (EDE-Q 6.0) among university students in Malaysia. Eat Behav. 2021;42:101533. https://doi.org/10.1016/j.eatbeh.2021.101533. Epub 2021 Jun 10. PMID: 34182294.
Mroczkowska D, Ziółkowska B. Eating disorders among men in the context of mental health and socio-cultural gender issues. Przegląd Kryt. 2021;3(1):65–78.
Lavender JM, Brown TA, Murray SB. Men, Muscles, and Eating Disorders: an Overview of Traditional and Muscularity-Oriented Disordered Eating. Curr Psychiatry Rep. 2017;19(6):32. https://doi.org/10.1007/s11920-017-0787-5. PMID: 28470486; PMCID: PMC5731454.
Franceschini A, Fattore L. Gender-specific ap-proach in psychiatric diseases: Because sex matters. Eur J Pharmacol. 2021 Apr 5;896:173895. https://doi.org/10.1016/j.ejphar.2021.173895. Epub 2021 Jan 26. PMID: 33508283.
Mangweth-Matzek B, Kummer KK, Hoek HW. Update on the epidemiology and treatment of eating disorders among older people. Curr Opin Psychiatry. 2023;36(6):405-411. https://doi.org/10.1097/YCO.0000000000000893. Epub 2023 Jul 19. PMID: 37471308; PMCID: PMC10552830.
Krukowska-Zaorska A, Kot K, Marek E, Dura W, Safranow K, Lipski M. Knowledge of Oral and Physical Manifestations of Anorexia Nervosa Among Polish Dentists: A Cross-Sectional Study. Front Psychiatry. 2021;12:751564. https://doi.org/10.3389/fpsyt.2021.751564. PMID: 34777055; PMCID: PMC8578852.
Guo EL, Katta R. Diet and hair loss: effects of nutrient deficiency and supplement use. Der-matol Pract Concept. 2017;7(1):1-10. https://doi.org/10.5826/dpc.0701a01. PMID: 28243487; PMCID: PMC5315033.
DiGioacchino RF, Keenan MF, Sargent R. Asses-sment of dental practitioners in the secondary and tertiary prevention of eating disorders. Eat Behav. 2000;1(1):79-91. https://doi.org/10.1016/s1471-0153(00)00004-0. PMID: 15001 069.
Otsu M, Hamura A, Ishikawa Y, Karibe H, Ichijyo T, Yoshinaga Y. Factors affecting the dental erosion severity of patients with eating disorders. Biopsychosoc Med. 2014;8:25. https://doi.org/10.1186/1751-0759-8-25. PMID: 25904974; PMCID: PMC4406023.
Lin JA, Woods ER, Bern EM. Common and Emergent Oral and Gastrointestinal Manifestations of Eating Disorders. Gastroenterol Hepatol. 2021; 17(4):157-167. PMID: 34035776; PMCID: PMC8132634.
Esteves CV, Freitas RS, Campos WG, Shimabukuro N, Thomaz DY, Cordas T, Benard G, Witzel AL, Lemos CA. Oral yeast colonization in patients with eating disorders: commensal acquisition or due to purgative habits? Rev Inst Med Trop Sao Paulo. 2020;62:e32. https://doi.org/10.1590/s1678-9946202062032. Epub 2020 May 29. PMID: 32491142; PMCID: PMC7266616.
Hodgson L. Effectiveness of dental undergraduate education on eating disorders: the student perspective. Br Dent J. 2024 Aug;237(3):198. https://doi.org/10.1038/s41415-024-7746-4. PMID: 39123022.
Johansson AK, Johansson A, Nohlert E, Norring C, Åstrøm AN, Tegelberg Å. Eating disorders - knowledge, attitudes, management and clinical experience of Norwegian dentists. BMC Oral Health. 2015 Oct 14;15(1):124. https://doi.org/10.1186/s12903-015-0114-7. PMID: 26463731; PMCID: PMC4604665. Oral Health. 2015 ;15:124.
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