Gidlund Ulrica, Hasselblad Tove, Larsson-Gran Pernilla, von Hausswolff-Juhlin Yvonne, Dahllöf Göran
Department of Prosthetic Dentistry, Public Dental Service, Folktandvården Stockholms Län AB, Stockholm, Sweden.
Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
J Eat Disord. 2024 Oct 9;12(1):158. doi: 10.1186/s40337-024-01117-6.
Evidence on how persons with and 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.
Ten female informants aged 21-51 years (mean age = 36.7, standard deviation 12.7) in remission from an eating disorder with a median duration of 12.5 (range 4-25) years of illness, 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. 10% of the patients had been diagnosed with anorexia nervosa and 90% with bulimia nervosa. All had been in remission from the eating disorder for at least one year. Transcripts of the interviews were analyzed with thematic analysis using an inductive approach.
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.
The participants in this study expressed a profound negative impact on daily life and a two-fold burden of stigma of having suffered from both an eating disorder and poor oral health.
关于饮食失调患者及其康复者口腔健康状况的证据有限。如今在瑞典，牙科治疗通常会推迟到医学康复完成之后，但这存在风险。对患者来说，风险是口腔健康严重受损并承受更多痛苦，而对社会和患者双方而言，成本都比原本所需的更高。
对10名年龄在21至51岁（平均年龄 = 36.7岁，标准差12.7）的女性受访者进行了半结构化访谈，她们均已从饮食失调中康复，患病时间中位数为12.5年（范围4至25年），询问她们对口腔健康的看法。所有参与者均被转介至专科牙科诊所，且需要进行口腔康复治疗。10%的患者被诊断为神经性厌食症，90%为神经性贪食症。所有人从饮食失调中康复至少已有一年。访谈记录采用归纳法进行主题分析。
分析得出一个总体主题：在饮食失调康复期间，牙齿损伤作为一种可见且持久的疤痕依然存在，令人想起这种疾病及其后果。确定的三个主要主题分别为：(1) 身体影响，(2) 心理影响，以及(3) 对日常生活的影响。第一个主要主题包括牙齿磨损侵蚀、口腔功能及美观受损。受访者将第二个主题描述为耻辱感、内疚、羞耻、焦虑和担忧等情绪，尤其是对因自我催吐导致的牙齿损伤感到自责。最后一个主要主题涵盖了一些回避策略，比如限制微笑和大笑，尽量减少与他人一起吃饭、追求理想职业以及结识伴侣等社交场合。
本研究中的参与者表示，饮食失调和口腔健康不佳给日常生活带来了严重的负面影响，并且造成了双重耻辱负担。
