Oral & Mental Health

Developing a Dietitian Initiated program for oral health and eating disorders

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The prevalence, incidence and magnitude of eating disorders (ED) are increasing worldwide. In Australia, more than 1 million individuals are estimated to have an ED. Research has established a link between eating disorders and poor oral health. Findings from two systematic reviews identified that individuals with an ED are five times more likely to have tooth erosion and are at an increased risk of developing caries, regardless of ED subtype. While the association between eating disorders and adverse oral health outcomes have been well documented, there is a scarcity of research investigating the oral health care practices of individuals with a mental health illness, including eating disorders.

The Dietitians Association of Australia (DAA-Australia) and the Academy of Nutrition and Dietetics (in the United States) both confirm the bi-directional relationship between nutrition and oral health and emphasise the role of the dietitian in actively screening for oral health concerns, especially in vulnerable populations. Dietitians form part of the multidisciplinary primary care team involved in the care of the individual with an eating disorder and therefore, are in an ideal position to promote oral health during consultations. However, there is currently no evidence of dietitian led interventions that assist in early identification, screening and/or oral health education of individuals with eating disorders.

The overall aim of this study is to undertake a needs assessment to review the current role and experiences of dietitians in oral health promotion and prevention and explore the perceptions of individuals with an ED regarding their oral health practices.

The phases of this research are as follows:

    •Phase I: Scoping review– The dietitians role in oral health promotion
    •Phase II: Quantitative approach- national cross-sectional survey of dietitians to explore their knowledge, attitude and practices regarding oral health.
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    •Phase IIIA: Qualitative approach: interviews with dietitians who work in populations with eating disorders.
    •Phase IIIB: Qualitative approach: interviews with adults >18 years with an eating disorder to explore their perceptions towards oral health and the role of dietitians in this area.

The findings from these phases will help provide valuable insight into the facilitators and barriers for both dietitians and individuals with an ED regarding their knowledge and attitudes towards oral health, and as a result, how this shapes their behaviours. Furthermore, understanding the needs of both these populations will provide a foundation for the development of acceptable, feasible and sustainable intervention with the central goal of improving access to oral health care for enhancing nutritional outcomes.

Project team:

    • Tiffany Patterson Norrie – Western Sydney University, SWSLHD, Ingham Institute
    • Assoc Prof. Ajesh George – Western Sydney University, SWSLHD, University of Sydney, Ingham Institute
    • Dr Lucie Ramjan – Western Sydney University, Ingham Institute
    • Dr Mariana S. Sousa – University of Technology, Ingham Institute