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ORIGINAL ARTICLE
Year : 2019  |  Volume : 11  |  Issue : 1  |  Page : 27-31

Evaluation of Eating Disorders Using “SCOFF Questionnaire” Among Young Female Cohorts and Its Dental Implications − An Exploratory Study


1 Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, Karnataka, India
2 Manipal Academy of Higher Education, Manipal, Karnataka, India

Date of Web Publication9-Aug-2019

Correspondence Address:
Nikita Rungta
Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jofs.jofs_145_18

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  Abstract 


Introduction: Eating disorders can cause serious changes in eating habits that can lead to major, even life-threatening, health problems. This may cause devastating effects on teeth. Materials and Methods: The present study was conducted to assess eating disorders among 15 to 17-year-old female cohorts. The SCOFF [sick, control, one stone (1 stone is 6.3 kg), fat, and food] Questionnaire was distributed among the consented female cohorts. The study comprised five questions. The oral health examination was carried out using mouth mirror and WHO probe. The presence or absence of dental caries, dental erosion, gingivitis, as well as the body mass index was documented. The pamphlets regarding healthy dietary habits and ill effects of acidic foods were distributed to the participants after the oral health examination. Results: A total of 200 young female cohorts with mean age 15.85 ± 0.59 were screened. The prevalence of eating disorders according to the SCOFF Questionnaire was 10.5%. Those who had an eating disorder showed higher body mass index (19.21 ± 2.16) compared to those without it (17.51 ± 2.62). This showed statistical significance with P value equal to 0.005. However, there was no statistically significant difference in the dental caries experience among cohorts with disorders to without disorders. Conclusion: Although there was no difference in caries experience among cohorts with eating disorder to without disorder, it is the dentists’ duty to educate the person before they develop dental symptoms.

Keywords: BMI, eating disorders, oral manifestations, SCOFF Questionnaire


How to cite this article:
Rungta N, Kudpi RS. Evaluation of Eating Disorders Using “SCOFF Questionnaire” Among Young Female Cohorts and Its Dental Implications − An Exploratory Study. J Orofac Sci 2019;11:27-31

How to cite this URL:
Rungta N, Kudpi RS. Evaluation of Eating Disorders Using “SCOFF Questionnaire” Among Young Female Cohorts and Its Dental Implications − An Exploratory Study. J Orofac Sci [serial online] 2019 [cited 2019 Nov 15];11:27-31. Available from: http://www.jofs.in/text.asp?2019/11/1/27/264183




  Introduction Top


Eating disorders can cause serious changes in eating habits that can lead to major, even life-threatening, health problems. Eating disorders typically develop during adolescence or early adulthood. Doctors are not certain what causes eating disorders.[1],[2] Previous studies done on Indian population show that the information regarding these disorders is very limited among South Kanara population.[3],[4],[5] Some studies have also reported that eating disorders have been on the increase among Indians, particularly among adolescent and young adult females.[5],[6],[7] They suspect a combination of biological, behavioral, and social factors.[8] Many children and teens with eating disorders struggle with one or more problems like distress, fear of becoming overweight, feelings of helplessness, and low self-esteem. Thus, to cope up with these issues, harmful eating habits are adopted.

Dietary habits can and do play a role in oral health. Everyone has heard from their dentist that eating too much sugar can lead to cavities, but high intake of acidic foods can have an equally devastating effect on teeth. In fact, while up to 89% of bulimic patients show signs of tooth erosion usually associated with regurgitation, some studies have found similar prevalence rates in patients with highly restrictive dietary habits. The harmful habits and nutritional deficiencies that often accompany disordered eating can have severe consequences on dental health.[8],[9]

Stedal and Dahlgren[10] found that the prevalence rate for anorexia is highest among females aged 15 to 19 years, whereas those with the highest risk for bulimia are females aged 20 to 24 years. The average age of onset of anorexia is 17 years. Young individuals, especially those in the high-school age group, are specifically at risk for developing eating disorders due to personal reasons, family, and peer pressures.[9],[11],[12] Due to oral implications of the disorders, such as perimolysis and caries, dentists and dental hygienists are often the first health providers to have the opportunity to identify a pattern associated with an eating disorder.[4],[6] To understand this younger age group of females, this study was carried out to survey young female cohorts between the ages 15 to 17 years.


  Aim and Objectives Top


Our aim was to evaluate eating disorders using “SCOFF Questionnaire” among young female cohorts and its dental implications along with the following objectives of determining whether 15 to 17-year-old females have eating disorders; to compare the individual participant’s body mass index (BMI) with actual healthy weight status; and last to check for oral complications, that is, dental caries, gingivitis, and dental erosion.


  Materials and Methods Top


The study design was a descriptive and comparative study with two Pre-University Colleges being selected by lottery method of sampling.

The sample size was 200 participants of 15 to 17-year-old female cohorts who were studied in this pilot study.

The exclusion criteria for the 15 to 17-year-old female cohorts was the presence of any medical history like asthma, diabetes, or bleeding disorders.

All ethical clearance was fulfilled including permissions from The Principal of the Pre-University Colleges, ethical clearance from the Institutional Ethics Committee (No. 11069), informed consent from all the participants and their guardians, referral of participants to dental hospital for the treatment if required, and confidentiality of the participants was preserved.

The present study was conducted to assess the eating disorder among 15 to 17-year-old female cohorts. The SCOFF Questionnaire was distributed among the consented female cohorts. The study comprised of five questions, the “SCOFF [sick, control, one stone (1 stone is 6.3 kg), fat and food] Questionnaire”.[11],[12],[13] This questionnaire is a simple memorable screening instrument for nonspecialists. This instrument has yes or no response options. Two or more yes responses indicate that an eating disorder of some kind may exist.

The oral health examination was carried out using mouth mirror and WHO probe. The presence or absence of dental caries, dental erosion, and gingivitis was documented.

The pamphlets regarding healthy dietary habits and ill effects of acidic foods were distributed to participants after the oral health examination.

Data collection

A detailed diet history and thorough clinical examination using Oral Health Assessment Form[14] was carried out. The decayed missing filled teeth (DMFT), gingival status, and presence or absence of dental erosion was documented for every patient.

The SCOFF Questionnaire was used as the instrument for interview. It included five questions as follows: Do you make yourself Sick because you feel uncomfortably full?; Do you worry that you have lost Control over how much you eat?; Have you recently lost more than One stone (14 lbs or 6.3 kg) in a 3-month period?; Do you believe yourself to be Fat when others say you are too thin?; and Would you say that Food dominates your life? In addition to the SCOFF Questionnaire, the study included calculation of the BMI using the following formula:

BMI = Weight in kilograms/(Height in meters)2

Statistical analysis

The collected data was statistically analyzed using Statistical Package for Social Sciences (SPSS), version 16.0 (SPSS Inc, Chicago IL). The level of significance was kept at P > 0.05. The descriptive statistics of DMFT status and gingival index was calculated. The Student t test and Chi-square test were applied to assess the association between eating disorder and dental findings. Other analysis done were univariate analysis, bivariate analysis, and binary logistic regression analysis.


  Results Top


The characteristics of the study participants was studied which included age, weight, height, BMI, sugar score, decayed teeth, filled teeth, missing teeth, and DMFT [Table 1]. The mean age of the female cohorts in our study was found to be 15.85 ± 0.59. The mean ± standard deviation for BMI, sugar score, and DMFT was found to be 17.68 ± 2.63, 23.58 ± 11.17, and 4.29 ± 3.06, respectively. The SCOFF Questionnaire assessment was done, and individual question response was compared between those with and without eating disorders. A yes response for the five questions were given by 42 (21%), 20 (10%), 9 (4.5%), 25 (12.5%), and 7 (3.5%), respectively. A no response was given by 158 (79%), 180 (90%), 191 (95.5%), 175 (87.5%), and 193 (96.5%), respectively [Table 2].
Table 1 Characteristics of study participants

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Table 2 Participants response to Scoff Questionnaire

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On examination of 200 study participants for the presence of eating disorders, it was found that 21 female cohorts had signs of an existing eating disorder whereas the remaining 179 had no significant signs. Therefore, the prevalence of eating disorders in our study was found to be 10.5% [Figure 1].
Figure 1 Prevalence of eating disorder among study subjects.

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Following this, the individual participant’s BMI was compared among those with eating disorders to those without eating disorders. Statistical significance with a P value of 0.005 was noted [Table 3].
Table 3 Comparison of participants with and without eating disorder to BMI

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When oral complications such as dental caries was checked for and compared between those with and with eating disorders, the P value of sugar score, DMFT, decayed teeth, filled teeth, and missing teeth was found to be 0.14, 0.70, 0.76, 0.42, and 0.33, respectively. No statistical significance was noted [Table 4].
Table 4 Association between dental implications to eating disorder

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When other dental implications namely gingivitis and dental erosion was assessed for, no erosion was evident and there was no statistical significance with gingival score to the presence of eating disorder. The Chi-square value was 0.43, degrees of freedom was 2, and P value was found to be 0.80.

The evaluation of negative predictive value, positive predictive value, sensitivity, and specificity of SCOFF Questionnaire was 0.82%, 0.26%, 0.57%, and 0.72%, respectively.


  Discussion Top


The present study findings were compared with that of literature. There was a statistical significant association of BMI with eating disorder. This was found to be in accordance with the literature. Although it cannot be confirmed here whether it was due to self-induced vomiting or malnourishment. In the literature, high BMI was significantly associated with high score of drive for thinness, body dissatisfaction, low self-esteem, interceptive deficits, and maturity fears, along with body weight status. Almost all weight control concerns and behaviors investigated were significantly associated with high eating disorder scores. However, the association of BMI and drive for thinness, and body dissatisfaction were considerably weaker when weight control behaviors were not included.[15]

No statistically significant association was found between the other variables like dental caries, gingivitis, or erosion with eating disorders in our study. In the literature, with regard to erosion, it was found that patients who suffered from anorexia nervosa, but did not vomit, had significantly more erosion than a control group but less than the vomiting groups.[16],[17] With regard to dental caries, the literature has shown conflicting conclusions. It was seen that the presence or absence of vomiting is an important modifying factor in the caries experience of patients with eating disorder. The observed lower caries incidence in patients with eating disorder where vomiting is a feature[4],[5] has been explained by the observation that cariogenic Streptococcus mutans cease to metabolize at pH values below 4.2. However, Belli and Marquis[18] have shown that S. mutans can adapt, survive, and still remain viable with pH as low as 3.14. Young[19] has observed that patients with eating disorder tend toward higher and not lower caries incidence. In relation to the effect on the gingival tissue, some studies[2],[5] suggest that patients with eating disorder tend to have worse oral hygiene and increased prevalence of gingivitis. It was noted in the present study that sensitivity of using SCOFF was in accordance with Solmi et al.[20] but specificity was found to be low.

Limitations

The major limitations of the study were due to the fact that the study had been conducted on a relatively small scale, though conducting a pilot study was desired, with further investigations, if needed. Also, while interviewing the study participants, the socioeconomic status was not considered, which could have had a role in the etiology and thus might have altered the results of the study. Also, because 1-day diet history was taken from the participants, results could have been more appropriate if a detailed diet diary was recorded.

Recommendations

The study should be carried out on a larger scale for the purpose of generalizing it. Initiation of the dentist toward educating the person should be the primary aim. Dentist can start this practice in routine dental care treatment, which will reduce patient’s healthcare expenditure in the long run. This will also increase their productivity by positively affecting the economy.


  Summary and Conclusions Top


Our study showed that the prevalence of eating disorders among the young female cohorts was 10.5%. There was statistical significance found to exist between eating disorders to BMI and sugar scores.

However, to get more solid results and associations, this study should be carried out on a larger scale. This would further help in generalizing it to a larger population.

Implication

Dental professionals have an obligation to be concerned not just about the patient’s oral health, but also their overall health. Along with physicians, psychiatrists, nurses, dietitians, psychologists, social workers, parents, teachers, and coaches, there is a pressing need for oral healthcare professionals to be a part of the patient’s eating disorder healthcare team. The average age of onset of anorexia is 17 years of age. Young individuals, especially those in the high-school age group, are specifically at risk for developing eating disorders due to personal, family, and peer pressures. Due to oral implications of the disorders, dentists are often the first health providers to have the opportunity to identify a pattern associated with an eating disorder. So, a dentist can significantly contribute toward primordial prevention of eating disorders among young female cohorts. Early detection, referral, and treatment are essential and include all actions that can modify the severity and extent of the problem including recognition and treatment of intraoral damage to the teeth, oral mucous membranes, and periodontium. It also favors improvement in general well-being of the young female patients. Dentist can start this practice in routine dental care treatment, which will reduce patient’s healthcare expenditure in the long run and increase their productivity there by positively affecting the economy.[21]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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