ORIGINAL ARTICLE Orofacial manifestations in outpatients with anorexia nervosa and bulimia nervosa focusing on the vomiting behavior Maria Lourenço 1 & Álvaro Azevedo 1 & Isabel Brandão 2 & Pedro S. Gomes 3,4 Received: 23 February 2017 /Accepted: 20 November 2017 # Springer-Verlag GmbH Germany, part of Springer Nature 2017 Abstract Objective This case-control study aims to evaluate the oral health status and orofacial problems in a group of outpatients with eating disorders (ED)—either anorexia nervosa (AN) or bulimia nervosa (BN)—further focusing on the influence of vomit. Materials and methods Fifty-five women outpatients with AN or BN diagnosis were invited to participate, of which 33 agreed. ED outpatients and matched controls were submitted to a questionnaire and clinical oral examination. Results Multivariate analysis identified a significantly higher incidence of teeth-related complications (i.e., tooth decay, dental erosion, and self-reported dentin hypersensitivity), periodontal disease, salivary alterations (i.e., hyposalivation and xerostomia), and oral mucosa-related complications in ED outpatients. Dental erosion, self-reported dentin hypersensitivity, hyposalivation, xerostomia, and angular cheilitis were found to be highly correlated with the vomiting behavior. Conclusions ED outpatients were found to present a higher incidence of oral-related complications and an inferior oral health status, compared to gender- and age-matched controls. Alterations verified within outpatients were acknowledged to be quite similar to those previously reported within inpatients, in both of nature and severity, thus sustaining that the cranio-maxillofacial region is significantly affected by ED, even in the early/milder forms of the condition, as expectedly verified within outpatients. Keywords Anorexia nervosa . Bulimia nervosa . Eating disorders . Vomit . Oral manifestations Eating disorders (ED) are psychiatric diseases, with a multi- factorial etiology, characterized by alterations of the eating behavior and associated with significant psychosocial impair- ment, systemic complications, and increased suicide risk [1–3]. The fifth edition of Diagnostic and Statistical Manual (DSM-V) comprises anorexia nervosa (AN) and bulimia nervosa (BN) as avoidant/restrictive eating disorders [4]. Anorexia nervosa is characterized by a body mass index (BMI) below 17.5Kg/m 2 and a patient’ s sustained weight loss [4]. Additionally, anorexia nervosa is subdivided into restric- tive type, in which the weight loss is accomplish through food intake reduction, prolonged fasting, and excessive physical activity; or purgative type—characterized by the use of laxa- tives, diuretics and/or appetizer’ s suppressors, or vomit induc- tion [4]. Patients with bulimia nervosa present a BMI above 17.5Kg/m 2 and recurrent episodes of binge eating. Similar to AN, it can be subdivided into restrictive or purgative types [4]. Previous studies provided some information on ED- associated oral complications, but with conflicting results re- garding its prevalence, reversibility, and association with the ED subtypes and exacerbation periods [5]. Tooth decay, den- tin hypersensitivity, dental abrasion, dental attrition, sialoadenosis, and hyposalivation are some of the parameters with conflicting results, notwithstanding the verified tendency for ED patients to present an inferior oral health status com- pared to age- and gender-matched controls [6–9]. The major- ity of previously published data on ED-related oral manifes- tations has been gathered from inpatients, considering the clin- ical diagnosis of AN or BN, but discarding associated symp- toms that may be relevant for oral health status, such as vomiting. Little is known regarding the relevance of the ED subtype and associated conducts, particularly the vomiting behavior * Pedro S. Gomes pgomes@fmd.up.pt 1 Faculty of Dental Medicine, U. Porto, Porto, Portugal 2 Faculty of Medicine, U. Porto, Porto, Portugal 3 Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, U. Porto, Porto, Portugal 4 REQUIMTE/LAQV, U. Porto, Porto, Portugal Clinical Oral Investigations https://doi.org/10.1007/s00784-017-2284-y