Oral Manifestations in Children and Adolescents with Eating Disorders or Eating-Disorder Risk: A Systematic Review and Stratified Meta-Analysis

Background: Eating disorders (EDs), primarily anorexia nervosa, bulimia nervosa, and related risk behaviors, are complex biopsychosocial conditions frequently accompanied by stomatognathic alterations. Systemic malnutrition and chronic purging behaviors significantly impact oral tissues, giving dental practitioners a valuable opportunistic position for early recognition. Objective: We aimed to systematically evaluate and quantitatively synthesize stomatognathic manifestations in children and adolescents with clinically diagnosed eating disorders compared to those with screening-identified eating-disorder risk. Material and Methods: A systematic review and stratified meta-analysis were conducted according to PRISMA 2020 guidelines (PROSPERO: CRD420261490862). Comprehensive searches were executed across PubMed, Scopus, and Embase on 24 July 2026. Eligible primary studies evaluated oral outcomes in pediatric cohorts aged nine to eighteen years. Studies were stratified into clinical diagnoses and screening-defined at-risk cohorts, utilizing random-effects meta-analyses and GRADE assessments. Results: A total of twelve studies were included (nine comparative studies with healthy controls and three single-arm descriptive case series; seven comparative studies contributed to quantitative meta-analyses). In the stratified meta-analysis for erosive tooth wear (four studies, N = 1030), patients with clinically diagnosed anorexia nervosa exhibited an individual study odds ratio of 7.72 (95% CI: 2.24–26.64), whereas screening-positive community cohorts showed a pooled odds ratio of 3.50 (95% CI: 1.49–8.23; three studies); between-group differences remain descriptive. For caries experience (three studies, N = 392), clinically diagnosed patients showed elevated DMFT scores in a single study (MD = +1.90), whereas screening-identified school cohorts showed no statistically significant elevation (pooled MD = +0.88, 95% CI: −0.95 to 2.71), with high heterogeneity (I2 = 86.8%). Unstimulated whole salivary flow rate was significantly reduced in diagnosed clinical anorexia (two studies, N = 156, MD = −0.20 mL/min); however, both studies originated from a single specialized center in Poznan, Poland, precluding multicenter generalization. In nationwide survey data, adolescents exhibiting unhealthy weight control showed no statistically significant differences in poor subjective oral health. Conclusions: Stomatognathic manifestations in children and adolescents vary descriptively across clinical diagnostic and screening-risk cohorts, characterized primarily by erosive tooth wear and resting salivary hypofunction in diagnosed anorexia nervosa. Although the certainty of evidence remains very low across evaluated outcomes and erosive tooth wear is etiologically multifactorial rather than pathognomonic, dental practitioners occupy a valuable position for recognizing suspicious non-carious wear, prioritizing conservative preventive stabilization, and coordinating prompt interdisciplinary referral with pediatric medical and mental health teams.