Exploring relationships between chewing difficulty, eating experience, pain, and wellbeing: A cross-sectional self-report study

Background & Aims
Chewing difficulties are associated with poor physical and mental well-being in elderly populations. Little is known about these relationships in other age groups. Pain and biopsychosocial domains of eating (physical – anatomical, physical – functional, sensory, cognitive, behavioural, social/cultural, and emotional), as defined by the Altered Eating Framework (AEF)(23) have also not been considered as influential factors when exploring the impact of chewing difficulty on well-being. This study aimed to a) investigate relationships between chewing difficulty, pain, AEF domains, and well-being, and b) explore pain as a potential mediator between chewing difficulty and well-being.

Method
One-hundred and seventy-nine participants, aged 19 – 82 years (mean = 43.39 yrs, SD = 15.46 yrs) completed an online survey comprising 8 measures, including chewing difficulty, pain and health, altered eating, and well-being. Data were collected April to November 2023.

Results
Chewing difficulty was a significant positive predictor of depression, anxiety, and stress. Pain positively predicted depression and partially mediated the relationship between chewing difficulty and depression. The emotional AEF domain positively predicted depression and stress.

Conclusion
Chewing difficulty was associated with poor well-being across a wide age range, findings highlight the importance of considering the impact of pain when exploring such relationships. The emotional AEF domain was most strongly associated with poor well-being, suggesting a possible hierarchical relationship between AEF domains. Future work is needed using prospective designs, and to develop a validated altered eating scale to capture eating experiences and impacts on well-being in real-time.