This study aimed to evaluate the changes in food consumption in adolescents during orthodontic treatment.
Twenty-five adolescents aged between 12 and 18 years participated in the study. Before the treatment, the participants were interviewed, and their food consumption frequency and 24-hour retrospective food consumption records were taken. Participants were followed up for 3 months, that is, in the first, fourth, and 12th week of the treatment. In the interviews, questions about food consumption changes and posttreatment pain were asked to the participants, and 24-hour retrospective food consumption records were obtained.
When the food consumption records of the adolescents before the orthodontic treatment and at the first week, first month, and third month of the active orthodontic treatment were compared, there was no significant difference between total energy, protein, and carbohydrate intake. However, total fat intake decreased in the first week of treatment and increased significantly during the treatment period ( P = 0.05). There was a significant decrease in the amount of fiber ( P = 0.039), vitamin E ( P = 0.043), and vitamin C ( P = 0.048) intake of patients during the orthodontic treatment.
Nutrition and feeding habits are important for growth and development in adolescence. In adolescents having orthodontic treatment, vitamin C, vitamin E, and fiber intake decreased significantly, especially in the first weeks of treatment. The intake of these nutrients did not return to their initial levels by the 12th week of the orthodontic treatment. It is thought that cooperation with dietitians and orthodontists might minimize the undesired nutritional effects of the orthodontic treatment.
Orthodontic treatment causes changes in food consumption, especially in the first days.
Total fat intake decreased in the first week but then increased significantly.
Intake of vitamin C, vitamin E, and fiber decreased significantly in the first weeks of the treatment.
The most important goals of orthodontic treatment are esthetic and functional improvement. In addition to esthetic correction, orthodontic treatment can enhance the quality of a patient’s life by achieving better occlusion and improving chewing function and the variety of food intake. The duration of fixed orthodontic treatment may vary according to the severity of the malocclusion and the treatment applied and may last approximately 1-3 years. , During orthodontic treatment, food consumption can be affected negatively because of pain and functional limitations. In addition, physiological and emotional stress during the orthodontic treatment are thought to increase the nutritional requirements of the patient.
A good quality diet plays a fundamental role in maintaining good oral and overall health. Nutrition affects periodontal health, immune system, growth, and development. It is thought that orthodontic treatment can affect these processes by changing the frequency, quantity, and quality of feeding. Nutrition affects the growth and proliferation process of cells and tissue and organ development. Nutrition is considered to be an important factor in increasing the tissue tolerance of patients undergoing orthodontic treatment. ,
Orthodontic treatment can be applied at any age. However, as the malocclusions perceived by children and their psychosocial effects affect the self-esteem of the children, the number of adolescents who search for orthodontic treatment is quite high. The adolescent period is an important time for physiological and psychosocial change associated with changing dietary needs. In this period, lifestyle changes have a significant impact on nutrient intake, and the nutritional requirements of patients are quite high. Regular and balanced nutrition of adolescents is important for their physical development and health. Maintaining adequate and balanced nutrition in the adolescent period is particularly important to prevent infections, support growth and development, and improve periodontal tissues during treatment.
During orthodontic treatment, the patients are instructed to avoid sticky, gummy, and very hard foods to prevent the breakage of the appliances. Those limitations on food intake might affect the nutrition pattern of the patients. , In addition, it is known that during orthodontic treatment, the teeth are sensitive to pressure, especially in the first weeks of activation, and this sensitivity can lead to functional limitations. , Patients may avoid chewing hard foods and may prefer consuming soft foods. Especially in the first 3-5 days after treatment, patients might avoid fruits, raw vegetables, and other hard foods because they cannot chew properly because of the sensitivity of the teeth. These changes in nutrition result in consuming significantly less protein, calcium, fiber, and some vitamins. Soft foods are preferred while avoiding hard foods during orthodontic treatment, and this might cause decreasing protein and fiber consumption and increasing carbohydrate and fat consumption.
There is a limited number of studies examining the effects of orthodontic treatment on nutrient intake and nutrition. When the importance of foods consumed, especially in adolescents in terms of quality of life and body development, is taken into consideration, the effects of orthodontic treatment on nutrition should be evaluated cautiously to direct the patients to proper nutrition during the treatment period. However, there is very limited information about the effects of orthodontic treatment on food intake. Therefore, this study aimed to evaluate the changes in nutrient intake in adolescents during the first 3 months of orthodontic treatment.
Material and methods
Ethics committee approval was obtained from the Hacettepe University Noninterventional Clinical Research Ethics Board. As a prospective cohort study, a different treatment program has not been applied other than the routine orthodontic treatment for research. Written informed consent was obtained from all participants. Informed consent forms were signed by both the patients and their parents because patients aged under 18 years were included in the study. The population of the study consisted of patients who started orthodontic treatment at the Department of Orthodontics, Faculty of Dentistry, Hacettepe University. In this follow-up study, it was planned to involve 25 adolescents without considering gender differences. The sample size was calculated using the PASS software (version 15, NCSS, Kaysville, Utah), and it was found to be 16, but the number of the sample was determined as 25 by considering the losses that may occur because of the follow-up nature of the study. , ,
The study was carried out with 25 adolescents who started orthodontic treatment at the Department of Orthodontics, Faculty of Dentistry, Hacettepe University. The inclusion criteria were (1) being aged under 18 years, (2) having skeletal Class I malocclusion, (3) having all permanent teeth erupted except third molars, (4) having nonextraction treatment, (5) starting orthodontic treatment with brackets bonded to all maxillary and mandibular teeth, and (6) not using an auxiliary appliance other than the brackets and routine archwires (0.014 and 0.016-in nickel-titanium [NiTi]) during the 3 months. Patients were followed up for 3 months.
In the first interview, a questionnaire was given to the patients to obtain their demographic characteristics and general eating habits. Food consumption frequencies and 24-hour food consumption of the patients were recorded. Height and weight measurements were made to calculate body mass index. The body weights of all participants were measured with 0.01 kg-sensitive TANITA model scales (Tanita Corporation, Arlington Heights, Ill) with the least possible clothes and without shoes. While the feet were next to each other and the head is on the Frankfurt plane, the height of participants was measured. In this session, the self-ligating brackets (Empower; American Orthodontics, Sheboygan, WI) and molar tubes were bonded to all maxillary teeth, and 0.014-in NiTi archwires were ligated. At the fourth week, all mandibular teeth were bonded, and 0.014-in NiTi archwires were ligated to the mandibular arch. At the eighth week, the maxillary archwire was replaced, and the 0.016-in NiTi wire was ligated, and in the 12th week, the mandibular archwire was replaced, and the 0.016-in NiTi archwire was ligated. This sequence of treatment was followed in all patients for standardization.
In the first, fourth, and 12th week, a questionnaire was given to the patients to evaluate their adaptation to the nutritional recommendations given by their orthodontist and the impact of orthodontic treatment on their food consumption. To observe the changes, we obtained 24-hour retrospective food consumption records in every visit.
The data were obtained by face-to-face interviews with the participants. Each participant was interviewed 4 times (on the first day of orthodontic treatment and in the first, fourth, and 12th week after starting treatment).
SPSS (version 23; IBM, Armonk, NY) package program was used for statistical analysis. Data were analyzed via Kolmogorov-Smirnov or Shapiro-Wilks tests. Descriptive statistics are given as mean and standard deviation if the data are distributed normally and as median and interquartile distribution range, if not. While evaluating the statistical significance of the difference between 2 variables, independent samples t test and Mann-Whitney U test were used. Chi-square test was used for the comparison of percentages. The significance was set at P <0.05. To evaluate the daily energy and nutrient intake of the participants, 24-hour food consumptions were recorded. The energy, macronutrient, and micronutrient contents of the diet were calculated by analyzing the records with BEBIS 8 (Nutrition Information System). Patients’ adaptations to nutritional recommendations of orthodontists were also evaluated.
Table I shows the general characteristics of the participants. A total of 25 adolescents (9 boys, 16 girls) participated in the study. The mean age of the children was 13.72 ± 1.79 years. The mean body mass indexes were 20.5 ± 4.02 kg/m 2 and 20.57 ± 2.74 kg/m 2 for girls and boys, respectively. It was found that 36% of the children were attending a private school, and 64% of the children were from public school. When the educational status of the parents was evaluated, it was seen that 66.6% of the mothers’ and 48% of the fathers’ education levels were above the high school level.
|Male (n = 9)||Female (n = 16)||Total (n = 25)||P value ∗|
|Mother’s educational status||0.636|
|Mother’s working status||0.144|
|Father’s educational status||0.196|
The 24-hour food consumption records of the participants were compared before the start of orthodontic treatment and in the first week, first month, and third month of the treatment ( Table II ). There was no significant difference between total energy, protein, and carbohydrate intake. However, total fat intake decreased in the first week of treatment and increased significantly in the treatment process.
|Before treatment||First wk||Fourth wk||12th wk||P value ∗|
|Energy (kcal)||1755.28 (651.95)||1702.21 (637.8)||1773.98 (578.18)||1767.36 (955.78)||0.065|
|Carbohydrate (g)||217.23 (56.76)||207.76 (81.61)||193.44 (88.14)||185.09 (130.79)||0.476|
|Protein (g)||66.97 (34.7)||62.79 (34.94)||63.28 (32.44)||77.19 (49.9)||0.236|
|Fat (g)||77.01 (36.29)||61.37 (37.76)||65.39 (21.09)||73.72 (30.51)||0.05 ∗|
|Fiber (g)||18.46 (5.99)||13.87 (7.26)||12.82 (8.0)||13.5 (6.19)||0.039 ∗|
|Vitamin A (mcg)||594.86 (647.91)||515.35 (503.03)||534.18 (498.58)||408.12 (321.37)||0.574|
|Vitamin E (mg)||22.35 (19.54)||13.43 (16.29)||15.04 (18.53)||16.43 (16.76)||0.043 ∗|
|Thiamine (mg)||0.84 (0.25)||0.67 (0.31)||0.71 (0.34)||0.68 (0.36)||0.172|
|Riboflavin (mg)||1.21 (0.85)||1.15 (0.69)||1.19 (0.66)||1.13 (0.8)||0.62|
|Vitamin B 6 (mg)||0.96 (0.44)||0.92 (0.66)||0.93 (0.49)||1.06 (0.74)||0.494|
|Folate (mcg)||205.1 (140.01)||211.72 (142.4)||197.27 (170.81)||186.12 (129.8)||0.299|
|Vitamin C (mg)||70.65 (50.96)||41.42 (44.12)||43.04 (32.68)||47.38 (63.36)||0.048 ∗|
|Calcium (mg)||768.15 (508.5)||563.95 (389.12)||632.3 (395.21)||472.02 (388.93)||0.377|
|Phosphorus (mg)||991.3 (547.63)||938.28 (524.12)||911.0 (279.39)||985.2 (443.3)||0.336|
|Iron (mg)||9.01 (4.01)||8.85 (3.8)||8.31 (7.42)||9.28 (3.45)||0.794|
|Zinc (mg)||9.9 (7.08)||8.05 (4.52)||8.53 (5.57)||9.73 (6.02)||0.181|
|Vitamini B 12 (mcg)||4.76 (4.58)||3.15 (2.96)||3.97 (3.64)||3.82 (4.26)||0.323|
|Omega 3 (g)||0.92 (0.56)||0.78 (1.03)||0.82 (0.58)||0.78 (0.83)||0.558|
|Omega 6 (g)||14.58 (15.22)||14.03 (10.89)||14.8 (13.14)||15.09 (16.04)||0.489|