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| REVIEW ARTICLE |
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| Year : 2023 | Volume
: 12
| Issue : 1 | Page : 41 |
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A systematic review and meta-analysis of the role of nutrition and its impact on orthodontic treatment/management
Mohammad Khursheed Alam1, Huda Abutayyem2, Haytham Jamil Alswairki3, Mohammad Younis Hajeer4, Yahya Abdullah Alogaibi5
1 Orthodontic Division, Preventive Dentistry Department, College of Dentistry, Jouf University, Sakaka, Saudi Arabia; Department of Dental Research Cell, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India; Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
2 Department of Clinical Sciences, Center of Medical and Bio-Allied Health Sciences Research, College of Dentistry, Ajman University, Ajman, United Arab Emirates
3 School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
4 Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, Syria
5 Consultant Orthodontist, Aseer Specialized Dental Center, Abha, Saudi Arabia
| Date of Submission | 20-May-2023 |
| Date of Decision | 05-Jun-2023 |
| Date of Acceptance | 23-Jun-2023 |
| Date of Web Publication | 04-Sep-2023 |
Correspondence Address:
Mohammad Khursheed Alam
Orthodontic Division, Preventive Dentistry Department, College of Dentistry, Jouf University, Sakaka
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jos.jos_85_23
The nutritional needs already increased by adolescent growth, activity, and stress are further exacerbated by the physical, physiological, and psychological stress that orthodontic treatment causes. Hence, the main objective of this systematic review was to analyze the relationship between adequate nutrition and its impact on orthodontic treatment success rates. Using relevant keywords, reference searches, and citation searches, the databases such as PubMed–Medical Literature Analysis and Retrieval System Online, Web of Science, Cochrane, and Scopus were all searched. “Diet,” “Minerals,” “Nutrition,” “Orthodontics,” and “Vitamins” were the search terms used to scour the database. The 10 studies selected for the systematic review and subsequent meta-analysis could not conclusively establish the correlation between proper nutrition and its impact on orthodontic treatment of the patient. There was virtually little connection between patients' dietary intake and the effectiveness of their orthodontic treatment. Additionally, a direct causal link between the two could not be established legitimately because the majority of the studies reviewed only noted an impact during the early stages of the treatment.
PROSPERO Registration Number: CRD42022380828
Keywords: Diet, minerals, nutrition, orthodontics, vitamins
How to cite this article:
Alam MK, Abutayyem H, Alswairki HJ, Hajeer MY, Alogaibi YA. A systematic review and meta-analysis of the role of nutrition and its impact on orthodontic treatment/management. J Orthodont Sci 2023;12:41 |
How to cite this URL:
Alam MK, Abutayyem H, Alswairki HJ, Hajeer MY, Alogaibi YA. A systematic review and meta-analysis of the role of nutrition and its impact on orthodontic treatment/management. J Orthodont Sci [serial online] 2023 [cited 2023 Sep 21];12:41. Available from: https://www.jorthodsci.org/text.asp?2023/12/1/41/385079 |
| Introduction | |  |
The science of food, the nutrients, and other substances within, their action, interaction, and balance in connection to health and diseases, and the processes by which the organism ingests, digests, absorbs, transports, utilizes, and excretes food substances[1] are all included in nutrition. The right amount of nourishment consumed determines the person's optimal growth and development. Any nutritional deficiency causes severe and long-lasting deformity when tissues and organs are still developing. Additionally, diet affects the time of sexual development, delaying menarche in cases of starvation and preponing it in cases of obesity.[2] Hippocrates stressed the significance of nutrition, saying “There are many additional maladies coming from inadequacy of diet, different from those of repletion, but no less awful”.[3] The scope of orthodontic therapy includes everything from addressing craniofacial complex growth and development to moving teeth through the medium of adjacent periodontal tissues. As a result, diet and orthodontic therapy interact strongly. This is so because orthodontic treatment has an impact on food consumption, quality, and consistency, while nutrition impacts periodontal condition, oral flora, healing potential, immune response, and growth of the individual.[4] The orthodontic treatment causes physical, physiological, and psychological stress, which increases nutritional needs already raised by adolescent growth, activity, and stress.[4] The lack of literature on the subject makes clear how neglected diet is, despite its crucial significance in orthodontic therapy.
Nutritional deficits can have a substantial impact on how well the body's endocrine glands work, which can affect both the dentition and the growth and development of the entire body.[5] The likelihood of cleft lip and palate in the progeny of animals fed a diet deficient in folic acid, riboflavin, and zinc is increased.[6] Malnutrition has been linked to retarded growth and the formation of face bones.[7],[8] Reduced skull base length, jaw height, maxillomandibular width, and reduced facial height[8] are all possible effects of malnutrition. The use of attachments and force elements during orthodontic treatment might have a negative impact on dietary intake and jeopardize the patient's nutrition. However, a balanced diet is necessary for orthodontic treatment to be successful. As a result, it enters a vicious cycle that both the patient and the orthodontist should be aware of. The connection between nutrition and orthodontic therapy is discussed in this essay. Orofacial structure development is also influenced by the method of obtaining nourishment. Breastfeeding is essential for the growth of dentofacial structures and the development and synchronization of the orofacial muscles, which in turn help with the maturation of numerous key functions as a whole.[9] In contrast to subjects on a hard diet, subjects on a soft diet had narrow arches caused by underdeveloped muscles and supporting structures.[10] The incidence of class II malocclusion increased when coarse and fibrous meals were avoided, according to research.[11] Vitamins and minerals are a crucial part of a balanced diet and play a crucial role in promoting healthy development and growth. While vitamin A excess and vitamin D shortage produce skull softening as a result of decreased calcium deposition and also enhance the susceptibility for cleft lip and palate, vitamin A insufficiency and protein deficit result in inadequate bone growth concurrent with malocclusion of teeth.[5],[12] Calcium and phosphorus metabolism, which is necessary for the development of the skeleton and teeth, is aided by vitamin D.[12] Lack of vitamin D results in rickets, maxillary dysplasia, difficulty closing facial sutures, an open bite, transverse hypodimension, and a malformed palate.[5]
To prevent appliance breakage and bracket debonding, orthodontists advise their patients to stay away from chewy, sticky, sticky–gummy, or very hard foods.[13] Choosing a soft diet over a hard one during orthodontic treatment causes dietary modifications that enhance fat intake while decreasing fiber and carbohydrate intake. During orthodontic treatment, copper and manganese levels decreased, according to Strause and Saltzmann.[14] It was attributed to avoiding nuts, whole grains, and eating fewer fruits and vegetables. Copper is necessary for the synthesis of hemoglobin and red blood cells, as well as for collagen cross-linking, redox system enzymes, and proper pigmentation.[13],[15],[16] Manganese is essential for glucose metabolism and bone remodeling.[14]
Hence, our primary objective in conducting this systematic review and meta-analysis was to examine research that had been written about the impact of nutrition and other dietary habits on various orthodontic treatment techniques. Additionally, we looked at whether nutrition played a role in the success or failure of orthodontic therapy.
| Materials and Methods | | |
Protocol employed
This systematic review was performed as per the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) strategy and rules from the Cochrane group and the book Orderly Reviews in Health Care: Meta-Examination.[17]
Review hypotheses
Through this systematic review, our primary objective was to review studies that were published in the orthodontic literature about the effects of nutrition and other dietary patterns on the various orthodontic treatment modalities. Also, we sought to identify if nutrition was critical in the success/failure of orthodontic treatment.
Study selection
There were a total of 484 documents discovered after an extensive search on online journals, and 231 of the papers were selected initially. Following that, 164 similar/duplicate articles were eliminated, which resultantly made 67 separate papers available at first. The abstracts and titles of submissions were then reviewed, and a further 57 papers were eliminated. Finally, 10 documents that met the requisite inclusion and exclusion criteria were chosen, which primarily included in vitro studies, literature reviews, and comparative assessments [Figure 1]. | Figure 1: Representation of the selection of articles through PRISMA framework
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Inclusion criterion
Articles that contained relevant data for our review objectives were selected for full-text screening. Studies that reported clinical trials, in vitro studies, randomized/non-randomized studies, systematic/literature reviews containing substantial sample volume, and detailed case reports were considered for inclusion in our review [Table 1]. We also monitored studies that possessed higher methodological quality. | Table 1: AMSTAR-2 16-point checklist of risk-of-bias assessment in studies selected for the systematic review
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Exclusion criteria
The following were excluded from the scope of our systematic review: incomplete data, seminar presentations, scholarly articles, placebo-controlled studies, and opinion articles.
Since the literature available on this topic was quite scant in volume, we did not limit our search in terms of the time period when the studies were published, that is, we took into account all the papers that were published with context to our topic (where the number of papers itself was found to be quite sparse in number). Also, excluded were literature reviews and cases published in languages other than English.
Search strategy
The databases such as PubMed–Medical Literature Analysis and Retrieval System Online, Web of Science, Cochrane, and Scopus were all searched using pertinent keywords, reference searches, and citation searches. The search terms utilized to comb through the database were “Diet,” “Minerals,” “Nutrition,” “Orthodontics,” and “Vitamins.”
Data selection and coding
Two independent reviewers located the relevant papers using the right keywords in various databases and online search tools. The chosen articles were compared, and a third reviewer was brought in if there was a dispute.
After choosing the articles, the same two reviewers independently extracted the following data: author, year of publication, country, kind of publication, study topic, population demographics (n, age), outcome measure(s), relevant result(s), and conclusion(s). The data were compared, and any differences were discussed with the third reviewer.
Risk-of-bias assessment
The A Measurement Tool to Assess systematic Reviews (AMSTAR)-2 technique[18] was used to evaluate the risk of bias in the studies we chose. AMSTAR-2 joins many other instruments that have been released for this purpose as a critical evaluation tool for systematic reviews. As seen in [Table 2], it is a 16-point checklist. Two instruments that have drawn a lot of attention served as the foundation for the creation of the original AMSTAR tool. The original AMSTAR was duplicated in two newly produced instruments. The AMSTAR-2 risk-of-bias items identify the domains specified in the Cochrane risk-of-bias instruments for systematic reviews. In each case, these indicate an agreement that was achieved after input from more than 30 methodology experts. | Table 2: Description and outcomes as observed in the studies selected for the systematic review
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Statistical analysis
After selecting data on the sample size, variables analyzed, and various elements of the investigations, the data were then entered into the RevMan 5 program for meta-analysis. Forest plots illustrating the odds ratio for different study methodologies were obtained as part of the meta-analysis for our study as shown in [Figure 2], [Figure 3], [Figure 4]. | Figure 2: Odds ratio of randomized control trials and qualitative studies selected in this systematic review that assessed the impact of dietary habits and nutrition on orthodontic treatment represented on a forest plot after meta-analysis
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 | Figure 3: Risk ratio of randomized control trials and qualitative studies selected in this systematic review that assessed the impact of dietary habits and nutrition on orthodontic treatment represented on a forest plot after meta-analysis
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 | Figure 4: Risk difference in randomized control trials and qualitative studies selected in this systematic review that assessed the impact of dietary habits and nutrition on orthodontic treatment represented on a forest plot after meta-analysis
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| Results | | |
The study design, methodology employed, description, and outcome are mentioned in [Table 2]. The results of the meta-analysis are provided in [Figure 2], [Figure 3], [Figure 4].
| Discussion | | |
According to the literature, a patient's dietary state may have an impact on how their tissues respond to orthodontic forces. For instance, the ascorbic acid shortage is thought to delay orthodontic tooth movement by reducing the body's capacity for healing. Too little ascorbic acid prevents collagen from breaking down and reforming, which is important for tooth movement.[4],[29] Ascorbic acid levels in orthodontic patients range from 17% to 72% below ideal.[29],[30] Although there is little literature on how orthodontic treatment affects a patient's diet and even fewer reports on specific diet guidelines for orthodontic patients, orthodontists frequently advise their patients to eat soft foods during treatment to accommodate pressure sensitivity experienced with tooth movement.[31] However, there is not much mention of how orthodontic treatment modalities are affected by the nutritional patterns of the patients using orthodontic appliances. To date, we discovered only three randomized clinical trials that discussed the direct correlation between orthodontic treatment and nutritional profile.[21],[27],[32]
Sean Beattie et al.[33] proposed that polymeric elastic bands serve as one of the foundations for orthodontic tooth movement by replicating the effects of daily diet and patient compliance with elastic band alteration. In contrast to using heavy force, using light force at the right rates allows for quick tooth movement during orthodontic therapy with the least amount of patient discomfort and mobility. Force degradation is influenced by lumen size, with smaller diameters requiring more frequent renewal to maintain the intended force application.[34] Studies have looked into the impacts of simulated saliva environments, pH, and thermocycling, in an effort to model different oral environments, on force degradation.[34],[35],[36],[37] The simplest formulation of artificial saliva is 0.09% aqueous sodium chloride, which is frequently employed in experiments simulating the intraoral environment. In general, the data showed that after elastics were subjected to experimental circumstances, force significantly relaxed. During clinical use, orthodontic elastic bands are believed to degrade mostly as a result of mechanical forces.[37] Leachable moieties, however, have been isolated from a few orthodontic elastic bands, and their rising concentrations in solution correlated with a gradual loss of force.[38] The majority of the experiments on the deterioration of orthodontic elastic materials have been done in artificial saliva or air, although this topic has been studied.[36],[37],[38] However, dental polymeric restorative materials' reactions to food-like oral environments have been researched. When polymeric restorative materials are exposed to ethanol/water, ethanol/artificial saliva, lactic acid, citric acid, and alcohol/water as simulated foods, several forms of degradation have been observed to be accelerated that include coffee, erythrosine, food colors, vinegar, Coca-Cola, whisky, and oranges.[39],[40],[41]
According to Gokhan Oncag et al.,[40] the study looked at how acidic soft beverages affected metal brackets' resistance to shear stresses both in vitro and in vivo and discovered that there was no statistically significant difference between the in vivo and in vitro groups in terms of debonding resistance. In both the in vitro and in vivo groups, areas of enamel surface defect brought on by erosion were seen close to the brackets. Coca-Cola and Sprite are examples of acidic soft beverages that negatively affect bracket retention against shearing pressures and enamel erosion.
Shimizu et al.'s[41] investigation on changes in the upper and lower alveolar bones' skeletal microstructure after masticatory loading brought on by feeding growing rats a soft diet. The findings show that in rats with modest masticatory stress throughout growth, alveolar osteopenia is more severe in the mandible than the maxilla.
The lack of randomized control trials can be attributed to being a major flaw in this systematic review of ours; however, the topic of nutrition and its correlation with orthodontic treatment/management modalities has been very poorly represented and quite under-researched in the literature as we observed. Also, a ton of literature/scoping reviews exist on this topic, which we believe do not paint an accurate picture since they lack evidence of a correlation between orthodontic treatment and dietary patterns. Hence, we believe that more studies are needed to ascertain the link between the two factors so that credible, fact-based recommendations can be devised that are beneficial for the patients undergoing treatment.
| Conclusions | | |
This systematic review found a very weak correlation between the nutritional intake of patients and its impact on their orthodontic treatment. Also, since most of the studies mentioned only noticed an impact during the beginning phase of the treatment, a direct causal link between the two could not be established credibly. Hence, we believe more studies are needed in this regard and we believe orthodontic patients should receive nutritional counseling, and enlisting the assistance of a nutritionist may be beneficial.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]
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