Dietary habits in adolescent patients undergoing fixed orthodontic treatment

Background To develop a reliable, well readable and easy to complete questionnaire that evaluated the dietary changes during fixed orthodontic treatment in adolescents and that identified the reasons for these changes. Methods An orthodontist and a psychologist developed a questionnaire with answers on a 5-point-scale from “not at all” to “very much”. The functional limitation (FL) domain explored how the presence of the fixed appliance (FL1, 5 questions), pain and discomfort from teeth (FL2, 5 questions) or the occurrence of oral ulcerations (FL3, 5 questions) affected the ability to take a big bite, chew hard and soft food, drink and chew against resistance. The dietary modification (DM) domain investigated if the orthodontic treatment (DM1, 11 questions), the difficulty in maintaining a good oral hygiene (DM2, 11 questions), pain and discomfort from teeth (DM3, 11 questions) or eating within and outside of the home (DM4, 11 questions) affected the consumption of raw and cooked vegetables, cheese, cold cuts, meat, fish, pasta, bread, fresh and dried fruit, sweets. Finally, in the snack frequency (SF) domain, subjects were asked whether orthodontic treatment reduced snack frequency (SF1, 1 question) and to what extent this reduction was due to the difficulty in maintaining a good oral hygiene or eating specific food items, the worry about food getting stuck to braces, the presence of oral ulceration or pain and discomfort from teeth (SF2, 5 questions). Patients aged between 11 and 15 years scheduled for fixed orthodontic treatment were recruited. Exclusion criteria were previous orthodontic treatment and psychophysical impairment. The questionnaire had to be administered 1 month after the bonding of brackets and first molar tubes in the upper arch; a 0.012 Australian wire (AJ Wilcock Australin PTY Ltd, Whittleasea, Victoria, Australia) had to be used as first wire. A preliminary study was performed on 15 consecutive patients that completed the questionnaire twice, first 1 month after bonding and then 2 weeks later, with no procedures being performed between the 2 completions. The time taken to complete the questionnaire was recorded at first completion. Cohen's K was used to determine reliability; readability was assessed using the Gunning’s Fog and the Gulpease index. 47 patients collected between November and December 2015 constituted the study sample. After verbal instructions, each participant was given 10 minutes to complete the questionnaire, with an investigator available for clarifications. Results The questionnaire had an excellent intra-examiner reliability (k=0.996, p<0.0005) and readability (Gunning’s Fog index=2, Gulpease index=90). Time for completion was 4-10 minutes. 74% of the patients reported a change in dietary habits. The presence of the fixed appliance, pain from teeth and oral ulcerations affected the ability to chew hard foods (100%, 100%, 77% of the participants respectively), to chew against resistance (100%, 100%, 91%) and to take big bites (97%, 100%, 89%). Patients avoided raw vegetables (97%), dried fruit (97%), bread (77%) and meat (71%) due to pain. The consumption of dried fruit, sweets and meat was reduced also for the difficulty in maintaining a good oral hygiene (83%, 83%, 69% respectively). Snack frequency was reduced in 77% of the participants due to pain from teeth (100%) and worry about food getting stuck in the braces (96%). Conclusions A reliable, well readable and easy to complete questionnaire was developed to evaluate dietary changes in orthodontic patients. Adolescents changed their habits after 1 month of treatment. The study highlights the need to explore these dietary changes during later stages of treatment.