“You are what you eat” is a popular idiom that can be understood through many aspects of general and dental healthcare. Nutrition and our diets have a great impact on our physical health, as well as the growth of our bodies throughout life.
When looking at the development of the dentition, it’s important to realise how diet could influence occlusion, and vice versa. With this information, paediatric clinicians can make confident recommendations to parents and guardians to support a child’s nutritional development, but dental professionals will also be able to advise and support those with dietary restrictions imposed by malocclusion. Orthodontic treatment may be a possible solution in such cases, but this may present new challenges – depending entirely on the course of treatment that is pursued.
Diet makes a difference
Diet and the dentition are thoroughly linked throughout the available scientific research. The risk of caries increases with more frequent and higher free sugar intake, and with free sugar intake between meals also associated with increased caries rates.[i] When it comes to the development of malocclusion, we must focus on diet during childhood, as this is when the dentition and craniofacial bone structure see the most significant portion of development.
Malnutrition has been associated with malocclusion, especially dental crowding, which can complicate oral hygiene routines and have an impact on quality of life.[ii] Dietary choices are seen to impact the growth of the craniofacial bone, and malnutrition inhibits this development. This limits the space for dental eruption and, where it is inadequate, the patient can experience crowding and impaction.[iii] Protein-energy undernutrition has been observed in the literature to reduce the length of the skull-base, height of the mandible, width of the maxilla and mandible, and height of the facial lower third.[iv]
There is still debate around the impact of diet on orthodontic health, however. Some studies have failed to find an association between underweight children and malocclusion such as crowding, instead pointing towards factors such as low-for-age-height and mouth breathing.[v] Non-nutritive sucking habits, such as thumb sucking and extending dummy use is also associated with a significantly increased risk of anterior open bite, meaning nutrition alone isn’t the only prominent factor to focus on.[vi]
Difficulties with diet
The inverse relationship between occlusion and diet should also be considered. A compromised dentition, for example due to tooth loss, may not be able to masticate as successfully as the full dentition – affected individuals typically have to chew for longer and concede to swallowing larger, coarser food particles.[vii]
A 2024 systematic reviewvii found a connection between the number of occlusal supports (which it defined as contact between upper and lower same-named teeth) and nutritional status. It noted that the first and second molars make up 64.7% of the occlusal contact area, with minimal contribution by anterior teeth. This makes this area key to chewing food, facilitating nutrient absorption, and aiding general health. The review found that individuals with less occlusal support were associated with lower intakes of vegetables and meat, as well as lower intakes of proteins, fibres and vitamins.vii
The literature has also shown that prosthetic intervention for children with caries affected dentition provided them with the ability to intake basic nutrients, reinforcing the need for balanced occlusal forces throughout the dentition.[viii]
Effective intervention with orthodontic treatment can therefore be a significant aid. Clinicians should be confident in their skills to provide treatment, or refer to another professional if the case is too complex. However, patients still need support throughout orthodontic care, as dietary choices once again are affected by the chosen appliance.
Advice during treatment
The effect of orthodontic treatment on changes in diet has been heavily researched throughout the literature. When a patient has a fixed appliance, clinicians typically advise to avoid hard, chewy, and sticky food,[ix] as well as fizzy drinks.[x] Patients will typically restrict the foods they eat to reduce pain and discomfort, which again may stop them taking in the balanced diet that they require.
For this reason, clear aligners are sometimes a favourable alternative, as the appliance can be removed at meal times. Clinicians should only recommend them in cases where success is predictable, and where they are aptly trained for effective care. A course like the Clear Aligners (Level 1) from IAS Academy equips clinicians with knowledge surrounding the use of Inman and clear aligners, for confident case selection. Dental professionals can also plan for ideal occlusion and retention, and be able to support clinicians throughout treatment with issues such healthy diet choices that won’t compromise care.
Understanding the relationship between occlusion, orthodontics and diet is key to supporting patients throughout their life. With a greater understanding of how nutrition can influence an individual’s occlusal status, and vice versa, clinicians can identify opportunities to intervene with long-lasting orthodontic care that transforms a patient’s life.
For more information on upcoming IAS Academy training courses, please visit www.iasortho.com or call 01932 336470 (Press 1)
Dr Tif Qureshi founder and a clinical director of IAS Academy, qualified from Kings College London in 1992. He is a Past President of the British Academy of Cosmetic Dentistry, an International faculty that provides mentored education for general dentists on a pathway from appropriate simple to comprehensive orthodontics.
Tif has a special interest in simple orthodontics and truly minimally invasive dentistry. He has committed his life’s work to empowering dentists to provide important alternative techniques. He offers a wide variety of treatments to many more patients, while always respecting the fundamental precepts of orthodontics. Tif also pioneered the concept of Progressive Smile Design through Alignment, Bleaching, Bonding – a course that combines tooth alignment, composite bonding and teeth whitening to produce superior smiles using techniques with the absolute minimum of invasiveness available today.
An experienced teacher in the Dahl concept, Tif shows how this technique is used to plan tooth alignment and minimise invasive dentistry in the development of a beautiful smile. Tif now lectures and published scientific articles internationally.
[i] Tungare, S., & Paranjpe, A. G. (2018). Diet and nutrition to prevent dental problems. Europe PMC. (Online) Available at: https://europepmc.org/article/nbk/nbk534248 [Accessed September 2025]
[ii] Anand, T., Garg, A. K., & Singh, S. (2022). Effect of socioeconomic, nutritional status, diet, and oral habits on the prevalence of different types of malocclusion in school-children. Acta Bio Medica: Atenei Parmensis, 93(3), e2022161.
[iii] Anand, K., Menka, K., Maloth, S., Nayak, S. C., Chowdhary, T., & Bhargava, M. (2021). Analyzing the role of malnourishment in malocclusion: A cross-sectional study. Journal of Pharmacy and Bioallied Sciences, 13(Suppl 1), S452-S455.
[iv] Corrêa-Faria, P., Ramos-Jorge, M. L., Martins-Júnior, P. A., Vieira-Andrade, R. G., & Marques, L. S. (2014). Malocclusion in preschool children: prevalence and determinant factors. European Archives of Paediatric Dentistry, 15(2), 89-96.
[v] Thomaz, E. B., Cangussu, M. C. T., da Silva, A. A. M., & Assis, A. M. O. (2010). Is malnutrition associated with crowding in permanent dentition?. International journal of environmental research and public health, 7(9), 3531-3544.
[vi] Gao, C., Wang, M., He, H., Lei, H., & Mei, L. (2025). Association between Non-nutritive sucking habits and Anterior open bite: A systematic review and meta-analysis. BMC Oral Health, 25(1), 1124.
[vii] Mikami, R., Komagamine, Y., Aoyama, N., Mizutani, K., Sasaki, Y., Iwata, T., … & Kanazawa, M. (2024). Association between occlusal supports and nutritional status in older adults: A systematic review. Journal of Dental Sciences, 19(2), 813-827.
[viii] Dimitrova, D., & Dimova-Gabrovska, M. (2024, February). Occlusion and Nutrition after Peadiatric Prosthetic Treatment. In Proceedings of the Bulgarian Academy of Sciences (Vol. 77, No. 2, pp. 307-315).
[ix] En, P. L., SoYeon, O., Nor, N. N., Mei, L., Farella, M., & Prasad, S. (2023). Dietary experiences during fixed orthodontic treatment. APOS Trends Orthod, 13(2), 60-7.
[x] NHS, (2023). Orthodontic treatments. (Online) Available at: https://www.nhs.uk/tests-and-treatments/orthodontics/treatments/ [Accessed September 2025]
