Q. As an orthodontist, I have seen a variety of patients with symptoms that make me suspect they might have an eating disorder like bulimia nervosa. For example, some of my patients have erosion of tooth enamel and discomfort, which I’ve recently learned is due to frequent vomiting. Do you have any information about the connection between braces and eating disorders? (L.V., Trenton, MO)
A. During adolescence, it is well known that orthodontic treatment can lead to the development of problematic eating disorders. The results of a recent study may be helpful. Dr. Nawaf H. Al Shammary, of the Department of Preventive Dentistry at the University of Hail, Saudi Arabia (Cureus. 2024. 16:e57845, doi.10.7759/cureus), writes that orthodontic treatment with fixed appliances such as braces nearly always improves a patient’s dental health and appearance, but factors related to the braces can also increase the risk of disordered eating. For example, severe restriction of calories can lead to malnutrition, which negatively effects gum and bone health. Dr. Shammary offers the case of a 12-year-old boy who first arrived at the emergency room of his dental clinic with severe fatigue and widespread abdominal pain over the last 8 days.
Before wearing braces, the young man had a well-balanced diet and had a normal body mass index (BMI) of 19.2 kg/m2, normal for his age and gender. He had, however, lost 8 kg (nearly 16 lb) due to the discomfort of his braces, and also developed a fear of biting and chewing. He began avoiding meals at school and gradually reduced the amount of food he ate at home; he then continued restricting his food. After 24 days of treatment and increased calorie intake, he was prescribed 5 mg of the antidepressant mirtrazine to boost his appetite, and also had additional psychological support, followed by education about eating disorders.
He gained 3 kg (6.6 lb), but then was unwilling to continue medical care and declined further psychiatric assessments. He was discharged with schedules for nutritional education and regular follow-up appointments with the psychiatric division.
The moral of this story is that orthodontic braces can lead to anemia and electrolyte imbalances, and development of disordered eating. In this case, the young patient received a well-balanced diet and assessment in the hospital. Cognitive behavioral therapy, or CBT, nutritional rehabilitation, and professional dental care, were extremely helpful for helping him regain healthy eating patterns.
Janice Goldschmidt
Has worked with individuals with IDD for the last decade, and written and presented her work in a range of professional formats. She received her Master’s degree in Nutrition from the University of Maryland-College Park, where she initially developed her program for development of food preparation skills, Active Engagement. As Director of Nutrition Services at Community Support Services, Inc. (Gaithersburg, MD), she has continued to build on Active Engagement, which now includes many differing contexts for guiding individuals with IDD and autism to independent cooking skills. She has also worked on the identification, classification, and treatment of eating disorders for this population.