ABSTRACT
Introduction:
The measurement of bite force is increasingly gaining importance in dentistry. This preliminary report evaluates the maximum voluntary bite force (MVBF) of young healthy individuals with normal occlusion and correlates the effect of age and gender with the maximum bite force (MBF)
Materials and Methods:
405 participants in the age group of 18 to 40 years were selected from the outpatient department meeting inclusion and exclusion criteria. MVBF was measured with the help of a digital device called “Byte” at incisors, right first molar, and left first molar region.
Results:
There was a strong correlation between age with bite force. Bite force increased with age. Males had more bite force than females. The posterior region had higher bite force than the anterior region
Conclusion:
Measurement of bite force is very important for every patient undergoing restorative treatment. The “Byte” device was found to be very efficient.
KEYWORDS: Bite force, masticatory force, occlusal force, stomatognathic system
INTRODUCTION
The maximum voluntary bite force (MVBF) is an indicator of the functional state of the stomatognathic system. In dental research, bite force has been recorded as a variable to assess the efficacy of various dental procedures like prosthesis, restoration, orthodontic treatment, and jaw fracture treatment, or to study the effects of deformities and pathologies on the masticatory system like temporomandibular disorder and malocclusion.[1,2] There are many variables that can affect the measurement of maximum bite force (MBF) such as craniofacial morphology, age, gender, periodontal support of teeth, temporomandibular disorder and pain, dental status, occlusal contact, type of prosthesis, recording devices, and technique, unilateral or bilateral measurement, use of splints, the position of recording device in the dental arch.[3,4]
Most of the developed devices can record force levels in the range of 50–800 N with an accuracy level of 10 N.[2] Despite several devices and techniques that have been developed, a standardized measurement method that is also easy to use, economical, and reliable is still lacking. Understanding the importance of bite force measurement in dentistry, the aim of this paper was to evaluate the MVBF of young individuals having normal occlusion in the eastern part of India using a very simple digital bite force measurement device. The objectives of this study were to evaluate and compare the correlation between age, gender, and the side of the jaw with bite force.
MATERIALS AND METHODS
This study was conducted in the Department of Prosthodontics and Crown and Bridge, Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand. 405 healthy individuals (students of the dental college and the patients visiting the department) aged 18 to 40 years were selected based on inclusion and exclusion criteria.
Inclusion criteria
Participants should be physically and mentally healthy, understand the nature of the study, and give consent.
Should have a full set of teeth. The presence of a third molar was not considered for this.
Exclusion criteria
Missing teeth, fillings, root canal treatment, or any prosthesis with the teeth concerned.
Any abnormalities with the teeth concerned like dental caries, restorations, grossly destructed crown, non-vital tooth, any trauma, enamel cracks, developmental defects, or congenital anomalies.
Pain in and around teeth concerned (anterior teeth and first molars), TMJ, jaw, and musculature.
Recent history of any orthodontic treatment, orthognathic surgery, or jaw fracture treatment.
Any ongoing dental treatment that may be affected.
Participants with abnormal occlusion.
Participants preparation
Participants were made calm and comfortable in the chair. They were made to sit erect with the back well supported and without head support with a Frankfurt horizontal plane parallel to the floor and feet resting on the floor. Participants were trained to perform their highest biting force before actual measurement. Participants were asked to apply maximum clenching force without moving their heads for 3 to 4 seconds to record MVBF.
Recording of MVBF
Bite force was recorded using a digital device called “Byte” from Innovatios Technology, Bangalore.[5,6] The device was switched on and connected to the laptop. Disposable plastic sleeves were put on the head part of the device. The biting portion was kept on the teeth region where we wanted to record the bite force. Patients were asked to apply maximum biting force for 3–4 seconds. First measurements were made at the incisor region, next right first molar region, and then left first molar region. Between each reading, a gap of 5 minutes was given for the musculature to relax. A total of three readings were made on each region on three different days. The highest value recorded for a particular region for that particular participant was noted.
Statistics
All the data were noted, tabulated, and subjected to suitable statistical tests. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20. Results obtained were subjected to analysis of variance, Mann–Whitney test, and Wilcoxon signed-rank test [Tables 1 and 2].
Table 1.
Comparison of bite force in the anterior, right, and left posterior regions between males and females
| Gender | Bite force (anterior region) | Bite force (right posterior region) | Bite force (left posterior region) | |||
|---|---|---|---|---|---|---|
|
|
|
|
||||
| Mean±SD | Min-Max | Mean±SD | Min-Max | Mean±SD | Min-Max | |
| Male (n=183) | 167.98±86.49 | 32.00-348.00 | 346.02±82.37 | 182.00-496.00 | 389.95±79.32 | 237.00-571.00 |
| Female (n=222) | 85.16±38.12 | 20.00-156.00 | 279.49±92.61 | 104.00-482.00 | 284.94±100.86 | 111.00-538.00 |
| Mann–Whitney U test | MW=8051.000, P=0.000 (<0.001), Very high significant | MW=11993.000, P=0.000 (<0.001), Very high significant | MW=8424.000, P=0.000 (<0.001), Very high significant | |||
Table 2.
Correlation of age with bite force
| Tooth region | Spearman’s correlation coefficient | P |
|---|---|---|
| Anterior |
Ρ=0.978 Very strong positive relationship |
P=0.000 (<0.001), Very high significant |
| Right posterior |
Ρ=0.981 Very strong positive relationship |
P=0.000 (<0.001), Very high significant |
| Left posterior |
Ρ=0.974 Very strong positive relationship |
P=0.000 (<0.001), Very high significant |
RESULTS
There was a very strong positive relationship between bite force (anterior and posterior regions) with age. Bite force increases with an increase in age. Bite force in the right and left posterior regions was significantly higher than in the anterior regions. Also, bite force in the left posterior region was significantly higher than right posterior region.
DISCUSSION
In restorative dentistry, measuring bite force is regarded as a crucial stage in diagnosis and treatment planning. So, knowledge of MVBF in a particular population is indispensable for the success of any restorative and rehabilitative dental treatment. Several devices for bite-force measurement are commercially available with their own graces and faults.[7,8]
This preliminary report tries to identify the MVBF of young healthy individuals with normal occlusion and compare the effect of gender, age, and side of the jaw with that of bite force. It has been found that bite force increases with an increase in age (18–40 years). It may be due to the completion of growth which happens in 18 years. MVBF remains constant till a certain age (45 in males and 25 in females) and then declines.[9] Also, the normal aging process may result in a decline in MVBF in older individuals. We found that males have higher bite force than females almost double in the anterior region. Hormonal differences in males and females may contribute to the variation in the composition of muscle fiber so variation in MVBF. Also, the size of the dental arch which is higher in males might result in higher bite force in males.[10] It has also been found that MVBF was found to be more than twice higher in the posterior region than in the anterior region. It may be because of the closer positioning of the measuring device to the closing muscles of the mandible in the posterior region, whereas it is farther when it is positioned in the incisor region. A relatively younger population was selected as participants so as to avoid the effect of teeth wear. We also found that MVBF was slightly higher on the left side of the jaw than on the right side. The reason for this is not clear.
A wide range of bite force values has been recorded in various types of research. Hellsing[10] reported a 140–200 N force value in the incisor region while Hagberg reported it to be 600–750 N in the molar region. In the molar region, While Serra and Manns[11] reported MVBF value to be 231–698 N in males and 186–658 N in females, Veena Jain[12] reported it to be 372.39 ± 175.93 N. In this research study, MVBF values found were similar to Veena Jain et al. It was 167.98 N in the incisor region in males and 85.16 N in females. In the right molar region, it was 346.02 N in males and 279.49 N in females. While in the left molar region, MVBF found was 389.95 N in males and 284.94 N in females. There were instances of recording very high bite force in a few participants with more than 500 N in the posterior region. These types of patients need to be evaluated for reasons of such high force and treatment planning should be modified accordingly for a successful treatment.
Further research is required to understand the effect of wear, type and period of edentulousness, and type of prosthesis on the MVBF. Also, it needs to be evaluated about the various types of occlusions on bite force.
CONCLUSION
Within the limitations of this study, it is concluded that measurement of the bite force of the patients undergoing restorative treatment is necessary for a good prognosis of any rehabilitative dental treatment. In our sample population, MVBF recorded was about 167.98 N in males and 85.16 N in females, while in the first molar region, it was found to be 367.98 N in males and 282.22 N in females. The device “Byte” is found to be handy, reliable, and easy to use.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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