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| Year : 2014 | Volume
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| Issue : 3 | Page : 325-330 |
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| A preliminary study to find out maximum occlusal bite force in Indian individuals |
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Veena Jain1, Vijay Prakash Mathur2, Rajath Sasidharan Pillai3, Sandeep Kalra3
1 Department of Prosthodontics, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pedodontics and Preventive Dentistry, All India Institute of Medical Sciences, New Delhi, India
3 Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
Click here for correspondence address and email
| Date of Submission | 12-Apr-2013 |
| Date of Decision | 22-Nov-2013 |
| Date of Acceptance | 04-Jun-2014 |
| Date of Web Publication | 7-Aug-2014 |
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 Abstract | | |
Purpose: This preliminary hospital based study was designed to measure the mean maximum bite force (MMBF) in healthy Indian individuals. An attempt was made to correlate MMBF with body mass index (BMI) and some of the anthropometric features.
Methodology: A total of 358 healthy subjects in the age range of 18-47 years (mean age = 26.66 ± 6.83) were selected following the selection criteria. Demographic details along with general physical and facial parameters such as height, weight, facial form, facial profile, arch form, and palatal contour were recorded in a predesigned proforma. The maximum bite force was recorded on both (right and left) sides using a specially designed piezoelectric transducer based device.
Results: The MMBF in Indian individuals was found to be 372.39 ± 175.93 Newton (N). Males had significantly higher (P = 0.000) MMBF (448.47 ± 191.82 N) as compared to females (296.31 ± 116.79 N). Facial form (P = 0.001) and palatal contour (P = 0.000) showed a significant relationship with MMBF. Subjects having square facial form (421.34 ± 187.32 N) showed significantly higher MMBF as compared to other facial forms, that is, square tapered (358.86 ± 143.56 N; P = 0.038), ovoid (338.40 ± 163.02 N; P = 0.000) and tapered (349.22 ± 184.82 N; P = 0.028). Subjects with flat palatal contour showed significantly higher MMBF when compared to high (P = 0.002) and medium palatal (P = 0.002) contour. Though facial profile was not significantly related to MMBF, it was significantly higher in subjects having concave facial profile when compared to convex (P = 0.045) and straight (P = 0.039) facial profile. BMI and arch form showed no significant relationship with MMBF.
Conclusion: The MMBF is found to be affected by gender and some of the anthropometric features like facial form and palatal contour. Keywords: Anthropometric features, facial form, facial profile, mean maximum bite force, piezoelectric transducer
How to cite this article:
Jain V, Mathur VP, Pillai RS, Kalra S. A preliminary study to find out maximum occlusal bite force in Indian individuals. Indian J Dent Res 2014;25:325-30 |
How to cite this URL:
Jain V, Mathur VP, Pillai RS, Kalra S. A preliminary study to find out maximum occlusal bite force in Indian individuals. Indian J Dent Res [serial online] 2014 [cited 2023 Mar 26];25:325-30. Available from: https://www.ijdr.in/text.asp?2014/25/3/325/138330 |
The relationship of maximum voluntary bite force and masticatory system is well documented in literature to indicate the health of stomatognathic system. [1] Bite force is the result of coordination between different components of the stomatognathic system. Determination of individual bite force level has been used to understand the mechanics of mastication, to ascertain the therapeutic effect of prosthetic device, and as a reference value for studies on the biomechanics of prosthetic devices. [2]
Bite force has been shown to be affected by a number of physiological and morphological variables such as craniofacial morphology, [3],[4],[5],[6],[7] age, [8],[9],[10] gender, [8],[11],[12],[13] periodontal support of the teeth, [14],[15] height and body weight, [4],[16] temporo-mandibular disorders (TMD) [9],[17],[18] pain, [19] and dental status. Other variables reportedly affecting the bite force are the type of recording devices, technique employed to measure the bite force, position of sensor in the oral cavity, patient position, unilateral or bilateral measurements and magnitude of mouth opening during measurements. [2],[20],[21]
It is widely accepted that an interaction exists between craniofacial morphology and bite force. Subjects with well-developed masticatory musculature, have small craniofacial flexure, that is, a small anterior and large posterior facial height, more anterior inclined mandible as well as small gonial angle were found to have higher values of mean maximum bite force (MMBF) in contrast to others. [3],[4],[5],[6],[7],[22] However, Ingervall and Minder were unable to find any co-relation between bite force and facial morphology in children, [7] they hypothesized that the correlation between masticatory muscle force and facial form develops during adolescence.
A number of studies in the past have indicated influence of gender on bite force. [8],[11],[12],[13] Many authors have reported MMBF is higher in males then females. The greater muscle force of males was mainly attributed to the anatomic differences between both genders. [8],[11],[13] Ferrario et al. explained larger tooth size, having larger periodontal areas is responsible for higher bite force in males. [23] However, a study conducted by Abu Alhaija 2010 did not find any difference in mean bite force among both genders in Jordian population. [24] Other factors, which got attention of researchers are Bruxism, TMD, craniofacial morphology and body mass index (BMI).
Bite force has been demonstrated to be associated with dento-alveolar structure. Cephlometric studies have also been used to find a correlation between bite force and craniofacial morphology. [5],[6],[7],[24] Although in routine clinical practice, many soft tissue landmarks are used to determine facial type, facial profile, arch form and palatal contour, a concrete evidence for the same was not found in the literature. Recording of MMBF can provide valuable information for prosthetic treatment planning, especially for the design of prosthesis, material selection and number of occlusal contacts needed to avoid excessive force on the underlying structure. [25],[26] A number of investigators have tried to find out MMBF for some of the populations. The MMBF of Jordian population has been reported in the range of 573.42 ± 140.18 N, [24] whereas in Indonesian population the MMBF was reported to be 806.23 ± 324.83 N. [27]
The aim of this study was to provide preliminary data of MMBF in Indian subjects. The influence of various factors such as gender, BMI, and few anthropometric features such as facial form, facial profile, arch form and palatal contour on maximum bite force was also studied as a secondary outcome in this preliminary study.
Literature search
In order to find out relevant literature on Indian population electronic as well as manual search was performed in October 2011. The electronic search was done on PubMed and Google Scholar using the keywords bite force, Indian subjects, masticatory force but no articles was found on mean bite force in Indian subjects. The manual search was performed at the institute's central library and the National Medical Library, New Delhi. After confirming from both the sources it was concluded that no relevant data exists on MMBF of Indian population.
| Methodology | |  |
Ethical clearance was obtained from the Institutional Ethics Committee. A total of 358 healthy volunteers (179 males and 179 females) were screened over a period of 1 year, from the subjects or accompanying persons attending the general outpatient department of dental center. Subjects in the age range of 18-47 years with the full complement of natural teeth (with or without third molars) and showing no evidence of tooth wear, attrition, carious lesion or restorations in molars, periodontal diseases, malocclusion and TMD were included in the study. Care was taken to exclude all subjects with the history of parafunctional habits, occlusal rehabilitation by splint or muscle relaxant, orthodontic treatment or dental prosthesis, neuromuscular disorder, arthritis, communication disorder and immunosuppressant drugs. General demographic details (such as age, gender) physical characteristics (height, weight) oral (arch form and palatal type) and facial parameters (facial profile, facial form) were recorded in a predesigned proforma.
Oral parameters such as arch form were recorded as square, tapering (V-shape), and ovoid (U-shape) shape. The arch form with central incisors nearly in a line with the canines was termed as square arch form. The arch form with central incisors is at a greater distance forward from the canines were termed as tapered arch. The arch form with central incisors are forward of canines in positions between that of square and tapered arch was termed as ovoid arch. [28] Hard palatal contour were scored as high (narrow, V-shape), medium (U) and flat vault. [29],[30] Facial profile was recorded in lateral profile view as straight, convex or concave using the three soft tissue anatomic landmarks, that is, glabella, base of the nose and most prominent point on chin. [28],[30] Facial form were measured as oval, square, square tapered and tapered, using facial landmarks, that is, most prominent point on temporal bone, zygomatic protuberance, and angle of mandible. [31]
The bite force was recorded using a customized bite force measuring instrument. [32],[33] This instrument has three components, quartz miniature force sensor, (2.5 KN) integrated cable, and charge meter with liquid crystal display (M/S Kistler Inc., Switzerland). The intraoral part of the sensor was modified for use in the oral cavity. Two stainless steel (SS) plates (2 mm thick) were used. An indentation of 0.5 mm was made for placement of force sensor in both the plates. A guiding pin (to prevent flexure within the apparatus during biting) was incorporated in one of the SS plates. The total thickness of the transducer was 9 mm (6 + 1.5 + 1.5 mm). The cable passed through the gap between the plates connecting the force sensor to charge meter. The appliance was subjected to laboratory calibration before intraoral use. The appliance was calibrated using standard weight of 1 kg once prior to starting the study and thereafter after every 60 readings .
The bite force measurement method was first demonstrated to the subjects after they were seated comfortably in a dental chair in an upright position. A disposable plastic sleeve was used to cover the sensor assembly and placed on the occlusal surface of the first molar. An acrylic block of same dimensions as the sensor was placed on the contra lateral side to counter balance the biting force. The subjects were asked to bite hard on the sensor and the peak bite force reading on the charge meter display was recorded. Three such readings were taken, alternated on each side, with an interval of 3 min to avoid muscular fatigue. To reduce the error and bias in study single operator has filled the proforma and recorded the bite force in all subjects.
The arithmetic mean of three consecutive records on either side was taken as the MMBF of that side.
Statistical analysis
The data were entered into Microsoft Excel Sheet (Microsoft Office 2010) and then converted into SPSS 13.1 (SPSS Inc., Chicago, IL, USA) for study of frequency distribution. For the difference in MMBF between the genders independent t-test was applied. For the rest of the parameters, one-way ANOVA was applied (post-hoc analysis where mentioned). P < 0.05 was considered to be significant.
| Results | | |
The mean age (±standard deviation) of the participants was 26.66 (±6.83) years. Mean age in males was 27.36 (±6.95) and females was 25.96 (±6.66) years. There was no significant difference (P > 0.05) in the maximum bite force on the right and left side of each individual. Hence, the mean of the maximum bite force on both sides was taken for further analysis. The MMBF in the present sample was found to be 372.39 ± 175.93 N in 358 subjects.
Mean maximum bite force was found to be significantly higher (P = 0.00) in males (448.47 ± 191.82 N) than females (296.31 ± 116.79 N) [Table 1]. | Table 1: Mean maximum bite force with different physical and anthropological features with P value
Click here to view |
Statistical analysis for different craniofacial characteristics shows facial form (P = 0.001) and palatal type (P = 0.000) have a significant relationship with MMBF, while BMI, arch form and facial profile have no significant relationship with bite force [Table 1].
Subjects with concave profile showed significantly higher MMBF (454.15 ± 245.26 N) when compared to straight (369.01 ± 173.83 N; P = 0.039) or convex (364.65 ± 163.90 N; P = 0.045) facial profile [Table 1] and [Table 2]. | Table 2: Inter group comparison* of bite force for facial forms, facial profile and palatal type in Indian population
Click here to view |
Subjects with Square facial form showed significantly higher MMBF (421.34 ± 187.32N) when compared to other types of facial forms such as square tapered (358.86 ± 143.56 N; P = 0.038), ovoid (338.40 ± 163.02 N;
P = 0.000) and tapered (349.22 ± 184.82 N; P = 0.028) [Table 1] and [Table 2].
Subjects with flat palatal type have significantly higher MMBF (599.33 ± 191.50) when compared to high (362.40 ± 165.86 N; P = 0.02) and medium (369.10 ± 178.05 N; P = 0.02) palatal type [Table 1] and [Table 2].
In addition, gender-wise statistical analysis of bite force showed palatal type have a significant association with bite force in both males (P = 0.006) and females (P = 0.032). Subjects of both the genders having flat palatal type showed significantly higher MMBF as compare to high and medium palatal type [Table 3]. While the other parameters, that is, BMI, facial profile, facial form and arch form showed not significant relationship with bite force in both males as well as females. | Table 3: Relationship of mean maximum bite force to palatal types in different gender
Click here to view |
| Discussion | | |
This study is a cross-sectional, preliminary study to determine the MMBF in Indian population. MMBF in Indian subjects was found to be 372.39 ± 175.93 N, which is in agreement with previous studies. [5],[10],[24] A wide range of bite force value was noted in the study population (minimum: 117.67 N, maximum: 992.17 N). This can be explained by the fact that bite force is not only affected by sensor thickness, method of recording, position of sensor in the oral cavity, and type of sensor, but it is also affected by craniofacial morphology, body height, weight and muscle strength etc., [3],[4],[5],[6],[7],[16],[18] or may be due to patients apprehension for biting hard on quartz sensor.
Result showed no significant difference between right and left side, which is in agreement with previous studies. [7],[9],[34] Bite force was significantly higher in males when compared to females. Our results were found to be in agreement with the previous studies. [4],[34],[35] However, some studies reported that gender has no significant influence on bite force. [24],[36] The gender difference in bite force has been explained as greater muscle potential in men in many studies. [8],[11],[12],[13] In males masseter muscle have fibers with larger diameter and greater cross-sectional area then females. [36] However, bite force has not been proved to be varying with gender in children (below 18 years of age). [7] Braun et al. in 1996 reported that during the post pubertal period, maximum bite force increases at a greater rate in males as compare to females. [37] Previous studies explained larger bite force in males may be because of larger tooth size and larger periodontal ligament (PDL) area; it can give a greater bite force. [23],[11] While Waltimo and Könönen in 1993 reported a significant difference in bite force between gender only for the molar region, which can be explained by the fact that bite force on the incisal area could be limited by the PDL sensitivity not by the muscle strength as in the posterior area of the mouth. [11]
Body mass index is a composite of body weight and height. In our study, relationship was not found between various categories of BMI and bite force. Similarly, Koη et al. did not find a correlation between bite force and BMI. [38] While other studies showed low co-relation with height as well as weight. [4],[16] However Pereira-Cenci et al. found maximum bite force has a significant correlation with weight for both male and female subjects. Though they also reported bite force has a significant correlation with height in males' only. [9]
Analysis of data showed MMBF was significantly higher in subjects with concave profile, as compared to straight and convex profile. According to Proffit et al., concave facial profile is mostly associated with Class III jaw relationship. [39] Class III jaw relationship is also associated with horizontal growth pattern and smaller gonial angle, therefore these subjects may have a higher bite force.
Results also showed subjects with square facial form have higher MMBF when compared to ovoid, square taper and taper facial form. Our results coincide with the study conducted by Bonakdarchian et al. which showed square facial form have higher bite force as compared to other facial form. [12] Sondang [27] reported Indonesians have higher bite force as compared to what is reported in previous studies. [4],[5],[10],[40] Enlow in 1990 reported all Indonesians have brachycephalic or square jaw which are characterized by a relatively smaller gonial angle. [41] Ingervall and Thilander 1974 showed that persons with rectangular facial profile have powerful bite force. [42] Mechanical advantage of masticatory muscles could be a contributing factor for higher bite force in subjects who had wider head dimensions. [12],[43] Hannam and Wood found significant co-relation between bizygomatic arch width and cross-sectional area of the masseter or medial pterygoid muscles. [44] van spronsen et al. [45] found that the masseter muscle contributed mostly to the relation with facial morphology, followed by medial pterygoid muscle and to a lesser degree anterior temporalis muscle. [44] van Spronsen et al., strongly supported the idea that variation in maximum bite force is mainly dependent on the variation in size and direction of the masseter muscle, this direction being related to variation in craniofacial morphology. [46]
Results also showed patients with flat palate have higher bite force as compared to those with medium or higher palatal vault. According to previous studies [47],[48] the higher bite force in these subjects may be due to horizontal growth pattern, which is usually associated with low gonial angle also reported a positive relationship between transverse facial dimensions and bite force in adults. [43]
In this study on gender-wise analysis we didn't find any influence of the facial profile and facial form on bite force. This may be due to randomly selected subject's samples with no concentration on specific facial morphology or by the small number of subjects. Since it was a preliminary cross-sectional study, the sample distribution into different facial morphological features was unequal, suggesting that inferences related to correlation should be interpreted with caution.
| Conclusion | | |
On the basis of results, we can conclude that MMBF in Indian subjects is 372.39 ± 175.93 N. Males have higher MMBF then females. Bite force varies with gender, facial form and palatal type, while not differing with BMI and arch form. The authors are of the opinion that further studies with larger sample size and systematic distribution of subjects according to gender and different anthropological features are required.
| Acknowledgment | | |
This project was funded by Department of Biotechnology, Government of India under Rapid Grant for Young Investigators Scheme.
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Correspondence Address:
Vijay Prakash Mathur
Department of Pedodontics and Preventive Dentistry, All India Institute of Medical Sciences, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.138330
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