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 Table of Contents  
REVIEW ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 4  |  Page : 168-174

Bite force - What we should know: A literature review


Department of Pediatric Dentistry and Orthodontics, College of Dentistry, Taibah University, Medina, KSA; Department of Orthodontics, Faculty of Dentistry, Ibb University, Ibb, Yemen

Date of Submission21-Sep-2019
Date of Acceptance07-Nov-2019
Date of Web Publication17-Dec-2019

Correspondence Address:
Dr. Talat Hasan Al-Gunaid
Address for correspondence: Dr. Talat Hasan Al-Gunaid, Department of Pediatric Dentistry and Orthodontics, College of Dentistry, Taibah University, Medina

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijor.ijor_33_19

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  Abstract 

Ultimate and balanced occlusion is an inevitable result of harmony and consistency between the upper and lower jaws, teeth, temporomandibular joint, and muscular system. The magnitude of bite force reflects this coordination positively. For many researchers, maximum bite force has been a topic of interest, and several studies have been conducted to determine the relationship between maximum bite force and various parameters. These include facial morphology, age, sex, body mass index, temporomandibular disorders, occlusion, and orthodontic and orthognathic surgery treatments. The purpose of this review is to provide the reader with a thorough overview of the literature and highlight the possible impacts of certain factors that might affect the maximum bite force.

Keywords: Influential factors, maximum bite force, review


How to cite this article:
Al-Gunaid TH. Bite force - What we should know: A literature review. Int J Orthod Rehabil 2019;10:168-74

How to cite this URL:
Al-Gunaid TH. Bite force - What we should know: A literature review. Int J Orthod Rehabil [serial online] 2019 [cited 2020 Apr 9];10:168-74. Available from: http://www.orthodrehab.org/text.asp?2019/10/4/168/273318


  Introduction Top


The force resulted from the interaction between maxillary and mandibular teeth, bones, and muscles is defined as a bite force or masticatory force.[1] In dentistry, maximum bite force has been investigated to evaluate the effectiveness of various dental procedures on the masticatory system, including orthodontic treatment [2] and prosthodontics,[3] as well as the effects of facial deformities, such as malocclusion and temporomandibular disorders.[4] The importance of assessing bite force in orthodontics arises from the direct interaction between the bite force itself and the type of mechanics required by orthodontists during treatment. These include cross-elastics, intrusion or extrusion of teeth, stability of orthodontic treatment, and the well-matched position of the dentition in relation to muscle forces.[5] Previous studies have provided varying results on maximum bite force and its influential factors, which include sex,[5],[6] age,[6],[7],[8] temporomandibular joint (TMJ),[4] dentition status,[7] general musculature status, populations,[9],[10] and various measuring instruments and techniques.[11] What is available from scientific evidence is still debatable when it comes to providing accurate and scientific descriptions of the nature of factors that affect the maximum bite force. Only one study, published in 2010, attempts to explore the literature, gather data, and provide the reader with detailed insight into the subject.[12] With this background in mind, the purpose of this review is to provide the reader with a thorough overview of the bite force literature and highlight the relationship between several factors that could affect the maximum bite force. An electronic search was conducted via PubMed, Medline, and Google Scholar using the keywords “maximum bite force,” “bite force,” “human bite force,” and “occlusal bite force” for studies published mainly between January 2000 and May 2019.


  Historical Background Top


It has been reported that the first attempt to record bite force was completed by Borelli in 1681, using a device named a gnathodynamometer.[13],[14],[15] After that, Black designed a new type of gnathodynamometer in 1893, to measure intraoral forces.[13],[14] A wide range of methods and devices have been used to measure bite forces. These devices have been either mechanical, electrical, or a combination of both and range from simple springs to complex electronic devices.[15] Verma et al.[15] conducted an interesting study reviewing all types of devices used to record bite force. They categorized these into three different types: strain-gauge transducer, piezoelectric transducers, and pressure transducers. They also presented most of the commercial types that are currently available and provided further detail about the specifications, advantages, and disadvantages of these. Most modern devices utilize electrical resistance strain gauges, and the majority of the instruments can record forces between 0 and 800 N at 80% precision and accuracy.[16]


  Variables Affecting Bite Force Top


Ethnicity

Every race is known to have specific characteristics that distinguish it from others. When it comes to the magnitude of bite force, it has been reported that different races have varying biting forces, and this may be due to morphological variations, occlusion, occlusal surface architecture, and eating habits. However, various studies have assessed the bite force for different populations such as Europeans,[1],[17] Asians,[10],[18] Arabs,[19],[20] and Brazilians.[21] Regalo et al.[21] evaluated molar and incisor bite force in indigenous Brazilians and compared it to that of White Brazilians. They found that the maximum bite force of indigenous Brazilians was greater than that of White Brazilians. In indigenous people, they attributed greater maximum bite force to their eating habits; they tended to consume greater amounts of raw and natural foods, roots, dried fruits, and meat from wild animals, which in turn develops greater bite force as the mandibular elevator muscles try to resist the food.[21] Shinogaya et al.,[22] on the other hand, examined maximum bite force based on ethnicity. In their study, 46 participants were recruited and divided according to Danish (Caucasian) and Japanese (Asian) ethnicities. The authors did not find any significant differences between the bite forces of the two ethnic groups. To verify the normative values of different populations, several reports were also carried out. For instance, the maximum bite force was found to be 573.4 ± 140.1 N for Jordanians,[19] 806.2 ± 324.8 N for Indonesians,[10] 273 ± 4 N for Nepalese,[9] and 372.3 ± 175.9 N for Indians.[23] Unfortunately, no study has attempted to compare the bite force between different racial groups using the same device and protocol in our current modern lifestyle. This type of research might be an interesting topic for researchers to explore further, allowing them to provide a clear illustration of the variations in bite force across different groups.

Gender

Gender variations in terms of function and characteristics have received extensive research and scrutiny. The relationship between sex and maximum bite force has been analyzed in several studies. Some report that males have a stronger bite force than females.[24],[25],[26] These studies attribute this variation to the difference in muscle structures (muscle size, diameter, type of masseter muscle fibers), mandibular inclination, and type of exercises and activities. Tuxen et al.[27] reported that bite force is associated with skeletal mass and fiber-type composition, which is associated with the thickness of masseter muscle. In their study, they took a biopsy of both a male and female masseter muscle. They found that type II fibers were the major type of fiber found in the male muscle. They claimed that this could produce a faster contraction force than type I fibers. Tuxen et al.[27] and Bakke et al.[28] reported a stronger bite force in males compared to females and concluded that gender-related bite force is involved.

Miller et al.[29] and Sato and Ohashi [30] connected this difference to the larger tooth size and larger periodontal ligament in males. In boys, Scudine et al.[31] reported a greater biting force than in girls. They assumed that sex variations become more evident during the postpubertal period when the development of muscle mass takes place under the influence of anabolic steroids in males. Furthermore, their findings were consistent with that reported by Tuxen et al.[27]

In the molar region, Palinkas et al.[24] reported a 30% higher maximum bite force in males than in females and attributed this to the greater muscle mass and size of males. Bommarito et al.[25] observed a significant gender difference (36% higher among men than women). Koç et al.[32] further compared the occlusal bite force between genders and concluded that in individuals with normal occlusion, the mean maximum bite force was greater in men than in women. Owais et al.[20] investigated bite force in children at various dentition stages and reported a greater maximum bite strength in males compared to females, except for the permanent dentition group, in which females showed higher bite force than males. Kashiwazaki et al.[26] also analyzed bite force and found that in female subjects, the maximum bite force was lower than in male subjects. In contrast, Serra et al.,[33] Su et al.,[34] Abu Alhaija et al.,[19] and Suwal and Babu [9] failed to find gender differences regarding maximum bite force.

Age

Aging involves a gradual decline in neuromuscular functions, and this results in a reduction in muscle mass, muscle morphology, and a simultaneous decrease in muscle strength.[35] In humans, atrophy, fatigue, weakness, and changes in contractile properties have been reported to be associated with aging.[36] Muscle strength peaks between 20 and 35 years of age and begins to decrease between 35 and 50 years of age, with more abundant, rapid changes occurring after the age of 65.[37]

As a result of aging process, muscle alterations could affect bite force. Some reports have found that the maximum bite force tends to increase with age.[19],[20],[22],[24],[38],[39] Usui et al.[40] reported an increase in bite force up until the age of 20 years in males and 17 years in females; this remains stable from 20 to 40 years of age and then begins to decline. Sonnesen and Bakke [17] and Usui et al.[40] stated that bite force increased with age until 20 years, after which bite force is stabilized. At 40 years of age, however, bite force began to decline. Kamegai et al.[18] conducted a study on 2594 Japanese children between the ages of 3 and 17 years. The researchers concluded that bite force increases in both males and females from the age of 3–14 years. Owais et al.[20] investigated 1011 children aged 3–18 at different dentition stages and found that the maximum bite force increases with age. They attributed their findings to the increase in the amount of occlusal contact during transition through the different dentition stages.

Body mass index

The World Health Organization (WHO) defines body mass index (BMI) as the weight of a person in kilograms divided by the square of the height of that person in meters. It is a reliable body fat indicator. Obesity has been reported to change the function and composition of body muscles, including metabolism, adipokine secretion, inflammatory markers, increased lipolysis obesity, mitochondrial numbers and function, muscle fiber type, capillary density, and recruitment, resulting in skeletal muscle remodeling.[41] All of these changes lead to higher levels of free fatty acids that accumulate in skeletal muscles when compared to subjects who have never experienced obesity in their lives.[41],[42] It is common knowledge that people with a larger body structure, size, and weight are likely to have a greater bite force. Therefore, correlations between bite force and BMI have been investigated extensively. Sun et al.[41] investigated biting force in groups of obese, underweight, and normal boys. They measured the testosterone serum level in the obese group and compared this to the normal and underweight groups. They found that in the obese group, the testosterone level was significantly lower than it was in the normal and underweight groups. Their findings showed that bite force decreased in obese boys, contrasting with the results of the other groups. They linked this to the fact that muscle strength and muscle mass can be affected by levels of hormones, such as androgenic steroids, and the anabolic effects of testosterone on the skeletal muscle. These would normally lead to an increase in muscle size, strength, and power. Bommarito et al.[25] reported that people who have never been obese have greater muscle strength than individuals who have experienced obesity in their lives. They also stated that the adipose tissue interferes with muscle strength as a result of an endocrine reaction and that a high BMI may present more flaccid tissues and take longer to reach the muscle tone required for speech and mastication. Finally, they concluded that BMI is most likely not an influencing factor when discussing maximum bite force. They also reported that although high BMI values indicate impaired functions of other body muscles, it has no influence or significant correlation with the function of the masseter muscle.[25] The same finding was also conveyed in other studies, in which no relation between maximum bite force and BMI was found.[3],[25],[32],[34],[43] On the other hand, a significant correlation between the two has been found in several other studies.[19],[26],[44] Kashiwazaki et al. studied the relationship between bite force and BMI using a sample of elderly Japanese participants. They found a significant positive correlation between total bite force and BMI.[26] Another study conducted by Ikebe et al., also focusing on elderly Japanese people, reported that overweight subjects often exhibit lower biting force, meaning that bite force does not necessarily increase with body weight.[45]

Malocclusion

It is well known that interaction between maximum bite force and craniofacial morphology does exist.[8],[19],[46],[47],[48] Sonnesen and Bakke [17] highlighted the relationship between bite force and craniofacial morphology. They stated that vertical jaw relationship is fundamental when considering the impact of craniofacial morphology on boys' bite force. Shinogaya et al.[22] and Ferrario et al.[49] found that a long face can be associated with smaller biting force values. A negative correlation between bite force and mandibular inclination has been found by Pereira et al.[50] and Quiudini et al.,[51] who concluded that maximum bite force in severe brachyfacial subjects is commonly higher than in severe dolichofacial patients. In the molar region, the mean bite force was twice as high in normal subjects than in long-faced subjects, short-faced subjects produced higher forces than normal facial subjects.[46] Prema et al.[52] compared the bite force between different vertical facial patterns. They found that the bite force was higher in hypodivergent group than by normal and hyperdivergent groups. Kiliaridis et al.[53] assessed the relationship between bite force and facial morphology in 136 individuals aged 7–24 years. The maximum incisor bite force and the upper/lower height ratio of the face showed only slight positive connections. Braun et al. stated that the magnitude of maximum bite force varies with changes in craniofacial growth, complementing the growth of masticatory muscles and the normal growth process.[5] Olthoff et al.[54] observed that an increase in the vertical dimension results in variations in the orofacial morphology, and this affects the masticatory system and the value of the bite force. Koç et al.[32] concluded that the mean maximum bite force in men was higher in individuals with normal occlusion than in women; transverse facial dimensions influenced bite force only in men, suggesting that males with long faces tend to have a lower biting force than those with normal faces. Jain et al.[23] analyzed the mean maximum bite force in 358 Indian subjects, taking into account the influence of gender, BMI, facial type, facial profile, arch form, and palatal contour. It was found that the bite force was higher in subjects with a concave profile compared to those with a straight and convex profile, as well as in a square facial shape compared to an ovoid, square tapered, and tapered facial shape. The type of malocclusion has been reported to affect the masticatory performance and maximum bite force.[14],[18],[55],[56] Based on the Angle classification, de Araújo et al.[56] compared the bite force among individuals with different types of malocclusions. They found that subjects with normal occlusion had the highest bite force, followed by Class I, Class II, and Class III.[56] This can be explained with reference to Okeson,[57] who reported that ideal or normal occlusion subjects have a balanced distribution of occlusal contacts and, consequently, a balanced occlusal force. Similar findings have been reported by English et al.,[58] Henrikson et al.,[55] and Alomari and Alhaija.[59] Trawitzki et al.[60] compared subjects of Class II, Class III, and normal occlusion. The Class II and III groups demonstrated no significant differences, while the normal occlusion group showed significantly greater bite force than Class II and Class III groups. The researchers concluded that subjects with dentofacial deformities have lower bite force values, lower masticatory muscle electromyographic activity and efficiency, and lower occlusal contacts compared to those with normal occlusion. They also reported that the lower values of bite force and muscle function activity in individuals with dentofacial deformities might be due to the lower motivation to generate force, different sensory experiences, or the lower use of this musculature during masticatory function, thus resulting in reduced development. The researchers also attributed this to the effect of occlusal contacts, mandibular biomechanics, and masticatory muscles, as opposed to the type of malocclusion. Contrastingly, English et al.[58] investigated the effects of malocclusion on the masticatory performance of a sample with various types of malocclusion and compared them to individuals with normal occlusion. English et al.[58] found that the greatest difficulty could be seen among individuals with Class III malocclusions, followed by Class II and Class I malocclusions. They concluded that malocclusion negatively affects the ability of subjects to process and break down food and influences the individual's perception of how well they can chew.

A recent study by Telich-Tarriba et al.[61] reported that patients with hemifacial macrosomia had reduced electromyography values of the masseter muscle on the affected side, compared to the healthy control group, but bite force did not show significant between groups.

Orthodontic treatment

Understanding the effects of orthodontic treatment methods, such as functional appliances, fixed orthodontic appliances, and orthognathic surgery before, during, and after these treatment modalities, has led to numerous studies.[2],[59],[62],[63],[64],[65] It has been reported that bite force decreases during orthodontic treatment and this can be caused by pain, discomfort, and occlusal disturbances throughout. In turn, these may affect the magnitude of the bite force.[2],[59],[62],[63],[64],[65] Sonnesen and Bakke [62] examined bite force in unilateral crossbite children and reported that the bite force level decreased immediately following treatment, then increased after retention to reach the level of normal occlusion subjects. They attributed this to the transient changes in occlusal support, periodontal mechanoreceptors, and muscle reflexes of the jaw elevators. Yawaka et al.[66] examined the occlusal contacts and bite force in primary dentition among children with a crossbite, reporting a decrease in occlusal contacts during the orthodontic treatment period and attributing this to changes in the mandibular position and movement of the anterior maxillary teeth. Alomari and Alhaija [59] assessed changes with fixed appliances during orthodontic treatment. They reported that during the 1st month of treatment, the bite force was reduced. It then recovered to pretreatment levels following the 2nd month of treatment.

Prema et al.[52] reported that during the 1st week of fixed orthodontic appliance, the bite force is reduced to 50% of the pretreatment level. Yoon et al.[65] conducted a 2-year follow-up study to identify changes in occlusal contact and bite force in extraction and nonextraction orthodontic subjects. They found that the occlusal contact area and bite force decreased immediately after treatment and then gradually improved to pretreatment levels. Despite this, the occlusal contact area in the four premolar extraction groups did not fully recover after 2 years. They concluded that it may take longer than this period (posttreatment) to recover the occlusion. It has been suggested that functional appliance treatment can lead to mild muscle atrophy, possibly due to the decreased functional activity of the masticatory muscles.[67] Al-Khateeb et al.[63] investigated the change in bite force following orthodontic treatment with the Andresen functional appliance. They found that the bite force was reduced by 50% at the end of the 1st week, and they attributed this to changes in muscle activity and a decrease in occlusal contacts. However, the bite force was recovered overtime to reach the pretreatment levels. Following the 2nd month of orthodontic treatment, occlusal bite force showed a tendency to return to pretreatment levels.[63] Antonarakis et al.[68] observed a decrease in bite force in the molar region after functional appliance therapy. Winocur et al.[2] found an increase in bite force following orthodontic treatment compared to that measured before the removal of the appliance. Iwase et al.[64] evaluated the bite force, occlusal contact area, and chewing efficiency of Class III patients before and after sagittal split ramus osteotomy and compared them with a normal occlusion control group. They found that the patients' bite force before surgery was significantly lower than the controls'. Although the bite force improved after orthognathic surgery, it did not reach the values of the control group within 2 years postsurgery. They concluded that further adjustment is needed at the end of the treatment, as there is still inadequate occlusion and function postoperatively. Islam et al.[69] conducted a systematic review on the effects of orthognathic surgery on bite force. They found that for patients undergoing orthognathic surgery, bite force was lower than those with normal Class I skeletal pattern and Class I occlusion, even after 2 years of surgery. However, bite force would be expected to increase in the long term due to muscle adaptation and better occlusal contacts.

Temporomandibular disorders

Temporomandibular dysfunctions (TMDs) refer to a group of pain-related signs and symptoms; TMJ dysfunction, masticatory system disorders, limited mouth opening, limited jaw movement, and TMJ noise. It is suggested that individuals with TMDs will have a reduced maximum bite force. During chewing, patients with TMDs use higher relative masticatory forces than normal subjects. The correlation between bite force and temporomandibular disorders has been investigated, with some authors reporting that TMD might influence bite force and muscle activity. Kogawa et al.,[4] Pizolato et al.,[70] and Ahlberg et al.[71] reported a negative impact of TMJ disorders and muscle pain on bite force level. Kogawa et al.[4] stated that a stronger bite force might be disturbed by the presence of masticatory muscle pain and TMJ inflammation. They also noted that the mechanisms involved in this process are not well understood. In contrast, Pereira et al.[72] found an insignificant correlation between TMJ disorders and bite force, which they suggested was due to variations in recording techniques and the severity of TMD cases. Similarly, Hotta et al.[73] compared bite force with and without TMDs among full denture wearers. They suggested that the signs and symptoms of TMDs and denture design did not affect the maximum bite force of complete denture wearers. Shenoy et al.[74] evaluated and compared the maximum bite force in young adults with TMDs and bruxism with that of a healthy sample. They concluded that the TMDs and bruxism group had lower maximum bite force values.


  Conclusion Top


There is an apparent lack of clarity regarding the nature of the factors affecting bite force. These need to be studied in-depth through systematic reviews and meta-analyses studies to be understood further.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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