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Influence of anthropometry, TMD, and sex on molar bite force in adolescents with and without orthodontic needs

Einfluss von Anthropometrie, temporomandibulärer Dysfunktion und Geschlecht auf die Bisskraft der Molaren von Jugendlichen mit und ohne kieferorthopädischen Behandlungsbedarf

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Abstract

Purpose

Bite force has been studied as representative of functional indices of mastication and its value may have diagnostic significance in disorders of the musculoskeletal system of facial bones. This study aimed to evaluate bite force in adolescents with and without orthodontic needs considering presence of temporomandibular disorders (TMD) as well as anthropometry: craniofacial dimensions and body mass index (BMI).

Methods

A total of 80 subjects were screened (61 females, 19 males; 18 ± 3 years old). Unilateral molar bite force was measured using a digital dynamometer with a fork thickness of 12 mm. Direct anthropometry was used to quantify craniofacial measurements. Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were used to classify samples according to malocclusion and to TMD, respectively. Data were analyzed using normality tests, Mann–Whitney U test, and multiple linear regression analyses with stepwise backward elimination, controlling for the presence of malocclusion and TMD (p ≤ 0.05).

Results

The cephalic index was greater in females with malocclusion and the longitudinal cranial diameter was reduced in females with malocclusion. BMI was not different between normal and malocclusion groups for either gender. Bite force was negatively related with vertical dimension of the face, and positively related with facial width and facial index. The model explained 32% of bite force variability, considering the sample size (coefficient of determination R 2 = 0.324).

Conclusions

Even when orthodontic needs and TMD signs and symptoms are present, stronger bite force is still observed in males and in subjects with smaller anterior facial heights and wider facial widths.

Zusammenfassung

Zielsetzung

Die Bisskraft ist ein Parameter funktioneller Kauindizes wobei sie bei Störungen des muskuloskelettalen Systems im Gesichtsbereich von diagnostischer Relevanz sein kann. Ziel der vorliegenden Studie war es, bei Jugendlichen mit und ohne kieferorthopädischen Behandlungsbedarf die Bisskraft im Hinblick auf eine bestehende temporomandibuläre Dysfunktion (TMD) und auf anthropometrische Faktoren (kraniofaziale Dimensionen und Body-Mass-Index, BMI) zu evaluieren.

Methoden

Insgesamt 80 Probanden (61 weibliche, 19 männliche; 18 ± 3 Jahre) wurden untersucht. Die unilaterale Bisskraft im Molarenbereich wurde mit einem digitalen Dynamometer (12 mm) quantifiziert, die kraniofazialen Dimensionen wurden direkt anthropometrisch vermessen. Zur Klassifizierung entsprechend den Kriterien Malokklusion bzw. TMD dienten die Indizes IOTN-DHC (Dental Health Component of the Index of Orthodontic Treatment Need) und RDC7TMD (Research Diagnostic Criteria for Temporomandibular Disorders), zur Datenauswertung und zur Berücksichtigung einer Malokklusion bzw. einer TMD (p ≤ 0,05) Normalitätstests, der Mann–Whitney-U-Test und die multiple lineare schrittweise Regression mit Rückwärtselimination.

Ergebnisse

Bei weiblichen Probanden mit Malokklusion war der Kephalindex höher, der longitudinale kraniale Durchmesser (“longitudinal cranial diameter”, LCD) war geringer. Beim BMI zeigten sich keine Unterschiede zwischen Probanden mit und ohne Malokklusion, ebenso nicht zwischen weiblichen und männlichen Probanden. Die Bisskraft korrelierte negativ mit der vertikalen Gesichtshöhe, positiv dagegen mit der Gesichtsbreite und dem Gesichtsindex. Unter Berücksichtigung der Größe des untersuchten Kollektivs ließen sich mit dem Modell 32% der Bisskraftvariabilität erklären (Determinationskoeffizient R 2 = 0,324).

Schlussfolgerungen

Auch wenn ein kieferorthopädischen Behandlungsbedarf sowie Hinweise auf und Symptome einer TMD vorlagen, ließ sich bei männlichen Jugendlichen und bei Probanden mit geringerer anteriorer Gesichtshöhe sowie ausgeprägterer Gesichtsbreite eine höhere Bisskraft beobachten.

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Acknowledgements

The authors’ responsibilities were as follows: BLL, collected, analyzed the data, and wrote the manuscript; TSB, collected and analyzed the data; PMC and MBDG, designed the study, directly supervised the research project, and provided advice and consultation. The authors would like to show gratitude to all directors, gymnastic teachers, and participant pupils of the following Piracicaba Schools: SEST/SENAT Piracicaba, SESC, Colégio Salesiano Dom Bosco, ENFERMAP Colégio Técnico, Faculdade de Odontologia da Universidade Estadual de Campinas. This research has been supported by Grants (no. 2010/02020-0 and no. 2010/19616-3) from the State of São Paulo Research Foundation (FAPESP, SP, Brazil). None of the authors had personal or financial conflict of interest.

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Authors and Affiliations

  1. Federal University of Goias (UFG), Rod BR 364, Km 195, # 3800, Jataí, GO, 75801-615, Brazil

    Barbara de Lima Lucas

  2. Department of Pediatric Dentistry, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901 - Areião, Piracicaba, 13414-018, SP, Brazil

    Taís de Souza Barbosa & Maria Beatriz Duarte Gavião

  3. Department of Biological Sciences, Federal University of São Paulo (UNIFESP), R. São Nicolau, 210 – 1. andar/lab 11, Diadema, 09913-030, SP, Brazil

    Paula Midori Castelo

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  1. Barbara de Lima Lucas
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  4. Maria Beatriz Duarte Gavião
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Correspondence to Barbara de Lima Lucas.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Barbara de Lima Lucas PhD.

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de Lima Lucas, B., de Souza Barbosa, T., Midori Castelo, P. et al. Influence of anthropometry, TMD, and sex on molar bite force in adolescents with and without orthodontic needs. J Orofac Orthop 78, 487–493 (2017). https://doi.org/10.1007/s00056-017-0105-1

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