Bite force in Malocclusions  1567

BITE FORCE ANALYSIS IN DIFFERENT TYPES

OF ANGLE MALOCCLUSIONS

Análise da força de mordida nos diferentes tipos

de maloclusões dentárias, segundo Angle
Sarah Cueva Candido Soares de Araújo (1), Marilena Manno Vieira (2),
Christiane Aparecida Gasparotto (3), Silvana Bommarito (4)

ABSTRACT

Purpose: to analyze the maximum bite force in individuals with normal occlusion and types of Angle’s
malocclusion; to observe the frequency of occurrence of each type of occlusion; to analyze whether
there is any difference between measurements of force and relate bite force to body mass index (BMI).
Methods: the sample was composed of 100 students of the Speech and Language Pathology School
at UNIFESP, with ages between 17 and 25 years. Individuals with ATM disfunctions, mental or genetic
disorders and those who had already undergone miotherapy were excluded. Each individual went
through an evaluation, which consisted of: 1) gathering personal information, personal diet, chewing
preference, weight and height. 2) evaluation of dental occlusion as normal occlusion or malocclusion
Class I, Class II 1st division, Class II 2nd division or Class III. 3) evaluation of bite force, performed
by using a digital dynamometer. Different techniques were used for statistical analysis. Results:
individuals with normal occlusion were those who had the greatest bite force, followed by Classes I,
II 1st and 2nd divisions and Class III, respectively; there was higher occurrence of malocclusion Class
I, followed by normal occlusion, Class II 1st and 2nd divisions and Class III; There was an increase of
the average force between the first and third measurements for both sides; there was no correlation
between bite force and BMI. Conclusion: the type of occlusion influenced bite force, the greatest
force being obtained on the third measurement; there was no relation between BMI and bite force.

KEYWORDS: Dental Occlusion; Malocclusion; Bite Force; Stomatognathic System

„„ INTRODUCTION may be measured by the number of bites it takes to

process and swallow food, or by the ability to break
[Link] is extremely important for the stomato-
Mastication is the group of phenomena that occur
gnathic system as it comprises the first step in the
in the mouth and provide the mechanical degra-
process of food digestion, called the oral phase1.
dation of food, transforming it into small particles
Inefficient mastication may lead to a change
that are joined by saliva and finally form the food
in the choice of foods selected to compose an
[Link] qualification of the process of mastication individual’s diet, which may negatively influence
his health, and consequently lead to pathological
(1)
UNIFESP/EPM, São Paulo, SP, Brazil.
conditions such as malnutrition, for example. One
(2)
Speech Language Pathology Department of UNIFESP/ of the main factors that may influence the process
EPM, São Paulo, SP, Brazil
of mastication is bite force during chewing, as well
(3)
SOEBRAS – FUNORTE Núcleo Santo André, Santo André,
SP, Brazil as the number of lateralizations and the number of
(4)
Speech Language Pathology Department of UNIFESP/
occlusal contacts presented by the individual2.
EPM, São Paulo, SP, Brazil Bite force is defined by the force of mandible
Funding: Fundação de Amparo à Pesquisa do Estado de São muscles that determines the amount of energy
Paulo (FAPESP) - process2010/20436-0 available to cut or grind food. Its intensity is deter-
Conflict of interest: non-existent mined mainly by muscle capacity and may be related

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1568  Araújo SCCS, Vieira MM, Gasparotto CA, Bommarito S

to several anthropometric measurements, such as, Another characteristic – more subjective,

for example, weight and height3,[Link], there however valid in the relationship of bite force and
seems to be a consensus in specialized literature dental malocclusion – is the activity of chewing
concerning maximum bite force, according to sex, muscles, measured through surface electromy-
where it is greater in men, due to the larger muscle ography. These studies have been verifying a
fibers present in this sex3,5. difference between muscle activity in individuals
Since the condition of occlusion is needed in with different types of malocclusion16,17.
order to obtain bite force, it is verified that, in order However, in spite of what has been described,
to have normal occlusion, the first superior molar there are authors who did not find in their studies any
should occlude its mesiovestibularcusponto the relationship between bite force and malocclusion4,18.
sulcus of the first inferior molar.A malocclusion From the standpoint of the considerations made
is any deviation of the relationship among teeth on obtaining a maximum bite force and occlusion
that takes them out of their normal occlusion and, condition, and mainly due to the need to deal in
according to Angle6, may be classified in three great clinical practices with patients who mostly have a
disorder in their mastication function, the purpose
groups named Class I, Class II and Class III. This
of the present study was to analyze the maximum
classification takes the occlusion of the first superior
bite force in individuals with different types of dental
molars as a reference, since Angle believed that
occlusion, namely: normal occlusion and Angle’s
the position of this tooth in the dental arch was
Class I malocclusion, Class II division 1, Class II
immutable, since it is the first permanent tooth to
division 2 and Angle’s Class III. Furthermore, the
form and erupt – the so-called “six year molar”.For
secondary aims were to analyze the frequency of
this reason, this tooth was considered by Angle as
occurrence of the different types of occlusion in
the “key of occlusion”6.
the studied population, to analyze the difference
Thus, the relationships between bite force and the between the first and third measurement of
type of dental occlusion have been studied for some maximum bite force and to relate bite force with the
time, without a present consensus in [Link] body mass index (BMI).
studies justify that muscles, as well as teeth play an
important role in the direction of the course of bite „„ METHODS
force and that muscle anatomy may both cause and
reflect mandible movements and, thus the relative
This study was approved by the University’s
importance of the components of bite force may be
Research Ethics Committee in November 2010
associated to the different muscle anatomy of each
(CEP 1639/10). It was conducted in the Orofacial
[Link] addition, maximum bite force increases
Motricity outpatient unit of the Speech-Language
with the number of teeth that are present and the
Pathology Department, and begun only after the free
association between maximum bite force and the consent term was signed by each of the participants
amount of occlusal contacts is more relevant in the of the study. This is a cross-sectional prospective
posterior region and, as a consequence, the loss study.
of molars, for instance, would result in a reduction The sample was composed of 100 university
of bite [Link] are studies that have found students, enrolled in the speech-Language
statistically significant differences between force Pathology program, in between 17 and 25 years of
measurements and the different types of occlusion, age. Individuals with temporomandibular disorders,
measured directly – using a force transducer -, with those with mental and/or genetic disorders and
the smallest force having been found in individuals those who were undergoing Speech-Language
with malocclusion7,[Link] conducted with progna- Pathology treatment, specifically in the field of
thous patients before and after orthognathic surgery, Orofacial Motricity were excluded from the study.
measuring force in this same way, have shown that Each student was submitted to a Speech-
the parameters of bite force improve after surgery, Language Pathology evaluation, as shown in Figure
although none reached the values of individuals 1. This assessment was composed of the following
with normal occlusion9-13. steps:
Considering chewing performance as an 1) Anamnesis, composed of:
indicative factor of the quality of mastication, other a) Personal identification data, where infor-
authors have observed that the number of occlusal mation such as name, sex, age, address,
contacts are determinant for satisfactory chewing telephone number, schooling were gathered;
performance and that individuals with malocclusion b) Information about the type of daily meals:
would be less efficient in this task than others with each participant was asked how a usual day
normal occlusion14,15. was in terms of meals, from waking up until

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 Bite force in Malocclusions  1569
the time to go to sleep; this information was [Link], Class III is seem when the mesio-
collected in order to guarantee that all parti- vestibular sulcus of the first inferior permanent molar
cipants ate all kinds of food consistencies, is mesialized in relation to the mesiovestibular cusp
with no restriction regarding the consistency of the first superior molar.
of the food; 3) Bite force evaluation – Bite force was assessed
• Weight: was obtained through a digital by measuring the maximum bite force, using a digital
scale, of the X-Life brand, that was dynamometer type DDK/M (Kratos, São Paulo,
calibrated with the weight of a profes- Brasil). This device was developed to determine a
sional scale in order to guarantee the force applied by an individual at the moment of a
accuracy of the measurement. The parti- bite – has a scale in Kgf, N orIbf, a set zero key that
cipants had to be barefoot and remove enables the exact control of the obtained values and
heavy objects from their bodies (coats, also a peak register, that makes it easier to read the
cell phones, belts); maximum force applied during value measurement
• Height: was measured using a tape (capacity of up to 100 Kgf, adapted to mouth condi-
measure, and each participant was tions). This value is shown in a digital screen that
barefoot with their heels against a wall at enables this reading. Each individual was asked to
the moment of measurement; bite three times on each side, alternating right and
These last two items (weight and height) were left, so that the mean of the three measurements
measured during the evaluation; each volunteer’s could be calculated afterwards.
body mass index (BMI) was calculated using the The procedure was conducted at the Orofacial
formula [weight (kg)/ height² (m)] and used for Motricity outpatient unit at the [Link]
posterior analysis. examination, each student remained comfortably
2) Dental occlusion evaluation – Dental occlusion seated in a chair with feet on the ground and head
evaluation was conducted by direct observation. parallel to the horizontal plane. Each participant
The analysis was carried out by sitting the patient received detailed instructions about the procedure
in the horizontal plane, and the relationship in and, before the assessment began, tests were
between the upper and lower dental arches was performed where the subject bit the device before
measured, using the first permanent molars as the real records, in order to assure procedure
reference. In order to assure precision in the reliability.
analysis, the researcher, using hygienic gloves, In order to measure maximum bite force, the
drew a line in the middle of the mesiovestibular device was positioned in the region of the student’s
cusp of the first permanent superior molar first molar teeth, on each side of the dental arch,
using a copy [Link] occlusion is consi-
alternately, and the student was instructed to bite it
dered when the mesiobuccal cusp of the first
as hard as possible. Three records were made for
superior molar rests in the buccal sulcus of the
each side, with a two-minute rest in between each
first inferior molar and the teeth have an aligned
record. The maximum bite force was recorded in
occlusion in the arches (ideal occlusion).If the
Newtons (N) by recording the force peak shownon
analysis considered the case a malocclusion,
the screen. The values were written on each volun-
it was classified according to Angle (1899), as
teer’s record sheet, for posterior analysis.
Class I, II (division 1 or division 2) or III.
After each procedure, the dynamometer was
Angle Class I occurs when the mesiodistal
relationship between the maxillaand the mandible, cleaned with 70% alcohol and protected with
evidenced by the relationship between the superior disposable latex finger gloves positioned in the
and inferior first molars is neutral (neutroclusion), device’s bite sticks, as a biosafety measure.
however, there are disorders in the individual dental After the examination and data record, the data
positions in overjet and overbite (Angle 1899). was submitted to statistical analysis by a profes-
Class II is found when the mesiovestibular sulcus sional in this field. Since the analyzed population
of the first inferiorpermanente molar is distalized in presented continuous and quantitative data,
relationship to the mesiovestibular cusp of the first most tests selected for analysis were parametric.
superior permanent molar, and may be subdevided However, before the selection of the tests, the
into division 1 when the superior incisor teeth are Kolmogorov-Smirnov normality test was conducted
typically projected towards vestibular, causing an in order to verify the normality of the residues of the
excessive overjet, or division 2 when the central chosen statistical model. After verifying that all had
superior incisor teeth are almost in their normal a normal distribution, which guarantees the use of
position or are in slight linguoversion, while the such tests, the statistical analysis followed with the
superior lateral incisors have a vestibular or mesial following tests:

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1570  Araújo SCCS, Vieira MM, Gasparotto CA, Bommarito S

To verify if there was a statistically significant when the p-value was close to zero, it would mean
difference between bite forces in the right and left that there was no linear tendency among the
side in each measurement and to compare the elements. When both values were perfectly related,
difference in force between the 1st and 3rd measure- Spearman’s correlation coefficient would be equal
ments, the T-Student Paired test was conducted; to 1.
• To analyze the distribution of the relative For the parametric tests, the significance level
frequency (percentage) of the types of occlusion was established at 5% (p-value 0.05). The results
in the studied population, the Test of Equality of with a statistically significant difference were
Two Proportions was used; identified with an asterisk (*).
• To analyze force in comparison with the types of
occlusion according to the force measurements „„ RESULTS
and the different types of occlusion, the ANOVA
test was used; In order to answer the question in the general
• Finally, to determine between which types of purpose of the study, the sample was initially
occlusion there was a statistically significant distributed according to the type of occlusion.
difference after the ANOVA Test, the Tukey The characterization of the frequency distribution
Multiple Comparison test (in which paired data (percentage) according to occlusion group is shown
are analyzed) was conducted. in Figure 2.
To verify if there was a relationship between It was verified that the most prevalent type of
bite force and the body mass index (BMI) of each dental occlusion (48%) was Class I malocclusion,
individual Spearman’s Test (non-parametrical) was and this result was confirmed when a second
used, in order to observe the dependence between analysis about the existence of difference between
two [Link] order to conduct this test, it was the groups, comparing them two by two was
established that when the values of two analyzed conducted. Thus, Table 1 shows only the p-values
elements had a directly proportional growth of the comparisons among the types of dental
relationship, the correlation would be positive; occlusion, confirming the result shown in Figure 2.

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 Bite force in Malocclusions  1571

IDENTIFICATION INFORMATION

Name:

Date ofBirth: Age:

Gender:
Height:
Weight:
ContactTelephoneNumber:
email:

MYOFUNCTIONAL ASSESSMENT

Mastication

Chewing preference ( ) One side R or L

( ) Both sides

How are your meals during the entire day, from the time you wake up from the time you go to sleep?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Normal Occlusion( ) yes ( ) no

Angle Malocclusion
( ) Class I
( ) Class II - ( ) division 1; ( ) division 2
( ) Class III

Maximum bite force

Right side:
Measurement 1:
Measurement 2:
Measurement 3:

Left side:
Measurement 1:
Measurement 2:
Measurement 3:

Figure1–Analysis protocol of bite force and malloclusion

Then, there was a need to verify whether there It was observed that even though there is a
was a statistically significant difference of the mean difference between the sides for force in the
force measurements between the two sides of three measurements, these differences may not be
the dental arch; for this purpose, an analysis was considered statistically significant (all p-values >
made comparing the forces between the right and 0.05). Thus, it is concluded that there is no difference
left side in each measurement. Table 2 shows this (effect) in sides in the result of force.
comparison.

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1572  Araújo SCCS, Vieira MM, Gasparotto CA, Bommarito S

Figure 2 –Sample Distribution according to type of occlusion

Table 1 - P-values of the comparisons between types of dental occlusion

Class I Class II/1 Class II/2 Class III

Class II/1 <0.001*
Class II/2 <0.001* 0.800
Class III <0.001* 0.788 0.602
Normal 0.004* <0.001* <0.001* <0.001*
Tukey’s Multiple Comparisontest.

Then, the population was analyzed in the division precisely in between which types of occlusion this
according to the types of occlusion, using the right difference was present, all occlusion types were
and left sides of the face simultaneously and with the compared in pairs (Table 4).
three measurements to analyze force in comparison
to the types of occlusion. This analysis evidenced a When analyzing Table 4, it is concluded that there
statistically significant difference between mean bite were statistically significant diferences (p-values <
force and types of occlusion (Table 3). To determine 0.05) observed between:

Table 2 – Compares the Right Side and Left Side by Measurement (N)

1st Measurement 2nd Measurement 3rd Measurement

Force
Right Left Right Left Right Left
Mean 323.5 329.2 341.8 342.3 352.3 351.8
Median 288.0 300.0 335.4 320.8 326.4 327.0
Standard Deviation 157.2 146.0 152.0 148.9 151.3 151.3
Min 64.5 74.1 87.5 73.6 74.9 86.3
Max 723.4 791.8 828.5 708.1 709.8 724.9
N 100 100 100 100 100 100
CI 30.8 28.6 29.8 29.2 29.7 29.7
p-value 0.526* 0.942* 0.939*
ANOVA Test

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 Bite force in Malocclusions  1573
a) normal occlusion and Classes II and III third measurements was studies. This comparison
malocclusions; is expressed by Figure 3.
b) Class I and Class III malocclusions. After the statistical analysis, a statistically signif-
In order to answer the other questions in the icant difference was verified in between the mean
purpose, a comparison of bite force of the first and bite force in the first and third measurements on both

Table 3–Comparison between forces according to types of Occlusion (N)

Occlusion Normal Class I Class II Class III

Mean 372.2 342.6 311.6 265.1
Median 368.1 316.7 291.2 259.5
Standard Deviation 133.8 153.6 170.3 105.9
Min 81.4 91.0 64.5 113.4
Max 693.0 828.5 698.3 461.1
N 168 288 102 42.0
CI 20.2 17.7 33.0 32.0
p-value <0.001* <0.001* <0.001* <0.001*
ANOVA test
Key:min: lowest force valuefound in thesample;
max: highest force valuefound in thesample;
N: numberofpeople in eachtypeofocclusion
CI: confidenceinterval

Table 4–Comparison between the types of occlusion

Class I Class II Class III

Class II 0.479
Class III 0.024* 0.543
Normal 0.329 0.018* 0.001*
Tukey’s Multiple Comparison test

sides (right and left) and also in general. It was seen with each one’s BMI. These comparisons are repre-
that there was an increase in mean bite force in all sented in Figure 4.
situations, such as in the general measurement that After conducting a specific test for this analysis,
increased from 326.4 to 352.1N. evidenced in Table 5, and after verifying in Figure 4
there was a great dispersion of the findings, it was
Finally, in order to answer the last question, the possible to conclued that there was no statistically
mean force in all six measurements was calculated significant correlation of linear growth or decrease
for each individual and these values were compared between the variables bite force and BMI.

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1574  Araújo SCCS, Vieira MM, Gasparotto CA, Bommarito S

Figure 3 – Compares 1st and 3rd measurements, in each side and in general

followed by Class II malocclusion (36%) and Class

III (11,7%).Still in agreement with the data obtained
in this investigation, there is a study byBrito, Dias,
Gleiser20where, knowing that the knowledge of the
population’s epidemiological situation is important
to plan the execution of dental services in a deter-
mined population, have conducted a study with the
purpose of assessing the prevalence of malocclu-
sions in city-run school children in between 9 and
12 years of age in the city of Nova Friburgo, Rio
de Janeiro. The sample was composed of 407
individuals, 191 males and 216 females who were
Figure 4 – Comparison between mean bite clinically assessed by a trained professional. It was
forces and body mass index
observed that Angle’s Class I malocclusion was
the most prevalent type of occlusion, followed by
normal occlusion, Class II malocclusion and Class
Table 5–Spearman’s Coefficient and p-value
III malocclusion.
Spearman Coefficient 0.19 The same was found and reported by Bittencourt
P-value 0.06 and Machado21who conducted an epidemiological
Spearman Test investigation with 4776 Brazilian children in between
6 and 10 years of age with no distinction of race or
sex without previous orthodontic treatment of any
kind, in 18 states and the Federal District of Brazil.
„„ DISCUSSION
They found that 40.6% of the children had Class I
malocclusion, followed by Class II with 21.6% and
One of the most important variables to establish class III with 6.2%. Only 31.6% of the analyzed
an accurate comparison between bite force and population had normal occlusion.
dental occlusions is determining the prevalence
of each group so that result interpretation and However, Waked et al22found higher prevalence
analyses are not biased. Thus, in Figure 2 and Table of Class II malocclusion (52.6%), followed by
1 that regard the frequency of occurrence of the Class I malocclusion (36.8%) and Class III (10.5%)
type of dental occlusion, it is seen that there was a when analyzing the records of 76 patients, of both
greater occurrence of Angle’s Class I malocclusion. genders with ages varying between 7 and 18, with
These findings are in agreement with the studies a mean age of 13. However, it must be taken into
byArashiro et al.19that have found a greater preva- account that the sample was collected at an ortho-
lence of Class I malocclusion (39,7%) in their study, dontics school, and thus it is assumed that in this

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 Bite force in Malocclusions  1575
environment, patients with more severe malocclu- between six months and five years, depending on
sions seeking treatment are the ones who are more the study) bite force, occlusion areas and chewing
prevalent. performance of the groups with malocclusion were
Table 2 shows that there was no statistically significantly better than in the period before surgery.
significant difference between force measurements However, these values were still lower than those of
of the right and left sides. These findings agree with the control group, even years after intervention.
studies by some authors (Guimaraes, Carlsson, Observing studies by authors such as English et
Marie, 2007; Kogawa, et al., 2006 apud Silva)5 who al. and Toro et al.14,15, that report that the number of
have also not found statistically significant differ- occlusal contacts are determinant for a satisfactory
ences between both sides. However, Silva5found na chewing performance and that individuals with
increase in bite force on the left side for all studied maloccluison would be less efficient in this task than
groups (individuals with normal occlusion and those with normal occlusion, it would be possible
Angle’s malocclusion Classes II and [Link] 3 and to justify that as verified in the present study, the
4 analyzed bite force according to the type of dental individuals who had lower bite force were those with
occlusion and it was verified that the group with Class III malocclusion, those with fewer occlusal
normal occlusion had statistically significant higher contacts.
mean bite force when compared to the groups with In the present study, one hypothesis is that the
Angle’s malocclusion Classes II and III. The same difference in bite force found in individuals with
was true for Class I when compared to Class III. normal/Class I malocclusion and Class II and Class
However, these two types of occlusion (normal and III malocclusion may have occurred due to incorrect
Class I) had no statistically significant differences positioning of the molar teeth, in the case of Classes
among [Link] results are in accordance II and III dental malocclusions that have altered
to those in a study by Bakke7, who, in the bibliography molar relationships, which makes occlusal contact
review about the relationship between bite force and and, consequently, the employment of bite force,
malocclusion, reported that the maximum bite force more difficult. According to Herring2, the activation
increases with the number of present teeth and that and the coordination of mastication muscles
the association between maximum bite force and determine the direction of mandible movement, the
the number of occlusal contacts is more relevant in control of the force of occlusion and different types
the posterior [Link] hypothesis for the absence of cranial deformation. Muscles, as well as teeth,
of a statistically significant difference between bite play an important role in the direction of the course
force in the groups with normal occlusion and Class of bite force. The author also explains that muscle
I malocclusion may be that the posterior teeth (first anatomy may cause, as well as reflect mandible
molars) are in the same position in both occlusions, movements, and, therefore, the relative importance
and thus, molar relationship in both normal occlusion of the components of bite force may be associated
and in Class I malocclusion is the same. to each being’s different muscle anatomy.Bakke7, in
The results are also similar to those reported by his literature review, hasalso reported that there is a
Kamegaiet al8, who conducted a research with the positive and intimate relationship between bite force
purpose of analyzing bite force and dental occlusion and electromyographic activity of the mandible’s
in a sample of 2594 children in between 3 and 17 elevator muscles (temporal, masseter and medial
years of [Link] the findings, they observed pterygoid) during isometric contractions.
that the presence of malocclusion influenced bite Moreno et al.16performed an electromyography
force, and the mean values showed a pattern of of mastication muscles during dental clenching in
statistically significant reduction in the presence a healthy population with Angle’s Class I, II and III
of occlusion discrepancy after the age of nine. malocclusions, and found that the parameters of
Trawitzkiet al.13albeit using a sample of patients who occlusion influence the activity of the muscles of
had been referred to orthognathic surgery (Angle’s the stomatognathic system. Class III individuals
Class II and III), also found a significant reduction in had higher activity for all muscles in maximum effort
bite force, when compared to a group with normal (except for the digastric muscle). In addition, an
occlusion. investigation conducted by Gadotti, Bérzin andBia-
In the studies reported by Haradaet al., Iwase et sotto-Gonzaléz17with individuals with Class I and II
al. andBraber et al. 9,10,12, the authors assessed bite malocclusions, analyzed females with the purpose
force, occlusion areas and chewing performance in of verifying the values of the activity of the temporal
prognathous and retrognathic patients, before and and masseter muscles on both sides.A deviation
after orthognathic surgery, as well as in individuals in the activity pattern of mastication muscles in
with normal [Link] studies verified that individuals with Class II malocclusion was observed
at the end of the follow-up period (that varied when compared to Class I individuals (especially

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1576  Araújo SCCS, Vieira MM, Gasparotto CA, Bommarito S

in regards to the temporal muscle, that was more concluded that there was no statistically significant
active in the first group). The individuals with Class correlation of linear growth or decrease between
I malocclusion also had a more functional activity the variables bite force and [Link] findings
pattern than those with Class II malocclusion. are in agreement with those described in the study
However, the results above disagree with those byBraun et al.3, who conducted an investigation
found by Sonnesen and Bakke18who, aiming to with the purpose of assessing the maximum human
establish relationships between mastication force bite force and correlate it to several variables,
and malocclusion, facial dimensions and head among which are weight and [Link] sample
posture in children, observed that bite force did not was composed of 142 individuals of both genders
vary significantly among the types of malocclusion. in between 26 and 41 years of age, and, in order
In addition, Lemoset al4 did not find statistically to conduct the measurements, a transducer that
significant differences when relating bite force to measured the force in Newtons (N) was used. The
dental occlusion, but it should be noted that the age correlation coefficients for weight and height were
group of the individuals analyzed in these investi- low. Lemos et al4also reported a weak correlation
gations were children aged 13 or younger, a factor between these variables in their investigation – they
that may have been determinant in obtaining the studied the maximum bite force in children with mean
reported results. age of 9, considering each one’s occlusion condition
Regarding the measurement of bite force of the and body variations (BMI), with the hypothesis that
individuals in three consecutive trials, it is seen in these characteristics could be correlated. However,
Figure 3 that there was a statistically significant as in the present study, the results showed that bite
difference of mean force between the first and force had a weak correlation with BMI values.
third measurements obtained in both sides of the
face (right and left), with a medium increase of this „„ CONCLUSIONS
force. No studies were found in literature that have
performed similar analyses, but when observing the
It may be concluded that the type of occlusion
obtained bite forces, it is believed that asking one to
influenced bite force, with greater bite force in
bite hard on the dynamometer may be exploratory
individuals with normal occlusion, followed by
at first for the individual who is part of the sample
Classes I, II and III, respectively; there was higher
and, only during the third measurement the subject
frequency of occurrence of Class I malocclusion,
feels comfortable enough to bite according to the
followed by normal occlusion, Class II divisions 1
examiner’s [Link] on this analysis, it
and 2 and Class III; there is an increase in mean
is suggested that the measurement of bite force
bite force between the first and third measurement
should be performed at least three times, according
and that there was no correlation between bite force
to the results obtained in this study.
and body mass index (BMI).
Figure 4 shows the correlation between mean
bite forces and body mass index (BMI) and Table 5
shows Spearman’s coefficient as well as the p-value „„ ACKNOWLEDGMENTS
between the paired [Link] this table, it
may be verified that the findings are very disperse To FAPESP (process nº 2010/20436-0) for
and, after completion of a specific test, it was providing the funding for this study.

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 Bite force in Malocclusions  1577

RESUMO

Objetivo: analisar a máxima força de mordida na oclusão normal e maloclusões de Angle; observar
a frequência de ocorrência dos tipos de oclusões; analisar a existência de diferença entre as medidas
desta força e relacionar a força de mordida com índice de massa corpórea (IMC) de cada indivíduo.
Métodos: a amostra foi composta por 100 estudantes do curso de Fonoaudiologia, com faixas etárias
entre 17 e 25 anos. Cada indivíduo realizou: 1) Anamnese: composta por dados de identificação pes-
soal, informações sobre alimentação diária; preferência mastigatória; peso e altura. 2) Classificação
da oclusão dentária em: normal ou Classe I, II subdivisão 1ª e 2ª ou Classe III. 3) Avaliação da força
de mordida por meio de um dinamômetro digital. Os resultados foram submetidos aos testes esta-
tísticos: Kolmogorov-Smirnov, T-Student Pareado, Teste de Igualdade de Duas Proporções, Teste
ANOVA, Comparação Múltipla de Tukey e Teste de Spearman. Resultados: as maiores forças de
mordida foram obtidas nos indivíduos com oclusão normal, seguida das maloclusões Classes I, II
subdivisão 1ª e 2ª e III, respectivamente; houve maior frequência de ocorrência da maloclusão Classe
I, seguida da oclusão normal, maloclusão Classes II subdivisão 1ª e 2ª e III; houve aumento da força
média entre a primeira e terceira medida em ambos os lados; não houve correlação entre força de
mordida e o índice de massa corpórea (IMC). Conclusão: o tipo de oclusão influenciou na força de
mordida, sendo a maior força obtida após a terceira mensuração e não houve relação entre IMC e
força de mordida.

DESCRITORES: Oclusão Dentária; Má Oclusão; Força de Mordida; Sistema Estomatognático

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Received on: March 11, 2013

Accepted on: August 29, 2013

Mailing address:
Sarah Cueva C. S. de Araújo
Rua Igati, 25, São Paulo - SP
CEP: 04673-040
E-mail: [Link]@[Link]

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