Bite force of children and adolescents: a systematic review and meta-analysis

This systematic review aimed to assess bite force measurements in children and adolescents and to study the various devices that measure Maximum Voluntary Bite Force (MVBF). This systematic review included observational studies and experimental studies in children and adolescents (upto 19 years of age) which evaluated MVBF using a bite force measuring device. Studies on participants with systemic conditions were excluded. Databases such as PubMed, Embase, LILACS, and the Cochrane library were searched until September 2022, for which screening and quality assessment were performed. Newcastle-Ottawa, modified Newcastle-Ottawa and ROBINS-I tools were used to assess the Risk-of-bias. All observational studies reporting overall bite force values of participants were included for meta-analyses. A total of 8864 participants (3491 males and 3623 females) were included from 61 studies. Meta-analyses were conducted to evaluate mean average bite force value for each included dentition using R software v2.4-0. Estimation was done to derive an average BF value for variables such as age (dentition), gender, side, site, device and ethnicity. MVBF values were reported as mean average in the form of MLN with 95% CI (Confidence Interval). Using a random-effects model, 29 forest plots were generated. I2 values varied between 90% and 100%. Bite force ranged from 246.22 N (220.47; 274.98) to 311.72 N (255.99; 379.59) and 489.35 N (399.86; 598.87) in primary, mixed, and permanent dentitions, respectively. Six different sites for recording bite force and 11 different types of devices were reported with portable occlusal bite force gauge being the most common device. Outcomes of this review provide useful baseline reference values of bite force for clinicians and researchers.

Bite force; Children; Device; Dentition; Occlusion

[1] Calderon Pdos S, Kogawa EM, Lauris JR, Conti PC. The influence of gender and bruxism on the human maximum bite force. Journal of Applied Oral Science. 2006; 14: 448–453.

[2] Alhowaish L. Bite force evaluation in children following dental treatment [Doctoral Thesis]. England: University of Leeds. 2012.

[3] Gallagher S, O’Connell BC, O’Connell AC. Assessment of occlusion after placement of stainless steel crowns in children—a pilot study. Journal of Oral Rehabilitation. 2014; 41: 730–736.

[4] Alshareef AA, Alkhuriaf A, Pani SC. An evaluation of bite pattern in children with severe-early childhood caries before and after complete dental rehabilitation. Pediatric Dentistry. 2017; 39: 455–459.

[5] Testa M, Geri T, Pitance L, Lentz P, Gizzi L, Erlenwein J, et al. Alterations in jaw clenching force control in people with myogenic temporomandibular disorders. Journal of Electromyography and Kinesi-ology. 2018; 43: 111–117.

[6] Zwir L, Fraga M, Sanches M, Hoyuela C, Len C, Terreri MT. A case-control study about bite force, symptoms and signs of temporomandibular disorders in patients with idiopathic musculoskeletal pain syndromes. Advances in Rheumatology. 2018; 58: 7.

[7] Makino E, Nomura M, Motegi E, Iijima Y, Ishii T, Koizumi Y, et al. Effect of orthodontic treatment on occlusal condition and masticatory function. The Bulletin of Tokyo Dental College. 2014; 55: 185–197.

[8] Roldán SI, Restrepo LG, Isaza JF, Vélez LG, Buschang PH. Are maximum bite forces of subjects 7 to 17 years of age related to malocclusion? The Angle Orthodontist. 2016; 86: 456–461.

[9] Sun KT, Chen SC, Li YF, Chiang HH, Tsai HH, Li CY, et al. Bite-force difference among obese adolescents in central Taiwan. Journal of the Formosan Medical Association. 2016; 115: 404–410.

[10] Ferrario VF, Sforza C, Zanotti G, Tartaglia GM. Maximal bite force in healthy young adults as predicted by surface electromyography. Journal of Dentistry. 2004; 32: 451–457.

[11] Koc D, Dogan A, Bek B. force and influential factors on bite force measurements: a literature review. European Journal of Dentistry. 2010; 4: 223–232.

[12] Ohira A, Ono Y, Yano N, Takagi Y. Effect of chewing exercise in preschool children on maximum bite force and masticatory performance. International Journal of Paediatric Dentistry. 2012; 22: 146–153.

[13] Martini M, Wiedemeyer V, Heim N, Messing-Jünger M, Linsen S. Bite force and EMG evaluation after cranioplasty in patients with craniosynostosis. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2017; 124: e267–e275.

[14] Kampe T, Haraldson T, Hannerz H, Carlsson GE. Occlusal perception and bite force in young subjects with and without dental fillings. Acta Odontologica Scandinavica. 1987; 45: 101–107.

[15] Varga S, Spalj S, Lapter Varga M, Anic Milosevic S, Mestrovic S, Slaj M. Maximum voluntary molar bite force in subjects with normal occlusion. European Journal of Orthodontics. 2011; 33: 427–433.

[16] Gavião MBD, Raymundo VG, Rentes AM. Masticatory performance and bite force in children with primary dentition. Brazilian Oral Research. 2007; 21: 146–152.

[17] Su CM, Yang YH, Hsieh TY. Relationship between oral status and maximum occlusal bite force in preschool children. Journal of Dental Sciences. 2009; 4: 32−39.

[18] Subramaniam P, Girish Babu KL, Ifzah. Effect of restoring carious teeth on occlusal bite force in children. Journal of Clinical Pediatric Dentistry. 2016; 40: 297–300.

[19] Verma TP, Kumathalli KI, Jain V, Kumar R. Bite force recording devices—a review. Journal of Clinical and Diagnostic Research. 2017; 11: ZE01–ZE05.

[20] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71.

[21] Adolescent health/Health topics by WHO (World Health Organization). 2019. Available at: https://apps.who.int/adolescent/second-decade/section2/page1/recognizing-adolescence.html (Ac-cessed: 30 August 2019).

[22] Wells G, Shea B, O’Connell D, Robertson J, Peterson J, Welch V, et al. the newcastle-ottawa scale (NOS) for assessing the quality of non-randomized studies in meta-analyses. 3rd Symposium on Systematic Reviews: Beyondthe Basics. Improving Quality and Impact, Oxford, UK. 2013.

[23] Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, et al. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS One. 2016; 11: e0147601.

[24] Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355: i4919.

[25] Viechtbauer W. Conducting meta-analyses in R with the metaphor package. Journal of Statistical Software. 2010; 36: 1–48.

[26] Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327: 557–560.

[27] Kiriishi K, Doi H, Magata N, Torisu T, Tanaka M, Ohkubo M, et al. Occlusal force predicts global motion coherence threshold in adolescent boys. BMC Pediatrics. 2018; 18: 331.

[28] Karibe H, Ogata K, Hasegawa Y, Ogihara K. Relation between clenching strength and occlusal force distribution in primary dentition. Journal of Oral Rehabilitation. 2003; 30: 307–311.

[29] Mountain G, Wood D, Toumba J. Bite force measurement in children with primary dentition. International Journal of Paediatric Dentistry. 2011; 21: 112–118.

[30] Abu-Alhaija E, Owais AI, Obaid H. Maximum occlusal bite force in preschool children with different occlusal patterns. Journal of Clinical and Experimental Dentistry. 2018; 10: e1063–e1068.

[31] Heydari A, Nakhjavani YB, Anaraki EA, Arvan S, Shafizadeh M. Bite force of 3–6-year-old children after unilateral extraction of primary teeth. Journal of Dentistry. 2018; 15: 47–53.

[32] Usui T, Uematsu S, Kanegae H, Morimoto T, Kurihara S. Change in maximum occlusal force in association with maxillofacial growth. Orthodontics & Craniofacial Research. 2007; 10: 226–234.

[33] Varga S, Spalj S, Anic Milosevic S, Lapter Varga M, Mestrovic S, Trinajstic Zrinski M, et al. Changes of bite force and occlusal contacts in the retention phase of orthodontic treatment: a controlled clinical trial. American Journal of Orthodontics and Dentofacial Orthopedics. 2017; 152: 767–777.

[34] Antonarakis GS, Kiliaridis S. Predictive value of masseter muscle thickness and bite force on Class II functional appliance treatment: a prospective controlled study. European Journal of Orthodontics. 2015; 37: 570–577.

[35] Antonarakis GS, Kjellberg H, Kiliaridis S. Predictive value of molar bite force on Class II functional appliance treatment outcomes. European Journal of Orthodontics. 2012; 34: 244–249.

[36] Al-Khateeb SN, Abu Alhaija ES, Majzoub S. Occlusal bite force change after orthodontic treatment with Andresen functional appliance. European Journal of Orthodontics. 2015; 37: 142–146.

[37] Sonnesen L, Bakke M. Bite force in children with unilateral crossbite before and after orthodontic treatment. A prospective longitudinal study. European Journal of Orthodontics. 2007; 29: 310–313.

[38] Owais AI, Al-Battah AH, Abu Alhaija ES. Changes in occlusal bite force following placement of preformed metal crowns on primary molars in 4–6 years old children: a 6 months’ follow-up pilot study. European Archives of Paediatric Dentistry. 2019; 20: 9–14.

[39] Serra MD, Gambareli FR, Gavião MB. A 1-year intraindividual evaluation of maximum bite force in children wearing a removable partial dental prosthesis. Journal of Dentistry for Children. 2007; 74: 171–176.

[40] Alkan A, Arici S, Sato S. Bite force and occlusal contact area changes following mandibular widening using distraction osteogenesis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology. 2006; 101: 432–436.

[41] Kamegai T, Tatsuki T, Nagano H, Mitsuhashi H, Kumeta J, Tatsuki Y, et al. A determination of bite force in northern Japanese children. European Journal of Orthodontics. 2005; 27: 53–57.

[42] Palinkas M, Nassar MSP, Cecílio FA, Siéssere S, Semprini M, Machado-de-Sousa JP, et al. Age and gender influence on maximal bite force and masticatory muscles thickness. Archives of Oral Biology. 2010; 55: 797–802.

[43] Ingervall B, Minder C. Correlation between maximum bite force and facial morphology in children. The Angle Orthodontist. 1997; 67: 415−424.

[44] Shiau YY, Wang JS. The effects of dental condition on hand strength and maximum bite force. Cranio. 1993; 11: 48–54.

[45] Pizolato RA, Gavião MBD, Berretin-Felix G, Sampaio ACM, Trindade Junior AS. Maximal bite force in young adults with temporomandibular disorders and bruxism. Brazilian Oral Research. 2007; 21: 278–283.

[46] Linderholm H, Lindqvist B, Ringqvist M, Wennström A. Isometric bite force in children and its relation to body build and general muscle force. Acta Odontologica Scandinavica. 1971; 29: 563–568.

[47] Lindqvist B, Ringqvist M. Bite force in children with bruxism. Acta Odontologica Scandinavica. 1973; 31: 255–259.

[48] Graber TM. Maximum bite force values of children in different age groups. American Journal of Orthodontics. 1984; 86: 170.

[49] Ranta R, Tulensalo T, Helle A. Individual changes of maximum bite force in children. IRCS Medical Science. 1984; 12: 1020.

[50] Kiliaridis S. Masticatory muscle influence on craniofacial growth. Acta Odontologica Scandinavica. 1995; 53: 196–202.

[51] Duarte Gavião MB, Durval Lemos A, Diaz Serra M, Riqueto Gambareli F, Nobre Dos Santos M. Masticatory performance and bite force in relation to signs and symptoms of temporomandibular disorders in children. Minerva Stomatologica. 2006; 55: 529–539.

[52] Araujo DS, Marquezin MCS, Barbosa TDS, Gavião MBD, Castelo PM. Evaluation of masticatory parameters in overweight and obese children. European Journal of Orthodontics. 2016; 38: 393–397.

[53] Medhat AH, Al-Haidar AH. Maximum bite force among Iraqi primary school children in mixed dentition. Indian Journal of Public Health Research & Development. 2019; 10: 800–805.

[54] Kaya MS, Akyuz S, Guclu B, Diracoglu D, Yarat A. Masticatory parameters of children with and without clinically diagnosed caries in permanent dentition. European journal of Paediatric Dentistry. 2017; 18: 116–120.

[55] Awawdeh L, Hemaidat K, Al-Omari W. Higher maximal occlusal bite force in endodontically treated teeth versus vital contralateral counterparts. Journal of Endodontics. 2017; 43: 871–875.

[56] Sonnesen L, Bakke M, Solow B. Bite force in pre-orthodontic children with unilateral crossbite. European Journal of Orthodontics. 2001; 23: 741–749.

[57] Castelo PM, Gavião MBD, Pereira LJ, Bonjardim LR. Maximal bite force, facial morphology and sucking habits in young children with functional posterior crossbite. Journal of Applied Oral Science. 2010; 18: 143–148.

[58] Marquezin MCS, Gauch CG, De Siqueira CA, Kobayashi FY, Fonseca FLA, Castelo PM. Evaluation of masticatory and salivary parameters in preschool children with different morphological occlusion. Brazilian Dental Science. 2017; 20: 38–46.

[59] Sujitha P, Bhavyaa R, Muthu MS, Kirthiga M. Morphological variations and prevalence of aberrant traits of primary molars. Annals of Human Biology. 2021; 48: 294–306.

[60] Goodarzi F, Mahvi AH, Hosseini M, Nodehi RN, Kharazifard MJ, Parvizishad M. Prevalence of dental caries and fluoride concentration of drinking water: a systematic review. Dental Research Journal. 2017; 14: 163–168.

[61] Al Qassar SSS, Mavragani M, Psarras V, Halazonetis DJ. The anterior component of occlusal force revisited: direct measurement and theoret-ical considerations. European Journal of Orthodontics. 2016; 38: 190–196.

[62] Alam MK, Alfawzan AA. Maximum voluntary molar bite force in subjects with malocclusion: multifactor analysis. Journal of International Medical Research. 2020; 48: 030006052096294.

[63] Bonjardim LR, Gavião MB, Pereira LJ, Castelo PM. Bite force determination in adolescents with and without temporomandibular dysfunction. Journal of Oral Rehabilitation. 2005; 32: 577–583.

[64] Castelo PM, Pereira LJ, Bonjardim LR, Gavião MBD. Changes in bite force, masticatory muscle thickness, and facial morphology between primary and mixed dentition in preschool children with normal occlusion. Annals of Anatomy. 2010; 192: 23–26.

[65] Díaz-Serrano KV, Dias TM, Vasconcelos P, Sousa LG, Siéssere S, Regalo S, et al. Impact of temporomandibular disorders on the stomatognathic system in children. Medicina Oral Patología Oral Y Cirugia Bucal. 2017; 12: e723–e729.

[66] Ferreira B, Da Silva GP, Gonçalves CR, Arnoni VW, Siéssere S, Semprini M, et al. Stomatognathic function in Duchenne muscular dystrophy: a case-control study. Developmental Medicine & Child Neurology. 2016; 58: 516–521.

[67] Fields HW, Proffit WR, Case JC, Vig KWL. Variables affecting measurements of vertical occlusal force. Journal of Dental Research. 1986; 65: 135–138.

[68] Hama Y, Hosoda A, Komagamine Y, Gotoh S, Kubota C, Kanazawa M, et al. Masticatory performance-related factors in preschool children: establishing a method to assess masticatory performance in preschool children using colour-changeable chewing gum. Journal of Oral Rehabilitation. 2017; 44: 948–956.

[69] Sathyanarayana HP, Premkumar S. Assessment of maximum voluntary bite force in children and adults with normal occlusion. International Journal of Pharmacutical Science and Health Care. 2012; 1: 64–70.

[70] Jeong CW, Kim KH, Jang HW, Kim HS, Huh JK. The relationship between oral tori and bite force. Cranio. 2019; 37: 246–253.

[71] Lemos AD, Gambareli FR, Serra MD, Pocztaruk RDL, Gavião MBD. Chewing performance and bite force in children. Brazilian Journal of Oral Sciences. 2006; 5: 1101–1108.

[72] Maki K, Nishioka T, Morimoto A, Naito M, Kimura M. A study on the measurement of occlusal force and masticatory efficiency in school age Japanese children. International Journal of Paediatric Dentistry. 2001; 11: 281–285.

[73] Marquezin MCS, Pedroni-Pereira A, Araujo DS, Rosar JV, Barbosa TS, Castelo PM. Descriptive analysis of the masticatory and salivary functions and gustatory sensitivity in healthy children. Acta Odontologica Scandinavica. 2016; 74: 443–448.

[74] Oueis H. Factors affecting masticatory performance of Japanese children. International Journal of Paediatric Dentistry. 2009; 19: 201–205.

[75] Pedroni-Pereira A, Marquezin MCS, Araujo DS, Pereira LJ, Bommarito S, Castelo PM. Lack of agreement between objective and subjective measures in the evaluation of masticatory function: a preliminary study. Physiology & Behavior. 2018; 184: 220–225.

[76] Pereira LJ, Gaviao MBD, Bonjardim LR, Castelo PM, van der Bilt A. Muscle thickness, bite force, and craniofacial dimensions in adolescents with signs and symptoms of temporomandibular dysfunction. European Journal of Orthodontics. 2007; 29: 72–78.

[77] Rentes AM, Gavião MB, Amaral JR. Bite force determination in children with primary dentition. Journal of Oral Rehabilitation. 2002; 29: 1174–1180.

[78] Sakashita R, Inoue N, Kamegai T. Can oral health promotion help develop masticatory function and prevent dental caries? Community Dent Health. 2006; 23:107–115.

[79] Sato N, Yoshiike N. Dietary patterns affect occlusal force but not masticatory behavior in children. Journal of Nutritional Science and Vitaminology. 2011; 57: 258–264.

[80] Sonnaville WFC, Speksnijder CM, Zuithoff NPA, Verkouteren DRC, Wulffraat NW, Steenks MH, et al. Maximum bite force in children with juvenile idiopathic arthritis with and without clinical established temporomandibular joint involvement and in healthy children: a cross-sectional study. Journal of Oral Rehabilitation. 2021; 48: 774–784.

[81] Sonnesen L, Bakke M. Molar bite force in relation to occlusion, craniofacial dimensions, and head posture in pre-orthodontic children. European Journal of Orthodontics. 2005; 27: 58–63.

[82] Szymańska J, Sidorowicz L. Bite force and its correlation with long face in children and youth. Folia Morphologica. 2015; 74: 513–517.

[83] Takeshima T, Fujita Y, Maki K. Factors associated with masticatory performance and swallowing threshold according to dental formula development. Archives of Oral Biology. 2019; 99: 51–57.

[84] Thongudomporn U, Chongsuvivatwong V, Geater A. The effect of maximum bite force on alveolar bone morphology. Orthodontics & Craniofacial Research. 2009; 12: 1–8.

[85] Gudipaneni RK, Alam MK, Patil SR, Karobari MI. Measurement of the maximum occlusal bite force and its relation to the caries spectrum of first permanent molars in early permanent dentition. Journal of Clinical Pediatric Dentistry. 2020; 44: 423–428.

[86] Guo R, Hama Y, Hosoda A, Kubota C, Minakuchi S. Age and sex differences in oral functions from junior high school to young adulthood: a cross‐sectional study. Journal of Oral Rehabilitation. 2021; 48: 1373–1379.

[87] Aishwarya N, Nagarathna C, Poovani S, Thumati P. Comparison of bite force and the influencing factors pre- and post-cementation of stainless steel crown in children using T-scan. International Journal of Clinical Pediatric Dentistry. 2021; 14: 46–50.

[88] Prabahar T, Gupta N, Chowdhary N, Sonnahalli NK, Chowdhary R, Reddy VR. Comparative evaluation of occlusal bite force in relation to the muscle activity in the mixed dentition children of age group 9–12 years: a T-scan analysis. International Journal of Clinical Pediatric Dentistry. 2021; 14: S29–S34.