Effects of Changing Body Position on Dental Occlusion
LEWIS F. MC LEAN, HENRY S. BRENMAN, and M. G. F. FRIEDMAN
Department of Physiology, Thomas Jefferson University, Philadelphia,
Pennsylvania 19106, USA
Graded changes in body position produced
no noticeable changes in wax registrations
of dental contact patterns resulting from
voluntary jaw closure. Occlusal contact pat-
terns that resulted from electrically stimu-
lated jaw closures indicated an increase in
closing force and a mesial shift of prime
occlusal contact points as the body was
raised to an upright position.
The act of a voluntary closure of the jaw
may be categorized by three stages1: a rest-
ing tonic postural position; a closure move-
ment of the mandible effected by graded con-
tractions of the jaw-elevating muscles; and
an end point of closure of the jaws where
the mandibular teeth contact the maxillary
teeth. Initiation of the closure of the jaw
also may be induced electrically by per-
cutaneous stimulation of the motor point of
the masseter muscle, which is the main ele-
vating muscle of the mandible.2 This pro-
cedure produces a single, rapid contraction
of the muscle that results in ballistic jaw
closure, a brisk forceful movement of the
mandible toward the occlusal position as a
result of the twitch-like contraction of the
masseter muscle. Whether jaw closure is
voluntary or stimulated, its characteristics
are affected by changes in body (or head)
positions as determinants of gravitational
forces.
The effects of graded changes in body
position from supine to upright on the end
point of voluntary and stimulated jaw
closures were measured, as reflected by
changes in dental bite patterns and regis-
trations of occlusal contact points. The
effect of a change in gravitational force on
This paper was presented at the 49th annual meeting
of the IADR at Chicago, Illinois, March 20, 1971.
Received for publication July 20, 1972.
the physiologic rest position of the mandible
was considered.
Materials and Methods
Fourteen volunteer male and female med-
ical students, 20 to 27 years of age, were
studied. All of the volunteers had complete
dentitions, with the exception of some miss-
ing third molars; there was no evidence of
pathologic periodontal conditions or occlusal
dysfunctions. The contact patterns of the
teeth after a normal voluntary jaw closure
or a stimulated involuntary jaw closure were
measured by registration of occlusal contact
points on strips of 28 gauge green casting
wax applied to the maxillary occlusal sur-
faces. This wax was cut through or thinned
at the areas of occlusal contact as a result of
the closure.
Graded changes in body position were
effected by the rotation of each subject from
a supine to standing position in increments
of 300 by the use of an electric tilt-table.
A constant head-to-thorax axis was main-
tained with a specially designed head posi-
tioner3 (Fig 1) . The alatragus line was
used as a reference line; a weighted pointer
attached to the head positioner indicated
the angle of the reference line with respect
to the vertical axis of the body as the tilt-
table was raised or lowered.
Involuntary jaw closures were elicited by
the superficial application of a constant
voltage and constant duration electric stim-
ulus to the motor point of the masseter
muscle on the left side of the face. The
motor point of the masseter muscle was
located by application of a cathodic current
of 0.5 millisecond duration from a stimula-
tion unita to the skin over the muscle with
a Grass S-5, Grass Instrument Co., Quincy, Mass.
1041
1042 MCLEAN, BRENAIAN, AND ITRIEDMAIINj Dent lies
[I.(; 1-As x oltinltee's position xsas diangcd
fiom stipine to llpiigit, }ICI head -tiiotax axis
Nas chieckedt andt ivas maintained constant
timioiughotit expelruncut. (For (Icdloitstration
piiproscs, ''indiffei-eut" stimuitflation electiode is
located on latei al aspect of neck.)
the of at banana plUg connector as a
use
p)rol)incgelectrode. A metal plate otte inch
in diameter was placed on1 the lateral-dorsal
aspect of the neck at the lexel of cervical
vertelrae 5 d)i 6n.
, l isetveod as an wildlife ertt
electrode. Once the motor point was lo-
cated, a silver disk electroencephalogram
(EEG) electrode was secured oser tde area.
Wtith tte voliutteer in a supine positioit on
the tilt-table, an initial subthreshold stim-
ulus waIs raised to at voltage intensity that
woitld elicit anj ittvoluntary jaw clostire and
ain amllil)le tooth contact sountl with each
Stin1tuins presentationl. lTe tooth contact
sound was picked up bzy means of ione
conduction b)y a vil)ration microphonet
placed onl the midline oIn the forehead,
abloxe the nasion. Tootit contact sountls
were amplified l)rthe atnplifier of onte chan-
nel of a tape recorder and were displayed
on a storage cathode ray oscilloscope-,'
The electromyographic (EMG) activity
of the masseter muscles was recorded bilat-
erally from bipolar biopotential electrodes
placeti in the area of the zygomatic process
and tite angle of the mandible. A ground
lead was p)lacel on the forearm. The mas-
seteric EMG activity was led through high
'Sonotone Corp., Elmsford, N.Y.
Robherts 770X, Roberts Co., Los Angeles, Ctlif.
Tektronix lIic., Beaserton, Ore.
tectitan Itnstrmiecnts, Itnc., Fllerton, Calif.
September-Oclober 1973
ini)e(liaicte lroi)es an(i (liffereittial ampli-
fhers! ENIG activity was monitored throu-igh-
out the experimental )lroceiture on tile
cathode ray oscilloscope screen. The armpli-
fied tooth contact sounds and masseteric
ELG activity wiere recorded and stored on
magnetic trap e for later retrieval and
analysis.
Four b)od1y positions were stu-idied (suipine,
330 tilt, 600 tilt, and upright) . With each
citange in position, two voluitary jaw clos-
i
uires were performed by each indtiVidal, and
twso insolunrtiary jaw Closures were elicited by
applicationi of the constant x-oltage stinmltus
to the inotor i)oint of tlhe oLasseter mtuscle.
T-he stimuliis to the motor point of the mras-
seter muscle was delivered only when tie
timonitorec EiNIG actkixits was ait a nuLll or at
a mitinimnal le\el of spontaneous activity.
Before c ach olu-ntaivr or stimulated jaw
closure, strips of 28 gauge green casting wax
were applied bilaterally to the maxillary
molar andplrenlolar occlu-sal sturfaces. The
end point of the jaws closures p)rodluced an
imprint of the occluIsal contact points in
tile wa\. The wax strips with the restltting
(lewtal contact iitpressionis were transferred
to casts of the volu-nteer's rientition, an(d
contact transcriltions were made ofl the
models. With the uise of a modification of
tile method described by Anderson and
Mvers. tile occitusal C-orttacts oil the wax
bite registrations were mapped onto charts
of occliusal surfaces and were compared with
a standardized cilart that slowed the location
of centric stops in a centric occlusion.5t) Oc-
ctiusal contact scores xsere calculated from the
w~ax bite registrations of tlhe stimulated jaw
clostires as follows: (I) a complete perfora-
tion of tue wax wNafer received a score of 3;
(2) well-definedl translucent area received
a
a score of 2; andi (3) an opaque intlenitation
received a score of 1.
Results
VOLUt NIARY JAWN .LOSLRES.-All three types
of indentations of tile wax wafer were ob-
servel. Ili each individual the contact regis-
trations of the voluntary jaw closures showed
little or no variation in the locus and form
of intereLispal contact points with the graded
Grass P-)] i, Grass lnstrulmenit Co., Qtiinrcv, Slass.
Xmpex Corp., Redwood City, Calif.
Rol 52 No. 5 BODY POSITION AND DENTAL OCCLUSION 1043

changes in body position. The locus of the was changed from the supine to the upright
contact points that yielded the areas of position (Fig 2). Data from two volunteers
greatest translucence or of complete perfora- gave equivocal results.
tion on the wax registrations remained rela-
tively constant at each change of position. Discussion
Thus, the pattern of intercuspation regis- Voluntary and stimulated jaw closures at
tered by the wax wafer remained constant different body positions were performed with
for each individual at each of the graded
body positions. TABLE
STIMULATED JAW CLOSURES.-The charts of TOTAL OCCLUSAL CONTACT POINT SCORES FOR
the tooth contact registrations that resulted 14 VOLUNTEERS (stimulated jaw closure)
from the stimulated jaw closures showed
Position of Tilt-Table
considerable variation among individuals Volunteer
with respect to the locus of the prime con- Number 300 600 9O0
tact point (that is, the point of the greatest 3 3 8 17
degree of contact as reflected by the amount 2 3 5 9 20
of light translucence or perforation of the 3 4 6 12 14
wax wafer). All of the volunteers tended 4 7 12 12 25
toward an increased intercuspation as body 5 3 4 8 21
position was changed from the supine to 6 6 5 16 24
the upright position. This was indicated by 7 8 9 17 26
an increase in the number of contact points 8 6 6 7 12
9 6 7 14 16
and by an increase in force and shift of 10 6 3 12 19
tooth contact, which was reflected by the in- 11 5 3 14 20
crease in the number of translucent areas 12 6 14 12 19
and perforations in the wax registrations 13 6 10 12 20
(Table) . 14 4 5 8 16
In 12 of the 14 volunteers, the transcrip- Note: Scores are from bilateral incisor, premolar, and
tions of the dental contact registrations in- first and second molar surfaces. As body position ap-
dicated that the locus of the prime contact proached upright posture, there was a generalized in-
crease in occlusal contact point score for each of the
point moved mesially as the body position 14 volunteers.

o0 0
3030
60 *A. ots
900 * \ ,

FIG 2.-As this volunteer was raised from supine (0) to upright (90)
position, locus of prime contact points moved in mesial direction.
1044 MCLEAN, BRENMAN, AND FRIEDMAN
the individual in a relaxed condition and
with his jaw maintained in a relaxed, tonic,
postural position. This position of the man-
dible has been described by Kawamura6 as
the physiologic rest position and is defined
as "that position where all stomatognathic
structures are in balanced condition: the
lips are lightly contacted or are slightly
apart, the opposing teeth are separated by
the free-way space, all jaw muscles are
electromyographically silent, and the man-
dible is only passively suspended against
gravity." It has been reported that changes
of the head position in a relaxed subject
will alter the resting position of the man-
dible.7 Thus, if the head is inclined back-
wards, the mandible moves away from the
maxilla and the interocclusal clearance is
increased. The reverse occurs when the
head is bent forward.8 To eliminate the in-
fluence of these flexor-extensor variables on
mandibular position, a constant head-to-
thorax axis was maintained during the ro-
tational changes of the body position.
EMG "silence" (null electric activity) of
the masseter muscle and other jaw-elevating
muscles has been reported previously as
a criterion for the determination of the
physiologic rest position of the jaw.9-12 Spon-
taneous EMG activity also has been associ-
ated with higher cortical influences associ-
ated with an increase in anxiety or tension
and altered activity of the gamma efferent
system.9 Masseter muscle EMG activity was
monitored continuously during the experi-
mental procedures, and voluntary and stimu-
lated closures were performed only when the
jaw was in a "rest position."
Conclusions
The activity of the neuromuscular mech-
anisms that maintain the resting position
of the mandible appears to be influenced by
the position of the body in space. Any al-
teration in the placement of the entire body
will affect the activity and sensitivity of the
proprioceptive afferent components and the
alpha-gamma efferent components of the
myotatic reflex system, which maintains the
mandible in its "endogenous postural posi-
tion.""1 The results of the voluntary closure
series suggest that the overall performance
of the complex neuromuscular mechanisms
which allow the voluntary closure of the
J Dent Res September-October 1973
mandible to terminate in a maxillary inter-
cuspated tooth contact13 is not affected by
en en extreme changes in the position of
the body. The coordinated voluntary con-
tractions of the jaw-elevating musculature,
guided by the preconditioned "postural
sense'14 of the muscles themselves, and by
the sensory feedback from the periodontal
receptors,3 produced a series of almost
identical registrations of intercuspal contact
patterns at all positional changes of the
tilt-table in each volunteer.
In stimulated closure, a different experi-
mental condition exists. The afferent in-
fluences of the mandibular reflex system are
bypassed by the stimulation technique and,
instead of a graded, coordinated movement
of the mandible, a twitch-like contraction of
the stimulated muscle produces a rapid,
ballistic closure of the jaw to its end point
of occlusion. WkThile the body was in the
supine position, the more retruded position
of the mandible was indicated on the wax
registrations by the gradual movement of
the prime contact points toward a more
inesial location as the body position was
changed toward a more upright position.
This mesial shift of the prime contact
points also suggests a change in the ballistic
path of the mandible correlated with the
graded changes in body position.
The increase in the number of contact
points and translucent and perforated re-
gions in the wax registrations as the subject
was raised from the supine to the erect
position reflects the influence of the chang-
ing gravitational load on the mandibular
musculature. The pull of gravitational
forces on the postural muscles of the man-
dible is minimal when the subject is in a
supine position. It is possible that the
minimization of the normal postural load
may allow the masseter muscle to shorten
passix ely to less than its normal resting
(tonic) length. It is known that the force
of contraction of skeletal muscle is maxi-
mum at its normal resting length (that is,
when the body is in a "normal upright
position"'). and decreases when the muscle is
shorter or longer than its normal resting
length.15 Also, the reflex postural or anti-
gravity activity of the masticatory muscles is
dependent on the gravitational influences on
the myotatic reflex activity, the added ac-
tivity of the gamma-efferent (fusimotor)
Vsol 52 No. 5 BODY POSITION AND DENTAL OCCLUSION
system, and the related descending influences
from the reticular formation.16'7 The com-
bination of the increasing antigravity reflex
activity, the lengthening of the masseter
muscle to its normal resting length, and the
shift of the entire mandible to a less re-
truded position may account for the chang-
ing contact pattern and increased inter-
cuspation, as registered on the wax wafers
after stimulated jaw closures as the body
was raised from a supine to an upright
position.
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