The importance of occlusion in oral function and dysfunction

A. De Laat Copenhagen 2007

Introduction
 Aim

of dentistry and orthodontics in particular : maintenance and restoration of masticatory function  Other goals : speech, esthetics, .  ? Preventive action concerning development of dysfunction (and pain)

Outline
 Dental

occlusion and normal jaw function : - mastication, forces mastication, - swallowing (and speech) - mastication and development of occlusion  (Mal)occlusion and Temporomandibular Disorders - etiological role ? - management of TMD - other orofacial pains

Mastication

Lundeen, Gibbs, 1972-1985

Influence of food

Influence of tooth morphology

Influence of age

Influence of jaw relationship

P. Proeschel (1988, 2006)

 Different

chewing patterns :

Soft food Tough food

Angle Class

Cross bite

Reversed sequencing

Conclusion
 Differences

between groups with different (mal)occlusions or tooth morphology DO exist.. But are they important ?

Bite force
M. Bakke (2006)

 Objective

measure of one parameter  Relatively simple measurement

Maximum Bite Force

 Unilateral

molars : 300-600 N 300 Premolars : 70 %  Front teeth : 40 %  Bilateral molars : 140 % - 200 % (PVDF)  Maximum (Eskimos) : 1750 N (Waugh 1937)
Hagberg 1987, Bakke et al 1989, Ferrario et al 2004, Tortopidis et al 1998

Maximum bite force

 Depends

on number of teeth  Gender difference  Importance of motivation and cooperation

Rugh and Solberg 1972

Maximum bite force

 Influence
1999)

of pain : arthritis or TMD results in decrease of 40 % (Wenneberg et al 1995, Stohler to PPT (Hansdottir and Bakke 2004)

 Correlated

Maximum bite force

 Influence

of age (constant from 20-50 y, 20decreases later, Bakke et al 1990)  Decreases with increasing facial height, gonial angle, (Ingerval & Helkimo 1978, Throckmorton et al 1980, Proffitt et al 1983, Braun et al 1995)  No influence of tooth decay or loss of periodontal support (Miyaura et al 1999, Morita et al 2003)

Maximum bite force

 Dentures....

..and implant-support helps

(Bakke et al 2002, Van Kampen et al 2002)

Malocclusion and bite force

 Negative -

influence of : overjet on incisal MBF (Ahlberg et al 2003) unilateral cross-bite (Sonnesen et al 2001) crossopen bite (Bakke & Michler 1991)

Conclusions
 Occlusal

contact area seems most correlated, more than malocclusion

 Butdoes

it matter,since - only 10-20 % of variation explained 10(while e.g. thickness of masseter explains 55 %...)

- normal chewing forces are only 15-30 % 15of MBF.

Masticatory ability and performance

P.H. Buschang

 Anatomical

(occlusal contact area, malocclusion ); physiological (muscle strength, training, gender,) and psychological components interplay in mastication, and deficiencies in one part can be compensated for by others performance is an objective measure, directly linked to food breakdown, nutrition, digestion

 Masticatory

Masticatory performance
 Particle

size distribution of (test-)food, (testchewed a standard number of cycles  Methodology : fractional sieving  Typical food (peanuts, carrot, bread,) Optosil, or specially developed test-foods test-

Masticatory performance is influenced by :

 Number

of teeth/occluding units (but subjects with missing teeth do not chew longer)( Helkimo et al 1978, Yurkstas et al 1965, Henrikson et al 1998)  Patients with dentures increase the number of chewing strokes and wait longer to swallow (? Corrected for age )  Mixed dentition : increase in early, decrease in late phase

MP and malocclusion
 Less

potent effect than mutilated dentition  In cross-sectional studie, MP of Class III crosspatients is up to 60 % lower (English et al 2002, Lundberg et al 1974, Zhou and Fu 1995). MP of Class II is 30 to 40 % lower (Henrikson et al 1998) but Median Particle Size (MPS) was not significantly different (Toro et al 2006)

MP and malocclusion
 After

a predetermined number of chewing cycles (20,30,40) , the Median Particle Size is larger in subjects with ICON (index for complexity, outcome,need) < 43 than > 43  but no differences in particle distribution or masticatory frequency (Ngom 2007)

MP and digestion
 Animal

experiments clearly indicate relation between food particle size and digestion (Gyimesi et al 1972)  In man, also incompletely chewed food is digested. In elder persons, MP has been linked to GI-problems : 49 % of patients GIwithout posterior teeth have gastritis vs 6 % when no teeth are missing (Mumma 1970)

Mastication and developing occlusion

 Over

the centuries, malocclusion seems to have increased 10-fold and modern life10lifestyle and nutrition have been suggested as cause (Corrucini 1984, Varrela 1990,1992), even more than genetics (Townsend et al 1998)  Nutrition influences elevator muscle development and muscle function influences transverse and vertical facial dimensions (Kiliaridis 2006)

CONCLUSIONS
 Malocclusion

influences the chewing cycle  Number of occlusal contacts and units influences the maximum bite force  Class II and III patients have a lower masticatory performance but.  Probably not of clinical significance in nonnoncompromised patients