Bite force evaluation in children following dental treatment

A number of research studies have highlighted the fact that poor dental health impacts on quality of life as a whole due to a number of different elements. Dental caries is usually associated with negative consequences, such as discomfort and pain, which are known to affect growth and weight gain through effects on function, in addition to wellbeing and quality of life (George et al., 1999; Wendy and Sharleen, 1999). It has been suggested that a significant number of children may not be able to verbally complain of pain. This inability may be caused by their immaturity, level of cognition and language development. Children usually show difficulty in eating and loss of function which should be considered an indicator of oral problems (Anderson et al, 2004). Therefore functional impairment is a negative sequel of caries in children. This can be measured by different means and one of those is the evaluation of bite force which is known to be influential on mastication and chewing processes.

Bite force can be defined as ―the capacity of the mandibular elevation muscles to perform a maximum force of lower teeth against the upper teeth, under favourable conditions (Calderon et al, 2006). The evaluations of bite force have been proven to be constructive and thus widely utilised in dentistry (Koc et al., 2010), with the measurement of such conducted with the aim of determining muscular activity and jaw movements during the chewing process (Bakke,1992), with measurements also valuable in terms of masticatory efficiency (Toro et al., 2006; Julien et al., 1996).

When reviewing the literature on bite force and correlated factors, it becomes apparent that there is a lack in studies concerned with the effects of dental decay on bite force in child population specifically.

This is a clinical exploratory study that comprised 32 children (26 with completed measurements) with a mean age of 6.45 years. 43.75 % were boys and 56.25 % were girls.

The study sample was taken from children attending the Leeds Dental Hospital/Paediatric Dentistry Department for treatment. The Maximum Voluntary Comfortable bite force was determined for each participant immediately before treatment and 3-5 weeks following completion of the required dental treatment. A single tooth bite force device was used that has been previously verified for intra-oral use in children (Mountain, 2008). The difference in bite force magnitude before and after dental treatment was analysed statistically. In addition, the correlations of key variables including, age, height, weight, BMI, gender and caries severity or dental status with maximum bite force were statistically analysed.

The mean maximum bite force for the total sample (n= 32) prior to treatment was found to be 169.32 N (SD= 66.20). The mean bite force in the male subgroup was 174.49 N (SD= 64.69) while for the females the mean bite force was equal to 165.29 N (SD= 68.93). Following comprehensive dental treatment the recorded mean maximum bite force for the children (n= 26) who attended the post treatment review appointment was 180.60 N (SD= 65.85).

Paired sample t test revealed a statistically significant increase in mean maximum bite force (p < 0.01) following comprehensive dental treatment that included both restorations and extractions. Correlation coefficients were determined for a number of key variables and maximum voluntary bite force in the pre-treatment stage. Child‘s gender failed to show significant correlation with the bite force. In contrast, child‘s age, body build expressed by height and weight showed a significant positive correlation with bite force (p < 0.01). In addition, poor dental status prior to treatment, expressed by the number of decayed, missing and filled teeth and surfaces, exhibited a statistically significant negative correlation with the bite force (p < 0.05). Presence of an abscess and dental pain showed similar negative impact on bite force.

The present study‘s findings can be important in the field of paediatric dentistry. In addition to the previously proved positive effects of treating dental caries in children, this study adds that bite force and subsequently chewing function can be improved by comprehensive dental treatment of decayed teeth. Additionally, this study showed that bite force in children is negatively impacted by a number of essential factors including, severity of dental caries as well as presence of clinical symptoms (i.e. pain and dental abscess).

Therefore, the findings can serve as an additional supportive evidence of importance of dental treatment for children as it helps improving the maximum bite force a child can exert.