Journal of Oral Rehabilitation, 1989, Volume 16, pages 503-508 :' - / ; • : •'.

Effect of chewing training on mandibular postural

position
M. TZAKIS, G. E. CARLSSON* and S. KILIARIDISf
Department of Stomatognathic Physiology, University of Athens, Greece, and
Departments of *Prosthetic Dentistry and -\Orthodontics, Gothenburg University,
Sweden

Summary
The inter-occlusal rest space (free-way space) was studied before and after short and
long periods of chewing of a hard resin in 15 healthy subjects. During a month of
daily training for one hour of chewing no significant changes in the interocclusal rest
space were seen. After 30 min of intense chewing the mean interocclusal distance
increased to about twice its original size. This occurred both before and after the
training period. In a control group of eight subjects without any chewing exercise no
significant changes in the interocclusal rest space were noticed during the observa-
tion period.

Introduction
The concept that the postural or rest position of the mandible is constant during the
lifetime has had a profound impact on clinical dentistry. It stems from studies in the
forties (Thompson, 1946). The interpretation of this concept has often been that
changing the vertical dimension of occlusion is a hazardous procedure in prosthetic
treatment. The arguments have usually been that a 'bite raising' which encroaches
upon the normal inter-occlusal or free-way space will act as a constant undue
stimulus to the stretch reflex of the masticatory muscles and will thereby promote
muscle contractions with consequences for teeth, periodontium, denture-supporting
tissues, masticatory muscles and temporomandibular joints (TMJ) (e.g. Dawson,
1974; Boucher, Hickey & Zarb, 1975; Ramfjord & Ash, 1983). During the last
decades, however, a series of different papers have shown that the postural position
of the mandible may change subsequent to dental attrition, loss of teeth, prosthetic
treatment and orthognathic surgery, among other factors (Tallgren, 1957; Carlsson
& Ericson, 1967; Williamson, Woelfel & WilHams, 1975; Finn et al, 1980). It has
also been shown that the rest position of the mandible may be changed rapidly in
many ways, for example by changing the occlusal vertical dimension both in subjects
with natural teeth and in those with complete dentures by placing or removing
dentures, or inserting occlusal splints of different height or by changing the position
of the head (Posselt, 1968; Christensen, 1970; Carlsson, Ingerwall & Kocak, 1979;

Correspondence: Gunnar E. Carlsson, Department of Prosthetic Dentistry, Faculty of Odontology,

Gothenburg University, PO Box 33070, S-400 33 Goteborg, Sweden.

503
504 M. Tzakis, G. E. Carlsson and S. Kiliaridis
Rugh & Drago, 1981; Hellsing, 1984; Hellsing & Ekstrand, 1987; Araki & Araki,
1987).
Many studies using electromyography have shown that there is a difference
between the clinical rest position and a mandibular position with minimal tonic
concentration according to electromyographic registration. The electromyographic
studies have shown that there is a large range of decreased muscular activity
exceeding the clinically recorded rest position by up to 10 mm (Garnick & Ramfjord,
1962; Manns, Miralles & Guerrero, 1981; Manns, Miralles & Cumsille, 1985).
This brief survey indicates that there are controversial interpretations of research
related to the rest position of the mandible. The complexity of the problem is also
reflected in the many definitions used and recommended to evaluate the rest position
of the mandible and the frequent and continuing references to the significance of this
mandibular position in the clinical practice of dentistry (Mohl et al., 1988; Reikie &
Rugh, 1988; Woelfel, Brose & Igarashi, 1988). Ramfjord & Ash (1983) suggested
that concepts regarding the rest position of the mandible should be re-evaluated and
revised as the related neuromuscular mechanisms become better understood. It is,
therefore, desirable to pursue further research in this field.
In a series of experiments the effect of chewing training on the stomatognathic
system has been studied (Tzakis, 1987). Certain long-term effects of physiological
function on the mandibular rest position do not seem to have been investigated more
closely. It was therefore the aim of this paper to include a study of the effect of
chewing training on the mandibular rest position.

Materials and methods

The subjects of the study consisted of 11 male and 14 female dental students. All
participants were in good health and had a complete natural dentition. They
reported no symptoms of craniomandibular disorders. Students who chewed gum
more than occasionally were excluded. The subjects participated voluntarily after
having been thoroughly informed about the experiments. A self-administered ques-
tionnaire was used to gain information on general health, possible disturbances of
the masticatory system, chewing habits, dietary habits especially related to chewing
gum and hard food, and physical body exercise. A clinical examination of the
subjects was performed in order to record the dental status and conditions of the
masticatory muscles and the TMJ. All examinations were performed by the same
examiner (the first author) in order to select subjects with undisturbed conditions in
the masticatory system. The subjects were divided into an experimental group
consisting of seven male and ten female students and a control group containing four
males and four females.
The experimental group was instructed to use a special chewing gum during a
systematic training for 1 h a day over a period of 1 month. The chewing gum used for
this training period was the resin obtained from the bark of the mastiche tree growing
in the Greek island Chios. It was selected because of its hardness in chewing. Two
subjects were lost from the experimental group: one girl developed signs and
symptoms of dysfunction from the stomatognathic system 3 days after the start of the
chewing training; one boy was excluded due to lack of co-operation.
The subjects in the control group did not undergo any chewing training, but took
part in registrations of the interocelusal rest space at the same intervals as the
experimental group.
 Mandibular postural position 505
Registration of interocclusal rest space -• • ' ^ ' "• •
The inter-occlusal rest space is defined as the difference between the vertical
dimension of rest (VDR) and the occluding vertical dimensions (VDO) (Academy of
Denture Prosthetics, 1987). These dimensions were measured as the distances
between two arbitrary points, one placed just under the nose on the upper lip and
one placed on the chin in the facial midline; VDR with the mandible in rest position,
and VDO with the mandible in inter cuspal position. The measurements were
repeated four times and the mean value was used. A baseline registration (I) took
place 15 days before the start of the experiment. On the day of the start of the
experiment a new registration was made just before (II) and just after 30 min of
chewing (III). After 1 month of systematic chewing training the interocclusal rest
space was measured again before (IV) and after half an hour of chewing (V). In the
control group the measurements were performed at the same intervals but this group
had received no chewing training.

Statistical methods
For the statistical analysis the mean values of four measurements have been used.
For each group the means and standard deviations of the interocclusal rest space
have been determined for all five occasions. A paired t-test was used to determine
differences between the occasions of measurements.

Results
In the experimental group, the interocclusal rest space at registration I, II and IV
varied insignificantly between 1-9 and 1-6mm. T'his means that no statistically
significant differences were found between the two registrations before the start of
the training period (I and II) and after 1 month of chewing training (IV). However,
differences were found after 30 min of chewing both before and after the training
period (registrations III and V; Fig. 1). The interocclusal rest space was 3-4 and
3-6mm, respectively, on these occasions. These values differed significantly
(p<0-001) from the values obtained on the other three occasions (Fig. 1).

Experimentai group
Control group

^ 2

0
HI
Registrations ' • ' •
Fig. 1. The interocclusal rest space at registrations I to V for the experimental and control group.
506 M. Tzakis, G. E. Carlsson and S. Kiliaridis
In the control group, the interocclusal rest space varied between 1-6 and 1-8mm
on the different occasions of registration. There were no statistically significant
differences between the various registrations (Fig. 1).

Discussion
This study has clearly shown that an intense period of hard chewing (30 min with a
hard resin) has a pronounced effect on the interocclusal rest space. After such a
period of chewing the interocclusal space increased to about twice its original size,
which means that the mandible sank to a lower position. This result might be a direct
consequence of fatigue of the masticatory system. Carlsson & Helkimo (1971) found
that the postural position of the mandible increased after 2 min of maximal opening
of the mouth and they interpreted this finding as a result of fatigue.
The clinical measuring method using soft tissue points is rather imprecise when
using a single registration, but the precision has been improved by using the mean
values of four repeated measurements. In this way the clinical method used was
evaluated to be appropriate for the investigation.
Chewing training has been shown to have effects on the stomatognathic system,
for example on maximal bite force (Tzakis, 1987). Such a training does not seem to
change the rest position of the mandible. However, a period of intense chewing did
have this effect, and therefore also influenced the interocclusal rest space. This
indicates that fatigue is another factor that may have an effect on the postural
position. There are thus numerous conditions that have an important effect on the
size of the interocclusal rest space, as this has clinical implications. It is therefore not
recommendable to use the mandibular postural position uncritically as a reference
position in determining the vertical dimension of occlusion.
The mechanisms behind the postural position of the mandible are not fully
understood. Yemm (1979) regards it as a position where an equilibrium is estab-
lished between external factors (such as gravity) and the elastic elements of the soft
tissues. Based on this theory, the elastic properties of the masticatory muscles might
have been changed after the 30-min period of intense chewing, i.e. after extensive
dynamic contractions of the elevator muscles of the mandible. This is a possible
explanation as the contraction of the muscle fibres begins in the shding filaments of
the myofibrils, but the external manifestation of this activity comes from the utiliza-
tion of the elastic elements of the muscle (Vender, Sherman & Luciano, 1986).
However, the postural position of the mandible is considered by other investiga-
tors to be an actively determined position controlled by reflex mechanisms such as
the myotactic reflex originating in muscle spindles of the mandiblular elevators
(Moller, 1976; Eriksson, 1982) and reflexes initiated from receptors within the TMJ
or periodontal receptors (Kawamura & Majima, 1964; Moller 1976). The ease of
ehcitation of these reflexes may change temporarily after an overload of stimuli
(Owall & Moller, 1974), which may explain the change in the postural position of the
mandible after the period of intense chewing. It is not known how fast the system
needed to recover from the intense stimulation, but it is probably an effect of
relatively short duration as no long-term changes were observed.

Acknowledgment
This study was supported by the Swedish Medical Research Council Project Nr
K 89-24P-08894-01A. .
 , Mandibular postural position 507
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Manuscript accepted 20 May 1988