Journal of Oral Rehabilitation 2001 28; 485±491
Quantitative study of bite force during sleep
associated bruxism
K. NISHIGAWA, E. BANDO & M. NAKANO
School of Dentistry, Tokushima, Japan
SUMMARY Nocturnal bite force during sleep associ-
ated bruxism was measured in 10 subjects. Hard
acrylic dental appliances were fabricated for the
upper and lower dentitions of each subject. Minia-
ture strain-gauge transducers were mounted to the
upper dental appliance at the right and left ®rst
molar regions. In addition, thin metal plates that
contact the strain-gauge transducers were attached
to the lower dental appliance. After a 1-week
familiarization with the appliances, nocturnal bite
force was measured for three nights at the home of
each subject. From the 30 recordings, 499 bruxism
events that met the de®nition criteria were selected.
The above described system was also used to meas-
Introduction
Most previous research attempting to measure and
evaluate sleep associated bruxism has utilized polysom-
nographic methods (Reding et al., 1968; Solberg &
Rugh, 1972; Rugh & Solberg, 1975; Clark et al., 1979,
1981; Okeson et al., 1994; Okua et al., 1995; Ikeda et al.,
1996; Lavigne et al., 1996). Surface electromyography
tracing of masticatory muscle activities, especially that
of the masseter muscle, has been an essential compo-
nent in these recordings. Bruxism is commonly con-
sidered to be the main contributor to dental attrition,
periodontal disease and temporomandibular joint dis-
orders (Clark et al., 1981; Attanasio, 1991; McNeill,
1992). This nocturnal behaviour is comprised of rhyth-
mic, yet forceful, mandibular grinding as well as
prolonged muscular clenching of the dentition. One of
the primary areas of concern with respect to bruxing
behaviour is the creation of high bite force between the
upper and lower dentitions. The purpose of this
ã 2001 Blackwell Science Ltd
Department of Fixed Prosthodontics, The University of Tokushima,
ure the maximum voluntary bite forces during the
daytime. The mean amplitude of detected bruxism
events was 22á5 kgf (s.d. 13á0 kgf) and the mean
duration was 7á1 s (s.d. 5á3 s). The highest amplitude
of nocturnal bite force in individual subjects was
42á3 kgf (15á6±81á2 kgf). Maximum voluntary bite
force during the daytime was 79á0 kgf (51á8±
99á7 kgf) and the mean ratio of nocturnal/daytime
maximum bite force was 53á1% (17á3±111á6%). These
data indicate that nocturnal bite force during brux-
ism can exceed the amplitude of maximum volun-
tary bite force during the daytime.
KEYWORDS: bruxism, nocturnal bite force, maximum
1 voluntary bite force
research is to examine the nocturnal bite force that
occurs during bruxism using a newly developed bite
force detector.
Materials and methods
Subjects
Ten adult volunteers (eight males and two females)
participated in the present research project. The mean
age of these subjects was 28á9 years (range: 23±
36 years). All of the subjects presented complete den-
tition, except for the third molars. All subjects under-
went examination by questionnaire, which revealed
that ®ve of the subjects were aware of their current or
past nocturnal bruxism habit. Three subjects exhibited
intermittent unilateral clicking of temporomandibular
joint. None of the subjects had undergone treatment for
temporomandibular disorders (TMD) or bruxism
(Table 1).
485
486 K . N I S H I G A W A et al.

Table 1. Demographics of subjects

Aware of TMD
No. Gender Age bruxism symptom

1 Male 30 )
2 Male 27 +
3 Male 30 )
4 Male 36 )
5 Male 28 +
6 Male 23 + *
7 Female 27 +
8 Male 26 ) *
9 Female 33 + *
10 Male 26 )

*Intermittent clicking on right TMJ.

Recording system

Hard acrylic dental appliances were fabricated for the

upper and lower dentitions of each subject (Fig. 1).
These dental appliances ®xed ®rmly on dentitions with
four ball clasps. The occlusal surfaces of both dental
appliances were designed as simple planes that contact
uniformly at habitual jaw closure.
Then miniature strain-gauge transducers (LM-50-
KAM186, Kyowa Electronic Instruments Co., Tokyo,
Japan) were mounted at the right and left ®rst molar
regions of the upper dental appliance and thin metal
plates that contact the strain-gauge transducers were
attached to the lower dental appliance. The strain-
gauge transducers and metal plates were adjusted to be
parallel to the occlusal plane. By placing these trans-
Fig. 1. Upper and lower dental appliances containing miniature
ducers, the upper and lower dental appliances made
strain-gauge transducers.
contact only at the central projections of the strain-
gauge transducers during clenching and any lateral
excursion of the mandible. Thus, the total vertical acquisition system was 50 Hz. This system can record
component of bite force was registered by these two bite force continuously for up to 23 h.
strain-gauge transducers.
Output levels of left and right side strain-gauge
Procedure
transducers were adjusted almost same magnitude
during clenching at habitual jaw closure position. Total The following procedure was used to record bite force
thickness of these dental appliances was 7 mm at ®rst data for all subjects.
molar regions where the strain-gauge transducers were Maximum voluntary bite force during the daytime
mounted and this vertical dimension was exceeded was also measured using these dental appliances. Each
physiologic rest position of these subjects. subject was asked to bite down as hard as possible on
Bite force was detected as a two-channel signal, which the dental appliances. The voluntary bite was repeated
was acquired using a dynamic data logger (PCD-1000 A, three times with 5 min rest interval between repeti-
Kyowa Electronic Instruments Co., Tokyo, Japan) and tions. The maximum bite force was obtained as the
then transferred into a computer (PC-9801nx/c, NEC, highest amplitude of total output from the left and right
Tokyo, Japan). The sampling frequency of the data strain-gauge transducers.

ã 2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 485±491

 BITE FORCE DURING SLEEP ASSOCIATED BRUXISM 487

Fig. 2. Calibration of the sensor.

Nocturnal bite force was recorded at the home of The result of regression analysis showed high linear-
each subject for three nights. Recording equipment was ity between these two signals (Fig. 3). The capacity of
carried in subject's bedroom and the subjects were this strain-gauge transducer is 50 kgf. As bite force was
instructed in the use of bite force recorder. Insertion of detected as the total output of two strain-gauge trans-
the dental appliances and activation of the recording ducers, the linearity of the total recording system was
system was started just before going to sleep and con®rmed up to 100 kgf.
stopped immediately after wake up. In order to
familiarize the subjects with the recording environ-
ment, all subjects were asked to wear both the upper
and lower dental appliances during every night for
1 week prior to recording. Recording was performed
continuously for three nights and the ®rst and last
30 min of the data collected for each night was
excluded from the analysis.

Results

Calibration

A jaw force meter (MPM-2401, NIHON KODEN, Tokyo,

Japan) was used for instrument calibration. One subject
was asked to wear the dental appliances. The sensor
unit of the jaw force meter was ®xed in place between
the strain-gauge transducer and the lower dental
appliance (Fig. 2). The subject was then asked to bite
down on the sensor unit and the output signals from Fig. 3. Results of calibration. High linearity was observed
the jaw force meter and the strain-gauge transducer between the output signals of the jaw force meter and the
were compared. strain-gauge transducer.

ã 2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 485±491

488 K . N I S H I G A W A et al.

Fig. 4. An example of a bite force signal that was de®ned as a

bruxism event.

De®nition of a bruxism event Fig. 5. Histogram of bruxism event amplitude. The horizontal line
represents the peak amplitude of the bruxism event and the
Nocturnal bite force was calculated as the total output vertical line represents the frequency in each range.
from the left and right strain-gauge transducers.
Previous studies conducted by the present authors
reported a de®nition of bruxism events that involved
surface electromyography of the masseter muscle
(Okua et al., 1995; Ikeda et al., 1996). In the present
study, a bruxism event is de®ned according to the
criteria described below, which modify the previous
de®nition.
Amplitudes of the bite force signal above 5 kgf
were selected as bruxism events. If the interevent
interval of two events was 2 s or less, these events
were linked and treated as a single event. If the
duration of the event was less than 2 s, the event was
rejected. Any bite force signal that satis®ed all of the
above criteria was de®ned as a bruxism event.
Figure 4 represents a typical bruxism event that
satis®es all of the criteria. A total of 499 bruxism
events were detected during the data recording period Fig. 6. Histogram of bruxism event duration. The horizontal line
(137á3 h). represents the duration of the bruxism event and the vertical line
represents the frequency in each range.

Peak bite force and duration of bruxism event

The ranges of peak bite force and duration for the 499
bruxism events are shown in Figs 5 and 6. The mean
peak bite force of all bruxism events was 22á5 kgf (s.d.,
13á0 kgf) and the duration was 7á1 s (s.d., 5á3 s). The
highest amplitude of all bruxism events was 81á2 kgf
and the longest duration was 41á6 s. Figure 7 shows the
scatter plots of the correlation between peak bite force
and duration of bruxism events. Simple regression
analysis revealed no correlation between these two
parameters (R2 ˆ 0á19).
Maximum voluntary bite force and maximum
nocturnal bite force
Table 2 shows maximum voluntary bite force, maxi-
mum nocturnal bite force and other parameters of
bruxism events for all subjects. Maximum nocturnal
bite force was evaluated as the highest peak amplitude
of the bruxism events during all recordings for each
subject. The average maximum voluntary bite force was
79 kgf and the mean amplitude of the highest noctur-
nal bite force was 42á3 kgf. The mean percentage of

ã 2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 485±491

 BITE FORCE DURING SLEEP ASSOCIATED BRUXISM 489

maximum nocturnal to maximum voluntary bite force

was 53á1% (range: 17á3±111á6%).
The highest nocturnal bite force, observed in Subject
7, was 81á2 kgf and this amplitude was equivalent to
111á6% of the maximum voluntary bite force during
the daytime for this subject. Table 3 shows the corre-
lation matrix between maximum voluntary bite force
and parameters of bruxism event. Signi®cant correla-
tions were observed between maximum nocturnal bite
force and the number of bruxism events, peak ampli-
tude and the duration of bruxism events.

Fig. 7. Scatter plot of bruxism events. The horizontal line repre-
sents the peak amplitude and the vertical line represents the
duration of the bruxism event.
Discussion
Very few studies have examined bite force during
bruxism (Gentz, 1972). In the majority of previous
bruxism research, surface electromyograms (EMG) of
the masticatory muscle have been adopted as the
primary means of detecting bruxism (Reding et al.,
1968; Solberg & Rugh, 1972; Rugh & Solberg, 1975;
Clark et al., 1979, 1981; Okeson et al., 1994; Lavigne
et al., 1996). One reason for this technical trend is the

Table 2. Maximum voluntary and

Maximum Maximum Number of Mean peak Mean
nocturnal bite force and other
voluntary bite nocturnal bite bruxism amplitude duration
parameters of bruxism event in each
No. force (kgf) force (kgf) %MVC episodes/h (kgf) (s)
subject
1 99á7 64á5 64á7 11á5 25á1 7á1
2 97á7 45á6 46á7 4á3 22á2 7á2
3 92á3 64á6 69á9 4á1 26á7 10á2
4 90á4 15á6 17á3 0á5 10á2 3á6
5 76á0 38á2 50á3 0á5 12á4 3á6
6 73á7 46á0 62á4 7á5 16á2 7á3
7 72á8 81á2 111á6 3á6 33á3 6á3
8 70á0 19á2 27á4 1á0 12á5 4á2
9 65á3 27á5 42á1 1á6 12á9 4á1
10 51á8 20á1 38á8 0á3 14á8 4á8

Mean 79á0 42á3 53á1 3á6* 22á5* 7á1*

*n = 499.

Table 3. Correlation matrix of

Maximum Maximum Number of Mean
maximum voluntary and nocturnal
voluntary nocturnal bruxism peak
bite force and other parameters of
bite force bite force episode/h amplitude
bruxism event
Mean duration 0á489 0á713* 0á623 0á725*
Mean peak amplitude 0á362 0á939** 0á529
Number of bruxism episode/h 0á545 0á630*
Maximum nocturnal bite force 0á409

*P < 0á05, **P < 0á0001 (n = 10, Fisher's z transformation).

ã 2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 485±491

490 K . N I S H I G A W A et al.
simplicity of the EMG measurement. The unique
feature of the present study is the use of bite force to
detect bruxism. One advantage for this system of
measuring of bite force is the signal reliability. The
EMG amplitude of masticatory muscle activities during
bruxism is generally evaluated as the ratio to the
maximum voluntary contraction activity (%MVC). As
this is a relative evaluation, if the MVC level of a subject
is small, the amplitude of a bruxism event might be
estimated as being higher than the actual value.
Trenouth (1979) analysed nocturnal tooth contact
patterns for the evaluation of bruxism and commented
that the EMG signal is affected by factors such as
electrode position, posture, skin resistance, anxiety,
muscle bulk and the degree of ampli®cation. As the bite
force signal is more stable and is quantitative, the
evaluation can be performed using absolute magnitude
between different recordings and different subjects.
One drawback of the bite force measurement, how-
ever, is the requirement for dental appliances to be
inserted into the mouth, thus altering the oral envi-
ronment. Clark et al. (1979) reported that the insertion
of full arch maxillary stabilization splint resulted in
decrease of nocturnal masseter EMG activity level in
52% of TMD patients while other patients showed no
change or increase of activity level. Manns et al. (1983)
evaluated the effect of the different vertical dimension
splint (1±8á15 mm) for the masseter muscle activity of
TMD patients. He concluded that the use of occlusal
splint with a vertical height exceeding the physiologic
rest position did not encourage a hyperactivity of jaw
muscle. To avoid the temporary effect of the sleep
environment change that in¯uence bruxism, all sub-
jects were asked to undergo a 1 week period of
familiarization with the dental appliances. To evaluate
the exact relationship between these dental appliances
and the nocturnal bite force, the simultaneous meas-
urement of jaw muscle EMG activity before and after
insertion of bite force detector will be required.
The highest magnitude of bite force signal observed
in the present research was 99á7 kgf. The total capacity
of the two strain-gauge transducers is 100 kgf and the
calibration study revealed high linearity between bite
force and strain-gauge transducer output (Fig. 3).
Occlusal surfaces of upper and lower dentitions were
shaped as ¯at planes and these dental appliances made
contact only at the central projections of the strain-
gauge transducer during any excursion of the man-
dible. In addition, by attaching metal plates to the lower
ã 2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 485±491
dental appliance, all bite force was ef®ciently registered
by the two strain-gauge transducer units.
De®nition criteria of the bruxism event that was
adopted in the present research was developed by
modifying previous EMG criteria (Okua et al., 1995;
Ikeda et al., 1996). The 5-kgf threshold level was
employed in order to reject the effects of minor muscle
contractions, which are assumed to be insigni®cant in
clenching and grinding. The 2-s duration rule was
employed for the purpose of eliminating minor muscle
contractions as a result of swallowing. As bruxism
events sometime occurs as a closely linked series of
muscle contractions (Reding et al., 1968), the 2-s
interval linking rule was adopted. The amplitude and
duration of bruxism events (Figs 5 and 6) exhibit
histograms similar to those obtained in previous
research concerning masseter muscle EMG activity
(Ikeda et al., 1996). This ®nding shows that the char-
acteristics of bite force signal possess a qualitatively
similar tendency to the integrated or root mean square
masseter EMG signal.
As the bite force detector records the total output of
the strain-gauge transducers mounted on the left and
right molar regions of the dental appliances, the bite
force in this research can be taken as a measure of total
jaw force. Gibbs et al. (1981) studied the maximum bite
force of 20 adult subjects without missing teeth using a
gnathodynamometer capable of evaluating total jaw
force. The average maximum voluntary bite force of
these subjects was 74 kgf, which is similar to the results
of the present research (Table 2). Gibbs et al. (1986)
also hypothesized that bruxism patients may possess
hypertrained masticatory muscles and may exhibit
stronger bite force. In the present research, no signi®-
cant correlation was observed between maximum
voluntary bite force and frequency, peak amplitude or
duration of bruxism events (Table 3). These bruxism
parameters exhibit signi®cant correlation with maxi-
mum nocturnal bite force, suggesting that severe
bruxism patients may have a strong nocturnal bite
force.
The mean ratio of maximum voluntary bite force and
maximum nocturnal bite force was 54á5%. A 81á2 kgf
nocturnal bite force was recorded for one subject, the
amplitude of which is equal to 111á6% of the MVC of
the subject during the daytime (Table 3). Excessive
muscle contraction is generally inhibited by the con-
sciousness of the central nerve system (Ikai & Steihaus,
1964). It can be surmised that during sleep this
 BITE FORCE DURING SLEEP ASSOCIATED BRUXISM
inhibitory control does not function and nocturnal bite
force may have a higher amplitude than MVC during
the daytime. As most of the previous polysomnographic
studies of bruxism adopted EMG measurement, precise
evaluation of the maximum magnitude of bruxism
could not be performed. As the present study employs a
quantitative measurement of bite force, nocturnal bite
force during sleep-associated bruxism associated brux-
ism was con®rmed to have the potential for exceeding
the amplitude of MVC during the daytime. Therefore,
nocturnal bruxism is potentially harmful to oral health
through the destruction of oral tissues, restored teeth
and other dental prostheses.
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Correspondence: Dr. K. Nishigawa, Department of Fixed Prosthodon-
tics, School of Dentistry, The University of Tokushima, 3-Kuramoto-
cho, Tokushima 770-8504, Japan. E-mail: keisuke@dent.tokushima-
u.ac.jp