The Effect of Periodontal Bone Loss on Bite Force

Discrimination

W. N. Williams,* S. B. Low.t W. R. Cooper* and C. E. Cornell

Accepted for publication 30 June 1986

This study compared bite force discrimination between 14 treated periodontal patients
with significant bone resorption and 14 control subjects who were free of periodontal disease.
Bite force was measured using a strain gauge scale which permitted subjects to visually
monitor when their bite force equaled a preset resistance. A bite force of 500 gm was selected
as the standard. Subjects were presented with a series of paired resistance settings, one at a
time, the first of each pair being the standard and the second being the comparator setting
of some predetermined different amount. This procedure was continued until the subject's
difference limen (DL) value, the threshold of discrimination between two bite forces, was
established. The periodontal patients required an average of 334 additional grams of
resistance over the standard before they could detect a difference, whereas the control
subjects required only 201 additional grams. These group means were significantly different
(P < 0.01). The results of this study suggest that the periodontal ligament provides sensory
feedback relative to bite force discrimination.

A body of literature is developing relative to the
degree to which human subjects can detect differences
in forces applied to their teeth as well as determine
differences in their biting force.1"9 It is still unclear,
however, whether the primary system providing sensory
feedback relative to bite force is within the periodontal
ligament (PDL), the temporomandibular joints (TMJs),
or the mandibular musculature.
Lund and Lamarre10 designed a study to assess
whether feedback from the PDL was used in the control
of voluntary isometric contraction of the jaw. They
found that anesthetization of their subjects' teeth re
sulted in a 40% reduction in the amount offeree these
subjects would apply in biting. These authors concluded
that sensory input from the periodontal pressoreceptors
is important in the control of bite force. Cathelineau
and Yardin" assessed the influence of periodontal dis
ease on individuals' abilities to sense vibration trans
mitted through the teeth. They found elevated thresh
olds in vibration detection in subjects with severe peri
odontal disease and concluded that inflammation of
the periodontal tissues may play a role in altering
♦ Department of Oral Biology, Box J-424 JHMHC. University of
Florida, College of Dentistry, Gainesville, FL 32610.
t Department of Periodontics. Box J-434 JHMHC. University of
Florida.
X Private Practice in Periodontics, 6323 Corporate Court. Ft.
Myers. FL 33907.
236
sensation. Edel and Wills12 assessed the thrc nold of
perception of forces applied axially to individ il teeth
of patients with periodontal bone loss witho■ \ tissue
inflammation and found no significant decr> jses in
threshold level. However, with infiltration of :-n anes
thetic to the labial surfaces of the teeth, a dec ease in
force detection was observed. They concluded lat the
PDL is responsible for monitoring force directed igainst
the teeth.
Hellsing6 investigated individuals' inter-inci or bite
force discrimination abilities and found that bo h den
ture-wearing subjects and individuals with norn- tl den
titions could reliably perform requested amoi.nts of
bite force (relative to their demonstrated maximal
force). Hellsing also reported that, although anestheti
zation of the teeth of normal subjects led to inc -eased
maximal bite force, there was no demonstrable • npair-
ment in the subjects' ability to control requested levels
of bite force.
In a more recent stnady, Williams et al.,7 employing a
specially designed strain gauge scale, assessed the .bility
of a group of normal, young adult subjects in di crim
inating differences in their inter-incisor biting force
under several experimental conditions including anes
thetization of the incisors and the TMJs. They <ound
bite force discrimination to be significantly impaired
only in conditions in which the teeth were anesthe ized.
These authors concluded that the PDL is appa; *ntly
involved in providing sensory feedback relative t.1 this

type of bite force discrimination task, whereas the TMJs
enot
Although there is partial agreement in the literature
that the PDL is in part responsible for providing sensory
feedback relative to such oral motor functions as chew
ing and biting, the degree of sensory control is not
known. Further, it .is not known whether individuals
with periodontal disease suffer from impairment in
sensory input relative to their biting force. It is hypoth
esized that if the monitoring of bite force is dependent,
even in part, on the sensory acuity of the PDL, then
any diseased state of the PDL would result in impaired
performance. A measure of patients' ability to discrim
inate differences in their biting force might prove useful
in assessing periodontal integrity and provide further
quantification in defining impairment in oral function
related to periodontal disease.
The purpose of this study, therefore, was to deter
mine, on a task of bite force discrimination, whether
any performance differences existed between individ
uals within a specified degree of bone loss with no
inflammation and matched normal control subjects
who were free of periodontal disease.
MATERIALS AND METHODS
Subjects. The subjects for this study consisted of an
experimental group of 14 patients (10 females, 4 males)
with a mean age of 46 (range 24-57 years) and a control
group of 14 subjects (2 female, 12 males) with a mean
age of 35 (range 24-59 years). All subjects were either
patients or staff members of the College of Dentistry,
University of Florida, with noncontributory medical
histories.
The experimental group was comprised of previously
treated periodontal patients with radiographic evidence
of alveolar resorption who presently showed minimal
signs of inflammation (GI < 1.0) in the selected sites
(incisor teeth) at the time of testing. Subjects were
screened for anterior malocclusion and were omitted
from the study if overjet existed or if incisor overbite
was greater than one-third of the crown height of the
lower incisors. The control group contained incisor sites
with minimal inflammation (GI < 1.0) and no clinically
detectable bone resorption.
Clinical parameters included a Gingival Index (GI),13
pocket depth, and a radiographic assessment of the
incisor teeth. Periapical radiographs were projected
onto a screen from a standard distance, and bone levels
were measured by one examiner (WRC) as a percentage
of the distance from the cementoenamel junction to
the apex of the tooth root.14 Mesial and distal measure
ments were taken and averaged to calculate a mean
Percentage level for each tooth. The control subjects
had incisor tooth site measurements of within 1.0 mm
of the cementoenamel junction. The experimental
group had a mean bone level in the selected incisor
region of 42.7% (range 25%-68%).
Bite Force Discrimination 237
The measurement of static bite-force discrimination
involved the use of a specially designed strain gauge
scale. Resistance to an individual's biting force, exerted
on an extension beam between opposing teeth, could
be controlled by the examiner in 100-gm increments
up to a maximum of 11,000 gm. The resistance change
relative to the bite force was converted to a voltage
which was proportional to the force applied (0.07 volts/
100 gm). A modified voltage indicator permitted the
subjects to visually monitor when their bite force on
the extension beam equaled a preset resistance force
(Fig. 1).
Both surface areas on the extension beam, which the
teeth pressed against, were covered with a thin acrylic
plate to prevent possible subject discomfort from biting
on a steel beam. The beam was hinged to a handle so
that displacement of the beam 5 mm or more above or
below its free-floating center position triggered a light
signal. Subjects were instructed to hold the handpiece
in a manner to prevent the light from turning on. The
purpose of this design was to reduce the chance of
introducing extraneous forces to the beam via head
movement or manual torquing of the beam against the
teeth (Fig. 2).
Each subject was seated comfortably in a straight-
backed chair. The instrument was given to the subject
with the instructions to bite onto the end of the beam
using the two opposing teeth identified by the examiner.
A mirror was used to assist subjects in positioning the
extension beam between the teeth. A practice session
was included to familiarize each subject with the instru
ment and the level of bite forces to be assessed.
Procedures. For this study a modified method of
constant stimuli was used. A bite force of 500 gm was
selected as the standard. Subjects were presented with
a series of paired resistance settings, one at a time, the
first resistance of each pair being the standard or refer
ent resistance and the second being the comparator
Figure 1. A subject biting on the extension beam of the strain gauge
with a force equal to the resistance force preset by the examiner. The
subject is visually monitoring her biting force on the voltage meter.

238 Williams, Low, Cooper, Cornell
Figure 2. A subject positioning the extension beam between two
opposing incisors.
Table 1
Group Means, Standard Deviations, and Ranges of Bite Force
Discrimination (Standard Force = 500 gm)
Periodontal patients
Normal controls
(N= 14)
(N = 14)
(with bone loss)
X DL (gm) 331 201
SD (gm) 176 97
Range (gm) 100-800 100-600
resistance of a preselected greater amount. Administra
tive procedures required each subject to bite on the
beam with a selected pair of opposing incisors with
sufficient force to center the indicator needle to zero
on the voltage meter. Each subject was instructed to
use this first bite force as the standard or reference.
Immediately following the standard force, the resistance
setting was increased by an increment of 100 gm relative
to the previous comparator setting. The subject was
asked to bite again on the beam and report if this
second resistance setting required more, less, or an
equal amount ofbite force to center the indicator needle
compared to the previously administered standard. This
procedure of paired comparisons was continued until a
difference limen (DL) value (subject's threshold of dis
crimination between two biting forces) was established.
DL was defined as that resistance setting where the first
of four consecutive correct responses was obtained.
Three ascending runs or trials were conducted for each
subject. Bite force discrimination was determined for
each of two pairs of opposing incisors for subjects,
resulting in a total of 28 separate DLs for the clinical
group and 28 DLs for the normal controls.
RESULTS
A Wilcoxon rank sum test revealed no significant
differences (P> 0.5) in subjects' performance between
the three runs for either the experimental or control
group. Therefore, the mean discrimination threshold
toJ
APril, 1987
(or DL value) was calculated by averaging subjects'
performance over the three runs.
Table I summarizes the descriptive bite force per
formance data (means, standard deviations, and ranges)
for both the periodontal and control subjects. As can
be seen from this table, the periodontal patients re
quired a mean increase of 331 gm before they could
detect a difference in the resistance to their bite force
This compares with the normal subjects whose mean
DLs were only 201 gm. A / test was computed on the
performance of these two groups revealing that the bite
force discriminatory ability of the periodontal patients
was significantly (p < 0.01) less than that of the normal
controls.
DISCUSSION
It has been suggested that the perception of external
forces applied to the teeth, or that perception of differ
ences in biting force, is mediated in part by receptors
within the PDL. In a study of bite force discrimination
following anesthetization of the TMJs, and of the PDLs
in the region of the anterior teeth, Williams et al.8
found the PDL to be the primary controlling factor. In
addition, impaired bite force discrimination has been
identified in individuals with complete loss of the PDL
(full dentures) (Williams et al.).9 In neither of these
studies, however, was bite force discrimination com
pletely obliterated, therefore implicating the muscle
spindles within the jaw elevator musculature. To assess
the role of sensory input from the muscle spindles,
Williams et al.15 assessed normal subjects' ability to
discriminate differences in their biting force while re
ceiving mechanical bilateral vibratory stimulation to
their masseters. Again, although bite force discrimina
tion was impaired, it was not obliterated, suggesting
that sensory input from the PDL was providing ade
quate feedback for the control of different levels of
biting force.
Impairment in oral sensorimotor function as a result
of total loss of the PDL, as in edentulous cases, is
perhaps more clearly definable than when the PDL is
partially lost or compromised due to a disease state.
Steenberghe et al.16 reported that their sample of peri
odontal patients was less sensitive than control subjects
to small loads applied to the teeth. These authors sug
gested that the degree of inflammation may influence
sensory function of the periodontium more than a
reduction in tissue.
In the present study, although our subjects had a
mean alveolar resorption of 42% around the teeth used
in the bite force task, subjects had no signs of tissue
inflammation around these teeth. The periodontal pa
tients required a mean increase of 331 gm of biting
force before they could detect a difference from the
standard force of 500 gm. This compares with the
normal control subjects who only required a mean
Volume 58
dumber 4
increase of 201 gm before a difference could be de
tected. Alveolar bone resorption was measured by ra-
diographic evaluation. Although this measure is re
stricted to the mesial and distal areas of the selected
teeth, it did provide a method for defining the experi
mental group. In order to establish a correlation be
tween the amount of bone resorption in a periodontal
experimental group and bite force discrimination, a
volumetric parameter, such as the calculation of attach
ment loss, circumferentially, would be necessary.
Another factor to be considered in inter-incisor bite
force discrimination is the angulation of the opposing
incisors. It might be hypothesized that detection of
changes in biting force is dependent, in part, on the
angulation of the long axis of the teeth to the horizontal
biting surface of the instrument. However, in a study
assessing the effect of jaw opening on inter-incisor bite
force discrimination, resulting in a change in orienta
tion of the long axis of the teeth to the biting surface,
LaPointe et al.17 found no differences in the subjects'
performance. Nonetheless, subjects in the present study
were selected to have normal anterior occlusion.
The findings in this study, in addition to previous
research,8-9 suggest that inter-incisor biting force is con
trolled, in part, by the sensory system within the PDL.
Other systems that may be responsible for monitoring
this function have yet to be completely defined, but it
appears that proprioception from the jaw elevator mus
culature is a likely contributor.5'616 The data in this
present study suggest that individuals with loss of at
tachment, yet free of inflammation, have impaired
sensory function resulting in reduced control over bit
ing force. Further research is warranted to define the
combined effect of both PDL anesthetization and mas-
seter vibratory stimulation on subjects' ability to dis
criminate differences in their biting force. In addition,
research is needed to define the influence of inflam
mation surrounding the PDL on bite force discrimina
tion and other oral motor functions.
REFERENCES
I. Lowenstein, W. R., and Rathkamp, R.: A study on the presso-
receptive sensibility of the tooth. J Dent Res 34: 287, 1955.
Bite Force Discrimination 239
2. Bowman, D. C, and Nakfoor, P. M.: Evaluation of the human
subjects' ability to differentiate intensity of forces applied to the
maxillary central incisors. J Dent Res 47: 252, 1968.
3. Bonaguro, J. G., Dusza, G. R., and Bowman, D. C: Ability of
human subjects to discriminate forces applied to certain teeth. J Dent
Res 48: 236, 1969.
4. Wennstrom, A.: Psychological investigation of bite force.
Part I. Bite force in healthy adult women. Swed Dent J 64:807,1971.
5. Hannam, A. G.: The regulation of the jaw bite force in man.
Arch OralBiollh 641, 1976.
6. Hellsing, G.: On the regulation of interincisor bite force in man.
J Oral Rehabil 7: 403, 1980.
7. Williams, W. N., LaPointe, L. L., and Blanton, R. S.: Human
discrimination of different bite forces. J Oral Rehabil 11:407, 1984.
8. Williams, W. R, LaPointe, L. L., Mahan, P. E., and Cornell,
C. E.: The influence of TMJ and central incisor sensory impairment
on bite force discrimination. J Craniomandib Pract 2: 119, 1984.
9. Williams, W. N., Levin, A. C, LaPointe, L. L., and Cornell, C.
E.: Bite force discrimination by individuals with complete dentures.
J Prosthet Dent 54: 146, 1985.
10. Lund, J. P., and Lamarre, Y.: The importance of positive
feedback from periodontal pressoreceptors during voluntary isometric
contraction of jaw closing muscles in man. J Biol Buccale 1: 345,
1973.
11. Cathelineau, G., and Yardin, M: The relationship between
tooth vibratory sensation and periodontal disease. J Periodontol S3:
704,1982.
12. Edel, A., and Wills, D. J.: A method of studying the effects of
reduced alveolar support on the sensibility to axial forces on the
incisor teeth in humans. J Clin Periodontol 2: 218, 1975.
13. Loe, H., and Siiness, J.: Periodontal disease in pregnancy. I.
Prevalence and severity. Acta OdontolScand 21:533, 1963.
14. Schei, O., Waerhaug, J., Loudal, A., and Amo, A.: Alveolar
bone loss as related to oral hygiene and age. J Periodontol 30: 7,
1959.
15. Williams, W. M., LaPointe, L. L., Mahan, P. E., et al.:
Vibratory stimulation of jaw muscles and bite force discrimination.
J Dent Res 64: 265, 1985.
16. Steenberghe, D. Van, Van Den Berg, A., DeVries, J. J., and
Schoo, W. H.: The influence of advanced periodontitis on the psy
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J Periodont Res 16: 199, 1981.
17. LaPointe, L. L., Williams, W. R, Cornell, C. E., and Bicha-
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Dent Res 64: 2%4, 1985.
Send reprint requests to: W. N. Williams, PhD, Department of
Oral Biology, Box J-424, JHMHC, College of Dentistry, University
of Florida, Gainesville, FL 32610.