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Objectives: Tactile acuity is a somatosensory measure of the extent to which humans can discern tactile stimuli. It is influenced by how peripheral signals are processed centrally. In the oral cavity, Occlusal Tactile Acuity (OTA) is the ability to perceive minimal thicknesses between antagonist teeth. The aim of the current study was to assess the association between psychological traits and OTA of otherwise healthy individuals. Methods: Sixty‐three volunteers (32 males; mean age ± SD: 24.6 ± 2.7 years) participated in this study. Somatosensory amplification, anxiety, depression, physical symptoms and pain catastrophizing were scored using questionnaires, and subgroups of severity were created per variable based on cut‐offs. OTA was measured using 9 aluminium foils with thickness (ranging from 8 to 72 μm) and one sham test (without foil). Each thickness was tested 10 times in random order, the participants were instructed to report whether they felt the foil between their molars and the mean percentage of correct answers was computed. A linear mixed model was used with OTA as a dependent variable and psychological domain as an independent variable. Results: Significantly different OTA was observed among the anxiety subgroups (p =.003), supporting a decreased perception of thicknesses 24 and 32 μm (p =.018 and p <.001, respectively) in participants with moderate/severe anxiety compared to those with no/mild anxiety. Significantly different OTA was also observed among the pain catastrophizing subgroups (p =.008), showing decreased perception of thicknesses 32 and 40 μm (p <.001 and p =.007, respectively) in severe catastrophizing levels, compared to no/mild catastrophizing levels. No significant differences were observed for the other variables. Conclusions: Healthy adults with increased anxiety or pain catastrophizing levels show decreased interdental acuity as compared to participants with minor or no psychological impairment. [ABSTRACT FROM AUTHOR]

Background: The literature is unclear about how the different attachment systems for overdentures impact the maximum bite force, the masticatory efficiency and how this impact in the oral health self‐perception in patients. Objective: To evaluate the effect of two attachment systems (O‐ring and Locator) for mandibular overdenture using single implant on quality of life, maximum bite force (BF) and masticatory efficiency (ME). Methods: Twenty‐eight completely edentulous denture wearers with a mandibular symphysis implant were randomly selected and allocated into two groups in a crossover study, considering O‐ring and Locator attachment types. The quality of life and self‐perception of oral health were assessed using the Oral Health Impact Profile (OHIP‐Edent) and Geriatric Index of Determination of Oral Health (GOHAI) questionnaires, respectively. BF was measured using a gnathodynamometer and ME by chewing silicone cubes and almonds in different numbers of cycles. Results: There was no difference between the attachment systems about self‐perceived oral health and impact on quality of life (p >.05). The O‐ring‐type system obtained a significantly higher BF than the locator‐type system (p =.04). Regardless of the food chewed, no statistically significant difference was observed with the type of attachment (p >.05). The ME was directly proportional to the masticatory cycles only for almonds (p <.01). Conclusions: Locator and O‐ring inserts had a similar impact on patients' quality of life, self‐perception of oral health and ME. Additionally, the O‐ring system exhibited superior properties in the BF. [ABSTRACT FROM AUTHOR]

Background: Bilateral posterior crossbite (BPXB) is a severe malocclusion associated with maxillary hypoplasia. BPXB may involve the same or a different number of teeth between the sides. Objectives: To evaluate the masticatory function in BPXB and the association between the masticatory alterations and the occlusal features of BPXB. Methods: This observational study included 170 participants: 130 patients with BPXB (65 occlusally symmetric BPXB, i.e. same number and type of posterior teeth in crossbite between the sides, F = 33, M = 32, median age 9.6 (8.2–13) [years.months]; 65 patients occlusally asymmetric BPXB, F = 30, M = 35, median age 9.9 (8.3–13.6)) and 40 controls (F = 25, M = 15, median age 10.2 (9.4–11.6)). The masticatory function was evaluated by the detection of the Reverse Chewing Cycles (RCCs) recorded with a kinesiograph using standardised soft and hard boluses. Results: The frequency of RCCs was significantly increased in all BPXB patients compared to controls (p <.000). In symmetric BPXB patients, there were no significant differences in the frequency of RCCs during chewing on the left or the right side. In asymmetric BPXB patients, the frequency of RCCs was significantly increased during chewing on the side with relatively more teeth in crossbite (p <.000). Conclusions: The masticatory function was significantly altered in all BPXB patients and it was differently affected by symmetric or asymmetric occlusal features of the malocclusion. [ABSTRACT FROM AUTHOR]

Background: Oral and social problems can exacerbate long‐term care. Understanding the relationship between social aspects and oral hypofunction can help identify high‐risk factors for long‐term care. Objective: This study aimed to investigate the social aspects of oral hypofunction among medical outpatients. Methods: This retrospective cross‐sectional study included patients who visited an outpatient clinic for frailty. The oral function was assessed using seven items: oral hygiene, occlusal force, masticatory function, tongue‐lip motor function, tongue pressure, oral dryness and swallowing function. Participants with three or more functional declines were classified as having 'oral hypofunction'. Social aspects were assessed using 21 items in four categories: general resources, basic social needs, social resources and social behaviours/activities. We analysed the relationship between oral hypofunction and each social aspect. Results: A total of 316 participants (age 78.5 ± 6.4 years) were included, and 128 (41%) had oral hypofunction. Participants with oral hypofunction were significantly more likely to have limited education, require long‐term care, not use transportation, depend on others for shopping, not participate in events, lack association membership and not engage in charity or volunteer work. After logistic regression analysis, 'long‐term care' and 'no association membership' remained significantly associated with oral hypofunction (odds ratios 2.3, 2.3; 95% CI 1.1–5.0, 1.1–4.7, respectively). Conclusion: Participants with oral hypofunction faced challenges in 'general resources' and 'social behaviour/activities', which were linked to oral function issues. Future longitudinal studies are necessary to further investigate this relationship. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the effects on bite force and muscle thickness of the botulinum toxin (BoNT) injection for patients with sleep bruxism (SB) by comparing injections into the masseter muscle only and both the masseter and the anterior belly of the digastric muscle (ABDM) in a clinical trial. Methods: Twelve SB patients received BoNT‐A injections using US‐guided techniques into the masseter muscle only (Group A), while the remaining 12 SB patients received injections into both the masseter and ABDM (Group B). Bite force and muscle thickness were measured before injection, as well as 1 and 2 months after injection. Results: The bite force and masseter muscle thickness decreased in both Group A and Group B before injection, and at 1 and 2 months after injection. However, there was no significant difference (p >.05, repeated measures analysis of variance) between the two groups, and there was also no significant difference in ABDM thickness (p >.05, repeated measures analysis of variance). Conclusion: This study is the first to assess the short‐term effects of BoNT injected into ABDM for SB control. Results show no influence on SB reduction, suggesting the need for further research on BoNT's effectiveness in controlling intense ABDM contractions during sleep and assessing suprahyoid muscle potential impact on rhythmic masticatory muscle activity occurrence. [ABSTRACT FROM AUTHOR]

Background: Limited data exist on the mid‐ to long‐term masticatory capacity of mandibular overdenture (IOD) wearers, particularly regarding the use of posterior implants to retention. Objectives: To periodically evaluate mastication of IOD wearers, comparing the effectiveness of two to four implants to retain the prosthesis. Methods: In a randomised controlled clinical trial, 20 complete edentulous patients (14 women), aged 51–84 years (mean age 69.1 ± 9.6), received new bimaxillary complete dentures (CD). After adaptation, baseline measurements of masticatory performance (X50) and swallowing threshold were conducted using the sieving method. Patients were then randomly assigned to groups: control (two intra‐foraminal regular implants) and experimental (two intra‐foraminal regular implants and two extra‐short posterior implants) (n = 10 each). After 4 months, implants were splinted, and a new mandibular IOD was fabricated with bar/clip retention. Mastication was reassessed after 6, 12, and 48 months, and data analysed with repeated measures ANOVA and Sidak's post hoc (α = 0.05). Results: Despite a loss of two patients per group, masticatory performance significantly improved after mandibular IOD installation (p =.031) in both groups (p =.670). A second improvement was observed after 6 months (p =.027), with no subsequent changes (p >.05). Swallowing threshold improvements were noted with IOD, and no discernible differences between groups were observed (p >.05). Conclusion: Masticatory function significantly improved after mandibular IOD installation, with the number of implants demonstrating minimal influence. Clinical Trial Registration: The present study was not registered in a public database, as mandated. It is important to note that the recommendation for registration was initiated in 2017 by the Committee of Medical Journal Editors, while patient inclusion in the research took place in 2016. Given that the data presented in this manuscript cover a follow‐up period of up to 4 years post‐surgical intervention, delayed registration was not feasible. [ABSTRACT FROM AUTHOR]

Background: Orofacial myofunctional disorders (OMD) are often associated with limitations of oral ingestion of solid food. The Test of Masticating and Swallowing Solids (ToMaSS) is a simple diagnostic tool to assess and quantify oropharyngeal efficiency while eating a standardised cracker. Objectives: The objective of this study was to investigate the applicability and clinical utility of the ToMaSS in children with OMD. Methods: In this case–control study, data were collected from 18 children between 4 and 11 years with confirmed OMD. Inter‐rater reliability and age effects on the ToMaSS parameters were investigated and the specific performance profile of the OMD children was identified. Results: Inter‐rater reliability was excellent for the ToMaSS parameters 'bites' (ICC =.999), 'masticatory cycles' (ICC =.961), 'time'(ICC≧.999) and good for 'number of swallows' (ICC =.810). 'Masticatory cycles' and 'time' decreased as a function of age with a significant difference in the 'number of masticatory cycles' between the youngest (4–6 years) and oldest (10–14 years) participants (p =.006, Z = −2.739). Deviations from normative data in at least one of the four ToMaSS parameters were found in 90% of the OMD children with 'bites', and 'masticatory cycles' predominantly corresponding to the performances expected in typically‐developing children in younger age groups. Conclusions: The ToMaSS is a reliable diagnostic instrument and clinically useful to detect limited efficiency of oral solid bolus intake and specific impairments in chewing function and duration of food intake in children with OMD. Our data suggest that OMD is associated with delayed development of efficient solid bolus preparation. [ABSTRACT FROM AUTHOR]

Background: Occlusal contacts can be stained and thereby visualised employing occlusal indicators. Qualitative and quantitative indicators are differentiated. The hybrid system OccluSense supposedly combines analogue contact marking and digital registration of contacts. The reliability and validity of its contact marking have not yet been validated. Objectives: The aim of this controlled randomised in‐vitro study was to examine the reliability and validity of analogue contact staining with OccluSense compared to Arti‐Fol and the reference standard Gnatho‐Film. Materials and Methods: An experimental apparatus was designed to simulate static occlusion. The occlusal contacts were stained 50 times with Gnatho‐Film to determine the average number and location of contacts registered. For comparison, the contacts were pre‐stained with Gnatho‐Film and then registered with Arti‐Fol or OccluSense 50 times each. Every staining was statistically evaluated and compared to Gnatho‐Film alone, regarding the number and location of contacts. Based on the observed characteristic staining behaviour of OccluSense, a modified evaluation strategy was developed for its colour markings (OccluSense (mod.)). Results: Both evaluations of OccluSense determine that the same number of contacts was registered in over 94% of all cases. Neither OccluSense nor Arti‐Fol stain the exact same number of contacts as Gnatho‐Film, but the modified evaluation OccluSense (mod.) did improve the results for validity. Conclusion: When employing the modified evaluation strategy, OccluSense staining achieves similar reliability and validity as the reference standard. Pre‐colouring of occlusal contacts with Gnatho‐Film and the modified evaluation strategy, might become standard for analysing occlusal contacts stained by OccluSense in the future. [ABSTRACT FROM AUTHOR]

Objectives: Noncarious cervical lesions (NCCLs) are multifactorial and can be caused by the anatomical structure of the teeth, erosion, abrasion and abnormal occlusion. The aim of this case–control study was to explore the risk factors for NCCLs. Methods: Cone‐beam computed tomography was used to determine whether a wedge‐shaped defect existed at the cementoenamel junction. We compared 63 participants with NCCLs with 63 controls without NCCLs, matched for sex, age (±1 year) and toothbrushing‐related factors (e.g., type of bristle and brushing patterns, frequency and strength). All participants were asked to complete a questionnaire about self‐administered daily diet habits and health condition. Univariate and multivariate logistic regression analyses were conducted to determine the risk factors for NCCLs. Results: Significant variables in the univariate analysis (i.e., p <.2) included frequency of carbonated beverage consumption, sella‐nasion‐point B angle (SNB) and Frankfort‐mandibular plane angle (FMA). Multivariate logistic regression demonstrated that the consumption frequency of carbonated beverages (odds ratio [OR] = 3.147; 95% confidence interval [CI], 1.039–9.532), FMA (OR = 1.100; 95% CI, 1.004–1.204) and SNB (OR = 0.896; 95% CI, 0.813–0.988) was independent influencing factors. The area under the receiver operating characteristic curve (AUC) value of regression Model 1 (established with the frequency of carbonated beverage consumption, FMA, SNB and sleep bruxism) was 0.700 (95% CI, 0.607–0.792; p <.001), and that of regression Model 2 (established using the frequency of carbonated beverage consumption, FMA and SNB) was 0.704 (95% CI, 0.612–0.796; p <.001). Conclusions: The consumption frequency of carbonated beverages and FMA was risk factors for NCCLs; the higher the frequency of carbonated beverage consumption and FMA, the higher was the probability of NCCLs. SNB was a protective factor for NCCL occurrence; the larger the SNB, the lower was the probability of NCCL occurrence. These findings have further clarified the aetiology of NCCLs and provided clinicians with valuable insights into strategies for preventing the loss of dental tissue. [ABSTRACT FROM AUTHOR]

Background: Mandibular malpositioning may result in an abnormal concentration of stresses within the temporomandibular joint (TMJ) in adult rats, which may further lead to a series of pathological changes, such as articular cartilage wear, subchondral bone sclerosis and osteophyte formation. However, the pathological and adaptive changes in condylar cartilage caused by different stress distributions are still controversial. Objective: The aim of this study was to observe the effect of sagittal changes in mandibular position on condylar cartilage by changing the occlusal vertical dimension (OVD) in adult rats. Methods: Fifteen‐week‐old female rats were divided into three groups: control (CON), increased OVD (iOVD) and loss of occlusion (LO) groups. An occlusal plate and tooth extraction were used to establish the animal model. TMJ samples of the experimental and CON groups were observed and investigated by bone morphological, histomorphological and immunohistochemical staining analyses at 3 days, 1 week, 2 weeks, 4 weeks and 8 weeks. Weight curves were plotted. Results: Micro‐computed tomography showed that, compared with the CON group, cartilage destruction followed by repair occurred in both experimental groups, which was similar to the trend observed in haematoxylin‐eosin staining. All experimental results for the iOVD group showed an approximately similar time trend. Compared with the iOVD group, the toluidine blue and immunohistochemical staining results in the LO group showed no obvious change trend over time. Conclusion: Compared with occlusal loss, an increase in OVD caused faster and more severe damage to condylar cartilage, and subchondral bone repair occurred later. [ABSTRACT FROM AUTHOR]

Background: Class II subdivision is a malocclusion characterized by dental and functional asymmetry that is difficult to manage. Impaired muscle function can result in asymmetrical growth, leading to occlusal instability. Objective(s): The study aimed to assess occlusal force in patients with Class II subdivision malocclusion using Innobyte. Additionally, the discrepancies of force generated at the position of maximum intercuspidation between the left and right sides of the arches were evaluated. Methods: The occlusal force of 66 patients with Class II subdivision malocclusion (group S) was measured and compared with that of 66 patients with Class I (group I) and 66 patients with Class II malocclusion (group II). The S group patients had a Class I molar on the right side and a Class II molar on the left side. ANOVA test, followed by the Games‐Howell post hoc test, was performed to compare the mean of the total force among the groups. To assess the difference in force between the right and left arches, one‐way ANOVA test followed by Tukey's post hoc comparison was performed. Finally, a boxplot was created to show the trend of occlusal force recorded in the three groups of patients. Results: The occlusal force differed significantly among the groups (p <.001). Post hoc Games‐Howell analysis showed significant differences as follows: the total force in group S was 165.24 N greater than in group II and in group I was 218.06 N greater than in group II. The difference (right–left) in total force between the groups was statistically significant (p <.001). Tukey's post hoc test showed following significant correlation: in group S was 53.51 N greater than in group II and 63.12 N greater than in group I. Conclusions: Among the analysed groups, patients with Class II malocclusion exhibited the lowest value of occlusal force. In patients with Class II subdivision malocclusion, force asymmetry, characterised by a higher value on the Class I side and a lower value on the Class II side was observed. [ABSTRACT FROM AUTHOR]

Background: The T‐scan system has been used previously to analyse occlusion, but the quantitative analysis of occlusal contact by T‐Scan system has yet to be reported. Objectives: To evaluate the reliability and validity of T‐Scan system for quantitatively measuring occlusal contact area and occlusal contact number. Methods: Twenty‐two individuals with normal occlusion, 11 men and 11 women, were recruited for the study. Two occlusal analysis methods, including silicone transmission analysis method (STA) and T‐Scan occlusion analysis method (TSO), were used to make quantitative analysis to measure occlusal contact area (OCA) and occlusal contact number (OCN). A test–retest check was performed with an interval of 2 weeks. The values of intraclass correlation coefficients (ICC) between test‐retest of each method were calculated for reliability evaluation. Pearson correlations analysis, paired t‐tests, regression analysis and Bland–Altman analysis were performed for validity evaluation. Results: The ICC values of STA were greater than those of TSO for OCA while for OCN, ICC values of TSO were greater than STA. The higher OCA and OCN values were found in TSO compared with STA. Pearson's correlation coefficient indicated strong relations between TSO and STA (0.730–0.812) for OCA, while good relations between then (0.569–0.583) for OCN. Paired t‐test showed a significant difference between the OCA and OCN values between TSO and STA. Bland–Altman analysis showed good agreement between OCA and OCN values of TSO and STA both in men and women. Regression analysis identified a linear correlation between OCA values obtained from these two methods. Conclusions: T‐Scan method showed strong reliability for measuring OCA and OCN quantitatively. Strong correlations were found between OCA values from TSO and STA method, but the validity of TSO for measuring OCN needs to be promoted. Clinical Significance: T‐Scan system demonstrates good potential in quantitative analysis of occlusion, which will expand its clinical application. [ABSTRACT FROM AUTHOR]

Background: Myogenic temporomandibular disorders (M‐TMD) commonly involve occlusal splint (OS) therapy and musculoskeletal physiotherapy (MPT). Objectives: To compare the effects of combining OS with MPT and education (EG) against OS and education (CG), in chronic M‐TMD patients. Methods: In this double‐blind randomised controlled trial, 62 participants were assigned to either EG or CG. The primary outcomes, pain levels at rest (VAS rest), maximum oral opening (VAS open) and during chewing (VAS chew), were measured by Visual Analogue Scale (VAS) in cm. The secondary outcome was the range of motion (ROM) for maximum oral opening. Both interventions lasted 3 months, with outcomes assessed at baseline (T0), post‐treatment (T1) and 3 months post‐treatment (T2). Results: Intention‐to‐treat analysis revealed significant improvements favouring EG (VAS rest = −1.50 cm [CI95%: −2.67, −0.32], p =.04; VAS open = −2.00 cm [CI95%: −3.23, −0.75], p <.01; VAS chew = −1.71 cm [CI95%: −2.90, −0.52], p =.01; ROM = 4.61 [CI95%: 0.93, 8.30], p =.04). Additionally, VAS measures were influenced by follow‐up times (VAS rest = −0.73 cm [CI95%: −1.30, −0.17], p = 0.03; VAS open = −0.97 cm [CI95%: −1.57, −0.37], p <.01; VAS chew = −1.15 cm [CI95%: −1.73, −0.58], p <.01). At T1, EG demonstrated higher number of responders compared to CG for VAS open (χ2(1) = 4.39, p =.04) and VAS chew (χ2(1) = 11.58, p <.01). Conclusion: Adding MPT to education and OS yields better outcomes in terms of pain reduction and ROM improvement, in chronic M‐TMD. Trial Registration Number: NCT03726060. [ABSTRACT FROM AUTHOR]

Background: Pain‐free bite force (PFBF) is a promising measure to evaluate bite function in temporomandibular disorders (TMDs), yet the reliability of the measure is unknown. Objectives: Establish the (1) within‐session test–retest reliability of PFBF in a healthy population for a single and mean of three trials in supported and unsupported sitting; (2) standard error of measurement (SEM) and minimal detectable change (MDC). Methods: Thirty healthy participants (n = 15 female, mean [SD] age = 34.4 [11.0] years) completed two sessions (30–60 min apart) comprising three PFBF trials on each side, in both supported and unsupported sitting, to provide data for 60 (30 participants × two sides) test–retest assessments. Test–retest reliability for the first trial and mean of three trials in each position were determined using intraclass correlation coefficients (ICCs), before calculating the corresponding SEM and MDC for males (M) and females (F) respectively. Results: Within‐session reliability was considered excellent for a single trial in supported sitting (ICC = 0.85; SEM M/F = 99/84 N; MDC M/F = 275/232 N) and unsupported sitting (ICC = 0.91; SEM M/F = 72/59 N, MDC M/F = 200/163 N), and for a mean of three trials in supported sitting (ICC = 0.89; SEM M/F = 66/79 N, MDC M/F = 182/220 N) and unsupported sitting (ICC = 0.92; SEM M/F = 64/59 N, MDC M/F = 177/164 N). Conclusion: Single and a mean of three trials in supported and unsupported sitting appear reliable methods to measure PFBF in a healthy population. Testing PFBF using a mean of three trials in unsupported sitting appears superior over other methods though due to higher test–retest reliability, and lower SEM and MDC. Future studies should examine the reliability of PFBF in TMD populations. [ABSTRACT FROM AUTHOR]

Objective: This prospective study is part of a randomised clinical trial and reports the changes in masticatory performance (MP) and bite force, and explores their influential factors, 1 year after the provision of mandibular overdentures retained by four titanium–zirconium mini implants. Methods: Edentulous patients received conventional complete dentures, followed by placement of four mini implants (Straumann® Mini Implant System) in the anterior mandible and converting the conventional prosthesis into a mandibular overdenture. Treatment protocols were randomised using a 2×2 factorial design combining different surgical (flapped vs. flapless) and loading (immediate vs. delayed) protocols. MP was assessed using a two‐colour mixing ability test and a colorimetric analysis to measure the level of colour mixing (Variance of Hue–VoH). Maximum voluntary bite force (MBF) was measured by a digital gnathodynamometer in the posterior and anterior regions. Sex, age, surgical and loading protocols and ridge morphology were tested as independent variables. MP and MBF tests were performed at baseline (pre‐treatment) and the 3‐, 6‐ and 12‐month after implant loading. Descriptive statistics, independent t‐test, and linear mixed‐effect model (LMM) regression were used for data analysis. Results: Seventy‐four participants were assessed and 73 completed the 1‐year follow‐up. Statistically significant improvements in functional parameters were observed in all follow‐up periods compared to baseline (p <.001). The flapless protocol was associated with higher improvement in MP at the 3‐month follow‐up (p =.004), while less resorbed ridges were associated with better MP (p =.038) and higher MBF (p <.001). Conclusion: The mandibular overdenture protocol using four titanium–zirconium mini implants was effective in improving MP and MBF of edentulous patients, compared to pre‐treatment values. The findings also suggest that improvements in chewing function and bite force are impacted by clinical factors since better outcomes were observed for flapless surgeries and less resorbed edentulous ridges. CLINICAL TRIAL REGISTRATION: ClinicalTrials.Gov ID NCT04760457. [ABSTRACT FROM AUTHOR]

Background: Electromyographic activity (EMG) of masticatory muscles during wakefulness is understudied. It is unclear if single channel ambulatory EMG devices are sensitive enough to detect masticatory muscle activity (MMA) during wakefulness. Objectives: To compare the MMA of various oral tasks recorded with a single channel EMG device ((Grindcare4‐datalogger Prototype device) (GC4‐β)) and a conventional EMG (cEMG) device. Methods: EMG activity of 30 standardised oral tasks was recorded unilaterally from the masseter and anterior temporalis muscle in 24 healthy volunteers using GC4‐β and a cEMG device. To compare the EMG data, signal‐to‐noise ratios (SNR) were calculated as a way to normalise EMG activity across tasks. Analysis of variance was used to compare the SNR between the devices, muscles and oral tasks. Results: SNR measured from GC4‐β was overall significantly higher than the cEMG device (p =.001). The SNR for maximum voluntary contraction (MVC) was significantly higher than all other tasks (p <.001). SNR for temporalis with GC4‐β was significantly higher for MVC, hard food, soft food, gum chewing (dominant side), rhythmic clenching and upper lip biting compared to the cEMG device (p <.021). The SNR for masseter with GC4‐β was significantly higher for hard food and gum chewing (dominant side), rhythmic clenching, rhythmic biting of an object and yawning compared to the cEMG device (p <.022). Conclusions: This study provides novel insight into the EMG patterns of numerous oral tasks enhancing knowledge of physiological differences between the masticatory muscles. Further, single channel EMG devices can effectively measure the EMG activity of various oral tasks during wakefulness. [ABSTRACT FROM AUTHOR]

Background: Oral frailty, characterised by reduced oral function, is associated with systemic health issues in older adults. Although the criteria for diminished oral function often focus on motor and secretory abilities, texture perception also plays a crucial role in health due to its impact on food intake and palatability. Objective: This study aimed to explore the relationship between thickness discrimination ability (TDA) and oral motor and secretory functions in healthy young individuals. Methods: Twenty‐eight adults were assessed for texture perception using eight concentrations of aqueous xanthan gum solutions to determine TDA scores. Measurements of occlusal force, masticatory performance, tongue pressure, stimulated salivary flow rate and tongue–lip motor function were conducted. Spearman's correlation analysis was used to evaluate the relationship between TDA scores and oral functions. Participants were divided into high‐sensitivity and low‐sensitivity groups based on their TDA scores to compare oral function test results. Results: The TDA scores varied among the participants, with higher scores correlating with higher masticatory performance (r = 0.41, p <.05). Masticatory performance in the high‐sensitivity group was significantly higher than in the low‐sensitivity group (211.9 ± 59.2 mg/dL vs. 157.9 ± 43.0 mg/dL, p =.013), with no significant differences in other oral functions. Conclusion: Masticatory performance was correlated with TDA, suggesting a link between the selection function of mastication and thickness discrimination. These findings highlight the potential relevance of texture perception in oral function and indicate the need for further exploration, particularly in older adults with declining oral health. [ABSTRACT FROM AUTHOR]

Background: The noteworthy correlation between bite force and masticatory performance emphasizes its significance as a meaningful and objective method for assessing oral function. Furthermore, in the study of bruxism, the measurement of intraoral bite force assumes critical importance. Given the importance of assessing occlusal forces and bite force, this systematic review aims to assess the efficacy of wireless sensors in measuring these forces. Methods: The search methodology employed in this systematic review adhered to the guidelines outlined by PRISMA. The strategy involved the exploration of various databases, including PubMed/MEDLINE, SCOPUS and SCIELO. An assessment tool was employed to evaluate the bias risk and study quality. Results: This systematic review encompassed six prospective clinical studies involving a total of 89 participants. Wireless sensors for measuring occlusal forces and bite forces were predominantly employed in healthy adults or individuals with bruxism, along with children undergoing orthodontic treatment. All wireless sensors employed in the studies underwent validation and reproducibility assessments, affirming their reliability. The findings indicated that all wireless sensors exhibited efficacy in detecting occlusal forces and bite forces. Conclusion: Wireless sensors offer real‐time monitoring of occlusal and bite forces, aiding in understanding force distribution and identifying bruxism patterns. Despite limited studies on their application, these sensors contribute to evolving insights. Integration into clinical practice requires careful consideration of factors like calibration and patient compliance. Ongoing research is crucial to address limitations and enhance the efficacy of wireless sensors in measuring occlusal and bite forces and managing bruxism. [ABSTRACT FROM AUTHOR]

Background: It is still discussed whether occlusal wear (OW) affects the formation of non‐carious cervical lesions (NCCLs). Objective: To estimate effects of OW on the presence and development of NCCLs, using 16‐year follow‐up data from a cohort study. Methods: Occlusal and cervical defects were measured in 728 cast models (one from the upper jaw and one from the lower jaw) of 364 participants. Adjusted mixed‐effects ordinal logistic models analysing estimated cross‐sectional (N = 1308 teeth/291 subjects) and longitudinal (N = 718 teeth/226 subjects) associations of OW with NCCLs using tooth level data. Results: OW size was cross‐sectionally (OR = 1.74; 95% CI: 1.27–2.38 for OW size; OR = 0.97; 95% CI: 0.94–0.99 for squared OW size), but not longitudinally (OR = 1.14; 95% CI: 0.99–1.30) associated with odds of higher NCCL sizes. For cross‐sectional analyses, predicted probabilities of an NCCL size of 0 decreased from about 0.996 to 0.010 for OW sizes of 0 to 25. Conclusion: Results suggest an association between OW and NCCL size. However, as longitudinal results were non‐significant, while consistent in direction, large‐scaled cohort studies are demanded to more precisely estimate effect strength. [ABSTRACT FROM AUTHOR]

Background: Graftless sinus floor augmentation shows good results in bone gain, radiology and implant survival. Clinically, this technique can be recommended as an alternative to conventional procedures using augmentation materials. Objectives: This study aims to assess masticatory performance, masticatory ability and patient satisfaction after graftless sinus floor augmentation. Methods: The study group consisted of patients who had received a graftless sinus lift procedure in a split‐mouth design and was compared to patients with maxillary implant‐supported overdentures without augmentation and a natural dentition group. To assess objective masticatory performance, the mixing ability test was performed. Three questionnaires were used to assess patient reported outcomes related to mastication and patient satisfaction. Results: Each group included ten patients. Both the graftless sinus lift group and the edentulous control group had a worse masticatory performance compared to the natural dentition group. Masticatory ability, measured by patient reported outcomes, was not different between the graftless sinus floor augmentation group and implant‐retained overdentures group without augmentation, but the natural dentition group showed better results. Thereby, the better the masticatory performance in patients with a graftless sinus membrane elevation the better the patient satisfaction for 'prosthesis', 'appearance of prostheses', 'speech' and 'mastication and eating'. Conclusions: Patients with implant‐supported overdentures show inferior masticatory function compared to those with natural dentition. There were no significant differences in masticatory performance between patients with implant‐retained overdentures, with or without graftless augmentation. The decision on the preferred procedure should consider additional factors such as anatomical, surgical‐technical aspects and patient's preferences. [ABSTRACT FROM AUTHOR]

Background: Jaw clenching improves dynamic reactive balance on an oscillating platform during forward acceleration and is associated with decreased mean sway speed of different body regions. Objective: It is suggested that jaw clenching as a concurrent muscle activity facilitates human motor excitability, increasing the neural drive to distal muscles. The underlying mechanism behind this phenomenon was studied based on leg and trunk muscle activity (iEMG) and co‐contraction ratio (CCR). Methods: Forty‐eight physically active and healthy adults were assigned to three groups, performing three oral motor tasks (jaw clenching, tongue pressing against the palate or habitual lower jaw position) during a dynamic one‐legged stance reactive balance task on an oscillating platform. The iEMG and CCR of posture‐relevant muscles and muscle pairs were analysed during platform forward acceleration. Results: Tongue pressing caused an adjustment of co‐contraction patterns of distal muscle groups based on changes in biomechanical coupling between the head and trunk during static balancing at the beginning of the experiment. Neither iEMG nor CCR measurement helped detect a general neuromuscular effect of jaw clenching on the dynamic reactive balance. Conclusion: The findings might indicate the existence of robust fixed patterns of rapid postural responses during the important initial phases of balance recovery. [ABSTRACT FROM AUTHOR]

Background: Large horizontal maxillary overjet (overjet) is associated with reduced bite force (BF) and number of contacts, which influence the chewing effectivity (CE). Oral health, oro‐facial function (OF) and malocclusion have great impact on psychological well‐being and quality of life (QoL). Objectives: The aims of the study were to examine OF, temporomandibular disorders (TMD), BF, CE, QoL and well‐being in children and adolescents with large overjet. Methods: The study was a case–control study including healthy children with large overjet in the study group compared to a control group of healthy children with neutral occlusion, all 9–14 years old. OF was examined by use of Nordic Orofacial Test‐Screening (NOT‐S), Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and registration of morphological and functional occlusion. QoL and well‐being were examined using KIDSCREEN‐10 and Strengths and Difficulties Questionnaire. Results: The study and control groups included 37 and 32 participants, respectively. Significantly increased NOT‐S score (p <.001) and reduced BF (p =.011), numbers of contacts (p <.001) and CE (p =.005) were found in the study group. BF, numbers of contacts and CE were negatively associated with erupting canines and premolars. No significant difference was found in age, gender, dental eruption, TMD diagnosis or QoL between the groups. Significantly increased emotional symptoms (p =.007), hyperactivity (p =.043) and total difficulties score (p =.009) were found in the study group. Conclusion: The study group showed higher NOT‐S score and reduced BF, number of contacts and CE. No difference in QoL were found between the groups, although reduced well‐being and increased emotional symptoms, hyperactivity and total difficulties were found in the study group. [ABSTRACT FROM AUTHOR]

Background: Botulinum toxin type A (BTX‐A) is increasingly used to manage painful temporomandibular disorders (TMD). However, the effect of BTX‐A on muscular TMD remains unclear. Objective: To assess the efficacy, safety and optimal dose of BTX‐A for treating TMD. Methods: We conducted systematic literature searches in MEDLINE, Embase, Web of Science, ClinicalTrials.gov and Cochrane Library until March 2023. We extracted data from randomized controlled trials (RCTs) that evaluated the efficacy and safety of BTX‐A in treating muscular TMD. We performed a meta‐analysis using a random‐effects model. Results: Fifteen RCTs involving 504 participants met the inclusion criteria. BTX‐A was significantly more effective than placebo in reducing pain intensity, as measured on a 0–10 scale, at 1 month (MD [95% CI] = −1.92 [−2.87, −0.98], p <.0001) and 6 months (MD [95% CI] −2.08, [−3.19 to −0.98]; p =.0002). A higher dosage of BTX‐A (60–100 U bilaterally) was associated with a greater reduction in pain at 6 months (MD [95% CI] = −2.98 [−3.52, −2.44]; p <.001). BTX‐A also resulted in decreased masseter muscle intensity (μV) (MD [95% CI] = −44.43 [−71.33, −17.53]; p =.001) at 1 month and occlusal force (kg) at 3 months (MD [95% CI] = −30.29 [−48.22 to −12.37]; p =.0009). There was no significant difference in adverse events between BTX‐A and placebo. Conclusions: BTX‐A is a safe and effective treatment for reducing pain and improving temporomandibular muscle and joint function in muscular TMD patients. A bilateral dose of 60–100 U might be an optimal choice for treating muscular TMD pain. [ABSTRACT FROM AUTHOR]

Background: The impact of treatments on completely edentulous individuals on masticatory performance (MP), oral health‐related quality of life (OHRQoL), nutritional status (NS) and socio‐economic profile (SP) is unclear in the literature. Objective: To compare the MP, OHRQoL, NS and SP of totally edentulous elderly users of bimaxillary complete dentures (CD) and users of lower implant‐supported fixed complete dentures (IFCD). Methods: Forty participants were allocated into groups according to rehabilitation treatment (n = 20): bimaxillary CD (G1) and lower IFCD, and upper CD (G2). The evaluation of MP used almonds by the method of sieves. Four questionnaires (Geriatric Oral Health Assessment Index–GOHAI and Oral Health Impact Profile Edent–OHIP‐Edent, Brazilian Economic Classification Criteria–ABEP and Mini Nutritional Assessment‐MNA) were applied to assess the OHRQoL, SP and NS of the elderly, respectively. After evaluating the statistical assumptions, the Mann–Whitney (α =.05) test was applied to compare the groups regarding MP, OHRQoL, NS and SP. Spearman's correlation (α =.05) was performed to verify the correlation between the MP, the OHRQoL and the NS of the participants. Results: G2 showed better MP (p <.05) in all masticatory cycles, OHRQoL (p <.05) and NS than the G1. However, the participants' self‐perception of oral health did not differ between groups (p <.05). A moderate negative correlation was found between MP and OHRQoL for 40 masticatory cycles (r2 = −0.513; p =.001). Conclusion: Individuals rehabilitated with IFCD had a higher average monthly family income and achieved superior behaviour in MP and OHRQoL, in addition to lower risks of malnutrition when compared to individuals using bimaxillary CD. [ABSTRACT FROM AUTHOR]

Background: Occlusal interferences lead to changes in mandibular kinematics to compensate and improve function. However, the effects of different types of eccentric disturbance on the comminution capacity are not known. Objective: To determine the immediate effect of eccentric occlusal interferences on masticatory performance. Methods: This crossover clinical trial included 12 healthy dentate subjects aged 25.2 ± 3.3 years who were randomly submitted to seven types of occlusal interference: unilateral and bilateral laterotrusive and mediotrusive, protrusive, dummy and control (no interference). The interference forms were planned in a semi‐adjustable articulator, fabricated with composite resin and adhered to the mandibular first molars such that subjects' maximum intercuspation was maintained. Masticatory performance and the chewing rate during 20 cycles were evaluated during subjects' comminution of silicone test food under one interference condition per test day; the multiple sieve method was applied to the comminuted particles. The interference was removed upon test completion, and a 1‐week washout period was applied between tests. Results: Comminuted median particle sizes were larger under unilateral (4.94 ± 0.41 mm) and bilateral (4.81 ± 0.49 mm) laterotrusive, bilateral mediotrusive (4.65 ± 0.50 mm) and protrusive (4.83 ± 0.54 mm) interferences (p <.05) than under the control (4.01 ± 0.52 mm) and dummy (4.18 ± 0.58 mm) conditions (p <.05). Only unilateral and bilateral laterotrusive interferences narrowed the comminuted particle size dispersion (p <.05). The chewing rate did not differ among conditions (p =.1944). Conclusion: Artificial eccentric interferences had an immediate adverse effect on masticatory performance by resulting in larger comminuted particles. Clinical trial registration: Brazilian Registry of Clinical Trials (RBR‐8g5zfg8). [ABSTRACT FROM AUTHOR]

Background: The objective of this investigation is to assess the relationship between the utilisation of orthodontic intermaxillary elastics and temporomandibular disorder (TMD) symptoms in clear aligner patients and to examine the correlation between the elastic usage time with the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)—Axis II Evaluation Forms. Methods: This study was carried out on a total of 40 clear aligner patients using intermaxillary elastics in the experimental group and 30 clear aligner patients who did not use any intermaxillary elastics in the control group. The data were evaluated using the Mann–Whitney U, chi‐square, Fisher's exact chi‐square, and Fisher Freeman Halton exact chi‐square tests. Results: The characteristic pain intensity, mastication, mobility, communication, global and PHQ‐9 scores of the experimental group were significantly higher than those of the control group (p <.05). The characteristic pain intensity score, interference score and chronic pain grade score of patients using Class III elastics were statistically significantly higher than those of patients using Class II elastics (p <.05). Patients who used elastics for less than 6 months had statistically significantly higher PHQ‐9 scores than those who used elastics for more than 6 months (p <.05). Conclusions: Orthodontic treatment may affect occlusion, bite force and jaw movement, which may cause or worsen TMD symptoms, and the DC/TMD questionnaires can determine if orthodontic patients acquire TMD by assessing their psychosocial state and pain‐related problems. [ABSTRACT FROM AUTHOR]

SUMMARY: Objective: To review the materials and fabrications methods of occlusal splints with their advantages and shortcomings and to clarify the indications for each. Background: Temporomandibular joint disorders (TMDs) encompass a range of conditions affecting the masticatory system. Occlusal splints are currently recognised as a viable option for the management of TMDs when they are adopted in conjunction with additional approaches varying from conservative procedures (counselling, biofeedback, physical therapy, pharmacotherapy) to irreversible and less conservative ones (occlusal adjustments, orthodontics, arthroscopy and surgery). These splints can vary in design, function and material. The components used to fabricate the splints must withstand occlusal forces, be aesthetically pleasing, comfortable and minimally interfering with function and phonetics. Traditional methods for fabricating splints include sprinkle‐on, thermoforming and lost wax techniques. However, with the advancement of CAD/CAM technology, additive (3D printing) and subtractive (milling) manufacturing methods expand the range of possibilities by introducing novel solutions for elaborating splints. Methods: An electronic search was conducted on PubMed using the following keywords: "occlusal splint", "guard and "materials", and "manufacturing." Thirteen in vitro publications were screened and they consisted of four clinical studies, nine reviews (three of them were systematic reviews), and five case reports. Conclusion: The choice of material is crucial for the success of splint therapy. Factors such as biocompatibility, ease of fabrication, adjustability, cost and patient preference should be considered. Newer materials and techniques are emerging because of advancements in material science and manufacturing techniques. However, it should be noted that most of the evidence is based on in vitro studies with different methodologies, limiting their validity in daily practice. [ABSTRACT FROM AUTHOR]

Background: The assessment of masticatory performance (MP) is conducted in hospitals, but is difficult to perform in nursing facilities that lack specialists in dysphagia. To select the appropriate food textures in nursing practice, a simple method of evaluating the MP should be developed. Objective: The purpose of this study was to investigate motion parameters that influence MP by motion capture analysis of maxillofacial movement on chewing gummy jelly in healthy adults. Methods: The subjects were 50 healthy adults. The state of chewing gummy jelly was photographed using a high‐speed camera. Simultaneously, we evaluated the amount of glucose extracted (AGE) obtained with gummy jelly as a reference value for MP. The subjects were divided into two groups: normal and low masticatory groups (NG and LG, respectively) based on the AGE. The cycle of mastication was classified into three phases: closing phase (CP), transition phase (TP) and opening phase (OP) through motion capture analysis of the video photographed. Parameters of jaw movement and their associations with the AGE were examined. Results: The transition phase rate (TR) and opening phase rate (OR) were correlated with the AGE. Furthermore, the TR in the NG was significantly higher than in the LG, whereas the OR was significantly lower than in the LG. The age, TR and opening velocity were significant independent variables. Conclusion: Motion capture technology facilitated the analysis of jaw movement. The results suggested that MP can be evaluated by analysing the TP and OP rates. [ABSTRACT FROM AUTHOR]

Background: Myotonic dystrophy type 1 (DM1) is a neuromuscular multisystem disease. Early involvement of facial muscles may produce an extra load on the temporomandibular joint (TMJ) in DM1. Objectives: This study aimed to investigate the morphological analyses of the bone components of temporomandibular joint (TMJ), and dentofacial morphology in myotonic dystrophy type 1 (DM1) patients by cone‐beam computed tomography (CBCT). Methods: Sixty‐six individuals (33 DM1, and 33 healthy subjects) age ranging from 20 to 69 were included in the study. Clinical examinations of the patients' TMJ regions and evaluation of dentofacial morphology (maxillary deficiency, open‐bite, deep palate and cross‐bite) were performed. Dental occlusion was determined based on Angle's classification. CBCT images were evaluated regarding mandibular condyle morphology (convex, angled, flat and round) and osseous changes observed in the condyle (normal, osteophyte, erosion, flattening, sclerosis). DM1‐specific morphological and bony TMJ alterations were determined. Results: DM1 patients showed a high prevalence of morphological and osseous TMJ changes, and statistically significant skeletal alterations. The analysis of CBCT scans indicated the prevalent condylar shape among patients with DM1 was flat, the main osseous abnormality was flattening, there was a tendency towards skeletal Class II and a posterior cross‐bite was frequently detected in DM1 patients. There was no statistically significant difference between the genders on the parameters evaluated in both groups. Conclusion: Adult patients with DM1 presented a high frequency of crossbite, tendency to skeletal Class II and morphological osseous alterations of TMJ. The analysis of the morphological condylar alterations in patients with DM1 may be beneficial in the diagnosis of TMJ disorders. This study reveals DM1‐specific morphological and osseous TMJ alterations to provide an appropriate orthodontic/orthognathic treatment planning to patients. [ABSTRACT FROM AUTHOR]

Background: Dental malocclusions may cause disruption in occlusal harmony, and destructive interferences during mandibular functional movements can be seen. Ideal occlusal contacts during dynamic mandibular movements may be crucial for preventing the occurrence of mid‐buccal gingival recession (mbGR). While determining mbGR risk factors in young adults, the effect of occlusal interferences on mbGR has not yet been focused on. Based on this gap, this field needs to be clarified with new studies. Objective: The aim of this case–control study was to evaluate the relationships between the presence, extent and severity of mbGRs to dental malocclusions, occlusal interferences in anterior (AG) and lateral guidance (LG) and to determine the potential risk indicators in a young population. Methods: A total of 149 dental students were comprised and 70 of them presented mbGR(s) and 79 did not (18–25 years, 4553 teeth). Periodontal status was assessed with full mouth bleeding (FMBS) and plaque score (FMPS), probing depth, clinical attachment level, recession depth and keratinised tissue width (KTW) by a periodontist. Malocclusions and occlusal interferences were evaluated by an orthodontist. Logistic regression analyses provided data on the effect of occlusal interferences and the other indicators towards mbGR. Results: The mean of the number of teeth with mbGR(s) per subject was 4.3. The mean of the overall extent of teeth with mbGR(s) was 14.2%. FMBS, decreased KTW, self‐reported bruxism, group function occlusion, increased contact number of all teeth and only premolars/molars in AG or LG and Class III malocclusions were significantly associated with the presence of mbGR. Decreased KTW presenting mbGR in the mandible and non‐carious cervical lesion adjunct to mbGR significantly increased the odds of the severity of mbGR. Group function occlusion revealed higher mbGRs in premolar/molars than canine guided occlusion. Conclusion: Increase in the occlusal interferences in premolars/molars during lateral and anterior guidance may have an effect on the presence and severity of mbGR. Further studies should be designed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Anterior repositioning splint (ARS) is used to treat temporomandibular joint (TMJ) disc displacement with reduction (DDwR). However, high recurrence rate remains a problem especially in patients with unstable occlusions. Objective: This study optimised standard ARS therapy and proposed a step‐back ARS retraction (SAR) method in adult patients with DDwR. Methods: Dental examinations and magnetic resonance imaging of TMJ were obtained before treatment (T0), 1 to 3 months (T1), 3 to 6 months (T2) and 6 to 12 months (T3) during treatment in 48 adults (average age 27.1 ± 5.7 years). After 3 months of basic ARS wearing, personalised treatment for patients with normal disc–condyle relationship was prescribed depending on bilaminar zone adaptations and severity of molar openbite. SAR which required sequential ARS wearing was designed for patients with deep overbite/overjet until retrodiscal tissue adaptations and stable occlusions were achieved. Results: The maximum interincisal opening was increased from 44.3 ± 6.9 to 45.3 ± 6.3 mm (p <.01), and joint pain was alleviated after ARS treatment. The overall success rate of ARS wearing was 92.1% (58/63) featured by a recaptured disc. Fifteen patients who underwent SAR therapy all showed bilaminar zone adaptations in the end, and one patient had positive condylar bone remodelling. Conclusions: ARS treatment could improve mouth opening and joint symptoms in adult DDwR patients. SAR method was suitable for treating DDwR patients with deep overbite and overjet and improved retrodiscal tissue adaptations and condylar bone remodelling. [ABSTRACT FROM AUTHOR]

Background: Clinical use of botulinum neurotoxins (BoNTs) in masticatory muscles is usually bilateral, but most studies on the functional consequences of BoNT treatment have used unilaterally treated animals. Objectives: To test the hypothesis that bilateral BoNT treatment of the rabbit masseter hampers mastication and to assess its effects on bone density of the mandibular condyles. Methods: Ten 5‐month‐old female rabbits received injections of BoNT into both masseter muscles and nine sham animals received saline. Body weight, incisor bite force during masseter tetany, and surface and fine‐wire electromyography (EMG) of the masseter and medial pterygoid muscles were assessed at regular intervals. Half the sample was terminated after 4 weeks and the remainder after 12 weeks. Muscles were weighed and mandibular condyles were scanned with microCT to analyse bone density. Results: BoNT rabbits lost weight and required a soft‐food diet. Incisor occlusal force plummeted after BoNT injection and remained lower than the shams. The duration of masticatory cycles was increased in the BoNT rabbits for 5 weeks, with most of the increase due to the adductor burst. Masseteric EMG amplitude began to improve at Week 5, but remained low on the working side throughout the experiment. At the 12‐week endpoint, masseter muscles were smaller in the BoNT rabbits. Medial pterygoid muscles did not compensate. Condylar bone density was reduced. Conclusion: Bilateral treatment of the rabbit masseter by BoNT severely affected chewing performance. Even after a 3‐month recovery period, deficits remained in bite force, muscle size and condylar bone density. [ABSTRACT FROM AUTHOR]

Background: Masticatory dysfunction impacts food selection, nutritional intake and social activities; all of which play a vital role to ensure good general health and quality of life. Despite the rapidly ageing population, there is limited evidence regarding the risk factors that lead to masticatory dysfunction in older adults or protective factors which may help maintain masticatory ability. Furthermore, there is currently no consensus for a specific test which measures masticatory ability. Objectives: The objectives of this scoping review are to identify the risk and protective factors associated with masticatory dysfunction and determine the most commonly used objective measure of masticatory performance. Design: A scoping review was performed using the PRISMA recommendations. MEDLINE (Ovid), Embase, Scopus and Web of Science databases were searched. Seventy‐eight articles were included in this review. There were six randomised controlled trials, six interventional studies, one systematic review, one quasi‐experimental study, five prospective cohort studies, 58 cross‐sectional studies and one case–control study. Data were analysed for frequency of studies reporting on risk factors, protective factors and/or objective measures of masticatory performance. Results: This scoping review identified tooth loss as the most common risk factor for masticatory dysfunction. Other notable risk factors included musculoskeletal conditions such as frailty and sarcopenia, cognitive decline and malnutrition. Additionally, the review identified that the presence or addition of teeth was the main protective factor. Other protective factors included denture maintenance via liners and adhesives, textured foods, and oral exercises. Chewing gum was the most common objective measure of masticatory function, followed by the occlusal force and sieve methods. Conclusions: This scoping review found that there was limited evidence for a causal link between each of the risk factors and masticatory dysfunction or the protective factors and the maintenance of masticatory ability in older adults. Establishing a standard method for measuring masticatory performance such as the commonly used chewing gum method and encouraging clinicians to routinely measure masticatory function will enable comparisons across multiple risk and protective factors, improving the evidence base and contributing to better patient care. [ABSTRACT FROM AUTHOR]

Background: Digital occlusal splint is a novel approach in the treatment of temporomandibular disorders (TMD) and there is a lack of evaluation. Objective: To introduce Kovacs digital occlusal splint (KDOS) and evaluate its clinical and magnetic resonance imaging (MRI) outcomes and influencing factors in the treatment of TMD. Patients and Methods: Patients diagnosed of TMD by MRI and treated with KDOS from June 2020 to December 2021 were retrospectively reviewed. They were divided into three groups: anterior disc displacement with reduction (ADDwR), anterior disc displacement without reduction (ADDwoR) and ADDwoR + osteoarthritis (ADDwoR + OA). Visual analogue scales (VAS) scores of pain, diet, mandibular function, quality of life (Qol) and maximum interincisal opening were compared before and at least 8 weeks after treatment. Binary logistic regression was used to analyse the influence of four factors including age, gender, Wilkes stage and the severity of symptoms on treatment. MRI was used to evaluate the condylar bone status and disc length after at least 3 months treatment. Results: One hundred and eighty‐four patients were included in the study. The average age was 30.9 ± 14.2 years and the average follow‐up was 19.8 ± 10.0 weeks. Pain, diet, mandibular function and Qol were all significantly improved after KDOS treatment (p <.05), with the effective rates of 71.6%, 56.4%, 55.3% and 54.1%. Binary logistic regression showed that higher probabilities of improvement were related to the patients with older age, ADD without OA and higher VAS scores before treatment. MRI showed that 94.1% of the condylar bone status remained stable or improved and the disc length was unchanged after treatment. Conclusion: KDOS is effective for the treatment of TMD. Older age, ADD without OA and higher VAS scores before treatment had better results. [ABSTRACT FROM AUTHOR]

Background: The literature is unclear about bite force (BF) and handgrip force (HF) in a specific group of different ages and dentate conditions, or even a predictive model for each specific group, using BF and HF as factors. Objective: To establish the correlation between HF and BF in female participants with distinct ages and dentate conditions; also create a predictive model of BF as a function of HF. Methods: Participants were divided into three groups (GI: young natural dentate women, n = 65; GII: adult natural dentate women, n = 67; and GIII: edentulous women users of bimaxillary complete dentures, n = 67) and subjected to an HF measurement test using a digital dynamometer. Subsequently, BF was measured using a digital gnathodynamometer in the molar region. Pearson correlation coefficient (r) and multivariate analysis of variance (α = 0.05) were performed, and simple linear regression was used to obtain a model to predict BF from HF for each group separately (α = 0.05). Results: All groups presented moderate and strong correlations among the variables (GI: r = 0.838; GII: r = 0.714; GIII: r = 0.646). A significant difference in BF was observed (GI > GII > GIII; p <.05). GIII presented a significantly lower HF than the other groups (p <.05). Besides, three equations predicting BF, using HF, were obtained for use in young/adult dentate and edentulous women. Conclusion: All groups found a positive and significant correlation between BF, HF and groups. HF can be a simple and efficient method for predicting BF using the predictive models developed for women with good health. [ABSTRACT FROM AUTHOR]

Background: This study aimed at investigating the effect of loose teeth on the accuracy of occlusal records by comparing the differences in the number of occlusal contact points, occlusal contact area and the centre of the occlusal contact region under different occlusal forces in patients with periodontitis. Objective: The effects of different occlusal forces on the occlusal contact point (OCP), occlusal contact area (OCA) and the centre of occlusal contact region (OCC) of loose teeth. Methods: Occlusal training was performed on the 30 patients who completed periodontal serial treatment. One doctor took the occlusal records with silicone rubber and the T‐scan system; the patients were digitally scanned intraorally by a technician. The data of the healthy teeth were recorded as the control group, and the data of the loose teeth were recorded as the experimental group. Then, we used Image J to measure the numbers of OCP and OCA and Auto CAD to calculate the coordinates of OCC. A paired t test was used to analyse whether the differences in OCP, OCA and OCC were statistically significant when the occlusal forces were different. Results: The OCA of all three experimental methods increased under heavy occlusal force (p <.01), and the silicone rubber OCA increased the most. The OCC of all three experimental methods was shifted in the buccal and mesial (p <.01). And the occlusal records obtained by the T‐scan system showed a low correlation between the differences of OCA and OCC. Conclusion: Whether the teeth were loose or not, the OCA increased under heavy occlusal forces. For patients with loose teeth, the OCC was shifted towards the buccal under heavy occlusal force. [ABSTRACT FROM AUTHOR]

Background: Evaluating occlusal contacts during maximum intercuspation is one of the requirements for guiding clinicians during occlusal corrections and has been a topic of considerable importance for researchers over many decades. Objective: This systematised review intends to evaluate the average number of occlusal contacts present in dentate adults, as documented within the dental literature over the past four decades (1980s–2022). Methodology: Electronic searches were conducted in three databases (PubMed, Livivo and Ovid) using a combination of search words. Results: A total of 651 records were identified through PubMed and another 37 records through Livivo and Ovid databases. After eliminating duplicates and irrelevant records, 168 records were screened. Full texts of 61 articles remained, out of which 18 relevant papers that presented occlusal contacts in quantifiable value were considered. Various occlusal indicators, such as articulating paper, wax sheets, shimstock foil, impression material, gnathodynamometers and digital occlusal analysis systems, were used to evaluate occlusal contacts. The number of occlusal contacts widely ranged from 11 to 70. These variations likely depends upon the type and technique of occlusal indicator used, diversity among sampled populations and differing data collection procedures. Conclusion: Different methods of identifying occlusal contacts in the intercuspal position yield different numbers and patterns of contacts, depending on the nature and physical properties of the indicators used. [ABSTRACT FROM AUTHOR]

Background: One of the main goals of orthognathic surgery is to improve the masticatory performance in patients with maxillofacial deformities. Objective: The aim of this study was to evaluate the literature on assessing masticatory performance before, after orthognathic surgery and normal occlusion. Methods: An electronic search was performed via Pubmed, Scopus, LILACs and Web of Science without any restrictions until June 2022. The articles assessing masticatory performance using a comminution assay, bite force or occlusal contact area in patients undergoing orthognathic surgery with or without comparing controls were included. The risk of bias of the selected articles was assessed using the appropriate tools according to the study design. Results: Of the 2507 records identified, 21 studies were included in the qualitative evaluation and 17 studies in the meta‐analysis. Nine articles were cohort studies, and the other eight were before–after studies. Moderate to high risks of bias were found among the articles. Comparing the values before and after surgery, the meta‐analysis revealed a significant improvement in the bite force and occlusal contact area at 1‐ and 2‐year post‐surgery. However, regardless of the assessed parameters, the masticatory performance in patients with normal occlusion was significantly greater than those in patients undergoing orthognathic surgery at all evaluated time points. Conclusion: Although combined surgical orthodontic treatment can improve impaired masticatory function, assessed by the comminution method, bite force and occlusal contact area, the improvement may not reach that of normal occlusion. [ABSTRACT FROM AUTHOR]

Background: Loss of teeth is common among residents in long‐term care facilities (LTCF). To maintain occlusal support, lost teeth may be replaced with removable dentures. Objectives: The relationship of occlusal status with health‐related quality of life (HRQoL) was evaluated. Methods: A cross‐sectional FINORAL study (FINnish ORAL Health Studies in older adults), including comprehensive geriatric assessment, was performed in LTCF. Demographic and medical information was retrieved from medical records. HRQoL was assessed with the 15D instrument and nutritional status with Mini‐Nutritional Assessment (MNA). A standardised questionnaire filled in by trained nurses collected information on need for assistance in personal care or mobility, eating, and food consistency and swallowing difficulties. Clinical oral examination focusing on occlusal status was conducted for 338 residents. Four study groups (Gr) were established: Gr1 ≥ 10 natural teeth occlusal contact units (CU) (N = 51), Gr2 < 10 natural teeth CU (N = 87), Gr3 having CU of removable denture/s with or without natural teeth (N = 89), and Gr4 no CU (N = 111). Results: 15D index score (adjusted for age, sex, MNA, and Charlson comorbidity index) showed higher HRQoL in Gr1 and Gr3; Gr1 participants had significantly higher crude values in mobility and Gr3 participants in eating, speech, and mental function than the other groups. Differences were present between the study groups in nutritional status, swallowing difficulties, and need for assistance in eating and mobility. Conclusion: Occlusal status of partial or complete denture/s with or without natural teeth or natural teeth having 10 or more occlusal CU was associated with higher HRQoL than other statuses. [ABSTRACT FROM AUTHOR]

Background: Previous studies concerning the effect of botulinum toxin in masseter muscle have mainly reported effects observed through inspection of facial features or differences in pain levels. One systematic review of studies utilizing objective measurements reported that long‐term muscular effect of botulinum neurotoxin injections into masseter muscle was inconclusive. Objective: To evaluate the duration of reduced maximal voluntary bite force (MVBF) after botulinum toxin intervention. Methods: The intervention group was comprised of individuals seeking aesthetic treatment for masseter reduction (n = 20), the reference group (n = 12) comprised of individuals with no intervention. Intervention through 25 units of Xeomin® (Merz Pharma GmbH & Co KGaA, Frankfurt am Main, Germany) botulinum neurotoxin type A injected into the masseter muscles bilaterally (totalling 50 units). A reference group did not receive any intervention. MVBF was measured in Newtons using a strain gauge meter at the incisors and first molars. MVBF was measured at baseline, at 4 weeks, 3 months, 6 months, and after 1 year. Results: Both groups were similar in terms of bite force, sex and age at baseline. MVBF remained similar compared to baseline in the reference group. At 3 months, a significant reduction at all measurement points was observed in the intervention group; at 6 months, this reduction was no longer significant. Conclusion: A single intervention of 50 units of botulinum neurotoxin results in a reversible MVBF reduction of at least 3 months, although a visually discernable reduction may be more long‐lasting. [ABSTRACT FROM AUTHOR]

Background: Evaluation of a new vertical dimension of occlusion (VDO) in complex restorative treatments is considered a necessary step prior to placement of restorations. Objectives: This randomised controlled trial (RCT) aimed to assess the effects of using an evaluation of a VDO increase before restorative treatment in patients with moderate‐to‐severe tooth wear, on OHRQoL, freeway space (FWS) and interventions to restorations. Methods: Forty‐two patients with tooth wear were included and randomly allocated to either a test phase with a Removable Appliance (RA) or no test phase. Restorative treatment consisted of restoration of all teeth using composite restorations in an increased VDO. OHIP‐score, freeway space (FWS) and clinical acceptability of restorations were assessed at baseline and at recall appointments (1 month and 1 year). Intervention to restoration was scored in case of material chipping or when the abutment tooth had increased sensitivity that could be linked to occlusal overloading. ANCOVA analyses, Univariate Cox regression, t‐tests and descriptive analyses were performed (p <.05). Results: Clinical follow‐up after 1 year was completed for 41 patients. No significant effect of testing the VDO with a RA could be found on the OHIP‐score (p =.14). Reduction of FWS in the RA group, compared to the control group, was significantly lower at 1 year (p =.01, 95% CI −1.09 to −0.15). No effect on early interventions to restorations was found (p =.94). Conclusion: This RCT showed that a removable appliance is not indicated to functionally test the increased VDO prior to restorative treatment in patients with tooth wear. [ABSTRACT FROM AUTHOR]

Background: Although jaw asymmetry is commonly seen in skeletal Class III patients, its correlation with occlusal function and masticatory muscle activity has not been fully elucidated. Objectives: The purpose of this study was to investigate the occlusal function and masticatory muscle activity in skeletal Class III patients with various patterns of mandibular asymmetry. Methods: Forty‐two patients and 10 normal participants were examined. The patients were categorised into three groups. Groups 1 and 2 exhibited menton and ramus deviation to the same side. Menton deviation was larger than ramus deviation in Group 1, whereas Group 2 showed the inverse relation. Group 3 patients showed menton and ramus deviation in opposite directions. Occlusal contact area (OCA), relative bite force (RBF), and temporalis anterior (TA) and masseter muscle (MM) activity at maximum clenching were measured using T‐Scan Novus system and Bio‐EMG‐III. Statistical analysis was performed using the t‐test, one‐way analysis of variance with Bonferroni correction and Spearman correlation (α =.05). Results: Compared with normal participants, the patients had smaller OCA and greater asymmetry in the distribution of masticatory muscle activity. Greater ramus deviation was associated with smaller OCA in Group 1 but with larger OCA in Group 3. In Group 1, greater menton deviation was related to stronger TA activity on the non‐deviation side. In Group 2, greater ramus deviation was related to stronger MM activity on the deviation side. Conclusion: Deviation of the menton and ramus was individually related to OCA and masticatory muscle activity, and this relationship varied according to the pattern of mandibular asymmetry. [ABSTRACT FROM AUTHOR]

Background: During the mixed dentition period, masticatory performance may temporarily decline as deciduous teeth are replaced by permanent teeth. This may lead to an insufficient intake of chewy foods. Objectives: This study aimed to clarify the characteristics of factors that affect masticatory performance during the dentition exchange period. Methods: The participants were 229 students in grades 4–6 who were in the lateral dentition exchange period. Shearing performance (SP) was evaluated using gummy jelly, and mixing performance (MP) was evaluated using colour‐changing gum. The chewing rate, occlusal force and area, number of teeth, Hellman's tooth age, Rohrer index, grip strength and walking speed were also evaluated. The χ2 test, Mann–Whitney test, Spearman's rank correlation coefficient and a generalised linear model were used for statistical analysis. Results: SP/MP showed a significant positive correlation with occlusal force, occlusal contact area and chewing rate for gummy jelly and gum but there was a difference in the strength of the correlation between boys and girls. Chewing rate for gummy jelly and gum showed a significant relationship with both SP and MP, suggesting that masticatory performance is higher with slower chewing. Maximum occlusal force was selected as a significant independent variable for SP, and Rohrer index was selected as a significant independent variable for MP. When the occlusal force was higher and the Rohrer index was lower, the masticatory performance tended to be higher. Conclusions: Our results suggest that masticatory performance during the dentition exchange period is higher with slower chewing and a stronger occlusal force, which may be related to obesity. [ABSTRACT FROM AUTHOR]

Background: Currently, there is a lack of data relating to dental practitioners' habits with clinical occlusal assessment and the application of practical techniques in occlusion. Objectives: The aim of this study was to investigate habits with clinical occlusal assessment and the practical application of established concepts in occlusion amongst a cohort of international dentists. Methods: A piloted questionnaire with 20 statements was distributed by 5 recruiters. The recruiters were based in Malta (1), South Africa (1), Malaysia (1) and the UK (2). Outcomes were analysed using descriptives, chi‐squared and Fisher's exact test. All the analyses were carried out in Stata, Version 12. Significance was inferred at p <.05. Results: Four hundred thirty‐five completed responses were included in the sample (response rate, 70.7%). Overall, high levels of agreement were reported with the provision of single‐unit crown and onlay restorations (78.8%) and bridge prostheses (up to 3 units, 77.9%), respectively. One‐third (33.6%) agreed to observing dynamic occlusal relationships during an adult patient dental examination, 40.7% reported using articulators for crown and bridge cases, and 25.1% agreed to taking facebow records. Under half (47.3%) of the dentists expressed dissatisfaction with their undergraduate training in occlusion, with no significant association with the variables of the number of years of experience, the country of practice or being in general practice (p ≥.226). Conclusion: The results indicate a disparity between traditionally taught and applied concepts in clinical occlusion and the undertaking of occlusal assessments and the management of occlusion in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Anterior bite planes are bite‐raising appliances used for deep bite correction. However, muscle responses to anterior bite planes of different harnesses may vary. Objectives: To prospectively evaluate masticatory muscle activity, muscle balance and maximum bite force (MBF) responses to anterior bite planes fabricated from acrylic resin (ABP) or bi‐laminate thermoplastic (TBP) over 6 months in children with a deep bite. Methods: Sixty‐six children were randomly assigned to the ABP, TBP or untreated control groups. Masticatory muscle activity, activity index (AC) and percentage overlapping coefficient (POC) were assessed by surface electromyography; MBF, using a custom‐made bite force sensor. Data were collected before, immediately after appliance insertion and after 2 weeks and 1, 3 and 6 months of treatment. Within‐ and between‐group differences were analysed using the one‐way ANOVA/Kruskal‐Wallis and Mann–Whitney U tests (α =.05); Friedman's tests were used to assess within‐group differences over time (α =.08). Results: At rest, no dependent variables changed throughout the study. At maximum clenching, masticatory muscle activity immediately dropped significantly but returned to baseline values and was equal to the control group at 1–3 months. The ABP group had significantly lower masseter activity and AC than the TBP group after insertion. Neither POC nor MBF were significantly different within or between groups. Conclusion: Masticatory muscle activity reduced after anterior bite plane insertion but returned to baseline after 1–3 months. Masseter activity decreased significantly more in the ABP group than TBP group. Neither appliance significantly affected POC or MBF. Clinical trial registration: Thai Clinical Trial Registry (TCTR20210330002). [ABSTRACT FROM AUTHOR]

Background: Ehlers‐Danlos syndrome (EDS) is a hereditary disorder that affects the connective tissue and collagen structures in the body characterised by joint hypermobility, skin hyperextensibility and tissue fragility. Objective The aim was to investigate temporomandibular disorders (TMD), bite force, teeth in occlusal contact and osseous changes of the temporomandibular joints (TMJs) in 26 patients with hypermobile EDS (hEDS), differentiated by a genetic test, compared to 39 healthy controls. Methods: Clinical examination according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), radiological examinations of the TMJs by cone‐beam‐computed tomographic (CBCT) scans, registration of bite force and teeth in occlusal contact was performed. Statistical analyses included Fisher's Exact Test, multiple logistic and linear regression models adjusted for age, gender and Body Mass Index (BMI). Results: Single symptoms and signs of TMD occurred significantly more often in hEDS (p =.002; p =.001; p =.003; p = <.0001; p =.012) and maximum mouth opening was significantly smaller in hEDS compared to controls (p = <.0001). The DC/TMD diagnosis myalgia, myofascial pain with referral, arthralgia, headache attributed to TMD, disc displacement disorders and degenerative joint disease occurred significantly more often in hEDS compared to controls (p =.000; p =.008; p =.003; p =.000; p = <.0001; p =.010, respectively). No significant differences were found in bite force and in teeth in occlusal contact between the groups (p >.05). On CBCT of the TMJs, subcortical sclerosis occurred significantly more often in hEDS compared to controls (p =.005). Conclusion: Symptoms and signs of TMD and osseous changes of the TMJs occurred significantly more often in hEDS. Bite force and teeth in occlusal contact were comparable to controls. [ABSTRACT FROM AUTHOR]

Background: Apical microsurgery (AMS) involves removal of the root‐end which can affect the force regulation of teeth. Objective: To investigate the force regulation of incisor teeth treated with AMS during the unpredictable force control task in comparison with their contralateral teeth with complete root apices, in humans. Methods: Fifteen eligible participants (8 women and 7 men; mean age 52.9 ± SD 4.4 years) performed a standardised unpredictable force control task, which involved pulling and holding a force transducer with AMS‐treated incisors and their contralateral control teeth (n = 30 teeth). A series of four load masses: 100, 200, 50 and 300 gm were attached to the force transducer through a string in an unpredictable manner. The obtained force profile was divided into initial and later time‐segments. The peak force and peak force rate during the initial time‐segment, and the holding force and coefficient of variability during the later time‐segments were calculated and compared by the repeated measures analysis of variance. Results: During the initial time‐segment, the peak force and peak force rate were significantly lower in the AMS‐treated teeth than in the controls (p =.001, p =.013, respectively). However, during the later time‐segment, no significant differences in the holding force nor the coefficient of variability were observed between the AMS‐treated teeth and their controls (p =.755, p =.213, respectively). Conclusion: In contrast to incisors with complete normal root apices, AMS‐treated incisors do not show robust changes in force regulation. [ABSTRACT FROM AUTHOR]

The recent review article by Zonnenberg, Türp and Greene 'Centric relation critically revisited – What are the clinical implications'? opens an important debate by addressing topics of central relevance in Dentistry, namely the relationship between occlusion and the condyle‐to‐glenoid‐fossa position, and the need for diagnostic assessment and therapeutic alteration of the condylar position in orthodontic patients. Zonnenberg, Türp and Greene concluded that the mandibular condyle is correctly situated in most orthodontic patients. Thus, in their view, orthodontists can disregard this aspect during treatment, and rely on the plastic properties of the masticatory supporting structures, while aiming at finishing the cases in a good occlusal relationship. We think that this approach fails to consider that biological variation of the stomatognathic structures can also be pathological and that, as dental occlusion determines condylar relative position within the glenoid fossa, changes in the occlusion are likely to alter the original condylar‐to‐glenoid‐fossa relation. Hence, we claim that whenever the occlusal relationship must be changed, the clinician should carefully monitor the condyle position and the mandibular function to prevent possible iatrogenic effects. To advance the discourse on the topic, we invite Zonnenberg, Türp and Greene to clarify their definition of 'average patient' and their interpretation of 'full‐mouth orthodontic and orthognathic treatment', their understanding of 'biologically acceptable condylar relationship', their justification of maximum intercuspation as reference position, the extent to which they think it is safe to rely on the TMJ resilience, and finally their alternative to centric relation in the treatment of patients needing condylar repositioning. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the correlation between occlusal contact area and masticatory performance using BiteEye®, a photo occlusal analysis device and the multiple sieve method. Objectives: To calculate the occlusal contact area at various levels of interocclusal thicknesses and to measure masticatory performance with peanuts as the test material. Methods: Fifty‐two adults (30 men and 22 women) were enrolled according to specific exclusion/inclusion criteria. The occlusal contact area was measured by obtaining the interocclusal record of the maximum intercuspal position (MIP) using silicone impression material. Occlusal contact area measurements were performed in the ranges of 0–149, 0–89, 0–59, 0–29 and 0–9 μm. Masticatory performance was measured by obtaining the median particle size (X50) after converting the weight of comminuted peanuts into size using the multiple sieve method. Statistical analysis was performed at 95% significance level. Results: Interocclusal thickness comparison revealed the highest correlation with X50 in the 0–149 μm range. Stronger correlations between the occlusal contact area and X50 were observed in cases of 20 strokes of mastication (r = −.451) than in cases of 10 strokes (r = −.383), in the posterior occlusal contact area (r = −.456) than in the full arch occlusal contact area (r = −.451) and the molar area (r = −.478) than in the premolar area (r = −.296). Conclusions: The larger the occlusal contact area, the higher the masticatory performance; this correlation was statistically significant. Regarding interocclusal thickness, the highest correlation between the occlusal contact area and masticatory performance was observed in the 0–149 μm range. Clinical Trial Registration Number: GWNUDH IRB 2020‐A001. [ABSTRACT FROM AUTHOR]

Background: The relationships between the frequency of masticatory side switches (MSS) and other aspects of masticatory function are not clear. Objectives: In this study, we determined the effect of MSS frequency on masticatory performance and rhythm in dentate adults and explored the between‐subject relationships among side switch frequency, masticatory rhythm and laterality. Methods: In this crossover study, subjects performed six masticatory patterns of five trials each, chewing bagged silicone for 20 cycles. The six patterns were freestyle, unilateral right, unilateral left, and switching sides one, three and five times. Masticatory performance and rhythm were determined for each style by median particle size (MPS) and chewing cycle duration, respectively. In the freestyle mastication pattern, masticatory laterality was assessed by the unilateral chewing index, and the frequency of MSS was assessed by the MSS Index. Data were analysed using Friedman's test and repeated measures analysis of variance. Results: We included 29 participants (15 women; median age, 23 years). No significant between‐subjects differences in the MPS were detected obtained by switching one, three or five times per trial. Chewing cycle duration increased with the MSS number per trial. During freestyle mastication, the MSS Index was inversely correlated with the unilateral chewing index (Rho −0.569; 95% CI −0.25 to −0.78; p =.001; Spearman test), but not with the MPS or chewing cycle duration. Conclusion: Differences in MSS frequency do not affect masticatory performance, but they do alter the masticatory rhythm. Individuals with a higher MSS frequency also have a more symmetrical chewing pattern. [ABSTRACT FROM AUTHOR]