Indian Journal of Health Sciences and Biomedical Research KLEU

ORIGINAL ARTICLE
Year
: 2017  |  Volume : 10  |  Issue : 3  |  Page : 262--268

The effect of periodontal status and occlusal support on masticatory performance: A cross-sectional study


Priyanka Subramanian Iyer, Vinayak Kumbhojkar 
 Department of Periodontics, KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India

Correspondence Address:
Priyanka Subramanian Iyer
82, Gangambika Hostel, JNMC Campus, Nehru Nagar, Belagavi, Karnataka
India

Abstract

Background: The destruction of periodontal tissue caused by periodontitis affects the sensory function of the periodontal ligament, reduces the mechanical support of teeth, and ultimately results in reduced masticatory performance in natural dentitions. Research on those who have lost a large number of teeth and the effect of periodontal status on masticatory ability remains unknown. Objective: The aim of the study was to assess the correlation between the effect of periodontal status and occlusal support on masticatory performance among various age groups. Materials and Methods: A total of 240 patients included in the study were divided into three groups according to the severity of periodontal disease and occlusal support as healthy controls– A1 (Group 1), moderate periodontitis– B1 (Group 2), and severe periodontitis– C1 (Group 3) based on Community Periodontal Index (WHO 1987) and Eichner's Index (Eichner 1990). They were further categorized into age groups of 20–30, 30–40, 40–50, and 50–60 years, and equal male to female ratio was maintained among all groups. The masticatory performance was assessed by making patients chew a test gummy jelly freely 30 times and expectorate it into a clean cup. To eliminate the remaining glucose sticking to the surface, it was subjected to running water for 5 min and spun in a magnetic stirrer (10 min, 400 rpm) till it completely dissolved. A small amount of the supernatant was collected, and glucose estimation was done using a glucometer. The glucometer values were subjected to statistical analysis. Results: There was a statistically significant decrease in the masticatory performance when Group 3 was compared to Group 2 and Group 1. In addition, there was a decrease in the masticatory performance among females compared to males and a progressive decline in the masticatory performance with advancing age. Conclusion: All groups showed a statistically significant decrease in the masticatory performance with increase in the severity of periodontal disease and decrease in occlusal support. In addition, there was a decrease in the masticatory performance with an increase in age and males showed a superior masticatory performance than females.



How to cite this article:
Iyer PS, Kumbhojkar V. The effect of periodontal status and occlusal support on masticatory performance: A cross-sectional study.Indian J Health Sci Biomed Res 2017;10:262-268


How to cite this URL:
Iyer PS, Kumbhojkar V. The effect of periodontal status and occlusal support on masticatory performance: A cross-sectional study. Indian J Health Sci Biomed Res [serial online] 2017 [cited 2019 Nov 15 ];10:262-268
Available from: http://www.ijournalhs.org/text.asp?2017/10/3/262/214002


Full Text



 Introduction



Oral health means more than just good teeth; it is integral to general health and essential to the overall well-being of an individual. The craniofacial complex allows an array of activities such as to speak, smile, taste, and also provides protection against microbial infections and environmental threats. Oral diseases hinder routine activities, and its psychosocial impact diminishes the quality of life. The health-care industry is thus aimed at reducing the burden of oral diseases that impact lives as well as elucidates the risk factors behind it. One such association can be made between the craniofacial complex and mastication to a globally leading oral affliction– periodontal disease.[1]

Mastication is the first stage of the digestive process. The periodontal ligament in health attaches the root of the tooth to the alveolar bone. It contains mechanoreceptors that signal information to the brain about forces which are exerted by the teeth, and these signals are involved in the neural control of masticatory actions, such as food holding, biting, and chewing. It provides information on the jaw relations and occlusal loads during food break down, adjusting the masticatory forces.[2],[3]

Periodontitis is a chronic, inflammatory disease of the supporting tissues of the teeth resulting in progressive loss of the periodontal ligament and alveolar bone and subsequent loss of attachment.[4] Thus, a diseased periodontal ligament affects the neural control of masticatory actions because of degradation or changes in its sensory function. This leads to a subsequent decrease in the masticatory ability of the patient.[5]

Factors other than periodontitis such as occlusal support, number of residual teeth, maximum bite force, salivary function, and sensory function are also important with regard to mastication. The ability to generate occlusal force is positively linked with masticatory performance and is often used as a proxy for its objective evaluation.[6],[7],[8],[9],[10],[11]

Increase in life expectancy increases tooth retention in older adults. Such demographic transition toward an aging society dictates the prevention of a decline in functioning in activities of daily living. However, the periodontal status of the retained teeth is often compromised due to old age. Hence, occlusal force is greatly reduced by the loss of the teeth and tooth contacts.[3],[12],[13],[14],[15],[16],[17]

Loss of periodontal supporting structures had an adverse effect on masticatory performance, and it improved in periodontitis patients when they were given treatment. These studies, however, addressed patients with natural complement of teeth, and very few studies have been undertaken investigating the effect of periodontal status on masticatory ability in patients with reduced occlusal support. Hence, the need for investigation among those who have lost a large number of teeth and how periodontal status affects the masticatory ability remains unknown. In addition, there exists a paucity of literature regarding the differences in masticatory ability in males and females.[2],[3],[17],[18],[19],[20],[21],[22]

It was hypothesized that pathways existed from dentition status to perceived chewing ability and that the severity of periodontal disease and occlusal support affected the masticatory performance in various age and gender groups.[23],[24] Hence, the aim of the study was to determine the effect of periodontal status and occlusal support on masticatory performance.

 Materials and Methods



A total of 240 patients were equally divided into healthy controls-A1 (Group 1), moderate periodontitis-B1 (Group 2), and severe periodontitis-C1 (Group 3) as eighty patients each. They were further subdivided equally into age groups 20–30 years, 30–40 years, 40–50 years, and 50–60 years of twenty patients each with equal number of males and females in each group.

In moderate periodontitis and severe periodontitis, there is an increase in the loss of attachment as compared to healthy controls, and hence, there is an increased propensity for reduced number of teeth. Hence, the three groups were healthy controls with full occlusal support (A1) – Group 1, moderate periodontitis with three posterior occlusal contacts present (B1) – Group 2, and severe periodontitis with no posterior occlusal contacts (C1) – Group 3.

Inclusion criteria

Group A: No history of dental treatment in the preceding 6 months including oral prophylaxis, Community Periodontal Index (CPI) Code 0 to >24, Group A1 of the Eichner index, equal numbers of men and women were takenGroup B: No history of dental treatment in the preceding 6 months including oral prophylaxis, CPI Code ≤2/≥34, Group B1 of the Eichner index, equal numbers of men and women were takenGroup C: No history of dental treatment in the preceding 6 months including oral prophylaxis, CPI Code ≤3/44, group C1 of the Eichner index, equal numbers of men and women were taken.

Exclusion criteria

History of any systemic disease, smokers, and patients consuming tobacco in any forms, pregnancy or lactation, use of antibiotics or mouth rinses in the previous 3 months, patients classified into Group A2, A3, B2, B3, B4, C2, and C3 of the Eichner index, patients wearing dentures, patients with disorders of the temporomandibular joint, and masticatory muscle pathology.

Methodology

Informed consent was obtained from all study participants before starting the study. The name, age, sex, chief complaint, occlusal status, and severity of periodontal disease were recorded for each participant in a pro forma. After recording the preliminary information, the clinical examination was carried out using a mouth mirror and a CPITN-C probe [Figure 1].{Figure 1}

Evaluation of occlusal support was based on Eichner index (Eichner, 1990) and diagnosis of healthy/moderate/severe periodontitis was done according to CPI of Treatment Needs (Cutress, Ainamo, Sardo-Infirri, 1987; WHO 1987) using a CPI probe by means of partial 10 index teeth recording. Masticatory performance was evaluated using test gummy jelly.

Information on loss of attachment may be collected from index teeth to obtain an estimate of the total periodontal tissue destruction. The most reliable way of examining for loss of attachment is to evaluate it after recording the CPI score.

Masticatory performance examination

The participants were first instructed to masticate a piece of test gummy jelly (Fruitella– Orange, Perfetti Van Melle, India Pvt., Ltd.,) freely 30 times without swallowing after which they expectorated the comminuted jelly into a cup [Figure 2] and [Figure 3]. The comminuted pieces were rinsed under running water for 5 min to remove as much of saliva and glucose as possible adhering to the surfaces.{Figure 2}{Figure 3}

The test gummy jelly was subsequently placed in a plastic container, and 100 ml of water was added to it. The contents were agitated for 10 min with a magnetic stirrer (Remi MS 500, Remi Labs) at 400 rpm [Figure 4]. Immediately after this agitation, a drop of the supernatant was collected and placed in contact with a glucometer strip (SD Codefree, blood glucose monitoring system) [Figure 5].[25],[26],[27],[28],[29]{Figure 4}{Figure 5}

Statistical analysis

Comparison of the three groups (Group 1, Group 2, and Group 3) and four age groups (20–30 years, 30–40 years, 40–50 years, and 50–60 years) with glucometer masticatory (mg/dl) scores by two-way ANOVA was done.

Pairwise comparison of three groups (Group 1, Group 2, and Group 3) and four age groups (20–30 years, 30–40 years, 40–50 years, and 50–60 years) with glucometer masticatory (mg/dl) scores by Tukey's multiple post hoc procedure was done.

Comparison of the three groups (Group 1, Group 2 and Group 3) and four age groups (20–30 years, 30–40 years, 40–50 years and 50–60 years) with glucometer masticatory (mg/dl) scores by two-way ANOVA was carried out in male and female population separately as well.

Correlation between ages with glucometer masticatory (mg/dl) in three groups by Karl Pearson's correlation coefficient method was done.

 Results



The correlation between the three groups divided according to the severity of periodontal disease to the glucometer masticatory scores was statistically significant (P = 0.0001) [Figure 6]. In addition, the correlation between the four age groups and glucometer masticatory scores were statistically significant (P = 0.0001) [Table 1].{Figure 6}{Table 1}

It was observed that among the male population, the correlation between the three groups– Group 1, Group 2, and Group 3 to glucometer masticatory scores was statistically significant (P = 0.0001) [Figure 7]. The correlation between the four age groups to the glucometer masticatory scores is statistically significant (P = 0.0001) [Table 2].{Figure 7}{Table 2}

Even among the female population, the correlation was statistically significant between the three groups (P = 0.0001) [Figure 8]. The comparison of the four age groups with the glucometer masticatory scores in female samples was statistically significant (P = 0.0023) [Table 3].{Figure 8}{Table 3}

There is a statistically significant correlation between progression of periodontal disease, occlusal support, and glucometer masticatory values.

 Discussion



“A healthy mouth is a gateway to a healthy body.”

Dentition plays a crucial role in maintaining the homeostasis of the human body. This is achieved by a wide number of factors, the efficient masticatory process being pivotal among them. Food that is appropriately masticated is adequately digested, and the micronutrients present within is completely assimilated within the body. Optimal periodontal health and number of teeth for the masticatory function are a prerequisite if the above process were to occur physiologically.[15],[30],[31]

We, therefore, decided to explore the influence of periodontal disease and the dentition status on the masticatory efficiency in the local population. We observed a gradual increase in the mean glucometer readings least being for the youngest age group among healthy controls and maximum for the oldest age group in the severe periodontitis group [Table 1]. This can be attributed to gradual reduction in the total number of teeth (as per Eichner's index) across the group as well as to the reduction in the tone and force of contraction of the masticatory muscles. This was further endorsed when intergroup comparison between moderate and severe periodontitis was made. The observations were found to be statistically significant. The significance tended to be directly related to the periodontal status among the three groups (A1 to C1 as per Eichner's index).[16],[32]

When pairwise intergroup comparisons were made we observed that all the four age groups with healthy periodontal status had a lower glucometer reading which was statistically significant [Table 2]. This emphasizes the role of a healthy periodontium in the optimal masticatory efficiency irrespective of age and gender.

Further, when pairwise comparison between moderate and severe periodontitis was made, a statistically significant correlation was observed only for the age group of 50–60 years of severe periodontitis [Table 3]. This can be attributed to the increased the loss of natural dentition in these individuals due to severity of the periodontal disease, thereby drastically diminishing their masticatory efficiency.

This observation was endorsed when interage group comparison among the severe periodontitis group was made [Table 4].{Table 4}

[Table 4] shows a positive age correlation with progressing disease severity among all the three age groups. This can be attributed to the negative synergy that exists among periodontal status of existing teeth, number of missing teeth (Eichner's index), and reduction in the tonicity of the masticatory musculature with advancing age.[32]

We can, therefore, infer from our study that loss of dentition or an increase in periodontal disease severity of the existing teeth severely impairs the masticatory efficiency of these individuals. This can be a chief cause for the various systemic and nutritional disorders that plague these populations. It is, therefore, imperative that oral rehabilitation as well as treatment of periodontal disease to restore a healthy periodontium is a must in the population at large, whether partially or totally edentulous.[30],[33]

 Conclusion



Within the limitations of the study, it can be concluded that the severity of periodontal disease and occlusal support affects the masticatory performance and that gender and age are variables which affect the masticatory activity to a lesser extent.

In light of the observations of our study, the following conclusions can be drawn:

There is a decrease in the masticatory performance with an increasing severity of periodontal disease and a reduced occlusal supportThere is a decrease in the masticatory performance with increasing ageThe masticatory performance in male patients is more as compared to female participants.

Further investigation to restoration of the masticatory efficacy postocclusal rehabilitation and treatment of periodontal disease shall endorse the observations of our study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century – The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.
2Johansson AS, Svensson KG, Trulsson M. Impaired masticatory behavior in subjects with reduced periodontal tissue support. J Periodontol 2006;77:1491-7.
3Kosaka T, Ono T, Yoshimuta Y, Kida M, Kikui M, Nokubi T, et al. The effect of periodontal status and occlusal support on masticatory performance: The Suita study. J Clin Periodontol 2014;41:497-503.
4Newman Mg, Takei HH, Klokkevold PR, Carranza FA. Carranza's Clinical Periodontology. Chicago: Saunders Elsevier, 2006.
5Pereira LJ, Gazolla CM, Magalhães IB, Ramos-Jorge ML, Marques LS, Gameiro GH, et al. Treatment of chronic periodontitis and its impact on mastication. J Periodontol 2011;82:243-50.
6Alkan A, Keskiner I, Arici S, Sato S. The effect of periodontitis on biting abilities. J Periodontol 2006;77:1442-5.
7Fueki K, Yoshida E, Igarashi Y. A structural equation model to investigate the impact of missing occlusal units on objective masticatory function in patients with shortened dental arches. J Oral Rehabil 2011;38:810-7.
8Lepley CR, Throckmorton GS, Ceen RF, Buschang PH. Relative contributions of occlusion, maximum bite force, and chewing cycle kinematics to masticatory performance. Am J Orthod Dentofacial Orthop 2011;139:606-13.
9Morita M, Nishi K, Kimura T, Fukushima M, Watanabe T, Yamashita F, et al. Correlation between periodontal status and biting ability in Chinese adult population. J Oral Rehabil 2003;30:260-4.
10Pereira LJ, Duarte Gaviao MB, Van Der Bilt A. Influence of oral characteristics and food products on masticatory function. Acta Odontol Scand 2006;64:193-201.
11Pereira LJ, Gazolla CM, Magalhães IB, Dominguete MH, Vilela GR, Castelo PM, et al. Influence of periodontal treatment on objective measurement of masticatory performance. J Oral Sci 2012;54:151-7.
12Ikebe K, Nokubi T, Morii K, Kashiwagi J, Furuya M. Association of bite force with ageing and occlusal support in older adults. J Dent 2005;33:131-7.
13Ikebe K, Morii K, Matsuda K, Nokubi T. Discrepancy between satisfaction with mastication, food acceptability, and masticatory performance in older adults. Int J Prosthodont 2007;20:161-7.
14Jankelson B, Hoffman GM, Hendron JA Jr. The physiology of the stomatognathic system. J Am Dent Assoc 1952;46:375-86.
15Moriya S, Notani K, Murata A, Inoue N, Miura H. Analysis of moment structures for assessing relationships among perceived chewing ability, dentition status, muscle strength, and balance in community-dwelling older adults. Gerodontology 2014;31:281-7.
16Okeson JP. Management of temporomandibular disorders and occlusion. 6th ed. St. Louis (MO): The CV Mosby Company; 2008.
17Takeuchi N, Yamamoto T. Correlation between periodontal status and biting force in patients with chronic periodontitis during the maintenance phase of therapy. J Clin Periodontol 2008;35:215-20.
18Alkan A, Keskiner I, Arici S, Sato S. The effect of periodontal surgery on bite force, occlusal contact area and bite pressure. J Am Dent Assoc 2006;137:978-83.
19Borges Tde F, Regalo SC, Taba M Jr., Siéssere S, Mestriner W Jr., Semprini M. Changes in masticatory performance and quality of life in individuals with chronic periodontitis. J Periodontol 2013;84:325-31.
20Kosaka T, Ono T, Kida M, Kikui M, Yamamoto M, Yasui S, et al. Amultifactorial model of masticatory performance: The Suita study. J Oral Rehabil 2016;43:340-7.
21Miyaura K, Matsuka Y, Morita M, Yamashita A, Watanabe T. Comparison of biting forces in different age and sex groups: A study of biting efficiency with mobile and non-mobile teeth. J Oral Rehabil 1999;26:223-7.
22Okiyama S, Ikebe K, Nokubi T. Association between masticatory performance and maximal occlusal force in young men. J Oral Rehabil 2003;30:278-82.
23Boven GC, Raghoebar GM, Vissink A, Meijer HJ. Improving masticatory performance, bite force, nutritional state and patient's satisfaction with implant overdentures: A systematic review of the literature. J Oral Rehabil 2015;42:220-33.
24Okada K, Enoki H, Izawa S, Iguchi A, Kuzuya M. Association between masticatory performance and anthropometric measurements and nutritional status in the elderly. Geriatr Gerontol Int 2010;10:56-63.
25Hayakawa I, Watanabe I, Hirano S, Nagao M, Seki T. A simple method for evaluating masticatory performance using a color-changeable chewing gum. Int J Prosthodont 1998;11:173-6.
26Hidaka O, Iwasaki M, Saito M, Morimoto T. Influence of clenching intensity on bite force balance, occlusal contact area, and average bite pressure. J Dent Res 1999;78:1336-44.
27Ikebe K, Hazeyama T, Morii K, Matsuda K, Maeda Y, Nokubi T. Impact of masticatory performance on oral health-related quality of life for elderly Japanese. Int J Prosthodont 2007;20:478-85.
28Ikebe K, Matsuda K, Murai S, Maeda Y, Nokubi T. Validation of the Eichner index in relation to occlusal force and masticatory performance. Int J Prosthodont 2010;23:521-4.
29Nakatsuka Y, Yamashita S, Nimura H, Mizoue S, Tsuchiya S, Hashii K. Location of main occluding areas and masticatory ability in patients with reduced occlusal support. Aust Dent J 2010;55:45-50.
30N'gom PI, Woda A. Influence of impaired mastication on nutrition. J Prosthet Dent 2002;87:667-73.
31Magalhães IB, Pereira LJ, Marques LS, Gameiro GH. The influence of malocclusion on masticatory performance. A systematic review. Angle Orthod 2010;80:981-7.
32Hiiemae K, Heath MR, Heath G, Kazazoglu E, Murray J, Sapper D, et al. Natural bites, food consistency and feeding behaviour in man. Arch Oral Biol 1996;41:175-89.
33Peter S. Essentials of Public Health Dentistry (Community Dentistry). 3rd ed. New Delhi: Arya Publications, 2008.