Jourtial of Oral Rehabilitation, 1976, Volume 3, pages 57-67

Masticatory function—a review of the literature

III. Masticatory performance and efficiency

J. F. BATES, G. D. STAFFORD and k. HARRISON Dental School,

The Welsh National School of Medicine, Cardiff, Wales

Summary
A review and evaluation of the literature on mastication has been undertaken. Part 1*
discusses the form of the masticatory cycle in the natural and artificial dentitions,
including the controversial question of whether tooth contact occurs during function.
Part l i t reviews the literature concerning the speed of movement of the mandible,
rate of chewing, and the forces developed in chewing. Part 111 describes masticatory
efficiency and performance, the effect of food on masticatory function, and incorporates
a summary of all these three papers.

Masticatory performance and efficiency

The ability of the masticatory apparatus is measured in two ways; firstly, by assessing
the particle size distribution of food when chewed for a given number of strokes—the
Masticatory Performance, and secondly, by counting the number of masticatory strokes
required to reduce food to a certain particle size—the Masticatory Efficiency. The early
work of Christiansen (1924), Baiters (1928), Gelman (1933), Thompson (1937), Ascher
(1938). Dahlberg (1942. 1946), and others reviewed by Manly & Braley (1950) utilized
fractional sieving as a means of separating out the portions of food after chewing.
This technique has remained the method of choice and. with minor variation, is
still used. The test foods have varied and have included artificial food such as standard
sizes of formalin hardened gelatin, and a very wide range of natural foods. The
endeavours to obtain uniformity of quality of food have varied and have proved a
difficult problem. The types of foods used have led to variations in the results, because
of inherent properties and solubility. Manly (1951) devised a table from which masti-
catory efficiency could be determined for any given food platform area and molar
imprint length.

Test foods
Yurkstas & Manly (1950) developed a method of estimating masticatory performance
based upon a determination of the volume percentage of chewed food which will pass
* Published in thQ Journal of Oral Rehabilitation (1975), 2, 281.
"i" Published in the Journal of Oral Rehabilitation (1975), 2, 349.
Correspondence; Professor J. F. Bates, Dental School, Welsh National School of Medicine, Heath
Park, Cardiff CE4 4WY, Wales.

57
58 ./. F. Bates, G. D. Stafford atul A. Harrison

through a five or ten mesh screen after a given number of masticatory strokes. Using
this method they assessed the value of different test foods in masticatory performance
tests. Thirty-five different foods were used. They found that persons with natural teeth
had significant correlations between their performances with soft and tough foods, and
thus only one food is needed for measuring masticatory ability. Denture wearers did
not correlate in this way and tests with both types of foods are required for charac-
terization of their masticatory function. They concluded, therefore, that peanuts,
carrots or ham provided similar information in relation to mastication tests for
persons with a natural dentition, but that denture wearers do not masticate these foods
equally well, and that tests with ham and carrots are required.
On the other hand. Manly & Braley (1950) tested the suitability of salted peanuts,
shredded coconut, carrots and raisins for sieve analysis. Twenty per cent ofthe weight
of peanuts was lost by swallowing, solution, emulsification. or by loss of moisture
content. Shredded coconut lost 40",, and carrots and raisins 90%. They concluded
that carrots and raisins were not suitable for study when using methods of gravimetric
sieve analysis.
In subsequent studies on chewing, various test foods have been used; peanuts being
the most popular choice. The lack of correlation between soft and hard foods in
complete denture wearers led to a further study by Kapur, Soman & Yurkstas (1964) to
determine the procedures and the test foods that would be most reliable for measuring
the masticatory performance of denture wearers. They used the method of determina-
tion described by Yurkstas & Manly (1950), and found that in those subjects mastica-
tion was a non-preferential process wherein particles of all sizes are ground at random.
In the natural dentition, coarse particles are ground more rapidly than fine particles as
chewing proceeds. They concluded, in contrast to Yurkstas & Manly (1950) and
Manly & Braley (1950), that raw carrot was a suitable and reliable single test food for
the complete denture wearer.

Effect of loss of dentition

Dahlberg (1942), using hardened gelatin, studied masticatory efficiency in persons with
differing complements of natural teeth and wearing prostheses. He separated the food,
after chewing, into ten components and calculated the surface area ofthe food per unit
volume. He found that on this basis the efiiciency of chewing decreased as the natural
occlusion deteriorated although the differences were small and the individual variations
large. Persons with prostheses showed a higher chewing efficiency than the poorer
natural occlusions. The average number of chews per food portion also remained
reasonably constant for individuals in the different occlusal states and there was a
wide range between different individuals, e.g. the range varied in this study between
20 and 170 chews.
As e.xplained by Dahlberg, if occlusal surface area diminishes, it might be expected
that a person would chew longer to reach a swallowing threshold consistency of food,
but he did not find this occurred. He found that the subjects chewed the same number
of times whether the dentitions were good or poor, and thus proposed that there was an
habitual chewing habit for each individual. Dahlberg (1946) carried out further
investigations using natural food and half the subjects had good dentitions and half
poor dentitions. He found that the average number of chews with good and poor
dentitions was about the same, even though the efficiency of mastication deteriorates.
 Masticatory futu'tion. Ill 59

and that in the case of moderately hard food, poor teeth are not compensated for by
longer periods of mastication.
An improved method of measuring occlusal contact area was developed by
Yurkstas & Manly (1948). This was used by Manly (1951) who established a relation-
ship between masticatory performance and food platform areas in 103 young people
chewing peanuts and carrots.
Manly & Braley (1950) devised a method for measuring masticatory efficieticy and
performance on dentate and denture wearing subjects. Performance was expressed as a
percentage of masticated peanuts which would pass through a ten mesh screen after
twenty chewing strokes. They found that masticatory perforrnance deteriorated with
loss of teeth and for complete denture wearers, but that there were wide variations in
performances of individuals. Masticatory efficiency also deteriorated with loss of teeth
and is not compensated for by longer mastication time. This is in agreement with
Dahlberg (1946) and Yurkstas (1965). The compensation is by the swallowing of larger
particles or avoidance of foods that the subject knows are difficult to chew (Manly &
Braley, 1950). Kapur, Soman & Shapiro (1965) found in their studies on the effect of
food platform area and masticatory efficiency that, contrary to natural teeth, changes
in the antero-posterior dimension of the occlusal table did not alter the average
masticatory performance of denture wearers. The subjects were able to masticate their
food with equal ability whether two, three or four teeth areas were available.
Manly & Vinton (1951a) using the methods of Manly & Braley (1950) studied 100
persons wearing complete dentures to determine their chewing ability. They found that
the masticatory performance was much lower than for persons with natural dentitions
and, as with other workers, found considerable variation between subjects. They also
make the interesting observation that 'it cannot be demonstrated that any of our
measurements are important for determining how well persons with adequate dentures
can chew food or can adjust themselves to tough foods".
The research work reported so far confirms the view that as the dentition deteriorates
so does the efficiency and the performance, and that dentures are generally low in
performance and efficiency when compared with good natural dentitions. The marked
variation in results between persons indicates the wide ranges of ability to chew in
differing clinical states. It is also surmised that patients compensate for a poor occlu-
sion by swallowing larger particles rather than chewing more often.
Yurkstas (1951) carried out an investigation to determine whether persons with
impaired natural dentitions did chew longer or swallowed larger particles. He used the
masticatory performance methods described by Yurkstas & Manly (1950) and deter-
mined the degree of pulverization of the food when it was considered ready for
swallowing. He found that persons with deficiencies of the dentition tended to swallow
larger particles of food than subjects with a normal dentition, and do not chew for
longer periods of time. In this work there tnay be a problem in selecting the "swallowing
threshold' as the end point of chewing, because there are several factors such as
sensitivity of mucosa and taste sensibilities that add to the determination factors
used in deciding this threshold. Although it is recognized that people with poor
dentitions do not chew for longer periods of time by increasing the masticatory strokes,
there is a wide variation in the number of strokes required to achieve a suitable degree
of pulverization of food. This depends upon the individual rather than the state of his
dentition (Perez, 1967). Farrell (1956) has demonstrated that chewing is essential for
the complete digestion of certain foods.
60 ./. E. Bates, G. D. Stafford and A. Harrison

Ctisp form
Experiments to determine the effects of cusp form of artificial teeth have been carried
out by several workers.
Thompson (1937) studied masticatory performance using 33 posterior teeth.
Hall's inverted cusp teeth, 20 teeth and Sear's channel teeth, and showed respectively
a decreasing efficiency. The 33 teeth provided the best performance. Sobolik (1938),
utilizing test dentures himself, found that no one form was better than another for all
the foods he tested but his work suggests that Erench's and Tru-Kusp forms were
better than Hall's inverted cusp teeth. Manly & Vinton (1951a) in a study on 100
denture wearers fbund no difference in masticatory performance between those with
'anatomic' teeth and 'non-anatomic' teeth, but in a further study on a more limited
group Manly & Vinton (1951b) concluded there was a slight indication that the
masticatory performance was greater with 'non-anatomic" teeth than with 'anatomic'
teeth.
Trapozzano & Lazzari (1952) carried out a limited study on two subjects using
dentures with 20 , Hall and De Van 'non-anatomic", posterior teeth with subjects who
had been wearing dentures for some years. Whilst no real conclusion can be drawn
from such a study, they appeared to indicate that in these tests the 20 posterior teeth
were more efficient.
Sauser & Yurkstas (1957) studied the effects of variations in occlusal surface
carvings and suggested that masticatory performance was better when both upper and
lower occlusal surfaces were provided with markings than when one or both were
without markings, and also that the best masticatory performance occurred when
occlusal carvings ran longitudinally along the upper occlusal surface irrespective of the
character of the lower occlusal scheme. These results were obtained by placing overlays
over the natural dentition, and are not applicable to complete dentures. Similar results
were obtained by Kapur & Soman (1965c) who studied the infiuence of occlusal patterns
on masticatory performance in complete dentures. Eifteen differing occlusal patterns
were examined, on sixteen edentulous subjects. An acrylic resin block was used for the
posterior teeth and the various geometric patterns were cut into the blocks. They found
tliat, in general, posterior teeth with occlusal markings were more effective in pulveriz-
ing the test {ooAi^ (peanuts and carrots) than those with no markings.
Trapozzano (1959) carried out a study using 20 posterior teeth and Hall's (non-
anatomic) teeth. The subjective impressions of the eight subjects in the experiment
were that the 20 posterior teeth were more acceptable, probably because the subjects
felt they were able to chew more effectively. In chewing tests using fractional sieving
and peanuts as the test fbod, the 20 posterior teeth were more efficient.
Yurkstas (1963) studied the effect of straight line geometric occlusal carvings on the
masticatory effectiveness of complete dentures, and also compared the masticatory
effectiveness of these grooved patterns with similar patterns of raised metal inserts.
There was no significant difference between the patterns tested, although after a year
of use there was a general improvement in efficiency with a given pattern. After 3
months with the raised metal inserts there was an improvement in masticatory per-
formance. He found that occlusal carving on both upper and lower posterior tooth
segments seemed to be more effective than dentures with one or both quadrants fiat.
Kydd (1960) studied the effect of 33 , 20' and non-anatomic teeth on mastica-
tory efficiency using peanuts and raw carrots as the test foods. A strain gauge measur-
ing system was used with the gauges attached to the lingual side of the lower denture
 Masticatory function. HI 61

base near the midline, and one gauge was placed directly above the other. Cuspal angle
did not appear to alter the chewing efficiency significantly.
Kapur & Soman (1964) studied masticatory performance and efficiency in complete
denture wearers and developed standards by which functional impairment in denture
wearers could be evaluated. They found that the denture wearer has a chewing efficiency
of less than one-sixth of a subject with a normal dentition, and advised that one should
not compare masticatory performance of complete denture wearers with those of
persons with a natural dentition.
Kapur, Soman & Stone (1965) undertook a study investigating the efiect of denture
extension upon masticatory efficiency in complete denture wearers using carrot as the
test food. They found that overall reduction in extension ofthe periphery ofthe lower
denture base resulted in a reduction in masticatory performance, and also that previous
denture experience led to a greater ability to chew the test food than the subjects who
had no previous denture experience.
Kapur & Soman (1965a) studied the influence ofthe shape ofthe polished surface
of complete dentures on chewing efficiency, and found that on average no significant
variations appeared in the ability of subjects to chew with different denture forms,
although marked improvement did occur in some individuals. They also carried out a
study ofthe effect ofthe position ofthe occlusal table of complete dentures on masti-
catory efficiency (Kapur & Soman, 1965b). They examined twelve subjects with nine
different positions of food platforms. If the platform was over the crest of the lower
alveolar ridge at the height ofthe lower canine and parallel to the fiat portion ofthe
ridge, then the most effective chewing situation existed to masticate peanuts and raw
carrot test foods. There were significant reductions in chewing efficiency of subjects
when the food platforms were moved buccally.
Lambrecht (1965), in a study on five edentulous subjects, measured masticatory
performance before and after the reduction ofthe occlusal contact area. The amount of
contact area removed varied between 14-4% and 20-6 "„ and a loss of performance was
found in every test.
Neill & Phillips (1970, 1972) have shown that masticatory performance is related
directly to the quality of the dentures.

Adaptation to dentures
Yurkstas, Fridley & Manly (1951) found that patients supplied with fixed bridges and
removable prostheses showed an improvement in masticatory performance after
2 weeks, although they did not carry their studies beyond that time.
Abel & Manly (1953) in a study on persons with partial dentures describe a learning
period with improvement in masticatory performance after insertion of the dentures.
Maximum chewing efficiency was attained at about 1 month. Yurkstas (1963) studied
twenty edentulous subjects with complete dentures with different geometric occlusal
carvings and Hardy teeth and found that masticatory efficiency was improved after
1 year.
Vinton & Manly (1955) found that in a study of thirty-eight subjects there was some
slight improvement in masticatory performance and efficiency during the first 6 months
in adults under the age of 60 years receiving their first complete dentures. They did not
find this with persons who had worn complete dentures previously. They also found a
greater chewing efficiency in persons under 60 years of age when denture fixative was
used.
62 ,/. F. Bates, G. D. Stafford and A. Harrison

The efject of food upon the masticatory cycle

Several papers have discussed this particular problem which was first suggested by
Hildebrand (1931) who was of the opinion that different foods did not affect the
masticatory pattern.
He differentiated between a grinding and a crushing phase of chewing, but in the
investigations, crushing and grinding curves generally resembled one another and thus
'the reasons for retaining the two conceptions of crushing and grinding may be
deemed to be not quite clear'.
Klatsky (1940), Jankelson, Hoffman & Hendron (1953), Koivumaa (1961),
Ahlgren (1966) and Gillings, Graham & Duckmanton (1973), found variations
in the cycle that they ascribed to the character of the food. This, however, was not
possible to ascertain in the work of Beyron (1964) since only one type of food was
used.
As well as demonstrating considerable individual variation amongst test subjects,
several authors (Anderson & Picton, 1957; Kaires, 1957; Ahlgren, 1966) have also
noted that the nature of the test food influences the occurrence of contact as also did
the cuspal form of the teeth (Brewer & Hudson, 1961; Woelfel, Hickey & Allison,
1962).
Rudd. Morrow & Jendresen (1969), using a fluorescent photoanthropometric
tnethod were able to photograph spheres opposite the condyles and at the incisor
point, and using a beam splitter, to see these in three dimension. Films were then fed
into a motion picture analyser and the movement of the spheres in three planes could
be determined and expressed as a percentage of the total envelope of motion. It is
significant to compare the areas of the chewing envelope with different foods in one
subject. In the horizontal plane, with peanuts, the area of the molar indicator was
I mm'-, whilst for meat, it was 4 mm-', and carrots 10 mm'-. In the fVontal plane, the
chewing pattern with peanuts represented 33 mm'- compared with 47 mm'- for carrots,
and 63 mm- for meat.
In the sagittal plane, similar changes in the envelope of motion could be seen,
36 mm'- for the peanut cycle, 26 mm- for the carrot and 34 mm'- for meat. It is obvious,
since these areas involved are not in the same ranking order, that the masticatory
pattern changed. For peanuts this represented a more vertical component of chewing
compared to meat and carrot, which involved lateral motion.
Jankelson et al. (1953) demonstrated that the act of iticision and control of the food
bolus varied with different foods o\^ varying hardness. The chewing cycle varied with
the food as also shown by Shepherd (1960).
Schweitzer (1961) stated that the angle and length of the closing stroke were
determined by the type of f\^od, the vertical overlap of the anterior teeth and the neuro-
muscular control. Further, the teeth did not always tneet in the initial cycles when
chewing hard food. This is supported by Atkinson & Shepherd (1967) and Koivumaa
(1961) who also points out that the harder the food the more lateral the chewing stroke,
soft food being chewed in a rectilinear manner.
Wictorin, Hedegard & Lundberg (1971) also observed a difference in the duration
of the chewing cycle with the different test boluses.
Watson (1972) considered the chewing cycle using a cineradiographic technique
with hard and soft food. He detiionstrated that there was an improvement in
masticatory ability in partially edentulous patients with the provision of partial
dentures.
 Masticatory function. Ill 63

Summary
The form of the chewing cycle
The form of the chewing cycle has been studied by various workers using visual studies
of attrition facets, photography, graphic methods, radiography, electronic and tele-
metric techniques. It has been studied in the natural and the artificial dentition utilizing
test foods and in mouth empty movements.
In the frontal plane the form of the cycle is 'teardrop' in shape and the pattern is
with minor variations consistent for the individual due to his neuromuscular pattern,
but varies widely between individuals and is influenced by the occlusion and con-
sistency, shape, size and taste of the bolus of food. Extraction of the teeth or restora-
tions which alter the occlusion cause changes in the movement pattern. Chewing is
essentially a two-phased system passing from a buccal motion through a centric inter-
cuspal position into a lingual phase, and these movements produce curved marks on
the facets which are concentric with the rotational centres in the condyles. Subjects
chew on that side where most teeth are in contact, and where articulation is similar on
both sides, mastication takes place on the right and left alternately, and the bolus is
moved from one side to the other regularly and consistently for the individual. Con-
figuration of the cycle becomes smaller as chewing continues. In normal chewing the
envelope of motion is about half of the vertical and lateral movement possible in
maximum movement.
The angle of approach to and from centric occlusion is steeper than the cuspal
inclination, and thus the angle within the masticatory cycle always lies within the
confines of the cuspal inclines. Teeth are a major guiding factor in the closing phases of
the masticatory cycle, but exert little influence in the opening phases.
The static contact time is one-fifth of the total masticatory cycle (about 0-2 s) but
the total contact which includes the gliding aspects of this feature may double this time.
The number of contacts varies but is high in the natural dentition with subjects making
contact in the eccentric position and gliding into centric. The glide into and out of
centric occurs with a slight pause at the moment of change of direction. The area of
contact of the occlusal surfaces during mastication is about one-tenth of the total
occlusal area available.
In the sagittal plane, the opening movement is posterior to the closing stroke, but as
chewing proceeds, the opening stroke is sometimes anterior to; posterior to; along an
identical path with; or even crossed over from the closing stroke. The posterior border-
line closure does not seem to be reached during function.
Tooth contact occurs frequently with the artificial dentition and good complete
dentures allow the subject to function in chewing in much the same way as a person
with a natural dentition, but the efficiency of the dentures does alter the chewing
pattern if there is a loss of retention or stability. Dentures can move more than 20 mm
and the tongue is used to stabilize and aid retention of dentures, and thus the function
of the tongue in positioning the bolus of food on the occlusal table is required more to
retain a denture and is less able and less efficient to aid in chewing. Contrary to what
was previously believed, people wearing partial dentures do use them to chew as much
as the natural dentition. There does not seem to be any relationship between the cycle
of chewing and the form of the artificial teeth upon a denture, but the form of the cycle
is related to whether the dentures are retentive or not.
64 J. F. Bates, G. D. Stafford and A. Harrison

Speed of tnovement of the tytandible

The speed of the movement of the mandible is the speed developed by the mandible as it
approaches or moves away from the maxilla. The speed varies in different parts of the
chewing cycle and there are variations between individuals. The mandible moves faster
in the 'opening' phase of the masticatory cycle and at the moment before closure, the
rate of movement of the mandible decreases as the teeth approach. The contact of the
teeth with the bolus will also further decrease the rate of movement of the mandible.
The actual movement time varies but figures between 64 and 135 mm/s are acceptable
estimates of this speed.

Rate of chewing
In the natural dentition there is a wide variation of chewing cycle times from about 49
to 120 cycles/min. A chewing rate of 80 cycles/min is a reasonable estimate. The chew-
ing rate is affected by the type of food chewed.
In the artificial dentition there is also a wide variation between subjects although the
actual range is very similar, and as with the natural dentition an estimate of 80 chews/
min is acceptable. Individuals tend to have their own chewing rate which is further
affected by retention and stability of their dentures. More consistent measurements
have been made using telemetry techniques.

Forces developed in mastication

The forces developed between the teeth are those that occur in biting and those that
occur in chewing. Like much of the work reported on mastication the measurement of
forces has in the earlier days been subjected to wide variations due to inefficiencies in
the measuring techniques, and it is only in very recent times that improvements have
resulted in more accurate work. The earlier literature reviews the high values recorded
in the maximum bite situation and figures ranging between 1 and 352 kg have been
recorded as average total biting loads. On individual teeth loads as high as 120 kg have
also been recorded. Higher biting loads can be obtained on molar teeth than on other
teeth in the arch and natural teeth maxinumi bite loads are now recorded in the range
for the tirst molar o^ between 0-9 and 89-9 kg. Incisor biting loads are less and can be
placed in the region between 0-45 and 37-7 kg. Bite loads are less with short bounded
saddle partial dentures and less still with free and saddle dentures, and are lower still
with complete dentures. Although there is still wide variability in the figures that can be
produced.
In chewing in the natutal dentition forces between 0 3 and 7-2 kg are reported and
these forces also arc subject to wide variability depending upon the individual and
upon the food that is being chewed. One worker has reported that whole tooth loads
during chewing could rise to 14 kg. It is generally accepted though that the average
force produced in chewing on a tooth is much less and ranges between 0-2 and 2 kg. As
with other aspects of the masticatory mechanism, the maximum pressures produced are
characteristic of the patient and are generally independent of the food eaten. As can be
seen from some of the work reported the greatest amount of titiie during chewing is
spent at very much lower pressures, and the higher peak pressures are only reached and
maintained for a very short period of time.

Masticatory petfortnance and efficiency

The efficiency of the mastication has been assessed traditionally and is still assessed by
 Masticatory function. HI 65

means of fractional sieving. The test foods have varied and have included artificial as
well as natural foods. The greatest problem in the choice of food is to use one that does
not show solubility during the test, is obtainable in standard quality throughout a
period of time, and that will also break down when chewed without a change of
consistency. Carrot and peanuts have probably been the most useful foods in these
tests.
The efficiency of chewing decreases as the natural occlusion deteriorates, and is
worse for subjects with complete dentures. Differences are small and individual varia-
tions large. The subjects with good dentures show a higher chewing efficiency than
subjects with poor natural occlusions. The average numbers of chews per food portion
remain reasonably constant for the individual in the different occlusal states. Thus,
there must be a tendency for persons to swallow larger particles of food. Masticatory
efficiency is not compensated for by longer mastication time.
There is confiicting evidence concerning the benefit of different cusp forms placed
on complete dentures in relation to masticatory performance. It is suggested that
cusped teeth provide the best performance, but this is also related to the retention and
stability of the base. The literature does suggest that some form of occlusal markings or
cuspal indentation is more efficient than purely fiat tooth forms.
Reduction in the periphery of the denture base results in reduction of masticatory
performance and denture experience leads to a better masticatory performance. There
is little evidence that the shape of the polished surface of complete dentures improves
the chewing efficiency. Subjects generally improve their masticatory performance and
efficiency after adapting to the use of partial and complete dentures.
It is evident, therefore, that subjects possess a natural neurophysiology which
controls the masticatory pattern and gives each subject a consistent shape, speed and
force to the chewing cycle which is as characteristic of the individual as is walking or
talking. Alterations in the type of food will alter the cycle within limits set by the
neurophysiological pattern. There is, therefore, wide variation between individuals,
depending on such factors as past habits, age, sex and occlusion. Alterations to the
occlusion by extraction will affect the proprioceptive feed-back which will alter this
pattern. Extraction of the teeth and replacement by complete dentures will markedly
affect this pattern, depending on the retention and control of the denture by the
patient. It is not surprising that wide variations in the results by workers are obtained
in complete dentures.

Acknowledgments
The authors are deeply indebted to Miss M. Bater and Mrs J. C. Robins for their
patience and great care in typing this manuscript. They also wish to thank Mr B. A.
Jones and staff of the Audio-Visual Aids Unit of this Dental School.

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Manuscript accepted 28 October 1974