Journal of Oral Rehabilitation 2001 28; 1048±1055
A study of the effects of chewing patterns
on occlusal wear
S. K. KIM, K. N. KIM, I. T. CHANG & S. J. HEO
National University, 28 Yeongundong, Jongrogu, Seoul, South Korea
SUMMARY The chewing cycle is a functional move-
ment, closely related to occlusion, the neuromus-
cular system and the central nervous system.
Although actual chewing paths are complicated
and vary from individual to individual, there are
two typical patterns. One is more vertical in nature
and is similar to a chopping movement. The other
is a more lateral type that is similar to a grinding
movement. The purpose of this study was to
evaluate the effects of chewing patterns on occlusal
wear. Fifteen subjects exhibiting a chopping±chew-
ing pattern and 15 subjects exhibiting a grinding±
chewing pattern were selected using a jaw tracking
device. The occlusal wear values, obtained by both
ordinal and Woda's arbitrary scales, and frequencies
Introduction
Chewing movements performed by co-operative inter-
actions among various stomatognathic organs, their
proprioceptors, and higher brain centres are closely
related to the functional occlusal system. A change in
any of the information related to occlusion, the tempo-
romandibular joint, or the masticatory muscles will
affect the patterns of the chewing movements. A
number of researchers have argued that occlusion may
in¯uence the chewing path. It has been supported that a
part of the path of lateral excursions is present within
the chewing path and the path is affected by cuspal
inclinations (Schweitzer, 1961). In some research, the
relationship between the chewing path and the occlu-
sion has been supported (Adams & Zander, 1964).
Actual chewing paths are complicated and varied
(Schweitzer, 1961). However, despite the presence of
various patterns, two typical patterns have been con-
®rmed. One is more vertical in nature similar, to a
ã 2001 Blackwell Science Ltd
Department of Prosthodontics, College of Dentistry, Seoul
of non-working facets were calculated for each
group. The occlusal wear values in all teeth and in
each segment, obtained by the use of the ordinal
scale did not vary signi®cantly between the chop-
ping and the grinding type group. However, the
occlusal wear values of the grinding type group in
all teeth and in posterior teeth segments, obtained
by the use of Woda's arbitrary scale, were signi®-
cantly greater than those of the chopping type
group. Frequencies of non-working facets in pos-
terior teeth showed no signi®cant differences
between the groups.
KEYWORDS: chewing pattern, chopping, grinding,
jaw tracking device, occlusal wear, non-working
1 wear facet
chopping movement. In this pattern, very little sliding
of the teeth is observed, particularly during the opening
movement. The path is observable only on the chewing
side. The other pattern is a more lateral (horizontal)
type, similar to a grinding movement. Here there is a
distinct sliding of the teeth, especially to the non-
chewing side during the opening movement.
Gradual attrition of the occlusal surfaces of the teeth
appears to be a general physiological phenomenon
found in all mammals, in every civilization and at all
ages. Relatively few studies of tooth wear have been
reported in the literature. This lack of detailed research
is partly because of problems involved in measuring
techniques. The most frequently used methods are
based on clinical grading of the amount of wear of tooth
substance. As the wear of teeth in contemporary
industrialized populations is small, the ordinal scale of
these methods is not sensitive enough for the study of
tooth wear in normal young permanent dentition
(NystoÈm et al., 1990). On the other hand, planimetric
1048
 EFFECTS OF CHEWING PATTERNS ON OCCLUSAL WEAR 1049

methods (Russel & Grant, 1983) and Woda's arbitrary Table 1. Questionnaire on factors related to dental attrition
scale (Woda et al., 1987) provide a continuous and
more accurate scale that makes it possible for detailed Selected answer
Questions for study
information to be collected. Values obtained by the
planimetric methods and Woda's arbitrary scale have Do you spend much time in a dusty No
shown a signi®cant correlation for quanti®cation of the environment?
Do you use your teeth in your work? No
occlusal wear (Gourdon et al., 1987).
Have you had a dry mouth for a long No
The number and extent of facets of wear on all teeth
period of time?
has seemed to be more closely related to the length of Do you often have acid regurgitation? No
slide rather than the age of the individual (Reynolds, Do you often vomit? No
1970). Many facets have been observed on the occlusal Do you often clench or grind your teeth? No
surfaces of the grinding type group while they were Does your diet include
Citrus fruits? 1±2 times a week
limited to only the cuspid and ®rst premolar in the
Apples? 1±2 times a week
chopping type group (Nishio et al., 1988). The purpose Tomatoes? 1±2 times a week
of this study was to evaluate the effects of chewing Coke/Pepsi? 1±2 times a week
pattern type on occlusal wear. Fruit juices? 1±2 times a week
Cider? 1±2 times a week
Do you suffer from
Materials and methods Frequent headache? No
Pain in your jaw and/or face? No
A preliminary study was conducted on 120 students of Dizziness? No
Seoul National University Dental College who had a Tinnitus? No
complete healthy dentition and were between 23 and
25 years of age. Their selection was predicated on the record chewing movements for 10 s from 5 s after the
following criteria: absence of missing teeth (excepting start of chewing (Jeong & Kim, 1987; Lee et al., 1991).
third molars), caries, periodontal disease, bruxism, TMJ When placing the magnet, the centre of the magnet was
disorders, restorations and a history of occlusal or lined up with frenum, but was placed above the frenum
orthodontic therapy. Furthermore, good occlusion with at the gingival third of the teeth. The sensor array was
molar relationship in Angle class I and coincidence placed on the student's head, so that the upper crossbar
between maxillary and mandibular midlines were was parallel to the eyes (interpupillary line). The side
required to be present, along with regular teeth bar was parallel to the Frankfurt horizontal plane.
alignment and little evidence of dental wear. The third The preliminary study indicated two typical chewing
molars, when present, were not included in the pattern groups. One type was a group exhibiting a
analysis. To exclude other factors related to dental grinding movement path, similar to an herbivorous
attrition, a questionnaire related to possible background animal, from centric occlusion to the opposite side.
factors of importance for dental attrition (dietary, Hereafter, this grinding type is called G-type (Fig 1a, b).
environmental, working and parafunctional factors), The other group exhibited a chopping movement-type
signs and symptoms of functional disturbances of the path (similar to a carnivore) with no slide to the
masticatory system and recurrent headache (Carlsson opposite side. Hereafter, the chopping type is referred
et al., 1985) was given to 120 persons (Table 1). to as C-type (Fig 2a, b). Of the 84 persons so tested, 30
According to the results of the questionnaire, 36 people persons exhibiting the two standard types of chewing
who had possible factors of importance for dental patterns were selected for this study. Fifteen displayed
attrition or functional disturbances of the masticatory the C-type chewing pattern (age 24 ‹ 1 years, 10
system were excluded. Subsequently, in order to males and 5 females). Another 15 presented the G-type
identify chewing patterns, 84 students were instructed pattern (age 24 ‹ 1 years, 10 males and 5 females).
to chew peanuts at arbitrary rhythms on a speci®c side
of the mouth. Each of both unilateral side chewings was
Occlusal wear analysis by the use of the ordinal scale
performed by each student. The BioPAKÒ* was used to
The ordinal scale was used to measure occlusal wear
*Bioresearch Inc., Milwaukee, WI, USA. values of subjects. The following scale of original

ã 2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 1048±1055

1050 S . K . K I M et al.
attrition was applied: 0 ˆ no or little wear of enamel
only; 1 ˆ marked wear facets of enamel; 2 ˆ wear into
dentin; 3 ˆ extensive wear into dentin (> 2 mm2);
and 4 ˆ wear into secondary dentin. On the basis of
these criteria, an assessment was performed on sub-
jects through clinical oral examinations. To verify the
examiner's ability to interpret the scores of incisal or
occlusal wear, an interindividual comparison was
carried out on a randomly selected sample of 16
subjects. Each subject was scored independently by
each of the three examiners. Only 20 teeth of 448
teeth showed disagreed scores. Therefore, the agree-
ã 2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 1048±1055
Fig. 1. Grinding-type: (a) right side
chewing, (b) left side chewing.
ment in judgement between observers was very high
(96%).
Occlusal wear analysis by the use of Woda's
arbitrary scale (Woda et al., 1987)
Impressions of both dental arches were made in silicone
elastomer and only the dental part of the impression
was poured in arti®cial stone. Microbubbles were
eliminated from maxillary and mandibular casts, and
the form, dimension, and location of wear facets were
analysed with a magnifying lens. These observations
 EFFECTS OF CHEWING PATTERNS ON OCCLUSAL WEAR 1051

Fig. 2. Chopping-type: (a) right side

chewing, (b) left side chewing.

were then drawn on a cast of each arch, with care taken
to reproduce both the form and location of the wear
facets in relation to grooves and margins. We observed
that all available wear facets were engaged during
working and non-working simulated contact move-
ments (Fig. 3). Both types of wear facets (working and
non-working) in posterior teeth were shaded using
different colours. Woda's arbitrary scale used to quan-
tify the surface of wear facets. Anterior teeth were
assigned the following Woda's arbitrary values (1±4)
(Fig. 4):
1 ˆ One or several facets located only on the palatal or
buccal surface of the tooth.
2 ˆ One or several facets present only on the incisal edge.
3 ˆ One or several facets present on the incisal edge
and also on the palatal or buccal surfaces, but occupy-
ing less than one-third of the longitudinal length of the
tooth crown.
4 ˆ One or several facets present on the incisal edge
and also on the palatal or buccal surfaces, and occupy-
ing more than one-third of the longitudinal length of
the tooth crown.

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1052 S . K . K I M et al.

Posterior teeth were assigned the following Woda's
arbitrary values (1±5) (Fig. 5):
1 ˆ Facets occupying in bucco-lingual direction less
than one-third of cusp side.
2 ˆ Facets occupying in bucco-lingual direction more
than one-third of cusp side.
3 ˆ Facets occupying a total cusp side.
4 ˆ Facets occupying in bucco-lingual direction three
complete cusp sides (external working, internal work-
ing, and non-working) that are not situated in the same
frontal plane.
5 ˆ Facets occupying in bucco-lingual direction three
complete and contiguous cusp sides situated in the
same frontal plane.

Statistical analysis

Differences between groups was tested by means of

t-test (SPSS/PC+). The level of statistical signi®cance
used was P < 0á05.

Results

Occlusal wear values obtained by the use

Fig. 3. Diagram of three functional cusp sides on which working
facets (1, 1¢, 3, 3¢) and non-working facets (2, 2¢) are distributed.
of the ordinal scale (Table 2)
Mean and standard deviations were calculated for each
group in all teeth and in each segment. These ®gures
were used for a comparative study of the occlusal wear
values of the G-type and C-type subjects. The mean
occlusal wear value in all teeth, obtained by the use of
the ordinal scale, was not signi®cantly different
between the C-type and G-type group. The occlusal
wear values in each segment, obtained by the use of
ordinal scale showed very small differences between
the two groups. However, signi®cant differences
between the C-type and G-type group were not
observed.

Table 2. Occlusal wear values obtained by the ordinal scale

method
Fig. 4. Diagram of Woda's arbitrary criteria chosen to qualify
wear facets of incisors and canines.
Site C-type G-type

All teeth 1á1736 ‹ 0á168 1á2132 ‹ 0á178

Segment
UP* 1á0583 ‹ 0á114 1á1250 ‹ 0á206
LP² 1á0250 ‹ 0á097 1á0500 ‹ 0á092
P³ 1á0417 ‹ 0á099 1á0875 ‹ 0á143
UA§ 1á2667 ‹ 0á242 1á3333 ‹ 0á227
LA¶ 1á3444 ‹ 0á392 1á3444 ‹ 0á299
A** 1á3056 ‹ 0á290 1á3389 ‹ 0á243

*Upper posterior teeth.

²
Lower posterior teeth.
³
Posterior teeth.
§
Upper anterior teeth.
¶
Fig. 5. Diagram of Woda's arbitrary criteria chosen to qualify Lower anterior teeth.
wear facets of molars and premolars. **Anterior teeth.

ã 2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 1048±1055

 EFFECTS OF CHEWING PATTERNS ON OCCLUSAL WEAR 1053

Table 3. Occlusal wear values obtained by Woda's arbitrary scale posterior segment. These ®gures were used to com-
method pare the difference of the frequency between the
C-type and G-type group. The frequencies of
Site C-type G-type
non-working facets in posterior teeth exhibited no
All teeth 2á8792 ‹ 0á377 3á1771 ‹ 0á281 signi®cant divergence between the C-type and G-type
Segment groups. Working facets were found in all posterior
UP* 2á1583 ‹ 0á514 2á9839 ‹ 0á403 teeth regardless of chewing patterns. Non-working
LP² 3á2250 ‹ 0á668 3á6250 ‹ 0á263 facets were found in 82% of upper posterior teeth, in
P³ 3á1979 ‹ 0á546 3á8042 ‹ 0á301 71% of lower posterior teeth and in 79% of posterior
UA§ 3á0444 ‹ 0á582 3á0222 ‹ 0á672 teeth.
LA¶ 2á0889 ‹ 0á139 2á0778 ‹ 0á124
A** 2á5667 ‹ 0á317 2á5500 ‹ 0á356

*Upper posterior teeth. Discussion

²
Lower posterior teeth.
³ Chewing movements are smoothly performed func-
Posterior teeth.
§
Upper anterior teeth.
tional movements when the occlusion, temporoman-
¶
Lower anterior teeth. dibular joint, masticatory muscles, and higher brain
**Anterior teeth. centres constituting the functional occlusion system
function in harmony with one another. Therefore,
Occlusal wear values obtained by the use disturbances occurring in any of these will affect the
of Woda's arbitrary scale (Table 3) chewing movements. Indeed, disturbance of the chew-
Mean and standard deviations of occlusal wear values ing movement is well recognized in patients with
were calculated for each group in all teeth and in each dysfunction. In our clinical practice, we often encoun-
segment. The mean occlusal wear value in all teeth, ter situations in which the chewing path improves
obtained by the use of Woda's arbitrary scale, was with the improvement of symptoms. Among studies
signi®cantly greater in the G-type than in the C-type examining the chewing path from the viewpoint of
group (P < 0á05). This result was similar to that repor- occlusion, there have been reports which took the
ted by Nishio et al. (1988). Furthermore, the occlusal position that no occlusal contact was observed during
wear values in posterior teeth segments, obtained by chewing (Jankelson, 1953). However, of late, there
the use of Woda's arbitrary scale, were signi®cantly have been other reports emphasizing a relationship
greater in the G-type than in C-type group (P < 0á05). between the chewing path and occlusion. Some
However, the occlusal wear values in anterior teeth was patients with a steep cuspal inclination displayed a
not found to be signi®cantly different between the more vertical type of chewing movement, while others
C-type and G-type group. with gentle cuspal inclination exhibited a more lateral
type of chewing movement (Nishio et al., 1988). Actual
chewing paths are complicated and vary from individ-
The frequency of non-working facets (Table 4) ual to individual. Therefore, it would seem that a
The frequencies of non-working facets were calcula- detailed classi®cation would further complicate the
ted for each group in all posterior teeth and each study of the relationship with occlusion. However,
despite the presence of various patterns, two typical
Table 4. Frequency of non-working facets patterns were con®rmed in this study. One is a more
vertical type of movement similar to a chopping
Site C-type G-type movement, with very little sliding of the teeth,
§ particularly during the opening movement, and show-
UP* 6á2667 ‹ 1á486 6á8667 ‹ 1á356
LP² 5á6667 ‹ 1á291 5á7333 ‹ 1á624 ing a path only on the chewing side. The other is a
P³ 11á9333 ‹ 1á907 12á6000 ‹ 2á828 more lateral (horizontal) type, similar to a grinding
movement, with a distinct sliding of the teeth, pre-
*Upper posterior teeth.
²
Lower posterior teeth. dominantly to the non-chewing side during the open-
³
Posterior teeth. ing movement, and showing a path across the chewing
§
Number of teeth with non-working facets. and non-chewing sides. Of the 84 subjects examined,

ã 2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 1048±1055

1054 S . K . K I M et al.
19 patients exhibitied the G-type and 15 displayed the
C-types. The remaining 50 subjects displayed interme-
diate chewing paths that fell into neither of the two
patterns. It is important to compare the occlusions of
normal subjects exhibiting the two typical patterns in
studying the chewing path in relation to occlusion. For
this reason, normal subjects with G-type and C-type
chewing movement patterns were selected. Projections
on the frontal plane of the paths of lateral border
movement and opening and closing movement were
used for comparison, illustrating the differences in the
occlusal wear values between the two groups. In this
study, one difference is that the occlusal wear values,
obtained by the use of Woda's arbitrary scale, were
greater in the G-type group than in the C-type group.
These appear to relate to the facets during the
movement corresponding to the closing phase des-
cribed by Schweitzer (Schweitzer, 1961). Inclinations
of movement paths shown on the frontal projections of
lateral border movement paths were gentle in the
G-type group and relatively steep in the C-type group.
When the fact that the G-type group showed gentle
inclinations of lateral border movement and the
presence of many facets on the occlusal surfaces of
the posterior teeth is considered and the above results
are added together, the following hypothesis can be
derived: the upper and lower posterior teeth of the
G-type group are relatively close to each other not only 2,3 is more affected by incisal guidance (Schweitzer, 1961;
in centric occlusion, but also in lateral positions, while 2,3 Silness et al., 1993). In this study, all dental arches
the upper and lower posterior teeth of the C-type
group are separated in lateral positions. There are
many factors that can in¯uence the type and rate of
wear (Dahl et al., 1989). These factors are time/age,
gender, occlusal conditions, hyperfunction, bite force,
gastrointestinal disturbances, nutrition, environmental
factors, salivary factors, as well as other factors. The
factors of importance for dental attrition have been
shown to be bruxism, biting habits, and fruit juices
(Johansson et al., 1991). But there is no correlation
between subjects from differing geographic and/or
climate habits and the severity of tooth wear. Reynolds
reported that the number and extent of facets of wear
was related as follows: ®rst, the length of the slide from
terminal hinge relation to maximum intercuspation,
second, a lack of eccentric disclusion of the posterior
teeth (Reynolds, 1970). Many facets were observed on
the occlusal surfaces of the G-type models (Nishio
et al., 1988). These seemed to be the result of many
years of G-type chewing. They were limited to only the
ã 2001 Blackwell Science Ltd, Journal of Oral Rehabilitation 28; 1048±1055
cuspid and ®rst premolar in the C-type group. How-
ever, in this study, the occlusal wear facets were found
in all posterior teeth of the C-type group. Thus, it
appears that chewing patterns have little effect on
occlusal wear. Many factors of importance for occlusal
wear, other than the chewing patterns, have had more
effect on these subjects (Hugoson et al., 1988; Dahl
et al., 1989). Therefore, chewing patterns are an
aetiological factor, having little effect on occlusal wear.
In this study, the occlusal wear values of the C-type
and the G-type groups, obtained by the use of ordinal
scale, were not signi®cantly different. However, the
occlusal wear values obtained by the use of Woda's
arbitrary scale, were signi®cantly greater in the G-type
versus the C-type group. A difference in the results
may be because of: ®rst, the ordinal scale is not
suf®ciently sensitive for the study of occlusal wear in
normal young permanent dentition (NystoÈm et al.,
1990). Second, the difference of chewing movements
between the C-type and G-type group is related
primarily to the length of the slide. Therefore, Woda's
arbitrary scale is more suitable for identifying the
occlusal wear values attributed to chewing patterns. In
this study, the occlusal wear values in the anterior
teeth of the C-type and the G-type groups, obtained by
the use of Woda's arbitrary scale, was not signi®cantly
different. It appears that occlusal wear in anterior teeth
presented numerous wear facets. All the teeth dis-
played facets. Working facets were found in all
posterior teeth. Non-working facets were found in
82% of upper posterior teeth, in 71% of lower
posterior teeth and in 79% of posterior teeth. Wear
facets in posterior teeth were seen on the surface of the
three functional cusp sides. In premolars, working
facets were usually absent from internal working cusp
sides because of the low height of mandibular lingual
cusp, which prevented any possibility of contact with
this surface.
The ideas developed in this article raise additional
points of clinical interest.
1. The chewing pattern is one of the aetiological factors
related to the occlusal wear.
2. Occlusal contacts are surfaces that increase in diam-
eter with the development of abrasion. When pros-
thetic treatment or occlusal correction are required,
occlusal surfaces in a convex form may not really be
necessary.
 EFFECTS OF CHEWING PATTERNS ON OCCLUSAL WEAR
3. The presence of non-working facets and the evi-
dence of non-working contacts during chewing indicate
that a prophylactic elimination of all non-working
contacts will eliminate a great part of the functional
®eld of mastication.
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Correspondence: S.J. Heo, Department of Prosthodontics, College of
Dentistry, Seoul National University, 28 Yeongundong, Jongrogu,
Seoul, 110±749, South Korea.
E-mail: heosj@plaza.snu.ac.kr