RESEARCH PAPER

The Correlation Between Surface Electromyography and Bite Force

of Mastication Muscles in Asian Young Adults
Cheng-I Yen, MD,* Shih-Hsuan Mao, MD,* Chih-Hao Chen, MD,* Chien-Tzung Chen, MD,†
and Ming-Yih Lee, PhD‡

demonstrated a significant relationship between occlusal force and

Background: Mastication function is related to mandible movement, muscle
masticatory performance.3
strength, and bite force. No standard device for measuring bite force has been de-
Occlusal force is related to dental conditions, the type of pros-
veloped. A linear relationship between electromyographic activity and bite force
thetic reconstruction, the presence of temporomandibular disorders,
has been reported by several investigators, but data on the reliability of this rela-
and the fracture of the bones involved in the masticatory apparatus.4–9
tionship remain limited in Asian young adults.
Occlusal force can be measured directly between a pair of teeth by using
Aim and Objectives: The purpose of this study was to develop a clinically appli-
a suitable transducer.3,7,8,10–12 However, no standard device for measur-
cable, reliable, quantitative, and noninvasive system to measure the kinetic mas-
ing occlusal force has been developed, and thus, dental occlusion has
tication function and observe the correlation between surface electromyography
largely been a matter of guesswork for dentists. Articulation paper,
(sEMG) and bite force.
waxes, and pressure indicator paste are the main tools dentists use to
Materials and Methods: The study group consisted of 41 young healthy adults
assess and balance the forces of occlusion. Most of these methods are
(24 men and 17 women). Surface electromyography was used to evaluate bilateral
not sufficiently sensitive for detecting simultaneous contact, and none
temporalis and masseter muscle activities, and an occlusal bite force system was
of them can be used to measure both masticatory activity and bite
used concurrently to measure the bite force during maximal voluntary biting. Bi-
force simultaneously.
lateral symmetry was compared, and the correlation between EMG and bite force
An ideal measurement system is noninvasive, providing pro-
was calculated.
tection from artifactural loading by preventing an increase in the ver-
Results: The sEMG signals were 107.7 ± 55.0 μVand 106.0 ± 56.0 μV (P = 0.699)
tical dimension of the occlusion and interference with dentition. In
on right and left temporalis muscles and 183.7 ± 86.2 μV and 194.8 ± 94.3 μV
this study, we used surface electromyography (sEMG) to detect the
(P = 0.121) on right and left masseter muscles, respectively. The bite force was
activities of masticatory muscles and a thin custom-made splint with
5.0 ± 3.2 kg on the right side and 5.7 ± 4.0 kg on the left side (P = 0.974). A positive
a built-in force transducer to measure bite force. We calculated the
correlation between sEMG and bite force was observed. The correlation coefficient
variations between men and women and tested for the presence of
between the temporalis muscle and bite force was 0.512, and that between the mas-
side-to-side facial asymmetry. In addition, we combined the 2 devices
seter muscle and bite force was 0.360.
to determine the degree of correlation between sEMG signals and bite
Conclusion: No significant difference between the bilateral electromyographic
force. Because no previous related data have been collected in a
activities of the temporalis and masseter muscles and bilateral bite force was
Taiwanese population, before applying the system to patients, we sought
observed in young healthy adults in Taiwan. A positive correlation between
to establish a standard model in a young healthy population.
sEMG signals and bite force was noted. By combining sEMG and bite force,
we developed a clinically applicable, quantitative, reliable, and noninvasive sys-
tem for evaluating mastication function by using characteristics of biofeedback.
Key Words: mastication, mandible, electromyography (EMG), bite force
MATERIALS AND METHODS
(Ann Plast Surg 2015;74: S168–S172)
The study group consisted of 41 healthy people, 24 men and
17 women, with class I occlusion, intact dentition, and no craniofacial

M astication is a highly coordinated neuromuscular function involv-

ing mandible movements and continual modulations of force.1
When efficiently performed, mastication facilitates swallowing and
nutrient absorption.2 The strength of masticatory muscles is a well-
recognized parameter, and the capacity to exert sufficient bite force is
an indicator of normal masticatory function.3 In addition, one study
Received September 19, 2014, and accepted for publication, after revision, December
17, 2014.
From the *Department of Plastic and Reconstructive Surgery, Chang Gung Memorial
Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC;
†Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hos-
pital at Keelung, Keelung, Taiwan, ROC; and ‡Graduate Institute of Medical
Mechatronics, Chang Gung University, Taoyuan, Taiwan, ROC.
Conflicts of interest and sources of funding: none declared.
Reprints: Chih-Hao Chen, MD, Department of Plastic and Reconstructive Sur-
gery, Chang Gung Memorial Hospital, Chang Gung University College of
Medicine, 5 Fu-Hsin St, Kwei-Shan, Taoyuan 333, Taiwan, ROC. E-mail:
chihhaochen5027@yahoo.com.tw. Ming-Yih Lee, PhD, Graduate Institute
of Medical Mechatronics, College of Engineering, Chang Gung University,
259 Wen-Hwa First Road, Kuei-Shan, Taoyuan 333, Taiwan, ROC. E-mail:
leemiy@gmail.com; leemiy@mail.cgu.edu.tw.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0148-7043/15/7402–S168
DOI: 10.1097/SAP.0000000000000468
anomalies, previous facial trauma or facial surgeries, malocclusion, or-
thodontic treatment, or symptoms or clinical signs of temporomandibu-
lar disorders. The participants ranged in age from 23 to 32 years, and the
mean age was 28.4 years. Each participant was administered a history
survey and clinical examination to assess occlusion and jaw movement.
Two well-trained research assistants performed all measurements con-
currently. Each movement was repeated 3 times to determine the aver-
age and ensure that readings were accurate. Informed consent was
obtained from all participants, and the protocol was reviewed and ap-
proved by an institutional review board.
Surface Electromyography
The sEMG machine (Zebris EMG 4, Zebris GmbH, Isny im
Allgau, Germany) is a noninvasive tool used to analyze electrical sig-
nals that emanate during muscular contraction in the stomatognathic
system (Fig. 1). We used this machine to test the bilateral temporalis
and masseter muscles. The participants sat upright in a comfortable
chair and a relaxed environment. The skin was prepared and draped
using 75% alcohol cotton balls.13 Pregelled disposable electrodes were
applied to the bilateral temporalis and masseter muscles, which were
detected and located by performing palpation while asking the patient
to clench.13 Another reference electrode was placed on the left shoulder.

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Annals of Plastic Surgery • Volume 74, Supplement 2, May 2015
FIGURE 1. Positions of the surface electrodes on temporalis and
masseter muscles.
Bite Force
An occlusal bite force system was designed specifically for mea-
suring bite force (Fig. 2). It is a complete system comprising sensors, a
sensor-connecting device, and software. The 3 sensors on the occlusal
pad were positioned on the incisor and bilateral first molar region. Par-
ticipants whose first molars were missing were measured at the second
molars. The software converted pressure values into forces. In all exper-
imental sessions, measurement devices (an occlusal pad with a sensor
attached to a laptop computer system) were inserted intraorally to mea-
sure the maximal bite force in kilograms.
FIGURE 2. The occlusal bite force system comprising sensors,
sensor-connecting device, and software.
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Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
The Correlation Between sEMG and Bite Force
Examination Protocol
After the values of the sEMG signal had stabilized, the resting to-
nus was recorded for 6 to 8 seconds as a relaxation test. To determine
the maximal voluntary contraction (MVC), a bite test was conducted
in habitual intercuspation.13 Each participant bit as forcefully as possi-
ble for 2 seconds13 and then relaxed his or her mouth. The investigator
then placed the bite force device in the mouth gently and instructed the
participant to bite for 2 seconds again to determine the correlation be-
tween sEMG activity and bite force (Fig. 3). To determine the firing pat-
tern, the participants were asked to press their teeth together with
gradually increasing force for 10 seconds.13 In a fatigue test, the partic-
ipants bit their teeth by using their full strength for 10 seconds. Each test
was conducted 3 times, and the average value was calculated.
Statistical Analysis
The data were statistically analyzed using the SPSS package ver-
sion 20.0 for Windows. Means and standard deviations were computed
for each independent variable. Differences in the mean values were
assessed using the Mann-Whitney U test and Wilcoxon signed rank
test. The level of significance was set at P < 0.05.
RESULTS
The mean age of the study group was 28.40 ± 3.0 years. When
MVC was applied in habitual intercuspation, the mean EMG signals
were 107.7 ± 55.0 μV and 106.0 ± 56.0 μV (P = 0.699) on the right
and left temporalis muscles, and 183.7 ± 86.2 μV and 194.8 ±
94.3 μV (P = 0.121) on the right and left masseter muscles, respectively
(Fig. 4A). In the male group, the EMG activity was 119.5 ± 64.5 μVand
114.9 ± 43.3 (P = 0.191) on the right and left temporalis muscles, and
170.8 ± 93.1 μV and 187.1 ± 103.2 μV (P = 0.191) on the right and left
masseter muscles. In the female group, the EMG activity was 95.3 ±
45.6 μV and 100.9 ± 63.4 (P = 0.872) on the right and left temporalis
muscles, and 144.4 ± 64.1 μV and 138.3 ± 72.5 μV (P = 0.387) on
the right and left masseter muscles. No significant differences in the
right and left temporalis muscle (P = 0.339 and P = 0.286) or the right
FIGURE 3. Surface EMG with bite force assembly ready to
connect to measuring apparatus after intraoral positioning.
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Yen et al Annals of Plastic Surgery • Volume 74, Supplement 2, May 2015

and left masseter muscle were noted between men and women
(P = 0.369 and P = 0.177) (Fig. 4B).
The bite force was 5.0 ± 3.2 kg on the right side and 5.7 ± 4.0 kg
on the left side (P = 0.974) (Fig. 5). In the male group, the bite force
was 6.3 ± 3.2 kg on the right side and 7.0 ± 3.7 kg on the left side
(P = 0.859). In the female group, the bite force was 4.1 ± 3.0 kg on
the right side and 4.8 ± 4.1 kg on the left side (P = 0.972). The value
of bite force was significantly higher in the male group than in the fe-
male group. Regarding the correlation between sEMG signals and bite
force, the Pearson correlation coefficient was 0.512 between the
temporalis muscle and bite force (P = 0.000) and 0.360 between the

FIGURE 4. A, Graphic comparison of bilateral sEMG activities on

temporalis and masseter muscles. B, Graphic comparison of
temporalis and masseter sEMG activities between female and
male. RTA, right temporalis muscles; LTA, left temporalis
muscles; RMAS, right masseter muscles; LMAS, left masseter
muscles. *P < 0.05.

FIGURE 6. A, Correlation between bite force and sEMG activity

FIGURE 5. Graphic comparison of bite force between female and of temporalis muscle. B, Correlation between bite force and
male. *P < 0.05. sEMG activity of masseter muscle.

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Annals of Plastic Surgery • Volume 74, Supplement 2, May 2015
FIGURE 7. A, Improvement of sEMG activities of temporalis
and masseter muscles at postoperative 1, 3, and 6 months. B,
Improvement of bite force at postoperative 1, 3, and 6 months.
R, right side; L, left side.
masseter muscle and bite force (P = 0.014); both correlations were pos-
itive (Fig. 6).
No significant differences in MVC and maximal bite force were
observed between the bilateral temporalis and masseter muscles in a
normal population.
CLINICAL APPLICATION
A 21-year-old male patient experienced a right zygoma closed
fracture in a motorcycle crash. Open reduction and internal fixation
were performed 5 days after the injury. After the operation, the Zebris
sEMG system was used to evaluate the contraction strength of his
temporalis and masseter muscles at 1, 3, and 6 months after operation.
The temporalis muscle signal improved from 49.5 μV to 109 μV to
124.9 μV on the right side and from 65.5 μV to 86.1 μV to 157.3 μV
on the left side. The masseter muscle improved from 45.8 μV to
119.3 μV to 163 μV on the right side and from 32.1 μV to 185.6 μV
to 255.9 μVon the left side (Fig. 7). Although the right-side mastication
muscles did not fully recover to the reference range compared with the
left-side muscles, we observed a significant improvement in muscle
contraction strength after early rehabilitation and physical therapy.
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The Correlation Between sEMG and Bite Force
DISCUSSION
In our study, EMG signals were measured at the temporalis and
masseter muscles, which have also been used in previous studies. These
muscles provided easy access for localization and measurement and
exhibit the most definite contraction during maximal occlusion.14 The
bite force was measured while the participants clenched the first molar
area.14 According to Ramfjord and Ash, the first molar area exhibits
the largest bite force, and this force is similar to the bite force at centric
occlusion.14
Several investigators have reported a linear relationship between
electromyographic activity and bite force, but data on the reliability of
this relationship are limited.15 Gonzalez et al15 reported that the slope
of the sEMG activity versus bite force for a given biting situation was
reliable for temporalis and masseter muscles. In our study, we observed
a positive correlation between bite force and sEMG activity on both the
temporalis and masseter muscles. The contribution of this study was
that we used 2 devices concurrently, increasing the accuracy and effi-
ciency of detection and thus facilitating progress toward a goal of devel-
oping a comprehensive device. Moreover, no data on the bite force and
EMG activity have been collected in a Taiwanese population, and no
previous studies have compared differences among participants.
The standard deviation and variation in sEMG signals and bite
force between each participant were substantial, indicating that various
factors, such as the mastication pattern, occlusal contact point, mastica-
tion muscle strength, psychological factors, and measurement errors,
may affect the results.14 In addition, sEMG can be used to detect the ac-
tivity of the masticatory muscles on the skin but not the activity inside
the muscle. For some participants, we anticipated that the signal would
be small when conducting palpation to determine the location of the
masseter muscle before examination because the bulging of the muscle
while the participant clenched was weak. Interpretation of the sEMG
data was affected by technical specifications and physiologic limita-
tions.13 To improve the repeatability of the study, we controlled the ex-
perimental protocol, standardized the electrode positioning,13 and used
the average of 3 measurements for analysis.
The graphs recorded showed high uniformity and consistency be-
tween the repeated examinations, indicating that the intermeasurement
variability was low and that the study is repeatable and reliable. Although
some people may use one side of a muscle more often than the other side,
no statistically significant difference between left and right temporalis
and masseter muscle contractions and bite force was observed in a nor-
mal population. Thus, the system developed in this study can be used
to determine the muscle strength and mastication condition in people
with unilateral craniofacial trauma or deformity. This system may also
be useful in assessing the degree of improvement after treatment and
comparing the outcomes of various surgical and nonsurgical techniques.
The advantages of the system are that it is noninvasive, efficient
(examination requires only 20 minutes), and easy to understand and
use; moreover, real-time results can be displayed on a computer screen,
which is educational and has characteristics of biofeedback. The disad-
vantage of the device is that applying it to noncooperative people, such
as elderly people and children, as well as unconscious patients, is diffi-
cult. We hope that the system can be applied clinically to patients with
temporomandibular disorders, facial bone fracture, and head and neck
cancer with trismus. It can be useful in preoperative evaluation, postop-
erative follow-up, and outcome evaluation, and can facilitate the design
of rehabilitation programs and physical therapy. In addition, the system
can be combined with a jaw motion analyzer or sensory test to increase
the comprehensiveness of functional analysis.
CONCLUSION
We developed a clinically applicable, quantitative, reliable, and non-
invasive system for evaluating mastication function with characteristics
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Yen et al
of biofeedback. No difference between electromyographic activity on
the bilateral temporalis and masseter muscle and bilateral bite force
was observed in young healthy adults in Taiwan. A positive correlation
between sEMG signals and bite force was noted. An sEMG machine
and an occlusal bite force system can be combined to reduce the time
and increase the comprehensiveness of examinations. We hope that this
simple system can be combined with a jaw motion analyzer with an all-
in-one setting to facilitate application in facial trauma management in
the future.
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