PEDIATRIC DENTAL JOURNAL 19(2): 159164, 2009

The relationship between body balance function and occlusal

function during the mixed dentition period
Xiaopei Du, Sagiri Ogata, Yoshihide Okazaki, Omar M.M. Rodis,
Seishi Matsumura and Tsutomu Shimono
Department of Behavioral Pediatric Dentistry,
Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
2-5-1 Shikata-cho, Okayama 700-8525, JAPAN

Abstract The aim of this study was to investigate the relation between body
balance and occlusal balance during the mixed dentition stage. Fifty-six healthy
children with Hellmans Dental Age IIIA: (31 boys and 25 girls) with an
average age of 8.1 years, were selected from an elementary school. The body
balance, distance and area of gravity center movement (GCM) were measured
with automatic posture analytical devices. Occlusal abilities were measured
with pressure-sensitive sheets (Dental Prescale), including occlusal contacts
area, average occlusal pressure, maximum occlusal pressure, occlusal force and
occlusal balance. Analysis of occlusal balance was determined by separating
the middle group (|x|5mm) from the deflection group (|x|>5mm) based
on the position of occlusal balance center. Similarly, the children were instructed
to perform the GCM area of eyes-closed exercise. The first 25% of the
participants with the best balance were grouped as the good balance group;
and the last 25% with the worse balance were grouped as the bad balance
group. Results showed that occlusal contact area and occlusal force of the
middle group were more than the deflection group, GCM distance and area of
the middle group were less than the deflection group. occlusal contacts area
and occlusal force of the good balance group were more than the bad group.
Body balance function and occlusal balance function were observed to have
mutual influence during Hellmans Dental Age IIIA stage in this study.

Introduction
With the development of science and technology,
people now rely more on different machines and
tools that make life easy and comfortable. Some
researchers pointed out that the physical functions
and forms, including body balance functions and
occlusal functions of children, appear to be degenerating. This phenomenon is more obvious in developed countries like Japan1). The question that we
must consider is how to improve these functions and
when to start. In the dental field, many investigations
have examined the relationship between the bodys
Received on October 1, 2008
Accepted on June 24, 2009

Key words
Body balance,
Gravity center movement,
Mixed dentition,
Occlusal balance

physical function and occlusal function in adults24).

Understanding the nature of occlusal contacts is
important for the diagnosis and treatment of stoma
tognathic diseases5,6). There are many studies on
the relationship between functions of body and
occlusion with adult participants, but studies on
children are few.
In clinical research on occlusion, various techniques are used to measure the nature of occlusal
contacts in the intercuspal position, but few techniques can make quantitative analysis of the occlusal
contact area and occlusal force. The Dental Prescale
is able to make quantitative analysis of occlusal
contact area and occlusal force at every contact
point79). Dental Prescale is flexible and permits
natural occlusion while preventing mandibular
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Du, X., Ogata, S., Okazaki, Y. et al.

d isplacement during clenching. This system is very

reliable and makes measurement of occlusal function
easy, even for children10,11).
In the previous study12), we already confirmed
that there were some relationships between occlusal
balance and body balance during the deciduous
period. The aim of this study was to investigate the
relation between body balance and occlusal balance
in the mixed dentition period.

Materials and Methods

The participants of this study were 56 children, from
a total of 88, with an average age of 8.1 years (31
boys and 25 girls with Hellmans Dental Age IIIA
stage) at an elementary school. All of the subjects
had complete dentition, occluding first molars, and
none had signs or symptoms of craniomandibular
disorders, temporary crowns and active caries. The
childrens guardians understood the nature of the
research project and consented to participate. The
research project was approved by the university
hospitals medical ethics committees examination.
The childrens average body weight and standing
height were recorded before measurements were
taken. The Body Mass Index (BMI) was obtained
through calculation and results were checked if it
conforms to the Japanese Physical Strength standard
values8).
Measurement of occlusal ability
Occlusal contact area, occlusal pressure and occlusal
balance were recorded with the Dental Prescale
50H type S size, and the Occluzer FPD705, which
is a highly accurate measuring instrument producing
a visual display of the occlusal force. The Dental
Prescale is a dentition-shaped sheet of pressuresensitive material that responds to pressure through
a color-developing chemical reaction9). The amount
of occlusal pressure and area of occlusal contact
can be estimated by measuring the density and area
data with a color image scanner of the Occluzer.
The occlusal force and occlusal balance can be
calculated from the occlusal contact area and the
occlusal force.
The subjects were instructed to practice before
the measurements were taken. Subsequently, the
Dental Prescale film was prepared and correctly
placed in the subjects oral cavity. The subjects were
asked to clench on the film at the intercuspal position
with maximum bite force for three seconds. For a

measurable quantity analysis system, the Occluzer

was used to automatically obtain measurements
of the contact area, average occlusal pressure and
occlusal balance.
Measurement of equilibrium function
The system consisted of a dynamometric platform
(VTS-311 EGG 2000v, Patella Co., Japan) and a
computerized analysis system. This system can
measure and calculate the bodys Gravity Center
Movement (GCM) automatically. The system directly
reflects the GCM. and records the movement for 10
seconds in each phase. The computer can calculate
the total distance and area where the GCM moved
and the average position of the GCM. We evaluated
only the average position of GCM in this study
to show the tendency of the GCM as the standing
posture changes.
Furthermore, measurement methods and conditions were set after referring from the Japan Society
for Equilibrium Research and previous studies1315).
An apparent mark was recorded based on the measurement taken while the subject stood in Romberg
position and gazed forward at a CCD video camera
located two meters in front of the GCM platform.
Subsequently, an eye-mask was used to cover the
subjects eyes during the closed-eyes phase. The
GCM distance and area were then measured during
the eyes-opened and eyes-closed phases. The movement locus at each 10-second-phase was recorded.
The first 25% of the participants with the best
balance were grouped as the good balance group;
and the last 25% with the worse balance were
grouped as the bad balance group.
Statistical analysis
All the data were analyzed with SPSS16.0 statistical
package for Windows. Students t-test was used to
examine the difference between the distance and
area of GCM during the eyes-opened and closed
phases, Mann-Whitney test was used to examine
the difference between the middle group and the
deflection group, and the good balance group and
the bad balance group of GCM.

Results
The Body Mass Index (BMI) was obtained through
calculation and the results conforms to the Japanese
Physical Strength standard values8), no significant
differences were seen (Table 1).

occlusal balance function with mixeddentition

161

Table 1Physical and mental development states of 8-year-old children

Physical strength standard

Body weight (kg)

Standing height (cm)
Foot length (cm)
BMI index

Participants of this study

27.24.5

26.64.4

128.05.5

128.05.1

19.31.0

20.31.3

16.6

16.3

Boys n=31, Girls n=25

All data of physical strength standard are from the Japanese Physical Strength Standard,
edited by physical strength standard Research Board of Tokyo Metropolitan University
Printed in Japan by FUMAIDOU Co., JAPAN 2000.

Table 2Occlusal abilities and gender

Boys
MeanS.D.

Girls
MeanS.D.

Contact area (mm2)

18.15.3

14.13.3

0.004a

Average pressure (MPa)

39.84.1

39.75.0

0.830a

Maximal pressure (MPa)

109.49.1

109.510.7

0.967a

Occlusal force (N) 712.2151.6 541.8100.4

0.000a

: Mann-Whitney Test; Boys n=31, Girls n=25

An example of middle group

n=40 (Boys 21, Girls 19)

An example of deflection group

n=16 (Boys 10, Girls 6)

Fig. 1 Analysis of occlusal balance was determined by separating the middle group (|x|5mm) from the deflection
group (|x|>5mm) based on the position of occlusal balancing point. The sheet of occlusal force distribution
will change in color, middle group as green and deflection group as yellow.

The occlusal ability of the average occlusal

contact area and occlusal force, among boys was
found to be 18.1mm2 and 712.2N; among girls was
14.1mm2 and 541.8N. A significant difference was
found between boys and girls (Table 2). Analysis of

occlusal balance was determined by separating the

middle group (|x|5mm) from the deflection group
(|x|>5mm) based on the position of occlusal
balance center. The sheet showing occlusal force
distribution will change in color; The middle group

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Du, X., Ogata, S., Okazaki, Y. et al.

Table 3Gravity center movement (GCM) distance and area

Distance of GCM (cm)
MeanS.D.

Area of GCM (cm2)

MeanS.D.

Eyes-opened

22.67.4

6.15.2

Eyes-closed

28.08.9

**

8.15.3

**

**: P<0.01 t-test n=56

Table 4Occlusal abilities and occlusal balance

Middle group
MeanS.D.

Deflection group
MeanS.D.

Contact area (mm2)

17.35.3

14.22.4

0.048a

Average pressure (MPa)

39.94.8

39.33.7

0.670a

Maximal pressure (MPa)

109.710.1

108.89.0

0.451a

Occlusal force (N) 658.8161.2 557.5114.4

0.035a

: Mann-Whitney Test; Middle group n=40, Deflection group n=16

Table 5Occlusal balance and GCM distance, area

Distance of GCM (cm) Area of GCM (cm2)

Eyes-opened

Middle group

20.86.8

Deflection group

27.26.9

Eyes-closed

**

Eyes-opened

Eyes-closed

26.38.6 4.62.8 6.94.8

*
**
**
10.07.4
11.25.5

32.28.3

Mann-Whitney Test; *: P<0.05, **: P<0.01; Middle group n=40, Deflection group n=16

Table 6Groups of GCM and occlusal abilities

Good balance group

MeanS.D.

Bad balance group

MeanS.D.

Contact area (mm2)

18.45.5

14.23.0

0.029a

Average pressure (MPa)

38.84.9

41.13.7

0.161a

Maximal pressure (MPa)

108.511.4

110.59.0

0.806a

Occlusal force (N) 699.4184.1 587.7130.6

0.106a

: Mann-Whitney Test; Good balance group n=15, Bad balance group n=15

as green and the deflection group as yellow (Fig. 1).

The distance and area of GCM during the eyes-closed
phase were greater than them eyes-opened (Table 3).
The occlusal contact area and occlusal force were
less for deflection group than middle group (Table 4).
Some significant differences were found between
the middle group and the deflection group in the
distance and area of GCM with eyes-opened and
closed (Table 5).

For Equilibrium function of GCM distance and

area, a significant difference between boys and girls
was not found. The occlusal contact area and occlusal
force were less for the bad balance group than
the good balance group. Moreover, a significant
difference was found between the good balance
group and the bad balance group in average occlusal
contact area, while occlusal force demonstrated a
tendency (Table 6).

occlusal balance function with mixeddentition

Discussion
The inspection method of GCM is used in many
medical fields. For example, in Otolaryngology,
Neurology and Ophthalmology. In the dental field,
it is used to study the influence created by mandibular
movement16,17). The GCM system is a movement
analysis system which includes dynamometric platform, control unit, CCD video camera, picture
control unit and a computer for analysis. Usually, it
is used in sports and rehabilitation because of its
high reliability18,19). The system can record, analyze
and preserve data precisely. In this study, measurement methods and conditions were set after referencing the Japan Society for Equilibrium Research
and previous studies1315). The distance and area of
GCM with eyes-open and close were used to appraise
bodys balance. This method was affirmed and used
by many researchers. The GCM distance was used
to assess the subjective ability of body balance while
the GCM area was used to assess objective ability
of body balance. Eyes-close eliminated the compensation with vision function, and this was the reason
why we used GCM area with eyes-closed to appraise
the bodys balance ability. GCM distance was used
to refer just for reference purpose. In this study, the
distance and area of GCM during the eyes-closed
phase were greater than during the eyes-opened
phase. The deflection groups distance and area of
GCM were greater than that of the middle groups.
These results conform to previous studies. The
average occlusal balance and GCM results of the 56
participants selected were better than the results of
32 participants who were excluded. It demonstrated
that there are some differences between a stabilized
dentition and unstabilized dentition.
Diagnostic devices have been developed such
as the Photocclusion20), the T-scan system and the
Dental Prescale system. The Dental Prescale has
been used to measure occlusal force and occlusal
force distribution. A study reported that the Dental
Prescale is flexible and permits natural occlusion and
prevents mandibular displacement during clenching21).
Other studies showed that the Dental Prescale film
is unaffected by intra-oral humidity, temperature
change, velocity and the duration of force applied
to it has a negligible influence on color formation21,22).
Furthermore, the Dental Prescale system has many
advantages and are as follows: the thin material
induces only a small change in the occlusal vertical
dimension making measurements at a position near

163

the intercuspal position possible; it is not necessary

to prepare special measurement equipment; many
patients can be evaluated in a short period of time;
recording and storage, even for an extended period,
is simplified; and treatment is easy to explain to
the patients by using dental images. Thus, the Dental
Prescale system is very reliable for the measurement
of occlusal ability.
All study participants had complete dentition
with first molars and some participants were in the
mixed dentition stage in the anterior teeth region.
Some researchers reported that the proportion of
occlusal contact area and occlusal force were 2.9%
and 8.1% and these have not affected the total
dentition6). None had signs or symptoms of craniomandibular disorders, temporary crowns and active
caries. Nutritional condition of participants had little
difference in this study and some past studies23).
In contrast to the past study on deciduous dentition
period, the occlusal abilities during the mixed dentition period were obviously better than the deciduous
dentition period. In this study, the results of occlusal
contact area and occlusal force were higher than
some studies. The difference in occlusal measurement system used maybe a reason, and another
reason is that all of participates may have had a
healthy dentition. Moreover, Hellmans Dental Age
IIIA is a relatively stable period than Hellmans
Dental Age IIC and IIIB stage. This is the reason
why 56 of the 88 children were chosen to participate
in this study. The other 32 children were excluded
due to decayed teeth, orthodontic problems and
being at a different Hellmans Dental Age period.
The limitation of this study was that the subjects
were few. Thus, we anticipate more participants in
the future.

Conclusion
A relationship exists during the stable dentition
period such as Hellmans Dental Age IIIA period.
Body balance and occlusal balance were observed to
have interactive influence during Hellmans Dental
Age IIIA period. The influence of occlusal balance
on body balance is much stronger and obvious
than the influence of body balance over occlusal
balance.
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