臺灣博碩士論文加值系統

本研究之目的在於觀察完整齒列者與局部缺牙者對於咀嚼軟質食物之咀嚼效率及肌肉活動量是否具差異性。為此本實驗室設計一種將不透光物質Hydroxylapatite (HA) 細粒置於市售口香糖中所製成之軟質測試食物，分別讓20位具有完整齒列及11位具有單側缺牙之受測者咀嚼，依咀嚼後口香糖中HA細粒之分佈來判定其咀嚼效率。並記錄受測者咀嚼時之左右兩側前顳肌和咬肌的肌肉活動量、最大咬力及咬合接觸面積，以觀察其與咀嚼效率之關係。
咀嚼效率的GEE模型顯示咬合接觸面積及咀嚼次數兩因子對於咀嚼效率的影響最巨，而t-test及Paired t-test也分別顯示完整齒列組之慣用側與非慣用側和缺牙組之慣用側的咬合接觸面積大於缺牙組之非慣用側(p<0.05)，且咀嚼效率值的比較結果顯示在20及25次之咀嚼次數時，完整齒列組與缺牙組之咀嚼效率具有顯著的差異(p<0.05)，但於30次之咀嚼次數時，即無顯著差異。因此推論缺牙者對於此軟質口香糖之咀嚼效率較完整齒列者為差，且可藉由增加咀嚼次數以補償因缺牙而造成咀嚼效率不佳之情形。總肌肉活性的GEE模型顯示咬力較低者於咀嚼過程中有較低之肌活動量。另外，完整齒列組與缺牙組在分別以其慣用或非慣用側咀嚼時，其兩側之總肌肉活性無明顯的差異。咬力的GEE模型顯示非慣用側與低咬合接觸面積是影響咬力降低的兩項最主要因子。另外，咬力與咀嚼效率之相關性也不高。
由上所述，我們認為軟食之咀嚼需依賴閉口肌活動將其擠壓混合，但不需大的咬力，而牙齒的存在仍為影響軟食咀嚼效率之重要因素。因此，本測試口香糖在評估此類軟質食物的咀嚼功能上具有一定之利用價值。

The purpose of this study was to investigate the difference in soft food chewing efficiency and muscle activity between complete natural dentition and partial edentulous patients. For this purpose, a soft test food was designed which was hydroxylapatite (HA) particle contained chewing gum. Twenty subjects with complete natural dentition and eleven subjects with at least one posterior tooth missing in one quadrant without restoration were asked to chew the test food. Distribution of the HA particles in the chewed chewing gum was defined as the chewing efficiency. Moreover, simultaneous EMG of the right and left anterior temporalis and masseter muscle during gum chewing was recorded. Centric occlusion contact area and maximum bite force were also measured to relate to the chewing efficiency of gum chewing.
It was found that occlusal contact area and chewing stroke were the more powerful factors to effect chewing efficiency than others when GEE model was applied to analyze the variables in chewing efficiency. Habitual and non-habitual sides of complete dentition subjects were higher than the non-habitual side of incomplete dentition subjects (p<0.05) when t-test was used, and the habitual side was higher than non-habitual side of incomplete dentition subjects (p<0.05) when Paired t-test was used. It is also found that there was a significant difference (p<0.05) after 20 and 25 chews but there was not a significant difference after 30 chews between complete natural dentition and incomplete subjects. We suggested that the poor chewing efficiency of incomplete dentition subjects caused by lower occlusal contact area which is due to teeth missing could be compensated via increased chews during gum chewing. It is found that the lower total muscle activity during gum chewing accompanied with lower maximum bite force when the GEE model applied to analyze the variables in total muscle activity and there were not significant difference within the habitual and non-habitual sides of complete natural dentition and incomplete dentition subjects. It is also found that one chewed on non-habitual side or who had lower occlusal contact area were main to cause lower bite force when the GEE model applied to analyze the variables in maximum bite force and there was not highly relationship between bite force and chewing efficiency.
It was concluded that jaw-closing muscle activities were applied to pulverize and mix the content of chewing gum but highly bite force was not critical on it during gum chewing. Teeth essentiality was important during gum chewing. Finally, the HA contained chewing gum could be popular used to evaluate soft food masticatory function.

中文摘要……………………………………………………Ⅲ
英文摘要……………………………………………………Ⅴ
第一章、前言………………………………………………1
第二章、文獻回顧…………………………………………5
2.1咀嚼行為…………………………………………5
2.2影響咀嚼功能表現之因子………………………7
2.2-1肌肉活動量……………………………………7
2.2-2咬力……………………………………………9
2.2-3咬合接觸面積…………………………………10
2.3各種測試咀嚼效率的方法……………………….12
第三章、材料與方法………………………………………16
材料
一、 受測者……………………………………………...16
二、 軟質測試食物……………………………………...17
三、 肌電圖記錄器……………………………………...18
四、 其他材料及儀器…………………………………...18
五、 咬力記錄器………………………………………...19
六、 測量咬合接觸面積之材料及儀器………………...19
方法
一、 標準測試食物的製作……………………………...21
二、 咀嚼食物之肌活動記錄…………………………...21
三、 咀嚼效率值之測取………………………………...22
四、 最大咬力施出之測取……………………………...23
五、 咬合接觸面積之量取……………………………...24
六、 統計方法…………………………………………...26
第四章、結果………………………………………………29
第五章、討論………………………………………………37
5.1 (一)測試食物之選用………………………….37
5.2 (二)對於此測試方法之建議………………….38
5.3 (三)統計分析方法之探討…………………….39
5.4 (四)各種實驗誤差產生之評估……………….40
5.5 (五)影響咀嚼效率之因素…………………….41
5.6 (六)影響肌肉收縮量之因素………………….42
5.7 (七)影響咬力之因素………………………….44
5.8 (八)影響咬合接觸面積之因素……………….45
第六章、結論………………………………………………47
參考文獻……………………………………………………75

Agerberg, G., and Carlsson, G.E. (1981). Chewing ability in relation to dental and general health: analyses of data obtained from a questionnarie. Acta Odontol Scand 39, 147-153.
Ahlgren, J. (1966). Mechanism of mastication. A quantitative cinematographic and electromyographic study of masticatory movements in children, with special reference to the occlusion of teeth. Thesis, Acta Odontol Scand 24: suppl.
Akeel, R., Nilner, M., and Nilner, K. (1992). Masticatory efficiency in individuals with natural dentition. Swed Dent J 16, 191-198.
Arai, E. and Yamada, Y. (1993). Effect of the texture of food on the masticatory process. Japanese J Oral Biol 35, 312.
Bakke, M., Moller, E., and Thorsen, N.M. (1980). Occlusal contact and maximal muscle activity in natural mandibular positions. J Dent Res 59(Spec Issue): Abstract, 653.
Bakke, M., Michler, L., Han, K., and Moller, E. (1989). Clinical significance of isometric bite force versus electrical activity in temporal and masseter muscles. Scand J Dent Res 97, 539-551.
Bakke, M., Holm, B., Jensen, B.L., Michler, L., and Moller, E. (1990). Unilateral, isometric bite force in 8-68-year-old women and men related to occlusal factors. Scand J Dent Res 98, 149-158.
Bakke, M., and Moller, E. (1991). Occlusion, malocclusion, and craniomandibular function. In: Melsen, B., ed. Controversies in orthodontics. Chicago: Quintessence, 77-101.
Bakke, M., and Moller, E. (1992). Craniomandibular disorders and masticatory muscle function. Scand J Dent Res 100, 32-38.
Bakke, M., Michler, L., and Moller, E. (1992). Occlusal control of mandibular elevator muscles. Scand J Dent Res 100, 284-291.
Bakke, M., Stoltze, K., and Tuxen, A. (1993). Variables related to masseter muscle function: a maximum R2 improvement analysis. Scand J Dent Res 101, 159-165.
Bakke, M. (1993). Mandibular elevator muscles: physiology, action, and effect of dental occlusion. Scand J Dent Res 101, 314-331.
Berry, D.C., and Singh, B.P. (1983). Daily variation in occlusal contacts. J Prosthet Dent 50, 386-391.
Beyron, H. (1969). Optimal occlusion. Dent Clin North Am 13, 537-554.
Boretti, G., Bickel, M., and Geering, A.H. (1995). A review of masticatory ability and efficiency. J Prosthet Dent 74, 400-403.
Bramesco, N.P., and Setser, C.S. (1996). Salivation of sensory panelists: effects of selected psychological factors. J Sensory Stud 11, 69-79.
Bremer, F. (1923). Physiologie nerveuse de la mastication chez le chat et le lapin. Arch Int Physiol 21, 309-352.
Brodeur, J.M., Laurin, D., Vallee, R., and Lachapelle, D. (1993). Nutrient intake and gastrointestinal disorders related to masticatory performance in the edentulous elderly. J Prosthet Dent 70, 468-473.
Carlson B.R., Carlsson, G.E., Helkimo, E., and Yontchev, E. (1992). Masticatory function in patients with extensive fixed cantilever prostheses. J Prosthet Dent 68, 918-923.
Carlsson G.E. (1974). Bite force and chewing efficiency. In: Kawamura, Y., ed. Physiology of mastication. Front Oral Physiol 1, Basel: Karger, 265-292.
Carlsson, G.E. (1984). Masticatory efficiency: the effect of age, the loss of teeth and prosthetic rehabilitation. Int Dent J 34, 93-97.
Chapman, R.J., Maness, W.L., and Osorio, J. (1991). Occlusal contact variation with changes in head position. Int J Prosthodont 4, 377-381.
Chauncey, D.D., Muench, M.E., Kapur, K.K., and Wayler, A.H. (1984). The effect of the loss of teeth on diet and nutrition. Int Dent J 34, 98-104.
Corruccini, R.S., Henderson, A.M., and Kaul, S.S. (1985). Bite-force variation related to occlusal variation in rural and urban Punjabis (North India). Arch Oral Biol 30, 65-69.
Dellow, P.G., and Lund, J.P. (1971). Evidence for central timing of rhythmical mastication. J Physiol 215, 1-13.
Diaz-Tay, J., Jayasinghe, N., Lucas, P.W., McCallum, J.C., and Jones, J.T. (1991). Association between surface electromyography of human jaw-closing muscle and quantified food breakdown. Arch Oral Biol 36, 893-898.
Edlund, J., and Lamm, C.J. (1980). Masticatory efficiency. J Oral Rehabil 7, 123.
Fields, H.W., Proffit, W.R., Case, J.C., and Vig, K.W.L. (1986). Variables affecting measurements of vertical occlusal force. J Dent Res 65, 135-138.
Garcia, R.I., Perlmuter, L.C., and Chauncey, H.H. (1989). Effects of dentition status and personality on masticatory performance and food acceptability. Dysphagia 4, 121-126.
Gillings, B.R.D., Graham, C.H., and Duckmanton, N.A. (1973). Jaw movements in young adult men duing chewing. J Prosthet Dent 29, 616-627.
Gunne, H.S., Bergman, B., Enbom, L., and Hogstrom, J. (1982). Masticatory efficiency of complete denture patients: a clinical examination of potential changes at the transition from old to new denture. Acta Odontol Scand 40, 289-297.
Gunne, H-SJ. (1985). Masticatory efficiency and dental state: a comparison between two methods. Acta Odontol Scand 43, 139-146.
Hada, M., Tabe, T., Tsuka, H., Yamauchi, K., Muneoka, Y., and Kanno, Y. (1977). The properties of chewing-gum as a test food for measurement of masticatory performance [ in Japanese ]. J Hiroshima Univ Dent Soc 9, 232-235.
Hagberg, C. (1987). Assessments of bite force. a review. J Craniomandib Disord Facial Oral Pain 1, 162-169.
Harriman, L.P., Snowdon, D.A., Messer, L.B., Rysavy, D.M., Ostwald, S.K., Lai, C.H., and Soberay, A.H. (1990). Temporomandibular joint dysfunction and selected health parameters in the elderly. Oral Surg Oral Med Oral Pathol 70, 406-413.
Hayakawa, I., Watanabe, I., Hirano, S., Nagao, M., and Seki, T. (1998). A simple method for evaluating masticatory performance using a color-changeable chewing gum. Int J Prosthodont 11, 173-176.
Heath, M.R. (1982). The effect of maximum biting force and bone loss upon masticatory function and dietary selection of the elderly. Int Dent J 32, 345-356.
Heath, M.R., and Boutros, M.M. (1984). The influence of prostheses on mandibular posture in edentulous patients. J Prosthet Dent 51, 602-604.
Helkimo, E., Carlsson, G.E., and Helkimo, M. (1977). Bite force and state of dentition. Acta Odontol Scand 35, 297-303.
Helkimo, E., Carlsson, G.E., and Helkimo, M. (1978). Chewing efficiency and state of dentition. A methodologic study. Acta Odontol Scand 36, 33-41.
Helkimo, M. (1974). Studies on function and dysfunction of the masticatory system. Swed Dent J 67, 165-182.
Hiiemae, K., Heath, M.R., Heath, G., Kazazoglue, E., Murray, J., Sapper, D., and Hamblett, K. (1996). Natural bites, food consistency and feeding behavior in man. Arch Oral Biol 41, 175-189.
Hillsing, E., and Hagberg, C. (1990). Changes in maximum bite force related to extension of the head. Eur J Orthod 2, 148-153.
Huggare, J., and Skindhoj, B. (1997). A new method for assessing masticatory performance: a feasibility and reproducibility study. J Oral Rehabil 24, 490-495.
Ingervall, B., and Bitsanis, E. (1987). A pilot study of the effect of masticatory muscle training on facial growth in long-face children. Eur J Orthod 9, 15-23.
Jones, D.A., and Round, J.M. (1990). Skeletal muscle in health and disease. Manchester: Manchester University Press.
Julien, K.C., Buschang, P.H., Throckmorton, G.S., and Dechow, P.C. (1996). Normal masticatory performance in young adults and children. Arch Oral Biol 41, 69-75.
Kampe, T. (1987). Function and dysfunction of the masticatory system in individuals with intact and restored dentitions. A clinical, psychological and physiological study. Thesis, Swed Dent J 11: suppl.
Kapur, K.K., Garrett, N.R., and Fischer, E. (1990). Effects of anaesthesia of human oral structures on masticatory performance and food particle size distribution. Arch Oral Biol 35, 397-403.
Karkazis, H.C., and Kossioni, A.E. (1997). Re-examination of the surface EMG activity of the masseter muscle in young adults during chewing of two test foods. J Oral Rehabil 24, 216-223.
Kayser, A.F., and Van Der Hoeven, J.S. (1977). Colorimetric determination of the masticatory performance. J Oral Rehabil 4, 145-148.
Kayser, A.F. (1984). Minimum number of teeth needed to satisfy functional and social demands. In: Frandsen, A., ed. Public health aspects of periodontal disease. Berlin: Quintessence, 135-147.
Korioth, T.W.P. (1990). Number and location of occlusal contacts in intercuspal position. J Prosthet Dent 64, 206-210.
Krall, E., Hayes, C., and Garcia, R. (1998). How dentition status and masticatory function affect nutrient intake. JADA 129, 1261-1269.
Lamarre, Y. and Lund, J.P. (1975). Load compensation in human masseter muscles. J Physiol. 253, 21-35.
Lambrecht, J.R. (1965). The influence of occlusal contact area on chewing performance. J Prosthet Dent 15, 444-450.
Liedberg, B., and Owall, B. (1991). Masticatory ability in experimentally induced xerostomia. Dysphagia 6, 211-213.
Liedberg, B., and Owall, B. (1995). Oral bolus kneading and shaping measured with chewing gum. Dysphagia 10, 101-106.
Luke, D.A., and Lucas, P.W. (1985). Chewing efficiency in relation to occlusal and other variation in the natural human dentition. Br Dent J 159, 401-403.
Lund, J.P., and Widmer, C.G. (1989). An evaluation of the use of surface electromyography in the diagnosis, documentation, and treatment of dental patients. J Craniomandib Disord Facial Oral Pain 3, 125-137.
Lundeen, H.C., and Gibbs, C.H. (1982). Advances in Occlusion. John Wright PSG Inc., Boston. pp.18-19.
Lund, J.P., Donga, R., Widmer, C.G., and Stohler, C.S. (1991). Review: The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol 69, 683-694.
Lyons, M.F., and Baxendable, R.H. (1990). A preliminary electromyographic study of bite force and jaw-closing muscle fatigure in human subuects with advanced tooth wear. J Oral Rehabil 17, 311-318.
Mahmood, W.A., Watson, C.J., Ogden, A.R., and Hawkins, R.V. (1992). Use of image analysis in determining masticatory efficiency in patients presenting for immediate dentures. Int J Prosthodont 5, 359-366.
Manly, R.S., and Braley, L.C. (1950). Masticatory performance and efficiency. J Dent Res 29, 448.
Manns, A., Miralles, R., and Palazzi, C. (1979). EMG, bite force and elongation of the masseter muscle under isometric voluntary contraction and variations of vertical dimension. J Prosthet Dent 42, 674-682.
Mansour, R.M., and Reynik, R.J. (1975). In vivo occlusal forces and moment. . Forces measured in terminal hinge position and associated moments. J Dent Res 54, 114-120.
Matsui, Y., Neukam, F.W., Wichmann, M., and Ohno, K. (1995). Application of a low-adhesive color-developing chewing gum system to patients with osseointegrated implant-supported prostheses. Int J Oral Maxillofac Implants 10, 583-588.
Michler, L., Bakke, M., and Moller, E. (1987). Graphic assessment of natural mandibular movements. J Craniomandib Disord Facial Oral Pain 1, 97-114.
Michler, L., Moller, E., Bakke, M., Andreassen, S., and Henningsen, E. (1988). On-line analysis of natural activity in muscles of mastication. J Craniomandib Disord Facial Oral Pain 2, 65-82.
Mioche, L., Bourdiol, P., Martin, J.F., and Noel, Y. (1999). Variations in human masseter and temporalis muscle activity related to food texture during free and side-imposed mastication. Arch Oral Biol 44, 1005-1012.
Moller, E. (1966). The chewing apparatus. An electromyographic study of the action of the muscles of mastication and its correlation to facial morphology. Thesis, Acta Physiol Scand 69: suppl.
Moller, E., Sheikholeslam, A., and Lous, I. (1984). Response of elevator activity during mastication to treatment of functional disorders. Scand J Dent Res 92, 64-83.
Mollijoda, M.A., Berry, D.C., Gooding, P.G. (1986). Measuring diurnal variations in occlusal contact areas. J Prosthet Dent 56, 487-492.
Mowlana, F., Heath, M.R., and Auger, D. (1995). Automated optical scanning for rapid sizing of chewed food particles in masticatory tests. J Oral Rehabil 22, 153-158.
Moyers, R.E. (1949). Temporomandibular muscle contraction patterns in Angle ClassⅡ, DivisionⅠmalocclusions: an electromyographic analysis. Am J Orthod 35, 837-857.
Nakasima, A., Higashi, K., and Ichinose, M. (1989). A new, simple and accurate method for evaluating masticatory ability. J Oral Rehabil 16, 373-380.
Olthoff, L.W., Van Der Bilt, A., Bosman, F., and Kleizen, H.H. (1984). Distribution of particle sizes in food comminuted by human mastication. Arch Oral Biol 29, 899-903.
Olthoff, L.W., Van Der Bilt, A., De Boer, A., and Bosman, F. (1986). Comparison of force-deformation characteristics of artificial and several natural foods for chewing experiments. J Text Stud 17, 275-289.
O’Rourke, J.F. (1949). Significance of tests for biting strength. J American Dental Association 38, 627-633.
Omar, S.M., McEwen, J.D. and Ogston, S.A. (1987). A test for occlusal function. The value of a masticatory efficiency test in the assessment of occlusal function. Brit J Orthod 14, 85-90.
Plesh, O., Bishop, B., and McCall, W.D. (1996). Patterns of jaw muscle activity during voluntary chewing. J Oral Rehabil 23, 262-269.
Prinz, J.F. (1999). Quantitative evaluation of the effect of bolus size and number of chewing strokes on the intra-oral mixing of a two-colour chewing gum. J Oral Rehabil 26, 243-247.
Proffit, W.R., Fields, H.W., and Nixon, W.L. (1983). Occlusal forces in normal- and long-face adults. J Dent Res 62, 566-571.
Proschel, P., and Hofmann, M. (1988). Frontal chewing patterns of the incisor point and their dependence on resistance of food and type of occlusion. J Prosthet Dent 59, 617-624.
Riise,C., and Ericsson, S.G. (1983). A clinical study of the distribution of occlusal tooth contacts in the intercuspal position at light and hard pressure in adult. J Oral Rehabil 10, 473-480.
Sato, H., and Ohashi, J. (1989). Sex differences in static muscular endurance. J Hum Ergol 18, 53-60.
Sato, S., Ohta, M., Sawatari, M., Kawamura, H., and Motegi, K. (1999). Occlusal contact area, occlusal pressure, bite force, and masticatory efficiency in patients with anterior disc displacement of the temporomandibular joint. J Oral Rehabil 26, 906-911.
Schanne, F.J., and Chaffin, D.B. (1970). The effects of skin resistance and capitance coupling on EMG amplitude and power spectra. Electromyography 10, 273-286.
Shiau, Y.Y., and Yeh, A.I. (1993). The demands of artificial testfoods for the study of human mastication (abstract). J Dent Res 72, 267.
Shiau, Y.Y., Chang, H.F., Chang, Y.C. and Chang, Y.C. (1996). Observation of bolus position with standardized test foods and fluoroscopic technique. J Oral Rehabil 23, 607-614.
Slagter, A.P., Van Der Glas, H.W., Bosman, F., and Olthoff, L.W. (1992). Force-deformation properties of artifical and natural foods for testing chewing efficiency. J Prosthet Dent 68, 790-799.
Tallgren, A., Holden, S., Lang, B.R., and Ash, M.M. (1983). Correlations between EMG jaw muscle activity and facial morphology in complete denture wearers. J Oral Rehabil 10, 105-120.
Thexton, A.J. (1992). Mastication and swallowing: an overview. Br Dent J 173, 197-206.
Tzakis, M.G., Kiliaridis, S., and Carlsson, G.E. (1989). Effect of chewing training on masticatory efficiency. Acta Odontol Scand 47, 355-360.
Van Der Glas, H.W., Van Der Bilt, A., Olthoff, L.W., and Bosman, F. (1987). Measurement of selection changes and breakage functions during chewing in man. J Dent Res 66, 1547-1550.
Van Der Bilt, A., Van Der Glas, H.W., Olthoff, L.W. and Bosman F. (1991). The effect of particle size reduction on the jaw gape in human mastication. J Dent Res 70, 931-937.
Van Der Bilt, A., Olthoff, L.W., Bosman, F., and Oosterhaven, S.P. (1993). The effect of missing postcanine teeth on chewing performance in man. Arch Oral Biol 38, 423-429.
Visser, S.L., and De Rijke, W. (1974). Influence of sex and age on EMG contraction pattern. Eur J Neurol 12, 229-235.
Widmalm, S.E., Ericsson, S.G. (1982). Maximal bite force with centric and eccentric load. J Oral Rehabil 9, 445-450.
Wilding, R.J.C., Adams, L.P., and Lewin, A. (1992). Absence of association between a preferred chewing side and its area of functional occlusal contact in the human dentition. Arch Oral Biol 37, 423-428.
Wilding, R.J.C. (1993). The association between chewing efficiency and occlusal contact area in man. Arch Oral Biol 38, 589-596.
Wright, P.S. (1992). Image analysis and occlusion. J Prosthet Dent 68, 487-491.
Yamada, Y., and Haraguchi, N. (1995). Reflex changes in the masticatory muscles with load perturbations during chewing hard and soft food. Brain Res 669, 86-92.
Yamashita, S., Hatch, J.P., and Rugh, J.D. (1999). Review: Does chewing performance depend upon a specific masticatory pattern? J Oral Rehabil 26, 547-553.
Yuen, S.W.H., Hwang, J.C.C., and Poon, P.W.F. (1989). EMG power spectrum patterns of anterior temporal and masseter muscles in children and adults. J Dent Res 68, 800-804.