Maximum bite forces in healthy adults with complete natural dentition: A systematic review.

Maximum bite force (MBF), occlusal contact area (OCA) and bite pressure (BP) are important indicators of occlusal function; however, protocol-specific data describing their regional and single-tooth distribution in healthy young Asian adults remain limited. To describe the distribution of MBF, OCA and BP in healthy young adults; to examine sex-related differences in these parameters; and to analyse the association between MBF and OCA. A cross-sectional study was conducted with 101 healthy young adults, including 51 males (mean age: 25.71 ± 3.02 years) and 50 females (mean age: 24.49 ± 2.68 years). Maximum, regional, and single-tooth bite force, together with the corresponding OCA, were measured using the Teetester bite force analyser. BP was subsequently calculated as force per unit occlusal contact area. Data distribution was assessed using the Kolmogorov-Smirnov test, and sex-related differences were evaluated using appropriate parametric or non-parametric tests. The association between MBF and OCA was examined using Spearman's rank correlation coefficient, and a regression model was constructed to estimate MBF from OCA. No significant sex differences were found in total MBF, OCA or BP values (p > 0.05). In both sexes, the highest values occurred at the first molars and the lowest at the lateral incisors. Regional analysis showed significantly greater posterior OCA and corresponding higher MBF in males (p < 0.05), whereas the anterior regions showed no significant sex differences (p > 0.05). A linear regression model was established: MBF (N) = -333.68 + 2.65 × OCA (mm2), with OCA explaining 68.0% of the variance in MBF (R2 = 0.680, p < 0.001). Total MBF, OCA, and BP were comparable between sexes in this cohort of healthy young adults; however, regional and single-tooth distribution patterns showed subtle sex-related differences. OCA was strongly associated with MBF and may serve as an important biomechanical indicator of occlusal function under the present measurement protocol. These findings provide preliminary, protocol-specific normative estimates of MBF, OCA and BP distribution in healthy young Asian adults. They may offer comparative data for future studies on occlusal function, restorative treatment planning and intelligent occlusal analysis systems. Clinical Trial Registration No.: ChiCTR2500097064.

Aim: To compare the chewing process and swallowing threshold parameters of subjects with complete dentures and overdentures with data obtained from subjects with complete natural dentitions. Metho-dology: The chewing process in terms of swallowing threshold parameters of four groups of subjects with complete dentures (all females) was quantified by sieving particles after chewing of an artificial test ‘food’ and compared with that of subjects with com-plete natural dentitions as a reference group (33 sub-jects). All subjects (except those of the reference group) had a complete denture in the upper jaw. Regarding the lower jaw two groups with complete dentures (with high (24 subjects), respectively low mandible (12 subjects)) and two groups with overdentures (implant-retained (22 subjects), respectively natural root supported (19 subjects)) were composed. Results: The ‘overdenture-implants’ group needed significantly more chewing cycles and time (mean: 45 cycles in 32 seconds) until ‘swallowing’ compared to the group with complete natural dentitions (mean: 26 cycles in 19 seconds until ‘swallowing’). Also the ‘complete denture-low mandible’ group needed sig-nificantly more cycles and time (mean: 52 cycles in 44 seconds) until ‘swallowing’ than the complete dentition group. In the ‘overdenture-natural roots’ group these outcomes (33 cycles in 24 seconds) were not significantly different compared with the complete dentition group. The ‘complete denture-high mandi-ble’ group (32 cycles in 26 seconds) needed not sig-nificantly more cycles until ‘swallowing’, however time until ‘swallowing’ was significantly longer com-pared to the complete dentition group. All denture groups had significantly larger mean particle sizes when ‘swallowing’ (sizes in the order of 3 mm) than the natural dentition group (about 2 mm). Conclusion: Despite efforts to compensate for a reduced chewing efficiency, subjects with complete dentures (including overdentures) had 50% larger median particle sizes when ‘swallowing’ compared to subjects with complete natural dentitions.

Evaluation of molar and incisor bite force in indigenous compared with white population in Brazil

The assessment of bite forces on healthy single tooth appears essential for a correct quantification of the actual impact of single implant oral rehabilitations. In the present study, a new single tooth strain-gauge bite transducer was used in 52 healthy young adults (36 men, 16 women) with a complete permanent dentition. The influences of tooth position along the dental arch, of side, and of sex, on maximum bite force were assessed by an ANOVA. No significant left-right differences were found. On average, in both sexes the lowest bite force was recorded on the incisors (40-48% of maximum single tooth bite force), the largest force was recorded on the first molar. Bite forces were larger in men than in women (P < 0.002), and increased monotonically along the arch until the first or second permanent molar (P < 0.0001). The present data can be used as reference values for the comparison of dental forces in patients.

To examine the associations among handgrip force (HF), maximum bite force (MBF) and body mass index (BMI) in individuals of the same age group across both genders. It also explores the laterality correlation between MBF and HF. Furthermore, to establish a simple approach for clinical MBF assessment, we aimed to develop a predictive model for MBF. In this cross-sectional study, 102 healthy young adults (51 males, 51 females) underwent MBF measurement via a dental bite force tester and HF via a digital dynamometer. BMI was calculated from height and weight. Spearman's correlation assessed variable relationships and laterality patterns; gender differences were analysed using Mann-Whitney U tests. A multiple regression model was constructed to predict MBF. MBF and HF were significantly correlated in both genders (p < 0.01). BMI showed a stronger influence on MBF and HF in females (p < 0.01). Laterality correlations between HF and MBF were also stronger in females. Males exhibited higher HF and BMI (p < 0.01), while MBF showed no significant gender difference (p = 0.536). HF and BMI are strong predictors for MBF. The developed predictive model offers a practical and objective tool for MBF assessment in healthy young adults. This model provides a simple, reliable method for clinical evaluation of MBF. ChiCTR2500097064.

Impact of midface and upper face fracture on bite force, mandibular mobility, and electromyographic activity

Bite force is a significant component of chewing and masticatory function. The literature lacks studies that compare bite force values of implant-supported fixed bridges to natural dentition within same subjects. The objective of the study was to assess maximum occlusal bite force (MBF) among patients with an implant-supported fixed prosthesis and compare it to their opposite dentate side and also to determine the effect of gender, age and Body Mass Index (BMI) on maximum occlusal bite force. Forty patients (20 males and 20 females, mean age = 42.7 ± 9.6 years) with an implant-supported fixed prosthetic rehabilitation on one side and dentate on the other side were recruited into this study. Participants' MBF were measured bilaterally at the first molar region using a digital hydraulic occlusal force gauge (GM10). The measurements were repeated three times (with 45 s intervals between times) for each side, and the highest value of the bite force (MBF) was recorded for each side. The mean MBF was 577.9 N at the implant-supported prosthesis side and 595.1 N at the dentate side. The average MBF was higher at the dentulous side (P < 0.05). Maximum occlusal bite force was higher in males and participants with higher weight and height. However, BMI was not significantly related to MBF values. Maximum occlusal bite force values at the dentate side were slightly (3%) but significantly higher than MBF at implant-supported prosthesis side. Males, taller patients and patients with higher weights had higher MBF values. Body mass index was not significantly related to MBF values.

Background: Chronic kidney disease (CKD) is an escalating public health issue with increasing incidence and prevalence. Patients undergoing hemodialysis (HD) are particularly vulnerable to malnutrition, significantly impacting morbidity and mortality rates. Objective: This meta-analysis aimed to evaluate the effectiveness of nutritional education interventions for CKD patients undergoing hemodialysis, focusing on renal and nutritional outcomes compared to usual care. Methods: A comprehensive literature search was conducted from January 2011 to December 2023 using databases such as CINAHL, PubMed, Science Direct, Academia, and Google Scholar. The inclusion criteria were randomized controlled trials (RCTs) and quasi-experimental studies (QES) involving adult CKD patients undergoing hemodialysis. Data extraction and quality assessment were independently performed, and inconsistencies were resolved by consensus. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used for quality assessment. Data were analyzed using RevMan 5.4.1, employing a random-effects model to calculate pooled effect sizes for renal (eGFR, serum creatinine, serum urea) and nutritional outcomes (serum albumin, hemoglobin). Statistical heterogeneity was assessed using the I2 statistic, and the analysis was performed with SPSS version 25. Results: The analysis included nine RCTs and four QES, totaling 645 participants for RCTs and 202 for QES. The pooled effect sizes showed no statistically significant improvements in key biochemical markers. Changes in eGFR were -1.47 (95% CI: -4.04 to 1.10, p=0.26, I2=0%), serum creatinine 0.00 mg/dl (95% CI: -0.13 to 0.13, p=0.99, I2=0%), and serum urea -10.49 mg/dl (95% CI: -35.73 to 14.76, p=0.42, I2=80%). For nutritional outcomes, serum albumin levels changed by -0.07 g/L (95% CI: -0.24 to 0.10, p=0.44, I2=23%) and hemoglobin by 0.22 mg/dl (95% CI: -0.75 to 1.18, p=0.66, I2=77%). Notable improvements were observed when nurses and dietitians collaborated and involved patients in meal preparation. Conclusion: Nutritional education interventions favored the experimental group, although statistical significance was not achieved. Collaborative approaches involving nurses and dietitians and patient involvement in meal preparation showed potential benefits. This review highlights the importance of patient-centered, high-quality research to improve nutritional education for hemodialysis patients.

A systematic review and meta-analysis of extra-intestinal manifestation of inflammatory bowel disease in the Eastern Mediterranean Region (EMRO) countries.

Introduction: There is a wide variation in stroke epidemiology in India due to the differences in culture and the variability in the distribution of risk factors across the states. The present meta-analysis provides a pooled estimate of age, gender, and region-based stroke epidemiology in India based on epidemiological transition level (ETL) groups described in the Global Burden of Disease (GBD) Study (2016). Methods: We searched in PubMed and Google Scholar, and relevant studies published till February 2022 were included. Observational studies conducted in the Indian setting were included and global or Indian studies that exclusively estimated the prevalence, incidence, or mortality data among patients with stroke were excluded. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used for the risk-of-bias assessment and publication bias was evaluated by funnel plots and Egger’s test. The R software was used to perform this meta-analysis; I2 statistics were calculated to measure heterogeneity among studies. Results: We included 58 studies in the systematic review, and after quality assessment, 47 studies were finally included for meta-analysis. The sample sizes of the included studies ranged from 40 to 4989 and the mean age of the participants ranged from 31.7 (Standard Deviation, SD-7.4) to 70.5 (SD-10.7). The burden of stroke was estimated based on the ETL groups described in the GBD Study 2016. We found a male preponderance (64.5%; 95% confidence interval [CI]: 62.5%-68.3%) in the gender distribution of strokes and 75.2% (95% CI: 68.7%-81.7%) of the stroke occurred above the age of 50 years. Ischemic stroke is the predominant subtype of stroke in India, with a higher proportion in the middle ETL region (74.0%; 95% CI: 65.1%-81.3%) as compared to those with low ETL (67.2%; 95% CI: 49.9%-80.8%) and high ETL regions (67.5%; 95% CI: 57.0%-76.4%). Conclusion: There was a significant heterogeneity among the included studies. Majority of strokes occurred in the age group of more than 50 years with a male preponderance. Ischemic stroke was the most common type of stroke with its proportion varying from 67% to 74% depending on ETL. PROSPERO Registration: CRD42022316774.

BackgroundTuberculosis (TB) is a main concern of health care workers in sub-Saharan Africa. Healthcare workers have the potential to have contact with TB patients and are the main stakeholders in...

BackgroundAntimicrobial resistance (AMR) is a global public health concern that is fueled by the overuse of antimicrobial agents. Low- and middle-income countries, including those in Africa,. Point prevalence surveys (PPS) have been recognized as valuable tools for assessing antimicrobial utilization and guiding quality improvement initiatives. This systematic review and meta-analysis aimed to evaluate the prescription rates, indications, and quality of antimicrobial use in African health facilities.MethodsA comprehensive search was conducted in multiple databases, including PubMed, Scopus, Embase, Hinari (Research4Life) and Google Scholar. Studies reporting the point prevalence of antimicrobial prescription or use in healthcare settings using validated PPS tools were included. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A random-effects meta-analysis was conducted to combine the estimates. Heterogeneity was evaluated using Q statistics, I² statistics, meta-regression, and sensitivity analysis. Publication bias was assessed using a funnel plot and Egger’s regression test, with a p-value of < 0.05 indicating the presence of bias.ResultsOut of 1790 potential studies identified, 32 articles were included in the meta-analysis. The pooled prescription rate in acute care hospitals was 60%, with significant heterogeneity (I2 = 99%, p < 0.001). Therapeutic prescriptions constituted 62% of all the prescribed antimicrobials. Prescription quality varied: documentation of reasons in notes was 64%, targeted therapy was 10%, and parenteral prescriptions were 65%, with guideline compliance at 48%. Hospital-acquired infections comprised 20% of all prescriptions. Subgroup analyses revealed regional disparities in antimicrobial prescription prevalence, with Western Africa showing a prevalence of 65% and 44% in Southern Africa. Publication bias adjustment estimated the prescription rate at 54.8%, with sensitivity analysis confirming minor variances among studies.ConclusionThis systematic review and meta-analysis provide valuable insights into antimicrobial utilization in African health facilities. The findings highlight the need for improved antimicrobial stewardship and infection control programs to address the high prevalence of irrational antimicrobial prescribing. The study emphasizes the importance of conducting regular surveillance through PPS to gather reliable data on antimicrobial usage, inform policy development, and monitor the effectiveness of interventions aimed at mitigating AMR.

ABSTRACTBackground and AimsTungiasis, caused by the female sand flea Tunga penetrans, is a neglected tropical disease (NTD) with substantial health and socioeconomic burdens in low‐ and middle‐income countries (LMICs). This systematic review and meta‐analysis aimed to estimate the pooled prevalence of tungiasis and identify associated risk factors in Ethiopia's Oromia and Southern Nations, Nationalities, and Peoples' Region (SNNPR).MethodsWe systematically searched Scopus, Web of Science, PubMed, Science Direct, and African Journal Online (AJOL) for studies published between October 2015 and September 2024. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A random‐effects meta‐analysis model was employed to account for heterogeneity, quantified using I² statistics. Publication bias was evaluated via funnel plots, and Egger's regression test.ResultsAcross eight studies (n = 8502 individuals), the pooled prevalence of tungiasis was 39.0% (95% CI: 28.5–49.6). Subgroup analyses revealed regional disparities, with SNNPR exhibiting a higher prevalence (43.1%; 95% CI: 27.1–58.1) than Oromia (35.0%; 95% CI: 18.8–51.3). Temporal trends indicated a significant increase in prevalence post‐2017 compared to earlier years. Low education levels (adjusted odds ratio [AOR]: 2.7, 95% CI: 0.6–4.9), lack of footwear use (AOR: 8.8, 95% CI: 0.1–17.4) and mud/earthen flooring (AOR: 4.9, 95% CI: 2.6–7.2) were significantly associated with tungiasis among selected regions of Ethiopia.ConclusionThis meta‐analysis demonstrates a significant burden of tungiasis in Ethiopia's Oromia and SNNPR regions. Therefore, we recommend implementing integrated interventions that combine: (1) provision of community‐based health education programs to improve prevention awareness, (2) distribution of protective footwear to high‐risk populations, (3) housing improvements focusing on floor hardening, (4) expanded access to safe treatment modalities, and (5) targeted animal reservoir control measures. Such coordinated efforts, embedded within existing NTD control platforms, could substantially reduce tungiasis transmission while addressing the socioeconomic determinants that perpetuate high infection rates in these endemic regions.

Background & objectivesStudies suggest hypothyroidism is responsible for female infertility. This review aimed to determine the pooled prevalence of hypothyroidism in Indian infertile women so that hypothyroidism screening can be initiated, and policies are designed for prevalence reduction.MethodsElectronic databases including PubMed, Google Scholar and Cochrane library were searched to obtain the relevant articles. Studies that reported the proportion of hypothyroidism in Indian infertile women were selected. Systematic procedures for study selection and data extraction were followed. Each study was evaluated for quality using the Joanna Briggs institute (JBI) critical appraisal checklist. To pool the effect sizes, a random effects model was utilized. Funnel plot and Egger’s test were used to assess publication bias. To quantify heterogeneity among studies, I2 statistics were utilized. Subgroup and meta-regression analyses were used to further investigate the heterogeneity of pooled estimates. The sensitivity analysis done whereby each study was excluded in order to examine the influence of that study in the pooled estimate. A P-value of 0.05 or less was considered statistically significant.ResultsOut of 198 articles, a total of 20 studies involving 2396 cases met the inclusion criteria. The pooled prevalence of hypothyroidism in women with infertility was 28 per cent [95% confidence interval (CI): 20% to 36%] which was highest in Telangana at 62 per cent (n=1; 95% CI 48% to 74%) and lowest in Karnataka at 14 per cent (n=2; 95% CI: 10% to 18%).Interpretation & conclusionsInfertile women have high proportion of hypothyroidism, suggesting that screening programmes during diagnostic workup for infertility may provide optimal care. The result of this meta-analysis will help design guidelines and earmark highest prevalence regions to initiate preventive and diagnostic measures for prevalence reduction in future.

Background Malnutrition is major public health problem worldwide, particularly in developing countries including Ethiopia. In 2016, out of 667 million children under five years of age, 159 million were stunted worldwide. The prevalence of stunting has been decreasing greatly from 58% in 2000 to 44% in 2011 and 38% in 2016 in Ethiopia. However, the prevalence of stunting is still high and considered as public health problem for the country. The aim of this systematic review and meta-analysis is to assess the prevalence of stunting and its associations with wealth index among children under five years of age in Ethiopia. Methodology. The databases searched were MEDLINE, Scopus, HINARI, and grey literature studies. The studies' qualities were assessed by two reviewers independently, and any controversy was handled by other reviewers using the Joanna Briggs Institute (JBI) critical appraisal checklist. The JBI checklist was used in assessing the risk of bias and method of measurement for both outcome and independent variables. Especially, the study design, study participants, definition of stunting, statistical methods used to identify the associations, results/data presentations, and odds ratios (ORs) with confidence intervals (CIs) were assessed. In the statistical analysis, the funnel plot, Egger's test, and Begg's test were used to assess publication bias. The I2 statistic, forest plot, and Cochran's Q-test were used to deal with heterogeneity. Results In this review, 35 studies were included to assess the pooled prevalence of stunting. Similarly, 16 studies were used to assess the estimated effect sizes of wealth index on stunting. In this meta-analysis, the pooled prevalence of stunting was 41.5% among children under five years of age, despite its considerable heterogeneity (I2 = 97.6%, p < 0.001, Q = 1461.93). However, no publication bias was detected (Egger's test p=0.26 and Begg's test p=0.87). Children from households with a medium or low/poor wealth index had higher odds of stunting (AOR: 1.33, 95% CI 1.07, 1.65 or AOR: 1.92, 95% CI 1.46, 2.54, respectively) compared to children from households with a high/rich wealth index. Both of the estimated effect sizes of low and medium wealth indexes had substantial heterogeneity (I2 = 63.8%, p < 0.001, Q = 44.21 and I2 = 78.3%, p < 0.001, Q = 73.73) respectively). In estimating the effect, there was no publication bias (small-studies effect) (Egger and Begg's test, p > 0.05). Conclusions The pooled prevalence of stunting was great. In the subgroup analysis, the Amhara region had the highest prevalence of stunting, followed by the Oromia and Tigray regions, respectively. Low economic status was associated with stunting in Ethiopia. This relationship was found to be statistically more accurate in Oromia and Amhara regions. The government should emphasize community-based nutrition programs by scaling up more in these regions, just like the Seqota Declaration.