UDC: 531.78, 577.3, 616.

Measurement of cheekltooth forces during
speech production
by G. Cama1, P. Cappa
, V. Kaltsas
, F. Mastrantonio
and S.A. Scluto
l Department of Physiology, JSEF, Rome
2 Department of Mechanics and Aeronautics, University of Rome "La Sapienza"
3 School of Dentistry, University of Siena
4 Sorin Biomedica, Modena
5 Department of Mechanical and Industria[ Engineering, 111 University of Rome
This paper deals with the "in vivo" evaluation ofthe forces
exerted by perioral muscles on dental arches and describes
the relationship between these loads and the acoustic
emission, during speech production. To carry out the
research two miniaturised load cells were placed on the
upper incisors' vestibular surface of I 2 patients ( 6 male, 6
female age ranging from 19 to 25 years) to monitor the
contactforces generated during the pronunciation ofthree
phonemes containing labio-dental sounds. The acoustic
pressure was gathered by means of a capacitive microphone.
From the obtained results it is shown that some values of
the force applied during speaking are of significance in
corrective orthodontics; infact, the maxima ofthe recorded
values were approximately 2. 7N and 1.0N for female and
male subjects, respectively. Also a tendency was observed
for a logarithmic dependence between the loads exerted
by perioral muscles on teeth and the acoustic pressure leve l
due to the voice; infact, the correlation coefficients R were,
for some of the examined patients, >0. 9, even if values of
0.4 also were observed.
Key words: Force measurements, perioral muscle, tooth
movements, restorative dentistry, biomechanics of jaw, oral
cavity anatomy and physiology
When an orthodontic force is applied to a tooth, the tooth
moves owing to resorption of the alveolar bone on the
pressurised side and to apposition of the bone on the
opposite side. The resulting mechanical stress or bone
distortion is the main factor in the activation of the
periodontalligament and alveolar bone cells, responsible
for tooth displacements

• Such a phenomenon is widely
used in clinical dentistry, during orthodontic therapy, in
order to resolve common dental problems. As an example,
if the teeth are improperly spaced or orientated in the mouth,
there can be functional and aesthetic disturbances. Then,
in dental care of patients i t is of great importance to realign
the teeth and restore a normal occlusion; to do that,
malaligned teeth must be permanently moved with respect
to other teeth and bone of the jaw. It must be underlined
that tooth movement means translation or rotation relative
to the jaw over a peri od of weeks and months: to achieve
this, forces and movements are applied to target teeth by
wires, springs, and appliances
'Strain', August 1997
In recent times, a significant controversy has developed
about the role of perioral musculature in orthodontic
treatment. Some anatomists bave pointed out, by means of
dissections and careful exarninations of anatomica! finds,
that the perioral muscles form rea] functional units able to
affect the underlying bone and, therefore, the dental arch
shape and tooth position

These muscles (i.e. the buccinator and the orbicularis oris
muscle), in fact, are placed in the lip and cheek area and
they contract during various oral functions e.g. chewing,
swallowing, speaking and facial mimics. It is supposed that
these contractions cause a pressure on the dental arch antero-
lateral zones both in the rest position and during their
functions. If the previously indicated hypothesis is true,
such muscles might cause short term tooth movements in
response to intermittent loads occurring during daily oral
activities, or long-term movements, occurring over days
and months, in the presence of maxillofacial and dental
pathologies. Such a hypothesis could explain the results
obtained from some authors according to whom orthodontic
treatment of 66 per cent of the patients gave unstable results
and failure in about six years time

From the above reported considerations the importance in
clinica] dentistry of confmning this hypothesis, in order to
plan the correct orthodontic therapy, becomes evident.
Nevertheless, from an analysis ofliterature on this specific
subject a serious deficiency in the knowledge of this
musculature, believed for many years to be of unnoticeable
significance in dentistry, emerges. As an example some
authors disagree also on perioral muscle basic anatomy e.g.
insertion sites, disposal and correlation existing between
orbicularis oris muscle, facial muscles of the perioral zone
and the buccinator muscle. Such a lack ofknowledge about
this musculature implies, as it is obvious, a considerable
gap regarding its effects on dental tissue and, specifically,
the pressure exerted during the various functional activities
is untraceable in the literature

In order to obtain this information, in the present paper,
measurements of the forces applied by peri ora] muscles on
speaking patient dental arches were undertaken and their
correlation with acoustic pressure levels induced by the
voice, given out during speech production, was investigated.
The adopted measurement chain, according to a previous
, consisted of a condenser microphone and two
miniaturised load cells attached to dental tissue by means
of a photoactivatable polymer. The transducer outputs,
together with the microphone signa!, were gathered by
means of a digitai data acquisition system.
Experimental set up, procedure and results
To carry out the investigation, namely to measure perioral
forces acting on dental arches during speech production
and to associate them with the sound pressure leve!, it was
decided to use two miniaturised strain gauge based load
cells about 4mm thick. Such a value was chosen because,
as shown by some authors
, an increase in the transducer
thickness up to 4.5mm does not significantly affect the
output if the experimentalist waits a sufficient time length
to allow the ora! tissue to adjust to the new configuration.
As described previously, the load cells were applied directly
on teeth vestibular surfaces by means of a photoactivatable
polymer in arder to minimise the insertion errors due to a
clip device used in another study
• In particular, the sensing
element of the transducer had been placed near the upper
incisor, those being the most prominent teeth of the upper
arch and those that reasonably carry the major part of the
loads exerted by perioral muscles; the specific load celi
position in the proximity of the upper incisor depends on
the specific dental arch of the 13 examined patients.
According to Lear et al.
• it was decided to measure the
force applied by muscle instead of the pressure exerted by
them; in fact these researchers observed that muscle contact
is not always evenly distributed aver the entire sensing area
of the pressure transducer. Therefore, the commonly
employed pressure transducers are unsuitable for this kind
of experimental study. Thus, a force transducer, such as the
one described, is necessary for investigation in this specific
Load celi No.I
Straln pge slgnal Power
conditioning unit supply
Fig. 1 Scheme of the experimental setup
Figure l shows the adopted measurement system used to
monitor the transducer's output as function of time. It
consists of (l) two load cells (TML CLS-KA) based on
electrical resistance strain gauges, full scale =9.81N,
sensitivity =213.7J.lm/m/N, accuracy = ±2 per cent; (2) a
sound leve! meter system with a B&K 4165 condenser
microphone and the relative conditioner bandwidth 3Hz -
20kHz at -2dB; (3) strain gauge signa! conditioning units
with a D.C. amplifier specific for dynamic measurements
(Vishay 2100), bandwidth 0-5kHz at -0.5dB; and, finally,
( 4) anti-aliasing filters for the force signals (two Butterworth
two pale lowpass filters with a fina! RC passive stage, cut
offfrequency at -3dB 150Hz) and for speech recording (two
Butterworth two pole band pass filters with a fina! RC
passive stage to cut off the microphone bias voltage,
bandwidth at -3dB of l.5Hz- 1kHz). The gathered signals
were real time sampled (sampling frequency =2kHz,
resolution =16 bit) by using an A/D converter board
(National Instruments AT MIO 16X) plugged in a PC
controlling the instruments and stored in a magneto support
for post-processing analysis. The sampling frequency value
was chosen to accomplish the optimisation of the amount
of digitised data stored in the data acquisition system with
the requirement of a correct representation of the waveforms
because of the constraint of gathering the acoustic and force
signals (whose significant harrnonics are in the range 0-
15Hz9) at the same sampling frequency. However, it is
necessary to outline that an accurate recognition of the vocal
signa! requires a sampling frequency of almost 6kHz
according to standard criteria
although most of the acoustic
signa! power spectral density is distributed in the S0-350Hz
frequency band and outside this range the mean spectral
power decreases by about 30dB/decade
• As a consequence,
the chosen data sampling involved a power loss equa! to
18 percent that in this study could be considered acceptable
considering that only the magnitude of the acoustic pressure
leve! was of interest while the intelligibility of the voice
signa! was not essential.
The acquisition program was written in the National
Instruments Labview object orientated language, post-
processing analysis was performed in Matlab language.
For an evaluation of accuracy and zero shift effects relative
to the measurement chain after the load cells, a preliminary
and simple experimental analysis was performed before
carrying out the analysis on patients. Five static calibration
tests therefore were performed by means of a calibration
uni t specific for Wheatstone bridges (MM 1550A) applying
constant strains in the range 0-2000J.!m/m, that is equivalent,
for the load cells utilised, to 9.36N, roughly the load cells'
full scale. Each test was performed by sampling the step
input of the calibrator at a frequency rate of l O Hz and by
computing mean value and standard deviation of the 100
gathered samples. From the obtained results i t was observed
that the inaccuracy was always less than ±10J.!rnlm that is
equa! to ±0.05N, nominally the 0.5 percent ofthe sensors'
full scale, with a standard deviation of about ±2J.!m/m that
corresponds to 0.009N. Such force magnitudes are
insignificant in corrective orthodontics. Then the following
'Strain', August 1997
drift tests, that each Iasted for 24 hours, were conducted
(l) three zero shift tests, and (2) three drift tests imposìng
1000/lmlm straìn (equivalent to 4.68N) because, accordìng
to Lear et al.
, this is reasonably the maximum value exerted
by orofacial muscles during norma! daily activity. The
obtained results ha ve shown a zero shift in the range ±2/lml
m. Unfortunately, no data were available from the load celi
manufacturer conceming drift magnitude.
A teeth mode! was preliminary obtained for each of the 12
patients examined. The two load cells were fixed on the
patient who was asked to remain silent in arder to gather
the background sound; thereafter, the patient was asked to
repeat the word "papa" ten times gradually increasing the
voice volume. The previously indicated word was selected
because its pronunciation involves movements of the lips
that require considerable usage of the perioral muscle. An
example of the obtained results for the first female and
corresponding to the highest volume of the voice is shown
in Fig.2.
~ u
0.0 0.2 o.
o. o. a
~ ~
1.0 1.2 1.4 1.8
Fig.2 Female No1; load exerted by perioral musc/e and mean
acoustic pressure leve/ signa/ variation as a function of
ti me
The evaluation of the force recorded shows a noticeable
difference between the signa! waveforms recorded by the
two load cells; this difference was correlated with the patient
asymmetric muscular configuration and with the specific
muscular activation. It is also relevant to outline that the
negative force measured during the silence phase was within
the inaccuracy range ofthe measuring system, i.e. ±O.OSN.
Maximum load values N(xl0
) Mean Ioad values N(x IO-')
Left teeth arch Right teeth arch Left teeth arch Right teeth arch
No. l 25.5 22.6 7.8 7.8
No.2 16.7 10.8 6.9 9.8
No.3 8.8 9.8 5.9 7.8
No.4 10.8 12.8 5.9 6.9
No.5 4.9 4.9 2.9 3.9
No.6 10.8 11.8 6.9 6.9
Table 1 Results obtained with tema/e patients
'Strain ', August 1997
The comparative examination of the load and intensity voice
signa! variati an as a function of ti me showed a delay of l 0-
20ms between the maximum load value and the beginning of
the sound signa!; this delay was observed in ali the examined
patients. Peak and mean load values using the whole data
collected and the values obtained for female patients are
summarised in table l. The analysis of table l shows a data
spread among the patients, in addition a variability in the force
exerted by the right and the Ieft teeth arch was observed also
within the same patient. Similar data spread and asymmetry
were gathered formale patients (see table 2).
Maximum load values N(xlO') Mean load values N(xlO·')
Left teeth arch Righi teeth arch Left teeth arch Right teeth arch
No. l 6.9 3.9 4.9 2.0
No.2 4.9 6.9 2.0 3.9
No.3 - 4.9 - 2.0
No.4 6.9 5.9 2.0 2.0
No.5 6.9 16.7 2.0 6.9
No.6 12.8 17.7 3.9 7.8
Table 2 Results obtained with male patients
For male No.3, because of technical reasons, some data
were not available. From a global examination of tables l
and 2 it is possible to observe that two patients (female
No.2 and male No.5) showed a marked difference between
the right and the left teeth arch, thus, i t was decided to search
for a possible anatomica! explanation and it emerged that
both patients presented anatomica! dismorphysm. However,
although the analysis of the conformati o n of the de n tal arch
may suggest what is the area subjected to the greatest load,
only an experimental analysis, as presented here, allows
unsymmetricalload evaluation.
Finally, an attempt was made to evaluate the correlation
between the mean muscle load and the intensity voice
signa!; among the possible interpolations the Iogarithmic
one was chosen in arder to maximise the correlation
coefficient, R, value. The above observation suggests the
existence of a saturation phenomenon that limits the load
exerted by the perioral muscle independent from the voice
~ 0.1 ol-----1---r-.:71"'------t----t-----r--
0 ~ - - . - ~ ~ - - - - -   - - - - - - ~ - - - - - - P - - - - - ~
o 0.1 0.2 U D.4 o.s
Mean acouatlc presaure level [Pa)
Fig.3 Correlation between the mean load exerted by perioral
muscle and mean acoustic pressure leve/
One of the obtained results is shown in Fig.3 while the
obtained correlation coefficients are summarised in tables
3 and 4 for female and male patients, respectively.
Patient Left teeth arch Right teeth arch
No. l 0.85 0.81
No.2 0.74 0.85
No.3 0.96 0.97
No.4 0.85 0.91
No.5 0.93 0.87
No.6 0.89 0.91
Table 3 Female patients; correlation coefficient, R, between
load exerted by perioral muscle and voice volume
Patient Left teeth arch Right teeth arch
No. l 0.95 0.87
No.2 0.92 0.90
No.3 0.97 0.97
No.4 0.40 0.89
No.5 0.81 0.81
No.6 0.88 0.93
Table 4 Male patients; correlation coefficient, R, between
load exerted by perioral muscle and voice volume
lt should be noted that the R values are in ranges of 0.8-0.9
with the exception of one of the examined patients with
R=0.4 which indicates a probability of 25 percent for an
interpolation logarithmic line

Concluslon and future prospects
The present experimental study demonstrated the presence
of considerable effects induced by perioral muscle on the
upper dental arch, in particular this effect was remarkable
for some of the examined patients. In addition this study
allowed the identification and the evaluation of the effect
induced by the observed dental arch asymmetry and the
relationship between the force exerted by the perioral
muscle and the intensity voice signal. Moreover, a
correspondence between dental arch asymmetry and the
force difference measured by the two load cells is shown.
In order to verify the previously indicated observations, in
the ongoing research phase there will be examined a larger
number of patients and the number of load cells will be
increased in order to simultaneously monitor a larger
number of anatomica! sites and to individualise a
relationship between dental arch morphology and perioral
muscle force applied.
The authors wish to express their appreciation to Mr
Francesco Rapanotti, technician of the Department of
Mechanics and Aeronautics at University of Rome "La
Sapienza" for the support provided and the "Studi
Odontoiatrici Associati" of Rome for the experimental
facilities and assistance.
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5. D'Andrea M., Caligiuri F.M., Ripani M., "Ruolo della
muscolatura periorale nella pianificazione del
trattamento ortodontico", XXlli Congresso della Societa
Italiana di Odontostomatologia e Chirurgia Maxillo-
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mixed dentition", Am. J. Orthod. Dentofac. Orthop.,
May, (1990), 273-279.
7. Frederick S., ''The perioral muscular phenomenon: part
1", Australian Orthodontic Joumal, 12, (1992), 3-12.
8. Frederick S., ''The perioral muscular phenomenon: part
II", Australian Orthodontic Joumal, 12, (1992), 83-89.
9. Branca F.P., Cappa P., Mastrantonio F., "An
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10. Lear C.S.C., et al., "Measurement of latera! muscle
forces o n dental arche s", Archi ves of Oral Biology, 10,
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Roma, (1975), in Italian.
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'Strain', August 1997

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