Reliability of maximum bite force measurements in age-varying populations

In order for bite forces to be used clinically, they must be reliable. While bite force transducers are accurate and precise during bench tests, widely varying reliabilities of intra-oral bite forces have been reported when measured in human subjects. Because few studies have reported total reliability, the clinical use of intra-oral bite forces measurements remains questionable. The purposes of this study were to (i) estimate total reliability, including both within- and between-session reliabilities, of repeated maximum incisor and molar bite force measurements and (ii) demonstrate how extraneous variation affects reliability by comparing estimates for which the effects of age have and have not been controlled. A sample of 28 healthy subjects with Class I normal occlusion (seven subjects in each of four age groups: 5, 8, 11 and 14 years) performed two sessions approximately 90 min apart. Each session consisted of three maximum voluntary bites at three bite positions (incisor and right and left molars). For each bite position, between-subject variance (true variance), between-session variance and within-session variance were calculated using Multilevel modelling procedures. The variances were used to estimate between-session reliabilities, within-session reliabilities and total reliabilities. Within-session reliabilities were substantially higher than between-session reliabilities, which in turn was higher than total reliabilities at all bite positions. Reliabilities were highest at the incisor bite position. Not controlling for age effects substantially overestimated total reliability at all bite positions. After controlling for age effects, total reliabilities of repeated maximum bite forces were low to moderate.