Association of Non-carious Cervical Lesions With Oral Hygiene Aspects and Oclusal Force

Association of Non-carious Cervical Lesions With Oral Hygiene Aspects and Oclusal Force | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association of Non-carious Cervical Lesions With Oral Hygiene Aspects and Oclusal Force Rafael Dario Werneck, Daher Antonio Queiroz, Diana Leyva del Rio, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1670528/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract One of the theories that contribute to explaining the evolution of non-carious cervical lesions (NCCLs) refers to fatigue wear, in which the concentration of stresses in the cervical region leads to the formation of microfractures in the dental tissues and progressive structure loss. However, due to a combination of factors that may cause wear, there is still uncertainty about the role of the occlusal factor as a risk factor that causes NCCLs. Objectives: The purpose of this case-control study was to investigate the association between the presence of NCCLs with occlusal force and other potential risk factors. Materials and Methods: Thirty-nine participants with NCCLs (cases) and 39 non-carrier patients (control), aged between 20 and 59 years old, were enrolled in the dental clinic of the Faculdade Integradas São Pedro (FAESA), located in Vitória, Espírito Santo State, Brazil. Information was collected through anamnesis, clinical examination, and a questionnaire addressing aspects related to tooth brushing, dentifrice, and mouthwash use. In clinical examination, patients were submitted to four measurements of occlusal force in the maxillary first premolars and maxillary first molars, using a strain gauge sensor of medium intensity, the Flexiforce (Tekscan, South Boston, MA, USA). The sensor was calibrated for the unit of measurement in Newtons (N). Results: Data was analyzed using a Student's t-test and multiple logistic regression, adopting the significance level of 5%. There was no statistically significant difference between the case and control groups regarding the bite force in the four measured regions. Logistic regression identified sex as a factor significantly associated with non-carious cervical lesions (p = 0.020). For the calculation of the odds ratio, the female sex presented a six-fold chance (OR = 6.082; CI = 1.332 - 27.765) higher than non-carious cervical lesions. Conclusions: It was concluded that females presented a higher risk factor for non-carious cervical lesions than men, whereas there was no association of occlusal strength, as well as aspects related to brushing and deleterious habits. Clinical Relevance: NCCLs are highly prevalent in daily clinical practices and can impact aesthetics and function, leading to hypersensitivity and impairment of oral-health-related quality of life. Gingival recession is an important clinical indicator for the presence of NCCLs. Bite Force Dental Occlusion Non-carious cervical lesions Tooth Wear Figures Figure 1 Figure 2 Figure 3 1. Introduction Dental enamel is a highly crystalline structure composed of 96% of its constituents of mineral nature limiting the elasticity of the tissue. Dentin has a mineral content of approximately 70%, being the rest of its composition of proteins, lipids, and water that provides a certain degree of elasticity [1,2]. One of the processes that can affect this natural interaction is dental wear, mainly in the cervical region, where the enamel is thinner, forming non-carious cervical lesions (NCCLs) which is a common condition found regularly by clinicians. In general, it is believed that NCCLs are not caused by a single factor, but rather by a combination of factors. NCCLs have a multifactorial origin and progression, and the contribution of these various processes is not yet well defined in the scientific literature. Among the processes that cause NCCLs are abrasive, corrosive, and fatigue wear. The diagnosis of NCCLs can be based on a detailed history, visual inspection, and intraoral examination [3-13]. Based on its clinical characteristics, some NCCLs, have been labeled as abfraction lesions. This term was established by Grippo in 1991[14], from the Latin ab = out and fractio = fracture. The abfraction hypothesis is based on the biomechanical theory that there is a concentration of tension in the cervical region caused by the flexion during occlusal loading, resulting in the formation of cervical microfractures, ultimately causing the rupture between the apatite crystals of the enamel and the dentin [7, 15-18]. From the clinical point of view, this lesion initially presents as minor grooves, which gradually undergo a process of fatigue wear caused by occlusal load, culminating with the formation of a wedge-like lesion, ending in thin and delicate enamel. When the affection progresses, radiographically it will show an increased thickening of the periodontal ligament and lamina dura. One possible explanation for these lesions is the traction forces in the region of the vestibular and palatine alveolar bone caused by oblique loads during eccentric movements. Since bone is thinner in the vestibular region, the compressive force may be more critical on the surface, promoting a vestibular bone loss accompanied by a gingival recession. This favors the progression of non-carious lesions on the buccal aspect of teeth since there is a loss of support with the loss of enamel structure in the cervical region. This is especially true in patients with decreased mucosal keratinization and fine gingival biotype [2, 18-20]. Abrasion consists of the wear of dental tissues through frequent contact of objects which results in mechanical wear, while erosion is the chemical loss of hard dental tissue by the action of intrinsic and extrinsic acids [21,22]. The occlusal factor is discussed in the literature as a possible factor that may be associated with the etiology and progression of non-carious cervical lesions, usually related with occlusal trauma by lateral forces, a subject not well described in the literature [10,16,23,24]. Since there is still a lack of information correlating certain factors such as occlusal force, deleterious habits such as biting objects, and oral hygiene habits with the progression of NCCLs, the purpose of this case-control study was to investigate the association between the presence of non-carious cervical lesions with occlusal force and other potential risk factors such as sex, brushing, age and deleterious habits. 2. Materials And Methods 2.1 Ethical aspects This study was approved by the Ethics Committee of the Faculdade Integradas São Pedro (FAESA) with the number: 850.991 and validated by the Ethics and Research Committee of the São Leopoldo Mandic School. 2.2 Selection and characterization of the sample The sample size was determined based on a pilot study of 15 patients. The parameters used in the calculation were: significance level of 5%, mean of the sample of the case group of 165.3 N (SD 33.8 N), mean of the control group sample of 193.3 N (SD 41.8 N), with 90% test power and 1: 1 sample ratio. Thus, a sample size of 39 patients was established in each group. The program used for the calculation was BioEstat 5.0 (Instituto de Desenvolvimento Sustentável Mamirauá, Tefé, AM, Brazil). The participants were recruited among the patients in attendance at the dental clinics of the undergraduate course in Dentistry of the Faculdade Integradas São Pedro, FAESA, located in the city of Vitoria, ES, Brazil. In the case group, the patients were selected through a clinical examination performed by the same trained operator. These patients presented non-carious cervical lesions of the abfraction type located in the premolar and lower or mandibular teeth, this diagnosis was based on the clinical characteristics described by Consolaro and Consolaro (2006) [2] and Hayashi et al. (2022) [25]. According to the authors, lesions are located at the wedge-shaped cervical region and may present grooves resulting from the loss of enamel from the fractures, which can be diagnosed visually or with the aid of a very fine exploratory probe. The inclusion criteria for this study consisted of ASA I patients with at least 28 teeth not considering the presence of third molars, that didn’t report any odontalgias, periodontal disease, and temporomandibular disorder. The exclusion criteria consisted of patients aged less than 20 years or older than 59 years, report of hallucinogenic drug use, use of drugs associated with xerostomia, and patients that reported history of anorexia bulimia and gastroesophageal reflux disease. Additional exclusion criteria included patients with current or previous orthodontic appliances, high alcohol consumption, smokers, and history of bruxism. The later was assessed using the questionnaire proposed by Pintado et al. (1997) [26], as shown in Table 1. Table 1 - Bruxism assessment questionnaire. Has anyone ever heard your teeth grinding at night? Do you feel your joint fatigued or painful when you wake up? Do you feel your teeth or gums sore when you wake up? Do you have headaches when you wake up in the morning? Have you found yourself gnashing your teeth during the day? Have you found yourself clenching your teeth during the day? Source: Pintado et al., 1997. If the patient responded positively to at least two questions in the questionnaire, they were considered ineligible to participate in the study. After assessing the location and characteristics of the abfraction-type lesions, the patient responded to a semi-structured questionnaire with questions about oral hygiene habits and deleterious habits such as biting objects (Appendix A). For the selection of patients belonging to the control group, all the exclusion criteria determined for the case group were maintained, differentiating only that for the control group patients did not present any cervical lesions. 2.3 Assessment of axial occlusal force The axial occlusal strength of both groups was measured using a strain gauge sensor of the flexiforce type (Tekscan, South Boston, MA, USA) (Figure 1), which consists of a flexible ultra-thin circuit with a thickness of 0.208 mm. In this research, the medium intensity sensor (B201M, Tekscan, South Boston, MA, USA) was used; with sensitivity from 0 to 667 N. The active sensing area is a circle with a diameter of 0.375 cm, located at the end of the sensor (figure 2). The sensors are constructed of two layers of substrate, with a polyester film. The measurements of the bite force were always performed in the morning between the hours 10:00 and 11:00. For standardization, each measurement was performed with the patient sitting in the dental operatory, with the device coated with plastic for biosafety control and supported by the opposing teeth (figure 3). The patient was asked to perform the greatest clamping force possible for 2 seconds [27,28]. Four measurements were performed for each patient, on both sides of the arch, in the sequence: 14, 16, 24, and 26, allowing for a 1-minute interval of rest for the patient between each region. The sensor was calibrated for unit of measurement in Newtons (N). All methods were performed in accordance with the relevant guidelines and regulations. 2.4 Statistical analysis The descriptive analysis was performed by means of absolute and relative frequencies, measures of central tendency, and dispersion. The comparison of bite force between the group of patients with non-carious cervical lesions (case) and without non-carious cervical lesions (control) was analyzed with a Student's t-test for independent samples. The logistic regression was used to verify if any factor had an influence on the outcome. The likelihood ratio (OR) was also analyzed in the present study. The statistical software, SPSS Statistics version 21 (Armonk, NY, USA), was used to perform the statistical analysis. 3. Results Tables 2 and 3 describe the variables assessed in this study. Females make up 80.8% of the total sample. The most observed type of brushing was horizontal (46.2%). Most patients (61.5%) brush their teeth three times a day. The type of toothpaste with abrasive particles was observed in 30.8% of the patients, 62.8% of patients reported the use of mouthwash which from those, 52.0% reported daily use. Of the total sample, 32.0% had some deleterious habit and 67.9% used brushes with soft bristle consistency. There was no statistically significant difference (p = 0,188) in age when comparing the participants of the control group (mean = 31.2 years; SD ± 11.0 years) in relation to the case group (mean = 28.2 years, SD ± 8.8 years). When comparing the bite force between the case and control groups, no statistically significant difference was observed between them either when the measurement was conducted in the first right upper premolar (p = 0.724), in the upper right first molar (p = 0.790), in the left upper first molar (p = 0.964) or in the left first molar (p = 0.142). Table 2 - Gender and clinical profile of patients with and without non-carious cervical lesions. Control Case Total n % n % n % Gender Male 12 30,8 3 7,7 15 19,2 Female 27 69,2 36 92,3 63 80,8 Brushing technique Horizontal 15 38,5 21 53,8 36 46,2 Vertical 12 30,8 8 20,5 20 25,6 Vibratory 8 20,5 9 23,1 17 21,8 Charter technique 4 10,2 1 2,6 5 6,4 Frequency of brushing per day 2 times 2 5,1 0 0,0 2 2,6 3 times 23 59,0 25 64,1 48 61,5 More than 3 times 14 35,9 14 35,9 28 35,9 Type of toothpaste With abrasive 16 41,0 8 20,5 24 30,8 Non-abrasive 23 59,0 31 79,5 54 69,2 Do you use mouthwash? Yes 27 69,2 22 56,4 49 62,8 No 12 30,8 17 43,6 29 37,2 If so, how often? Daily 15 53,6 11 50,0 26 52,0 weekly 13 46,4 11 50,0 24 48,0 Do you have any harmful habits (such as biting objects)? Yes 15 38,5 10 25,7 25 32,1 No 23 59,0 27 69,2 50 64,1 Don’t know 1 2,5 2 5,1 3 3,8 What consistency of the bristles of your toothbrush? Soft 24 61,6 29 74,4 53 67,9 Average (medium) 13 33,3 10 25,6 23 29,5 Hard 2 5,1 0 0,0 2 2,6 Table 3 – Age (years) and bite force (N) results. Minimum Maximum Average Standard Deviation P value* Age Case 20 59 28,2 8,8 0,188 Control 20 57 31,2 11,0 First right upper premolar Case 99,0 230,3 152,6 33,3 0,724 Control 90,0 233,8 155,6 41,0 First upper right molar Case 103,5 250,1 167,2 33,0 0,790 Control 103,7 256,8 169,6 44,9 First left upper premolar Case 85,0 220,7 153,1 33,2 0,964 Control 100,2 225,5 152,7 30,5 First upper left molar Case 130,9 290,6 180,3 32,8 0,142 Control 100,5 259,2 168,6 36,9 Table 4 shows the bite force load in premolars, molars, or overall, and did not present any statistically significant difference between men and women in the case group. In the control group, bite force was significantly higher in males, except for the first left upper premolar, where there was no significant difference in bite force between males and females. If control and case patients were considered jointly, for all evaluated teeth, bite strength was significantly higher among men. There was no difference in the means of the bite forces between individuals of the case and control groups. Likewise, no significant difference was found when comparing males and females for bite force (table 5). Table 4 - Comparison of the means of bite forces (N) in the sites evaluated between the two genders. Group Tooth Gender Average Standard deviation P value* Patients with cervical lesion Maxillary right first premolar Male 183,83 28,78 0,091 Female 150,02 32,61 Maxillary right first molar Male 192,17 29,66 0,176 Female 165,12 32,82 Maxillary left first premolar Male 185,43 15,85 0,079 Female 150,38 32,93 Maxillary left first molar Male 209,90 17,91 0,104 Female 177,82 32,68 Total average strength Male 192,83 18,10 0,069 Female 160,83 28,90 Control Maxillary right first premolar Male 184,42 35,33 0,002 Female 142,81 37,04 Maxillary right first molar Male 196,68 48,52 0,010 Female 157,53 38,21 Maxillary left first premolar Male 165,42 28,10 0,084 Female 147,12 30,33 Maxillary left first molar Male 188,85 42,17 0,020 Female 159,54 30,97 Total average strength Male 183,84 34,45 0,006 Female 151,75 30,02 Total Maxillary right first premolar Male 184,30 33,15 < 0,001 Female 146,93 34,48 Maxillary right first molar Male 195,78 44,49 0,002 Female 161,87 35,14 Maxillary left first premolar Male 169,42 26,93 0,024 Female 148,98 31,63 Maxillary left first molar Male 193,06 38,97 0,021 Female 169,98 32,99 Total average strength Male 185,64 31,51 0,001 Female 156,94 29,49 Table 5 - Comparison between the means of bite forces (N) between male and female and case and control groups. Gender Group Average Standard deviation P-value* Male Case 192,83 18,10 0,675 Control 183,84 34,45 Female Case 160,83 28,90 0,229 Control 151,75 30,02 Total Average Case 163,29 29,35 0,818 Control 161,62 34,43 *. Student’s t-test for independent samples. Logistic regression was used to verify the association between the factors (questionnaire questions) and the outcome (patients with non-carious cervical lesions). The regression showed statistical significance for sex (p = 0.020), with being female increasing the chances of having non-carious cervical lesion by 6.1 times compared to men (table 6). Table 6- Association between the factors and the outcome. Carriers of non-carious cervical lesions P-value OR 95% confidence interval for Odds Ratio (OR) Inferior limit Upper limit Age 0,398 0,975 0,918 1,034 Gender Female 0,020 6,082 1,332 27,765 Brushing technique Horizontal 0,217 4,954 0,390 62,894 Vertical 0,658 1,813 0,130 25,294 Vibratory 0,289 4,130 0,300 56,769 Frequency of brushing per day 2 times 0,999 0,000 0,000 3 times 0,633 0,748 0,227 2,465 Type of toothpaste With abrasive 0,125 0,405 0,128 1,284 Do you use mouthwash? Yes 0,515 0,695 0,232 2,079 If so, how often? Daily 0,802 0,867 0,283 2,651 Do you have any harmful habits? (such as biting objects) Yes 0,754 0,639 0,039 10,573 No 0,937 0,894 0,056 14,294 What is the consistency of the bristles of your toothbrush? Soft Average - 0,964 1 1,030 - 0,287 - 3,690 Hard 0,999 0,000 0,000 4. Discussion In the literature, there is a lack of consensus among authors regarding the role of occlusal overload in the etiology of non-carious (abfraction) cervical lesions. Among the main hypotheses that may contribute to the origin of these lesions are occlusal overload, malocclusion, horizontal forces, abrasion, and erosion. Therefore, the main purpose of this study was to investigate the association between the presence of non-carious cervical lesions with occlusal force and other potential risk factors such as tooth brushing and deleterious habits. In this research, the selection of patients was based on several factors that included age and number of teeth. Additionally, it was decided to include participants of 20 to 59 years of age since according to Helkimo et al. (1977) [29] for this age group, the maximum bite force remains constant, while the normal aging process past this age is known to cause loss of muscle strength and therefore yield lower occlusal forces. Additionally, patients also had at least 28 teeth in the dental arch to standardize the sample and maintain maximum bite force [30-32]. An important exclusion criterion was any pain reported by the patient that originated from the periodontium since according to Alkan et al. (2006) [33], patients with healthy support tissues show significantly greater bite force compared to patients with compromised periodontium [34]. Furthermore, patients with temporomandibular joint pain or pain at the masticatory muscles were ineligible because according to Pereira-Cenci et al. (2007) [35], the overall bite force of patients with any temporomandibular disorder is significantly lower. Also, the presence of pain or discomfort could limit the execution of the maximum bite force [35-38]. Finally, individuals diagnosed with bruxism were also excluded from the study, as according to some authors [39-41]. To measure force, we selected to use a medium intensity sensor because it has a wide range (0 to 667 N), with a diameter of 0.37 cm, which allows precision when placing intraorally, and a thickness of 0.208 mm thus allowing the complete closing both arches during the measurement of the patient's maximum bite force. The most modern system for measuring maximum bite force is based on the action of the strain gauge's electrical resistance. This methodology can also be found in other studies [37, 42-47]. Based on the results of the present study, there was no association found between the presence of non-carious cervical lesions and the mean occlusal strength measured at the first right and left premolars and first right and left molars. In a study by Wood et al. (2009) [20], authors also did not find a relationship between the occlusal load and the progression or existence of non-carious cervical lesions, however, they evaluated the reduction of occlusal load through occlusal adjustments during the mandibular excursion movements [48]. On the other hand, the association between occlusal load and the initiation and progression of non-carious cervical lesions has been mentioned on several occasions in the literature [6]. Munari et al. (2015) [18] stated that the higher the strength concentration in the cervical area of the enamel the greater the probability of fracture [15]. Sawlani et al. (2016) [13], in a 5-year prospective clinical trial, tried to measure the relationship between NCCLs and various etiologic factors. It was concluded that the progression of NCCLs was related to occlusal load and not correlated to other factors such as a heavily acidic diet, toothbrushing techniques, and adverse oral habits [48,49]. In the present study, when comparing the bite force between men and women, it was observed that in both case and control groups the mean values of bite force were higher for males. These findings are in accordance with several studies [37,42,47,50-55], where a greater bite force was also found in men. Table 5 shows did not show a statistically difference between females and males of having non-carious cervical lesions. Sawlani et al. (2016) [13] and de Araújo et al. (2022) [23] did not observe a statistically a significant difference between men and women in the prevalence of NCCLs. Although it was determined by Shinogaya et al. (2001) [28], that men had a greater area of contact, bite force, and arch size (both in width and height), which may generate a higher clamping force [56,57]. Patients included by these authors presented neutral occlusion or minimal malocclusion and had no restoration covering the occlusal surface of the teeth evaluated. Patients included in the present study were interrogated about their use of mouthwash, brushing habits such as frequency, hardness of bristles, type of toothpaste, and brushing technique. A significant association between the mentioned factors and NCCLs was not found. After NCCLs onset, other factors may influence the progression of the lesion, including erosion. It has been pointed out in the literature [21,24], that not only occlusion is related to NCCLs, but also chemical agents could be related to the etiology of erosion and physical factors such as abrasion. In the literature, Senna et al. (2012) [24], it has been a focus to associate occlusion and NCCLs, wherein this review the type of occlusion was not considered, whereas, in the present study, a physiological (non-parafunctional) occlusion was a main criterion for the inclusion criteria. Studies such as Koç (2011) [54] and Turkistani et al. (2020) [58] found no relationship between bite force and type of functional occlusion. In addition, Lee & Eakle (1984) [16] stated that the type of occlusion, when parafunctional, generates lateral forces yielding compression and traction loads larger than what natural dentition can withstand, thus suggesting that physiological occlusion is not a risk factor for NCCLs. In this study there was no association between bite force loads and NCCLs, therefore a prospective study is suggested since this case-control study cannot establish the cause-and-effect relationship between occlusal force and NCCLs. This is because occlusal strength may be the cause and/or consequence of NCCLs. Additionally, it would be noteworthy to evaluate additional factors such as erosion, abrasion, horizontal forces, and malocclusion and their relationship with the etiology and progression of NCCLs. 5. Conclusion Based on the results of this clinical study, it is concluded that females presented a higher risk for the development of non-carious cervical lesions meanwhile there was no association to occlusal force as well as other factors such as brushing technique and deleterious habits. Declarations Author contributions Dr. Rafael Dario Werneck has contributed in the material preparation, data collection and analysis, original draft of the manuscript. Dr. Daher Antonio Queiroz has contributed to the study conception and design, data analysis, review and editing of the manuscript. Dr. Diana Leyva del Rio has contributed in the material preparation, data analysis, review and editing of the manuscript. Balint Timothy Gabor Altdorfer has contributed with the statistical analysis and review of the manuscript. Dr. Cecilia Pedroso Turssi has contributed to the study conception and design, material preparation, data analysis, review and editing of the manuscript. Funding Declaration The authors have not received a grant for this project. Ethics Approval The study protocol and consent forms were approved by the Ethics Committee of the Faculdade Integradas São Pedro (FAESA) with the number: 850.991 and validated by the Ethics and Research Committee of the São Leopoldo Mandic School. The clinicians treating patients at FAESA were told the information of this clinical research. The potential subjects were identified in the clinic of Prosthodontics at FAESA. The principal investigator confirmed the eligibility of these patients. All patients signed the consent forms and were informed of the details of the study procedures as well as potential complications. After informed consent was obtained, the occlusal bite force was registered by the device mentioned in the manuscript. Conflict of interest The manuscript is an original research that is not under publication consideration elsewhere and free of conflict of interest. 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Shinogaya T, Bakke M, Thomsen CE, Vilmann A, Sodeyama A, Matsumoto M. Effects of ethnicity, gender and age on clenching force and load distribution. Clin Oral Investig. 2001 Mar;5(1):63–8. Helkimo E, Carlsson GE, Helkimo M. Bite force and state of dentition. Acta Odontol Scand. 1977;35(6):297–303. Bakke M, Holm B, Jensen BL, Michler L, Möller E. Unilateral, isometric bite force in 8-68-year-old women and men related to occlusal factors. Scand J Dent Res. 1990 Apr;98(2):149–58 Al-Gunaid TH, Sunitan AK, Alharbi AB, Alhrbei EA, Saito I. Relationship between mandibular dimensions and bite force: an exploratory study. Orthodontic Waves. 2021 Jul 3;80(3):117 – 23. Koç D, Dogan A, Bek B. Bite force and influential factors on bite force measurements: a literature review. Eur J Dent. 2010 Apr;4(2):223–32. Alkan A, Keskiner I, Arici S, Sato S. The effect of periodontitis on biting abilities. J Periodontol. 2006 Aug;77(8):1442–5. Kosaka T, Ono T, Kida M, Fushida S, Nokubi T, Kokubo Y, Watanabe M, Miyamoto Y, Ikebe K. Deterioration of periodontal status affects declines in masticatory performance: The Suita study. Journal of Clinical Periodontology. 2021 Sep;48(9):1208–15 Pereira-Cenci T, Pereira LJ, Cenci MS, Bonachela WC, Del Bel Cury AA. Maximal bite force and its association with temporomandibular disorders. Braz Dent J. 2007;18(1):65–8. Moleirinho-Alves PM, Cebola PM, Dos Santos PD, Correia JP, Godinho C, Oliveira RA, Pezarat-Correia PL. Effects of Therapeutic and Aerobic Exercise Programs on Pain, Neuromuscular Activation, and Bite Force in Patients with Temporomandibular Disorders. Journal of Personalized Medicine. 2021 Nov;11(11):1170. Gu Y, Bai Y, Xie X. Bite force transducers and measurement devices. Frontiers in Bioengineering and Biotechnology. 2021 Apr 9;9:253. Dinsdale A, Liang Z, Thomas L, Treleaven J. Are jaw range of motion, muscle function and proprioception impaired in adults with persistent temporomandibular disorders? A systematic review and meta-analysis. Journal of Oral Rehabilitation. 2020 Nov 1;47(11):1448-78. Dıraçoğlu D, Alptekin K, Cifter ED, Güçlü B, Karan A, Aksoy C. Relationship between maximal bite force and tooth wear in bruxist and non-bruxist individuals. Arch Oral Biol. 2011 Dec;56(12):1569–75. Lan TH, Chen PH, Fok AS, Chen YF. Contact fracture test of monolithic hybrid ceramics on different substrates for bruxism. Dental Materials. 2022 Jan 1;38(1):44–56. Sivrikaya E, Güler MS, Bekci M. Evaluation of Stress Distributions of Zirconia Connecting Screw in Bruxism: A Finite Element Analysis. Selcuk Dental Journal. 2021;8(3):617–22. Braun S, Bantleon HP, Hnat WP, Freudenthaler JW, Marcotte MR, Johnson BE. A study of bite force, part 1: Relationship to various physical characteristics. Angle Orthod. 1995;65(5):367–72. Kruse T, Lehmann HC, Braumann B, Fink GR, Wunderlich G. The maximum bite force for treatment evaluation in severely affected adult SMA patients—Protocol for a longitudinal study. Frontiers in Neurology. 2020 Feb 25;11:139. Edmonds HM, Glowacka H. The ontogeny of maximum bite force in humans. Journal of Anatomy. 2020 Sep;237(3):529–42. Soni R, Yadav H, Pathak A, Bhatnagar A, Kumar V. Comparative evaluation of biting force and chewing efficiency of all-on-four treatment concept with other treatment modalities in completely edentulous individuals. The Journal of the Indian Prosthodontic Society. 2020 Jul;20(3):312. van der Bilt A, Tekamp A, van der Glas H, Abbink J. Bite force and electromyograpy during maximum unilateral and bilateral clenching. Eur J Oral Sci. 2008 June;116(3):217–22. Bonakdarchian M, Askari N, Askari M. Effect of face form on maximal molar bite force with natural dentition. Arch Oral Biol. 2009 Mar;54(3):201–4. Nascimento BL, Vieira AR, Bezamat M, Ignácio SA, Souza EM. Occlusal problems, mental health issues and non-carious cervical lesions. Odontology. 2021 Sep 27:1–7. Kitasako Y, Ikeda M, Takagaki T, Burrow MF, Tagami J. The prevalence of non-carious cervical lesions (NCCLs) with or without erosive etiological factors among adults of different ages in Tokyo. Clinical Oral Investigations. 2021 Dec;25(12):6939–47. Hashimoto S, Kosaka T, Nakai M, Kida M, Fushida S, Kokubo Y, Watanabe M, Higashiyama A, Ikebe K, Ono T, Miyamoto Y. A lower maximum bite force is a risk factor for developing cardiovascular disease: the Suita study. Scientific Reports. 2021 Apr 7;11(1):1–8. Edmonds HM, Glowacka H. The ontogeny of maximum bite force in humans. Journal of Anatomy. 2020 Sep;237(3):529–42. Manzon L, Vozza I, Poli O. Bite force in elderly with full natural dentition and different rehabilitation prosthesis. International Journal of Environmental Research and Public Health. 2021 Jan;18(4):1424. Singh A, Tandon P, Singh GK, Nagar A, Shastri D. Maximum Voluntary Molar and Incisor Biting Force and Morphological Variables in Subjects With Different Vertical Skeletal Patterns. Journal of Indian Orthodontic Society. 2021 Nov 11:03015742211044856. Koç D, Doğan A, Bek B. Effect of gender, facial dimensions, body mass index and type of functional occlusion on bite force. J Appl Oral Sci. 2011 May-June;19(3):274–9. Calderon Pdos S, Kogawa EM, Lauris JR, Conti PC. The influence of gender and bruxism on the human maximum bite force. J Appl Oral Sci. 2006 Dec;14(6):448–53. Kendre S, Kamble S, Ambekar A, Kangane S. A Comparative study between facial growth pattern and dental arch width and form in regional population–an in vitro study. Annals of the Romanian Society for Cell Biology. 2021 May 9:15263–76. Shetty SK. Decoding the link between Dental Arch Dimensions and Vertical Facial Morphology in Class II Div 1 Subjects. Saudi J Oral Dent Res. 2021;6(12):530–42. Turkistani KA, Alkayyal MA, Abbassy MA, Al-Dharrab AA, Zahran MH, Melis M, Zawawi KH. Comparison of occlusal bite force distribution in subjects with different occlusal characteristics. CRANIO®. 2020 Oct 21:1–8. Additional Declarations No competing interests reported. Supplementary Files AppendixA.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1670528","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":110240602,"identity":"d55035a7-3796-4777-8688-1f95d6647985","order_by":0,"name":"Rafael Dario Werneck","email":"","orcid":"","institution":"FAESA- College of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Rafael","middleName":"Dario","lastName":"Werneck","suffix":""},{"id":110240603,"identity":"8deea83d-018e-4401-9f4c-83c52f953e0f","order_by":1,"name":"Daher Antonio Queiroz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABNElEQVRIie3PMUvDQBTA8VcOkiW2azLkO1w4aJFK/SoeAbuELi4BRU8Eu0SztiB+hkyuXjhsl2jXFKciOHWIWzppqiVNItFV8P7D8XjJj0sAZLK/GNcK8+eJ1ocLgDfbBqshWplEoOOv6WeyrXFZT5rTx/DFhd5gX70KeQJd6qs7i8XqVpx2oPUQpLBnBrxEjGhgWxHYR5r2dBCOoE/HFyrBxp3QdxlS5h4ckgrB3GkbDBD1dAcLDQQNhKLoVkYwR8ozrDcVMlt2VgzOtuR+TehNTt6/kdhpZ/8nCregjIQsJ7xKjHhJDIan1IsiHI5wn4yEgiw26RuBQO25h20yLpPmzLHemHtMh0OPJInbNX1/0likJ90Wnp6/xqnbM6/LZPN5+YAKW1R6VBv69Q2ZTCb7f30A09Z4wpQfgIMAAAAASUVORK5CYII=","orcid":"","institution":"The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry","correspondingAuthor":true,"prefix":"","firstName":"Daher","middleName":"Antonio","lastName":"Queiroz","suffix":""},{"id":110240604,"identity":"43e82966-2808-4d44-8ec6-11af63b15c39","order_by":2,"name":"Diana Leyva del Rio","email":"","orcid":"","institution":"The Ohio State University College of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Diana","middleName":"Leyva del","lastName":"Rio","suffix":""},{"id":110240605,"identity":"637235f2-7a81-4f67-8b68-d74c089b5ef3","order_by":3,"name":"Balint Timothy Gabor Altdorfer","email":"","orcid":"","institution":"Ohio University","correspondingAuthor":false,"prefix":"","firstName":"Balint","middleName":"Timothy Gabor","lastName":"Altdorfer","suffix":""},{"id":110240606,"identity":"76c82a45-242f-46e0-ae1c-a57d7bdc5245","order_by":4,"name":"Cecilia Pedroso Turssi","email":"","orcid":"","institution":"Sao Leopoldo Mandic Institute and Dental Research Center","correspondingAuthor":false,"prefix":"","firstName":"Cecilia","middleName":"Pedroso","lastName":"Turssi","suffix":""}],"badges":[],"createdAt":"2022-05-18 17:29:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1670528/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1670528/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":22192643,"identity":"a4de4dea-1336-4378-a0e4-cd226b6d129a","added_by":"auto","created_at":"2022-06-02 16:17:05","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2443852,"visible":true,"origin":"","legend":"\u003cp\u003eFigure legend not available with this version.\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1670528/v1/b36ae751d84d2d330584a6a7.jpg"},{"id":22193023,"identity":"a32217e6-abb7-42c0-ad9a-fc3f9816fcc2","added_by":"auto","created_at":"2022-06-02 16:22:05","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2474482,"visible":true,"origin":"","legend":"\u003cp\u003eFigure legend not available with this version.\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1670528/v1/fd5840c95a85a58d435935f1.jpg"},{"id":22193022,"identity":"ab074299-9f29-46bf-ac1e-0e8d2edfac6d","added_by":"auto","created_at":"2022-06-02 16:22:05","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2328106,"visible":true,"origin":"","legend":"\u003cp\u003eFigure legend not available with this version.\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1670528/v1/72cf07c3108b5cebbfdad29b.jpg"},{"id":22497386,"identity":"85fb16d3-5d29-4867-98c5-13263f8cb8d9","added_by":"auto","created_at":"2022-06-10 10:59:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":668732,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1670528/v1/09956543-70ed-4fa3-a6a3-c458f6418adf.pdf"},{"id":22192642,"identity":"86619872-060b-44c6-acf2-e99a987418a3","added_by":"auto","created_at":"2022-06-02 16:17:05","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14153,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.docx","url":"https://assets-eu.researchsquare.com/files/rs-1670528/v1/7aca13115789cd4c4f7d85d0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssociation of Non-carious Cervical Lesions With Oral Hygiene Aspects and Oclusal Force\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eDental enamel is a highly crystalline structure composed of 96% of its constituents of mineral nature limiting the elasticity of the tissue. Dentin has a mineral content of approximately 70%, being the rest of its composition of proteins, lipids, and water that provides a certain degree of elasticity [1,2]. One of the processes that can affect this natural interaction is dental wear, mainly in the cervical region, where the enamel is thinner, forming non-carious cervical lesions (NCCLs) which is a common condition found regularly by clinicians.\u003c/p\u003e\n\u003cp\u003eIn general, it is believed that NCCLs are not caused by a single factor, but rather by a combination of factors. NCCLs have a multifactorial origin and progression, and the contribution of these various processes is not yet well defined in the scientific literature. Among the processes that cause NCCLs are abrasive, corrosive, and fatigue wear. The diagnosis of NCCLs can be based on a detailed history, visual inspection, and intraoral examination [3-13].\u003c/p\u003e\n\u003cp\u003eBased on its clinical characteristics, some NCCLs, have been labeled as abfraction lesions. This term was established by Grippo in 1991[14], from the Latin ab = out and fractio = fracture. The abfraction hypothesis is based on the biomechanical theory that there is a concentration of tension in the cervical region caused by the flexion during occlusal loading, resulting in the formation of cervical microfractures, ultimately causing the rupture between the apatite crystals of the enamel and the dentin [7, 15-18]. From the clinical point of view, this lesion initially presents as minor grooves, which gradually undergo a process of fatigue wear caused by occlusal load, culminating with the formation of a wedge-like lesion, ending in thin and delicate enamel.\u003c/p\u003e\n\u003cp\u003eWhen the affection progresses, radiographically it will show an increased thickening of the periodontal ligament and lamina dura. One possible explanation for these lesions is the traction forces in the region of the vestibular and palatine alveolar bone caused by oblique loads during eccentric movements. Since bone is thinner in the vestibular region, the compressive force may be more critical on the surface, promoting a vestibular bone loss accompanied by a gingival recession. This favors the progression of non-carious lesions on the buccal aspect of teeth since there is a loss of support with the loss of enamel structure in the cervical region. This is especially true in patients with decreased mucosal keratinization and fine gingival biotype [2, 18-20].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAbrasion consists of the wear of dental tissues through frequent contact of objects which results in mechanical wear, while erosion is the chemical loss of hard dental tissue by the action of intrinsic and extrinsic acids [21,22]. The occlusal factor is discussed in the literature as a possible factor that may be associated with the etiology and progression of non-carious cervical lesions, usually related with occlusal trauma by lateral forces, a subject not well described in the literature [10,16,23,24].\u003c/p\u003e\n\u003cp\u003eSince there is still a lack of information correlating certain factors such as occlusal force, deleterious habits such as biting objects, and oral hygiene habits with the progression of NCCLs, the purpose of this case-control study was to investigate the association between the presence of non-carious cervical lesions with occlusal force and other potential risk factors such as sex, brushing, age and deleterious habits.\u003c/p\u003e"},{"header":"2. Materials And Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Ethical aspects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Faculdade Integradas S\u0026atilde;o Pedro (FAESA) with the number: 850.991 and validated by the Ethics and Research Committee of the S\u0026atilde;o Leopoldo Mandic School.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Selection and characterization of the sample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was determined based on a pilot study of 15 patients. The parameters used in the calculation were: significance level of 5%, mean of the sample of the case group of 165.3 N (SD 33.8 N), mean of the control group sample of 193.3 N (SD 41.8 N), with 90% test power and 1: 1 sample ratio. Thus, a sample size of 39 patients was established in each group. The program used for the calculation was BioEstat 5.0 (Instituto de Desenvolvimento Sustent\u0026aacute;vel Mamirau\u0026aacute;, Tef\u0026eacute;, AM, Brazil).\u003c/p\u003e\n\u003cp\u003eThe participants were recruited among the patients in attendance at the dental clinics of the undergraduate course in Dentistry of the Faculdade Integradas S\u0026atilde;o Pedro, FAESA, located in the city of Vitoria, ES, Brazil.\u003c/p\u003e\n\u003cp\u003eIn the case group, the patients were selected through a clinical examination performed by the same trained operator. These patients presented non-carious cervical lesions of the abfraction type located in the premolar and lower or mandibular teeth, this diagnosis was based on the clinical characteristics described by Consolaro and Consolaro (2006) [2] and Hayashi et al. (2022) [25]. According to the authors, lesions are located at the wedge-shaped cervical region and may present grooves resulting from the loss of enamel from the fractures, which can be diagnosed visually or with the aid of a very fine exploratory probe.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for this study consisted of ASA I patients with at least 28 teeth not considering the presence of third molars, that didn\u0026rsquo;t report any odontalgias, periodontal disease, and temporomandibular disorder. The exclusion criteria consisted of patients aged less than 20 years or older than 59 years, report of hallucinogenic drug use, use of drugs associated with xerostomia, and patients that reported history of anorexia bulimia and gastroesophageal reflux disease. Additional exclusion criteria included patients with current or previous orthodontic appliances, high alcohol consumption, smokers, and history of bruxism. The later was assessed using the questionnaire proposed by Pintado et al. (1997) [26], as shown in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1 - Bruxism assessment questionnaire.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eHas anyone ever heard your teeth grinding at night?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eDo you feel your joint fatigued or painful when you wake up?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eDo you feel your teeth or gums sore when you wake up?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eDo you have headaches when you wake up in the morning?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eHave you found yourself gnashing your teeth during the day?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003eHave you found yourself clenching your teeth during the day?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSource: Pintado et al., 1997.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIf the patient responded positively to at least two questions in the questionnaire, they were considered ineligible to participate in the study. After assessing the location and characteristics of the abfraction-type lesions, the patient responded to a semi-structured questionnaire with questions about oral hygiene habits and deleterious habits such as biting objects (Appendix A). For the selection of patients belonging to the control group, all the exclusion criteria determined for the case group were maintained, differentiating only that for the control group patients did not present any cervical lesions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Assessment of axial occlusal force\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe axial occlusal strength of both groups was measured using a strain gauge sensor of the flexiforce type (Tekscan, South Boston, MA, USA) (Figure 1), which consists of a flexible ultra-thin circuit with a thickness of 0.208 mm. In this research, the medium intensity sensor (B201M, Tekscan, South Boston, MA, USA) was used; with sensitivity from 0 to 667 N. The active sensing area is a circle with a diameter of 0.375 cm, located at the end of the sensor (figure 2). The sensors are constructed of two layers of substrate, with a polyester film.\u003c/p\u003e\n\u003cp\u003eThe measurements of the bite force were always performed in the morning between the hours 10:00 and 11:00. For standardization, each measurement was performed with the patient sitting in the dental operatory, with the device coated with plastic for biosafety control and supported by the opposing teeth (figure 3). The patient was asked to perform the greatest clamping force possible for 2 seconds [27,28].\u003c/p\u003e\n\u003cp\u003eFour measurements were performed for each patient, on both sides of the arch, in the sequence: 14, 16, 24, and 26, allowing for a 1-minute interval of rest for the patient between each region. The sensor was calibrated for unit of measurement in Newtons (N). All methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe descriptive analysis was performed by means of absolute and relative frequencies, measures of central tendency, and dispersion. The comparison of bite force between the group of patients with non-carious cervical lesions (case) and without non-carious cervical lesions (control) was analyzed with a Student\u0026apos;s t-test for independent samples. The logistic regression was used to verify if any factor had an influence on the outcome. The likelihood ratio (OR) was also analyzed in the present study. The statistical software, SPSS Statistics version 21 (Armonk, NY, USA), was used to perform the statistical analysis.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eTables 2 and 3 describe the variables assessed in this study. Females make up 80.8% of the total sample. The most observed type of brushing was horizontal (46.2%). Most patients (61.5%) brush their teeth three times a day. The type of toothpaste with abrasive particles was observed in 30.8% of the patients, 62.8% of patients reported the use of mouthwash which from those, 52.0% reported daily use. Of the total sample, 32.0% had some deleterious habit and 67.9% used brushes with soft bristle consistency. There was no statistically significant difference (p = 0,188) in age when comparing the participants of the control group (mean = 31.2 years; SD \u0026plusmn; 11.0 years) in relation to the case group (mean = 28.2 years, SD \u0026plusmn; 8.8 years). When comparing the bite force between the case and control groups, no statistically significant difference was observed between them either when the measurement was conducted in the first right upper premolar (p = 0.724), in the upper right first molar (p = 0.790), in the left upper first molar (p = 0.964) or in the left first molar (p = 0.142).\u003c/p\u003e\n\u003cp\u003eTable 2 - Gender and clinical profile of patients with and without non-carious cervical lesions.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.964664310954063%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"45.053003533568905%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"11.66077738515901%\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"11.66077738515901%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"11.66077738515901%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" width=\"65.13274336283186%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.95575221238938%\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.725663716814159%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.95575221238938%\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.725663716814159%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.95575221238938%\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.548672566371682%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"44.680851063829785%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.390070921985817%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e30,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e7,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.560283687943262%\"\u003e\n \u003cp\u003e19,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e69,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e92,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e80,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" width=\"44.680851063829785%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBrushing technique\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.390070921985817%\"\u003e\n \u003cp\u003eHorizontal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e38,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e53,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.560283687943262%\"\u003e\n \u003cp\u003e46,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eVertical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e30,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e20,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e25,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eVibratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e20,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e23,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e21,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eCharter\u003c/p\u003e\n \u003cp\u003etechnique\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e10,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e2,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e6,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" width=\"44.680851063829785%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of brushing per day\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.390070921985817%\"\u003e\n \u003cp\u003e2 times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e5,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e0,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.560283687943262%\"\u003e\n \u003cp\u003e2,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003e3 times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e59,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e64,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e61,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eMore than 3 times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e35,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e35,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e35,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"44.680851063829785%\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of toothpaste\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.390070921985817%\"\u003e\n \u003cp\u003eWith abrasive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e41,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e20,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.560283687943262%\"\u003e\n \u003cp\u003e30,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eNon-abrasive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e59,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e79,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e69,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"44.680851063829785%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you use mouthwash?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.390070921985817%\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e69,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e56,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.560283687943262%\"\u003e\n \u003cp\u003e62,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e30,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e43,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e37,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"44.680851063829785%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIf so, how often?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.390070921985817%\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e53,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e50,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.560283687943262%\"\u003e\n \u003cp\u003e52,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eweekly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e46,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e50,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e48,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" width=\"44.680851063829785%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you have any harmful habits (such as biting objects)?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.390070921985817%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e38,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e25,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.560283687943262%\"\u003e\n \u003cp\u003e32,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e59,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e69,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e64,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e2,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e5,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e3,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" width=\"44.680851063829785%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat consistency of the bristles of your toothbrush?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.390070921985817%\"\u003e\n \u003cp\u003eSoft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e61,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.73758865248227%\"\u003e\n \u003cp\u003e74,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.964539007092198%\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.560283687943262%\"\u003e\n \u003cp\u003e67,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eAverage (medium)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e33,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e25,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e29,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.85897435897436%\"\u003e\n \u003cp\u003eHard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e5,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.179487179487179%\"\u003e\n \u003cp\u003e0,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.974358974358974%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.85897435897436%\"\u003e\n \u003cp\u003e2,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 \u0026ndash; Age (years) and bite force (N) results.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.863636363636363%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"18.66883116883117%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinimum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.14935064935065%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.175324675324676%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.766233766233766%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;P value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"30.40650406504065%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.032520325203253%\"\u003e\n \u003cp\u003eCase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.682926829268293%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.170731707317072%\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.731707317073171%\"\u003e\n \u003cp\u003e28,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\"\u003e\n \u003cp\u003e8,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.78048780487805%\"\u003e\n \u003cp\u003e0,188\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.289719626168225%\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.22429906542056%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.925233644859812%\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.42056074766355%\"\u003e\n \u003cp\u003e31,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.523364485981308%\"\u003e\n \u003cp\u003e11,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.616822429906541%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"30.40650406504065%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst right upper premolar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.032520325203253%\"\u003e\n \u003cp\u003eCase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.682926829268293%\"\u003e\n \u003cp\u003e99,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.170731707317072%\"\u003e\n \u003cp\u003e230,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.731707317073171%\"\u003e\n \u003cp\u003e152,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\"\u003e\n \u003cp\u003e33,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.78048780487805%\"\u003e\n \u003cp\u003e0,724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.289719626168225%\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.22429906542056%\"\u003e\n \u003cp\u003e90,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.925233644859812%\"\u003e\n \u003cp\u003e233,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.42056074766355%\"\u003e\n \u003cp\u003e155,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.523364485981308%\"\u003e\n \u003cp\u003e41,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.616822429906541%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"30.40650406504065%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst upper right molar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.032520325203253%\"\u003e\n \u003cp\u003eCase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.682926829268293%\"\u003e\n \u003cp\u003e103,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.170731707317072%\"\u003e\n \u003cp\u003e250,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.731707317073171%\"\u003e\n \u003cp\u003e167,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\"\u003e\n \u003cp\u003e33,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.78048780487805%\"\u003e\n \u003cp\u003e0,790\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.289719626168225%\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.22429906542056%\"\u003e\n \u003cp\u003e103,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.925233644859812%\"\u003e\n \u003cp\u003e256,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.42056074766355%\"\u003e\n \u003cp\u003e169,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.523364485981308%\"\u003e\n \u003cp\u003e44,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.616822429906541%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"30.40650406504065%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst left upper premolar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.032520325203253%\"\u003e\n \u003cp\u003eCase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.682926829268293%\"\u003e\n \u003cp\u003e85,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.170731707317072%\"\u003e\n \u003cp\u003e220,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.731707317073171%\"\u003e\n \u003cp\u003e153,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\"\u003e\n \u003cp\u003e33,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.78048780487805%\"\u003e\n \u003cp\u003e0,964\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.289719626168225%\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.22429906542056%\"\u003e\n \u003cp\u003e100,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.925233644859812%\"\u003e\n \u003cp\u003e225,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.42056074766355%\"\u003e\n \u003cp\u003e152,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.523364485981308%\"\u003e\n \u003cp\u003e30,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.616822429906541%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"30.40650406504065%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst upper left molar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.032520325203253%\"\u003e\n \u003cp\u003eCase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.682926829268293%\"\u003e\n \u003cp\u003e130,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.170731707317072%\"\u003e\n \u003cp\u003e290,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.731707317073171%\"\u003e\n \u003cp\u003e180,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\"\u003e\n \u003cp\u003e32,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.78048780487805%\"\u003e\n \u003cp\u003e0,142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.289719626168225%\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.22429906542056%\"\u003e\n \u003cp\u003e100,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.925233644859812%\"\u003e\n \u003cp\u003e259,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.42056074766355%\"\u003e\n \u003cp\u003e168,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.523364485981308%\"\u003e\n \u003cp\u003e36,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.616822429906541%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 4 shows the bite force load in premolars, molars, or overall, and did not present any statistically significant difference between men and women in the case group. In the control group, bite force was significantly higher in males, except for the first left upper premolar, where there was no significant difference in bite force between males and females. If control and case patients were considered jointly, for all evaluated teeth, bite strength was significantly higher among men. There was no difference in the means of the bite forces between individuals of the case and control groups. Likewise, no significant difference was found when comparing males and females for bite force (table 5).\u003c/p\u003e\n\u003cp\u003eTable 4 - Comparison of the means of bite forces (N) in the sites evaluated between the two genders.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.457912457912458%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"39.562289562289564%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTooth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.457912457912458%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.952861952861953%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.2996632996633%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.26936026936027%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" width=\"12.457912457912458%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients with cervical lesion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"39.562289562289564%\"\u003e\n \u003cp\u003eMaxillary right first premolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.457912457912458%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.952861952861953%\"\u003e\n \u003cp\u003e183,83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.2996632996633%\"\u003e\n \u003cp\u003e28,78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"10.26936026936027%\"\u003e\n \u003cp\u003e0,091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e150,02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e32,61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eMaxillary right first molar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e192,17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e29,66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e0,176\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e165,12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e32,82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eMaxillary left first premolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e185,43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e15,85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e0,079\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e150,38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e32,93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eMaxillary left first molar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e209,90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e17,91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e0,104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e177,82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e32,68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eTotal average strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e192,83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e18,10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e0,069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e160,83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e28,90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" width=\"12.457912457912458%\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"39.562289562289564%\"\u003e\n \u003cp\u003eMaxillary right first premolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.457912457912458%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.952861952861953%\"\u003e\n \u003cp\u003e184,42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.2996632996633%\"\u003e\n \u003cp\u003e35,33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"10.26936026936027%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e142,81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e37,04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eMaxillary right first molar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e196,68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e48,52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e157,53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e38,21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eMaxillary left first premolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e165,42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e28,10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e0,084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e147,12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e30,33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eMaxillary left first molar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e188,85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e42,17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e159,54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e30,97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eTotal average strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e183,84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e34,45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e151,75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e30,02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" width=\"12.457912457912458%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"39.562289562289564%\"\u003e\n \u003cp\u003eMaxillary right first premolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.457912457912458%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.952861952861953%\"\u003e\n \u003cp\u003e184,30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.2996632996633%\"\u003e\n \u003cp\u003e33,15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"10.26936026936027%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e146,93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e34,48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eMaxillary right first molar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e195,78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e44,49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e161,87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e35,14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eMaxillary left first premolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e169,42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e26,93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e148,98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e31,63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eMaxillary left first molar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e193,06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e38,97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e169,98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e32,99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003eTotal average strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.23076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.653846153846153%\"\u003e\n \u003cp\u003e185,64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.192307692307692%\"\u003e\n \u003cp\u003e31,51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"11.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.035714285714285%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.696428571428573%\"\u003e\n \u003cp\u003e156,94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"35.267857142857146%\"\u003e\n \u003cp\u003e29,49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 5 - Comparison between the means of bite forces (N) between male and female and case and control groups.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.361344537815125%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.067226890756302%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"28.361344537815125%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003eCase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003e192,83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003e18,10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"18.067226890756302%\"\u003e\n \u003cp\u003e0,675\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e183,84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e34,45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"28.361344537815125%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003eCase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003e160,83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003e28,90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"18.067226890756302%\"\u003e\n \u003cp\u003e0,229\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e151,75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e30,02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"28.361344537815125%\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003eCase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003e163,29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.857142857142858%\"\u003e\n \u003cp\u003e29,35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"18.067226890756302%\"\u003e\n \u003cp\u003e0,818\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e161,62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e34,43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" width=\"100%\"\u003e\n \u003cp\u003e*. Student\u0026rsquo;s t-test for independent samples.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eLogistic regression was used to verify the association between the factors (questionnaire questions) and the outcome (patients with non-carious cervical lesions). The regression showed statistical significance for sex (p = 0.020), with being female increasing the chances of having non-carious cervical lesion by 6.1 times compared to men (table 6).\u003c/p\u003e\n\u003cp\u003eTable 6- Association between the factors and the outcome.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"51.623931623931625%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCarriers of non-carious cervical lesions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"11.282051282051283%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"11.282051282051283%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"25.811965811965813%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% confidence interval for Odds Ratio (OR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003e\u003cstrong\u003eInferior limit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper limit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"51.5358361774744%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,975\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e0,918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e1,034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.03071672354949%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.505119453924914%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e\u003cstrong\u003e6,082\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e\u003cstrong\u003e1,332\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e\u003cstrong\u003e27,765\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"37.03071672354949%\"\u003e\n \u003cp\u003eBrushing technique\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.505119453924914%\"\u003e\n \u003cp\u003eHorizontal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e4,954\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e0,390\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e62,894\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.035230352303522%\"\u003e\n \u003cp\u003eVertical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\"\u003e\n \u003cp\u003e0,658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\"\u003e\n \u003cp\u003e1,813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59620596205962%\"\u003e\n \u003cp\u003e0,130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59620596205962%\"\u003e\n \u003cp\u003e25,294\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.035230352303522%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVibratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\"\u003e\n \u003cp\u003e0,289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\"\u003e\n \u003cp\u003e4,130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59620596205962%\"\u003e\n \u003cp\u003e0,300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59620596205962%\"\u003e\n \u003cp\u003e56,769\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"37.03071672354949%\"\u003e\n \u003cp\u003eFrequency of brushing per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.505119453924914%\"\u003e\n \u003cp\u003e2 times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e0,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.035230352303522%\"\u003e\n \u003cp\u003e3 times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\"\u003e\n \u003cp\u003e0,633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\"\u003e\n \u003cp\u003e0,748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59620596205962%\"\u003e\n \u003cp\u003e0,227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59620596205962%\"\u003e\n \u003cp\u003e2,465\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.03071672354949%\"\u003e\n \u003cp\u003eType of toothpaste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.505119453924914%\"\u003e\n \u003cp\u003eWith abrasive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e0,128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e1,284\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.03071672354949%\"\u003e\n \u003cp\u003eDo you use mouthwash?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.505119453924914%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e0,232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e2,079\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.03071672354949%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIf so, how often?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.505119453924914%\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,802\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e0,283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e2,651\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"37.03071672354949%\"\u003e\n \u003cp\u003eDo you have any harmful habits? (such as biting objects)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.505119453924914%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e0,639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e0,039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e10,573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.035230352303522%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\"\u003e\n \u003cp\u003e0,937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\"\u003e\n \u003cp\u003e0,894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59620596205962%\"\u003e\n \u003cp\u003e0,056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59620596205962%\"\u003e\n \u003cp\u003e14,294\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"37.03071672354949%\"\u003e\n \u003cp\u003eWhat is the consistency of the bristles of your toothbrush?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.505119453924914%\"\u003e\n \u003cp\u003eSoft\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e0,964\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.262798634812286%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1,030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e0,287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.969283276450511%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e3,690\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.035230352303522%\"\u003e\n \u003cp\u003eHard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\"\u003e\n \u003cp\u003e0,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\"\u003e\n \u003cp\u003e0,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59620596205962%\"\u003e\n \u003cp\u003e0,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59620596205962%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn the literature, there is a lack of consensus among authors regarding the role of occlusal overload in the etiology of non-carious (abfraction) cervical lesions. Among the main hypotheses that may contribute to the origin of these lesions are occlusal overload, malocclusion, horizontal forces, abrasion, and erosion. Therefore, the main purpose of this study was to investigate the association between the presence of non-carious cervical lesions with occlusal force and other potential risk factors such as tooth brushing and deleterious habits.\u003c/p\u003e\n\u003cp\u003eIn this research, the selection of patients was based on several factors that included age and number of teeth. Additionally, it was decided to include participants of 20 to 59 years of age since according to Helkimo et al. (1977) [29] for this age group, the maximum bite force remains constant, while the normal aging process past this age is known to cause loss of muscle strength and therefore yield lower occlusal forces. Additionally, patients also had at least 28 teeth in the dental arch to standardize the sample and maintain maximum bite force [30-32].\u003c/p\u003e\n\u003cp\u003eAn important exclusion criterion was any pain reported by the patient that originated from the periodontium since according to Alkan et al. (2006) [33], patients with healthy support tissues show significantly greater bite force compared to patients with compromised periodontium [34]. Furthermore, patients with temporomandibular joint pain or pain at the masticatory muscles were ineligible because according to Pereira-Cenci et al. (2007) [35], the overall bite force of patients with any temporomandibular disorder is significantly lower. Also, the presence of pain or discomfort could limit the execution of the maximum bite force [35-38]. Finally, individuals diagnosed with bruxism were also excluded from the study, as according to some authors [39-41].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo measure force, we selected to use a medium intensity sensor because it has a wide range (0 to 667 N), with a diameter of 0.37 cm, which allows precision when placing intraorally, and a thickness of 0.208 mm thus allowing the complete closing both arches during the measurement of the patient\u0026apos;s maximum bite force. The most modern system for measuring maximum bite force is based on the action of the strain gauge\u0026apos;s electrical resistance. This methodology can also be found in other studies [37, 42-47].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the results of the present study, there was no association found between the presence of non-carious cervical lesions and the mean occlusal strength measured at the first right and left premolars and first right and left molars. In a study by Wood et al. (2009) [20], authors also did not find a relationship between the occlusal load and the progression or existence of non-carious cervical lesions, however, they evaluated the reduction of occlusal load through occlusal adjustments during the mandibular excursion movements [48].\u003c/p\u003e\n\u003cp\u003eOn the other hand, the association between occlusal load and the initiation and progression of non-carious cervical lesions has been mentioned on several occasions in the literature [6]. Munari et al. (2015) [18] stated that the higher the strength concentration in the cervical area of the enamel the greater the probability of fracture [15]. Sawlani et al. (2016) [13], in a 5-year prospective clinical trial, tried to measure the relationship between NCCLs and various etiologic factors. It was concluded that the progression of NCCLs was related to occlusal load and not correlated to other factors such as a heavily acidic diet, toothbrushing techniques, and adverse oral habits [48,49].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;In the present study, when comparing the bite force between men and women, it was observed that in both case and control groups the mean values of bite force were higher for males. These findings are in accordance with several studies [37,42,47,50-55], where a greater bite force was also found in men.\u003c/p\u003e\n\u003cp\u003eTable 5 shows did not show a statistically difference between females and males of having non-carious cervical lesions. Sawlani et al. (2016) [13] and\u0026nbsp;de Ara\u0026uacute;jo et al. (2022) [23]\u0026nbsp;did not observe a statistically a significant difference between men and women in the prevalence of NCCLs. Although it was determined by Shinogaya et al. (2001) [28], that men had a greater area of contact, bite force, and arch size (both in width and height), which may generate a higher clamping force [56,57]. Patients included by these authors presented neutral occlusion or minimal malocclusion and had no restoration covering the occlusal surface of the teeth evaluated.\u003c/p\u003e\n\u003cp\u003ePatients included in the present study were interrogated about their use of mouthwash, brushing habits such as frequency, hardness of bristles, type of toothpaste, and brushing technique. A significant association between the mentioned factors and NCCLs was not found. After NCCLs onset, other factors may influence the progression of the lesion, including erosion. It has been pointed out in the literature [21,24], that not only occlusion is related to NCCLs, but also chemical agents could be related to the etiology of erosion and physical factors such as abrasion.\u003c/p\u003e\n\u003cp\u003eIn the literature, Senna et al. (2012) [24], it has been a focus to associate occlusion and NCCLs, wherein this review the type of occlusion was not considered, whereas, in the present study, a physiological (non-parafunctional) occlusion was a main criterion for the inclusion criteria. Studies such as Ko\u0026ccedil; (2011) [54] and\u0026nbsp;Turkistani et al. (2020) [58]\u0026nbsp;found no relationship between bite force and type of functional occlusion. In addition, Lee \u0026amp; Eakle (1984) [16] stated that the type of occlusion, when parafunctional, generates lateral forces yielding compression and traction loads larger than what natural dentition can withstand, thus suggesting that physiological occlusion is not a risk factor for NCCLs.\u003c/p\u003e\n\u003cp\u003eIn this study there was no association between bite force loads and NCCLs, therefore a prospective study is suggested since this case-control study cannot establish the cause-and-effect relationship between occlusal force and NCCLs. This is because occlusal strength may be the cause and/or consequence of NCCLs. Additionally, it would be noteworthy to evaluate additional factors such as erosion, abrasion, horizontal forces, and malocclusion and their relationship with the etiology and progression of NCCLs.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eBased on the results of this clinical study, it is concluded that females presented a higher risk for the development of non-carious cervical lesions meanwhile there was no association to occlusal force as well as other factors such as brushing technique and deleterious habits.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Rafael Dario Werneck has contributed in the material preparation, data collection and analysis, original draft of the manuscript.\u003c/p\u003e\n\u003cp\u003eDr. Daher Antonio Queiroz has contributed to the study conception and design, data analysis, review and editing of the manuscript.\u003c/p\u003e\n\u003cp\u003eDr. Diana Leyva del Rio has contributed in the material preparation, data analysis, review and editing of the manuscript.\u003c/p\u003e\n\u003cp\u003eBalint Timothy Gabor Altdorfer has contributed with the statistical analysis and review of the manuscript.\u003c/p\u003e\n\u003cp\u003eDr. Cecilia Pedroso Turssi has contributed to the study conception and design, material preparation, data analysis, review and editing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have not received a grant for this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol and consent forms were approved by the Ethics Committee of the Faculdade Integradas S\u0026atilde;o Pedro (FAESA) with the number: 850.991 and validated by the Ethics and Research Committee of the S\u0026atilde;o Leopoldo Mandic School.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe clinicians treating patients at FAESA were told the information of this clinical research. The potential subjects were identified in the clinic of Prosthodontics at FAESA. The principal investigator confirmed the eligibility of these patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll patients signed the consent forms and were informed of the details of the study procedures as well as potential complications. After informed consent was obtained, the occlusal bite force was registered by the device mentioned in the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript is an original research that is not under publication consideration elsewhere and free of conflict of interest.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGoldberg M, Den Besten P, editors. Extracellular Matrix Biomineralization of Dental Tissue Structures. Springer International Publishing; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConsolaro A, Consolaro MFMO. Abfra\u0026ccedil;\u0026atilde;o: hipersensibilidade, trauma oclusal e outras les\u0026otilde;es cervicais n\u0026atilde;o cariosas. Rev Dental Press Est\u0026eacute;t. 2006;3(3):122\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeumans M, Politano G, Van Meerbeek B. Treatment of noncarious cervical lesions: when, why, and how. The international journal of esthetic dentistry. 2020;15(1):16\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLim GE, Son SA, Hur B, Park JK. Evaluation of the relationship between non-caries cervical lesions and the tooth and periodontal tissue: An ex-vivo study using micro-computed tomography. PloS one. 2020 Oct 28;15(10):e0240979.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemarco FF, Cademartori MG, Hartwig AD, Lund RG, Azevedo MS, Horta BL, Corr\u0026ecirc;a MB, Huysmans MC. Non-carious cervical lesions (NCCLs) and associated factors: A multilevel analysis in a cohort study in southern Brazil. Journal of Clinical Periodontology. 2022 Jan;49(1):48\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHussain AS, Melibari R, Al Toubity MJ, Sultan MS, Alnahhas A. Diagnosis of non-carious cervical lesions. Clinical Dentistry Reviewed. 2021 Dec;5(1):1\u0026ndash;9\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeixeira DN, Thomas RZ, Soares PV, Cune MS, Gresnigt MM, Slot DE. Prevalence of noncarious cervical lesions among adults: A systematic review. 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Non-carious cervical lesions (NCCLs) and associated factors: A multilevel analysis in a cohort study in southern Brazil. Journal of Clinical Periodontology. 2022 Jan;49(1):48\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWood ID, Kassir AS, Brunton PA. Effect of lateral excursive movements on the progression of abfraction lesions. Oper Dent. 2009 May-June;34(3):273\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNassar HM, Hara AT. Effect of dentifrice slurry abrasivity and erosive challenge on simulated non-carious cervical lesions development in vitro. Journal of Oral Science. 2021;63(2):191\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoshizaki KT, Francisconi-Dos-Rios LF, Sobral MA, Aranha AC, Mendes FM, Scaramucci T. Clinical features and factors associated with non-carious cervical lesions and dentin hypersensitivity. J Oral Rehabil. 2017 Feb;44(2):112\u0026ndash;118\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Ara\u0026uacute;jo KG, C\u0026acirc;mara JV, Ribeiro MS, da Silveira Pereira GD. Prevalence of non-carious cervical injuries and their associations with risk factors: integrative literature review. Research, Society and Development. 2022 Mar 8;11(3):e57411326645-.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSenna P, Del Bel Cury A, R\u0026ouml;sing C. Non-carious cervical lesions and occlusion: a systematic review of clinical studies. J Oral Rehabil. 2012 June;39(6):450\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHayashi M, Kubo S, Pereira PN, Ikeda M, Takagaki T, Nikaido T, Tagami J. Progression of non-carious cervical lesions: 3D morphological analysis. Clinical Oral Investigations. 2022 Jan;26(1):575\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePintado MR, Anderson GC, DeLong R, Douglas WH. Variation in tooth wear in young adults over a two-year period. J Prosthet Dent. 1997 Mar;77(3):313\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan SI, Rao D, Ramachandran A, Ashok BV. Influence of personality traits on the intensity of maximum voluntary bite force in adults. Indian Journal of Dental Research. 2020 Sep 1;31(5):706.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShinogaya T, Bakke M, Thomsen CE, Vilmann A, Sodeyama A, Matsumoto M. Effects of ethnicity, gender and age on clenching force and load distribution. Clin Oral Investig. 2001 Mar;5(1):63\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHelkimo E, Carlsson GE, Helkimo M. Bite force and state of dentition. Acta Odontol Scand. 1977;35(6):297\u0026ndash;303.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakke M, Holm B, Jensen BL, Michler L, M\u0026ouml;ller E. Unilateral, isometric bite force in 8-68-year-old women and men related to occlusal factors. Scand J Dent Res. 1990 Apr;98(2):149\u0026ndash;58\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Gunaid TH, Sunitan AK, Alharbi AB, Alhrbei EA, Saito I. Relationship between mandibular dimensions and bite force: an exploratory study. Orthodontic Waves. 2021 Jul 3;80(3):117 \u0026ndash; 23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKo\u0026ccedil; D, Dogan A, Bek B. Bite force and influential factors on bite force measurements: a literature review. Eur J Dent. 2010 Apr;4(2):223\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlkan A, Keskiner I, Arici S, Sato S. The effect of periodontitis on biting abilities. J Periodontol. 2006 Aug;77(8):1442\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKosaka T, Ono T, Kida M, Fushida S, Nokubi T, Kokubo Y, Watanabe M, Miyamoto Y, Ikebe K. Deterioration of periodontal status affects declines in masticatory performance: The Suita study. Journal of Clinical Periodontology. 2021 Sep;48(9):1208\u0026ndash;15\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePereira-Cenci T, Pereira LJ, Cenci MS, Bonachela WC, Del Bel Cury AA. Maximal bite force and its association with temporomandibular disorders. Braz Dent J. 2007;18(1):65\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoleirinho-Alves PM, Cebola PM, Dos Santos PD, Correia JP, Godinho C, Oliveira RA, Pezarat-Correia PL. Effects of Therapeutic and Aerobic Exercise Programs on Pain, Neuromuscular Activation, and Bite Force in Patients with Temporomandibular Disorders. Journal of Personalized Medicine. 2021 Nov;11(11):1170.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu Y, Bai Y, Xie X. Bite force transducers and measurement devices. Frontiers in Bioengineering and Biotechnology. 2021 Apr 9;9:253.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDinsdale A, Liang Z, Thomas L, Treleaven J. Are jaw range of motion, muscle function and proprioception impaired in adults with persistent temporomandibular disorders? A systematic review and meta-analysis. Journal of Oral Rehabilitation. 2020 Nov 1;47(11):1448-78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDıra\u0026ccedil;oğlu D, Alptekin K, Cifter ED, G\u0026uuml;\u0026ccedil;l\u0026uuml; B, Karan A, Aksoy C. Relationship between maximal bite force and tooth wear in bruxist and non-bruxist individuals. Arch Oral Biol. 2011 Dec;56(12):1569\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLan TH, Chen PH, Fok AS, Chen YF. Contact fracture test of monolithic hybrid ceramics on different substrates for bruxism. Dental Materials. 2022 Jan 1;38(1):44\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSivrikaya E, G\u0026uuml;ler MS, Bekci M. Evaluation of Stress Distributions of Zirconia Connecting Screw in Bruxism: A Finite Element Analysis. Selcuk Dental Journal. 2021;8(3):617\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun S, Bantleon HP, Hnat WP, Freudenthaler JW, Marcotte MR, Johnson BE. A study of bite force, part 1: Relationship to various physical characteristics. Angle Orthod. 1995;65(5):367\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKruse T, Lehmann HC, Braumann B, Fink GR, Wunderlich G. The maximum bite force for treatment evaluation in severely affected adult SMA patients\u0026mdash;Protocol for a longitudinal study. Frontiers in Neurology. 2020 Feb 25;11:139.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdmonds HM, Glowacka H. The ontogeny of maximum bite force in humans. Journal of Anatomy. 2020 Sep;237(3):529\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoni R, Yadav H, Pathak A, Bhatnagar A, Kumar V. Comparative evaluation of biting force and chewing efficiency of all-on-four treatment concept with other treatment modalities in completely edentulous individuals. The Journal of the Indian Prosthodontic Society. 2020 Jul;20(3):312.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Bilt A, Tekamp A, van der Glas H, Abbink J. Bite force and electromyograpy during maximum unilateral and bilateral clenching. Eur J Oral Sci. 2008 June;116(3):217\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonakdarchian M, Askari N, Askari M. Effect of face form on maximal molar bite force with natural dentition. Arch Oral Biol. 2009 Mar;54(3):201\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNascimento BL, Vieira AR, Bezamat M, Ign\u0026aacute;cio SA, Souza EM. Occlusal problems, mental health issues and non-carious cervical lesions. Odontology. 2021 Sep 27:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKitasako Y, Ikeda M, Takagaki T, Burrow MF, Tagami J. The prevalence of non-carious cervical lesions (NCCLs) with or without erosive etiological factors among adults of different ages in Tokyo. Clinical Oral Investigations. 2021 Dec;25(12):6939\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashimoto S, Kosaka T, Nakai M, Kida M, Fushida S, Kokubo Y, Watanabe M, Higashiyama A, Ikebe K, Ono T, Miyamoto Y. A lower maximum bite force is a risk factor for developing cardiovascular disease: the Suita study. Scientific Reports. 2021 Apr 7;11(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdmonds HM, Glowacka H. The ontogeny of maximum bite force in humans. Journal of Anatomy. 2020 Sep;237(3):529\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManzon L, Vozza I, Poli O. Bite force in elderly with full natural dentition and different rehabilitation prosthesis. International Journal of Environmental Research and Public Health. 2021 Jan;18(4):1424.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh A, Tandon P, Singh GK, Nagar A, Shastri D. Maximum Voluntary Molar and Incisor Biting Force and Morphological Variables in Subjects With Different Vertical Skeletal Patterns. Journal of Indian Orthodontic Society. 2021 Nov 11:03015742211044856.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKo\u0026ccedil; D, Doğan A, Bek B. Effect of gender, facial dimensions, body mass index and type of functional occlusion on bite force. J Appl Oral Sci. 2011 May-June;19(3):274\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalderon Pdos S, Kogawa EM, Lauris JR, Conti PC. The influence of gender and bruxism on the human maximum bite force. J Appl Oral Sci. 2006 Dec;14(6):448\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKendre S, Kamble S, Ambekar A, Kangane S. A Comparative study between facial growth pattern and dental arch width and form in regional population\u0026ndash;an in vitro study. Annals of the Romanian Society for Cell Biology. 2021 May 9:15263\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShetty SK. Decoding the link between Dental Arch Dimensions and Vertical Facial Morphology in Class II Div 1 Subjects. Saudi J Oral Dent Res. 2021;6(12):530\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurkistani KA, Alkayyal MA, Abbassy MA, Al-Dharrab AA, Zahran MH, Melis M, Zawawi KH. Comparison of occlusal bite force distribution in subjects with different occlusal characteristics. CRANIO\u0026reg;. 2020 Oct 21:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bite Force, Dental Occlusion, Non-carious cervical lesions, Tooth Wear","lastPublishedDoi":"10.21203/rs.3.rs-1670528/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1670528/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOne of the theories that contribute to explaining the evolution of non-carious cervical lesions (NCCLs) refers to fatigue wear, in which the concentration of stresses in the cervical region leads to the formation of microfractures in the dental tissues and progressive structure loss. However, due to a combination of factors that may cause wear, there is still uncertainty about the role of the occlusal factor as a risk factor that causes NCCLs. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e The purpose of this case-control study was to investigate the association between the presence of NCCLs with occlusal force and other potential risk factors. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e Thirty-nine participants with NCCLs (cases) and 39 non-carrier patients (control), aged between 20 and 59 years old, were enrolled in the dental clinic of the Faculdade Integradas São Pedro (FAESA), located in Vitória, Espírito Santo State, Brazil. Information was collected through anamnesis, clinical examination, and a questionnaire addressing aspects related to tooth brushing, dentifrice, and mouthwash use. In clinical examination, patients were submitted to four measurements of occlusal force in the maxillary first premolars and maxillary first molars, using a strain gauge sensor of medium intensity, the Flexiforce (Tekscan, South Boston, MA, USA). The sensor was calibrated for the unit of measurement in Newtons (N). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Data was analyzed using a Student's t-test and multiple logistic regression, adopting the significance level of 5%. There was no statistically significant difference between the case and control groups regarding the bite force in the four measured regions. Logistic regression identified sex as a factor significantly associated with non-carious cervical lesions (p = 0.020). For the calculation of the odds ratio, the female sex presented a six-fold chance (OR = 6.082; CI = 1.332 - 27.765) higher than non-carious cervical lesions. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e It was concluded that females presented a higher risk factor for non-carious cervical lesions than men, whereas there was no association of occlusal strength, as well as aspects related to brushing and deleterious habits.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eClinical Relevance:\u003c/strong\u003e NCCLs are highly prevalent in daily clinical practices and can impact aesthetics and function, leading to hypersensitivity and impairment of oral-health-related quality of life. Gingival recession is an important clinical indicator for the presence of NCCLs.\u003c/p\u003e","manuscriptTitle":"Association of Non-carious Cervical Lesions With Oral Hygiene Aspects and Oclusal Force","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-06-02 16:17:03","doi":"10.21203/rs.3.rs-1670528/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"67a9f734-e829-476e-9a69-b2b34cb3d054","owner":[],"postedDate":"June 2nd, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-06-10T10:59:15+00:00","versionOfRecord":[],"versionCreatedAt":"2022-06-02 16:17:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1670528","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1670528","identity":"rs-1670528","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}