Chewing in adolescents with overweight and obesity: An exploratory study with behavioral approach

Mastication and oral myofunctional status in excess weight children and adolescents: A cross-sectional observational study

BACKGROUND

Masticatory function seems to play a role in the aetiology of obesity. However, literature on the association between oral myofunctional status and overweight and obesity in children and adolescents is scarce and contrasting.

OBJECTIVE

To compare masticatory performance, orofacial myofunctional status and tongue strength and endurance between children and adolescents with overweight and obesity and those with normal weight.

METHODS

Thirty children and adolescents with overweight and obesity and 30 subjects with normal weight matched for age and sex were recruited. All subjects were evaluated with the Test of Masticating and Swallowing Solids in Children (TOMASS-C) for masticatory performance and with the Italian Orofacial Myofunctional Evaluation with Scores (I-OMES) for the orofacial myofunctional status. Anterior and posterior maximum tongue pressures and tongue endurance were measured. Parents-reported (PRO) duration of meals was recorded. Data were compared between the groups through the paired samples t-test or the Wilcoxon signed-rank test.

RESULTS

Children and adolescents with overweight showed significantly lower number of bites (p = .033), lower I-OMES scores (p < .05), and shorter meal duration (p = .005) compared to their peers with normal weight. No significant differences were found between the two groups for the number of swallows, the number of masticatory cycles and the total time of the TOMASS-C, and none of the tongue pressure measurements.

CONCLUSIONS

Eating in children and adolescents with overweight and obesity is characterised by a larger bolus sizes and shorter PRO meal duration. Additionally, overweight and obesity seem to be associated with poorer orofacial skills and structures in the paediatric population.

Early Influences on Development of Sensory Perception and Eating Habits

Infancy and early childhood are important periods for the development of food choices and eating preferences that are tracked into adult life, influencing weight gain, body composition, and metabolism and ultimately affecting the balance between health and disease. In this narrative review, we discuss studies focused on the effects of fetal programming and early food experiences, highlighting recent advances in the discovery of factors that contribute to the development of food preferences and eating behavior. Food preference can be influenced by early direct contact with flavors, textures, and aromas, as well as by environmental adversities during early development. Evidence suggests that exposure to intrauterine growth restriction is associated with increased preferences for highly palatable foods, such as those rich in carbohydrates and fats, over the life course. Early flavor experiences, whether from amniotic fluid or human milk, may also shape the development of food preferences. Finally, children are more likely to accept textures that they are able to manipulate, and early exposure to a range of textures facilitates the acceptance of foods of various textures later on. Improving dietary habits during gestation (fetal) and postnatal periods is of critical importance for the establishment of positive eating habits and healthy growth in infants and should be an important focus of primary prevention efforts.

Accuracy of newly developed color determination application for masticatory performance: Evaluating color-changeable chewing gum

PURPOSE

Color-changeable chewing gums are used to evaluate masticatory performance, as measured by a colorimeter or visually based on a color scale. Although anyone can use a color scale, the evaluation accuracy depends on the evaluator. We develop an application that can determine the degree of color change in chewing gum using smartphone images, making color evaluation accurate and easy to measure.

METHODS

For the application, 60 chewed gum samples were prepared. Two shots were captured using two smartphone models. To create the application algorithm, a formula was developed to approximately map the color value from the smartphone images to the true value using a colorimeter. A basic validation was performed on 60 new samples covering a range of colors, followed by a field validation on 100 healthy dentate participants aged 20-39 years.

RESULTS

The intraclass correlation coefficient for two repeated shots had a high value ≥ 0.97 in the basic and field validations, confirming reliability. No significant differences were observed in the paired t-test and Wilcoxon signed-rank test, and a significant and strong correlation (correlation coefficient ≥ 0.92) was observed between the evaluation values using the colorimeter and the basic and field validations. Bland-Altman plots further confirmed the validity of the application.

CONCLUSIONS

A software application was developed to enable easy, quick, and accurate determination of the masticatory performance of a chewing gum from images taken using a smartphone with highly reliable and validated results.

Association Between Masticatory Difficulty and Chronic Cough in a Korean Population

OBJECTIVE

Chronic cough, a common outpatient symptom, has various aetiologies, including upper airway cough syndrome, asthma, and gastroesophagoeal reflux. The potential link between dental issues and respiratory diseases has recently garnered attention. This study aims to investigate the association between masticatory difficulty and chronic cough using data from the 2011-2015 Korean National Health and Nutrition Examination Survey (KNHANES).

METHODS

Analysis included 9706 individuals from KNHANES. Participants self-reported masticatory function and chronic cough. Covariates included age, sex, underlying diseases, socioeconomic status, lifestyle factors, and laboratory markers. Binary logistic regression analysed odds ratios for chronic cough covariates. Multiple logistic regression assessed adjusted odds ratios for masticatory difficulty.

RESULTS

Masticatory difficulty prevalence was 32.2%, with chronic cough higher in this group (4.8%) than in the group without masticatory difficulty (3.0%). After adjusting for socioeconomic status, lifestyle factors, and laboratory markers, masticatory difficulty was significantly associated with greater chronic cough prevalence (odds ratio, 1.137; 95% confidence interval, 1.134-1.140).

CONCLUSIONS

Masticatory difficulty was linked with an elevated chronic cough risk in Korean healthy adults. Further research, including prospective studies and detailed investigations into gastroesophagoeal reflux disease and microbiological studies, is warranted to elucidate the impact of mastication on respiratory health. As masticatory difficulty may serve as a clinical indicator for chronic cough interdisciplinary collaboration between dental and respiratory health professionals can facilitate early intervention and enhance patient care.

Association between Self-Perception of Chewing, Chewing Behavior, and the Presence of Gastrointestinal Symptoms in Candidates for Bariatric Surgery

Given the changes in the digestive tract post-bariatric surgery, adapting to a new pattern of eating behavior becomes crucial, with special attention to the specifics of chewing mechanics. This study aimed to investigate the association between self-perception of chewing, chewing behavior, and the presence of gastrointestinal symptoms in preoperative patients undergoing bariatric surgery. Sixty adult candidates for bariatric surgery at a public hospital in Belém (Brazil) were analyzed. Participants predominantly exhibited unilateral chewing patterns (91.6%), a fast chewing rhythm (73.3%), a large food bolus (80%), liquid intake during meals (36.7%), and 41.7% reported that chewing could cause some issue. Significant associations were found between the perception of causing problems and chewing scarcity (p = 0.006), diarrhea (p = 0.004), absence of slow chewing (p = 0.048), and frequent cutting of food with front teeth (p = 0.034). These findings reveal a relationship between the perception of chewing problems and chewing scarcity, presence of diarrhea, and fast chewing.

Factors related to masticatory performance in junior and senior high school students and young adults: A cross-sectional study

PURPOSE

Maintaining good masticatory function from a young age promotes lifelong health, yet limited studies have explored masticatory performance in young individuals. We investigated the relationship of sex, age, and individual oral functions with masticatory performance among junior and senior high school students and young adults.

METHODS

This cross-sectional study included students aged 12-13, 14-15, and 16-17 years (groups S1, S2, and S3, respectively) and young adults aged 20-40 years (group YA). We assessed oral functions, the number of functional teeth, and anthropometric measurements. Masticatory performance was evaluated using color-changeable chewing gum. We analyzed sex-related differences in each group and age-related differences in each sex. Multiple linear regression analysis was performed using masticatory performance as the dependent variable to investigate related factors.

RESULTS

Among the 522 children and 100 young adults, males exhibited significantly higher masticatory performance than females in groups S1, S3, and YA. Among males, groups S2, S3, and YA exhibited significantly higher masticatory performance than group S1. Among females, group S2 exhibited higher masticatory performance than groups S1 and S3. Male sex, the maximum occlusal force and tongue pressure, and the number of functional teeth were significantly correlated with masticatory performance.

CONCLUSIONS

Masticatory function development differed by sex, with males exhibiting higher masticatory performance than females. We identified that male sex, the maximum occlusal force and tongue pressure, and the number of functional teeth were significantly associated with masticatory performance. Our findings provide a basis for masticatory performance assessment in different age groups.

Myofunctional orofacial examination tests: a literature review

INTRODUCTION

Myofunctional orofacial examination (MOE) is an important tool for the assessment of the stomatognathic system and orofacial functions, and the early diagnosis of orofacial myofunctional disorders. Therefore, the purpose of the study is to scan the literature and determine the most preferred test for myofunctional orofacial examination.

MATERIALS AND METHODS

A literature review was conducted to collect information. Pubmed and ScienceDirect database was explored by using keywords gained by MeSH (Medical Subject Headings).

RESULTS

Fifty-six studies were retrived from the search and all of the studies were screened and evaluated regarding the subject, aim, conclusions and the orofacial myofunctional examination test they used. It has been observed that traditional evaluation and inspection methods have been replaced by newer and methodological approaches in recent years.

CONCLUSIONS

Although the few tests used differ, 'Orofacial Examination Test With Scores' (OMES) was found to be the most preferred myofunctional orofacial evaluation method from ENT to cardiology.

Food consumption and masticatory performance of normal weight, overweight and obese children aged 7 to 12 years old

Childhood obesity is a significant public health problem. Studies show that obese children are more likely to become obese adults. In an attempt to ascertain the factors associated with childhood obesity, research has shown that this condition is associated with changes in food consumption and masticatory performance. The aim of this study was thus to evaluate food consumption and masticatory performance in normal weight, overweight and obese children aged 7 - 12 years. A cross-sectional study was carried out with 92 children aged 7 - 12 years, of both sexes, from a public school in a Brazilian municipality. The children were divided into the following groups: normal weight (n = 48), overweight (n = 26) and obese (n = 18). Anthropometric parameters, food consumption, food consistency preference, and masticatory performance were evaluated. Pearson's chi-square test was used to compare categorical variables. To compare numerical variables, the one-way ANOVA test was applied. For variables not conforming to a normal distribution, the Kruskal-Wallis test was used. The level of statistical significance was set at p ≤ 0.05. Our results show that the children with obesity consumed fewer fresh foods (median = 3, IQI = 4.00-2.00, p = 0.026), consumed more ultra-processed foods (median = 4, IQI = 4.00-2.00, p = 0.011), performed fewer mastication sequences (median = 2, IQI = 3.00-2.00, p = 0.007), and ate faster (median = 58.50, IQI = 69.00-48.00, p = 0.026) compared to children of normal weight. We conclude that children with obesity exhibit differences in food consumption and masticatory performance compared to children of normal weight.

Mastication in overweight and obese children: A comparative cross-sectional study

OBJECTIVE

The objective of this study was to analyze masticatory characteristics in children from 7 to 10 years, and to compare these characteristics among normal weight, overweight and obese children.

METHODS

This is a cross-sectional study, conducted in northeast Brazil, with a sample of 160 children, aged 7 to 10 years. The authors evaluated: nutritional and dental status; food intake; masticatory parameters and orofacial myofunctional characteristics. The children were divided according to nutritional status into normal weight (n = 101), overweight (n = 33) and obesity (n = 26) groups.

RESULTS

The results showed that Obese children had a larger bite size (g) (median = 6.0, Q1-Q3 = 4.0-9.0, p = 0.049) and performed fewer masticatory sequences (median = 3.0, Q1-Q3 = 2.0-3.2, p = 0.024) than children with normal weight (median = 5.0, Q1-Q3 = 4.0-7.0; median = 4.0, Q1-Q3 = 3.0-5.0). Furthermore, obese children finished feeding in a shorter time (s) (median = 62.5, Q1-Q3 = 50.5-70.0, p = 0.039) than normal weight children (median = 66.0, Q1-Q3 = 56.5-78.0) and overweight children (median = 66.0, Q1-Q3 = 58.0-81.5).

CONCLUSIONS

The present results suggest that obese children present changes in mastication, evidenced by larger bite-size, performing fewer masticatory sequences and rapid mastication, which may contribute to increased food consumption and the development of excess weight.

Effects of neuromodulation on executive functions and food desires in individuals with obesity: a systematic review

Introduction

Objective: to describe the effects of neuromodulation on the performance of executive functions in overweight and/or individuals with obesity. Methods: articles published in PubMed, ScienceDirect, BIREME, and Web of Science databases were selected using the following combination of descriptors: ("problem solving" OR "executive function" OR memory) AND (tDCS OR TMS) AND obesity. After applying the selection criteria, 08 articles were included for analysis. Results: the articles included had an average of 30.1 participants per study, with a minimum of 12 and a maximum of 76. The overall nutritional status ranged from underweight to grade 3 obesity, and the general mean body mass index was 28,1 kg/m2. Regarding the instruments used to assess executive functions, the most frequent were: the flanker paradigm; binocular rivalry for Continuous Flash Suppression (bCFS/NoCFS); Stroop task; Go/No-Go task; and N-back task. The primary outcomes were dependent on the neuromodulation target site. Reduced food craving and improved performance in the active group were observed from decreased response time and increased precision in cognitive tasks. Conclusion: neuromodulation can generate changes in executive functions, reducing food cravings in overweight and individuals with obesity.

Masticaticatory muscles characteristics in relation to adiposity and general muscular fitness: a population-based study

There is still considerable controversy surrounding the impact of mastication on obesity. The aim of this study was to identify the interplay between the masticatory muscles, teeth, and general muscular fitness and how they contribute to body adiposity in a general German population. This cross-sectional study included 616 participants (300 male, 316 female, age 31-93 years) from the population-based Study of Health in Pomerania. The cross-sectional areas of the masseter, medial and lateral pterygoid muscles were measured using magnetic resonance imaging (MRI), muscular fitness assessed by hand grip strength (HGS) and body fat distribution was measured by bioelectrical impedance analysis (BIA) and MRI. The overall prevalence of obesity was high in our cohort. The cross-sectional area of the masseter muscles was positively associated with the number of teeth, body mass index (BMI) and HGS, and negatively associated with the BIA-assessed body fat when adjusted for age, sex, teeth, and BMI. Especially the correlation was strong (p < 0.001). Analogous relationships were observed between the masseter, HGS and MRI-assessed subcutaneous fat. These associations were most pronounced with masseter, but also significant with both pterygoid muscles. Though the masticatory muscles were affected by the number of teeth, teeth had no impact on the relations between masseter muscle and adiposity. Physical fitness and masticatory performance are associated with body shape, controlled and directed by the relevant muscles.

Associations Between Abdominal Obesity, Chewing Difficulty and Cognitive Impairment in Dementia-Free Chinese Elderly

OBJECTIVE

To investigate the independent and synergistic associations between abdominal obesity, chewing difficulty and cognitive impairment in a community-dwelling older adults sample in China.

METHODS

Cognitive function was measured by the 5 min- Montreal Cognitive Assessment (5 min-MoCA) and abdominal obesity was measured by A Body Shape Index (ABSI) in 572 participants recruited from local communities. Chewing difficulty was assessed via a self-report questionnaire. Linear regression and general logistic regression were performed to investigate the association of chewing difficulty and abdominal obesity with cognition.

RESULTS

Chewing difficulty score [β (95% CI) = -.30 (-.49, -.11)] and ABSI [β (95%CI) = -.30 (-.55, -.05)] were independently associated with worse performance on the 5 min-MoCA. Whilst ABSI was not associated with cognitive impairment, the co-existence of chewing difficulty and abdominal obesity [OR (95% CI) = 2.22 (1.18, 4.17)] was found associated with the presence of cognitive impairment.

CONCLUSION

Chewing difficulty and abdominal obesity were independently associated with cognition. Abdominal obesity and chewing may have an additive effect on cognitive function.

The effect of bolus size on masticatory parameters at swallowing threshold in children using a hard, solid, artificial test food

The effect of different bolus sizes on food breakdown has been studied in adults, but not in children. The objective of this study was to study median particle size (MPS) and other parameters of masticatory function at swallowing threshold (ST) in 8–10‐year‐old‐children with two different bolus sizes. A randomized crossover trial was undertaken in 89 eight to ten‐year‐old children. The study was performed with informed consent and ethical approval. The artificial test food used was made of a condensation silicone (Optosil Comfort) following a standardized protocol. Two bolus sizes (three or four quarters of a 20‐mm diameter, 5‐mm thick tablet) were randomized to avoid an order effect and tested in different sessions. Variables were: MPS (X₅₀) at ST, number of cycles until ST, sequence and cycle duration as well as cycles/g. Comparisons were performed with paired t and Wilcoxon tests, regressions and correlations were run. Cutoff for statistical significance was .05. Statistically significant differences were found for all variables; X₅₀ (2.5 ± 0.8 vs. 2.8 ± 0.7 mm, p < .001), cycles until ST (38 vs. 40, p = .022), sequence (25 vs. 27 s, p = .003), and cycle duration (650 vs. 683 ms, p = .015) and cycles/g (27 vs. 21 cycles/g, p < .001), three or four quarters, respectively. In conclusion, in children, as in adults, chewing on a bigger bolus size leads to a larger MPS (X₅₀) at ST. When chewing on a larger bolus the number of cycles increases, but not enough to swallow the same particle size since the number of cycles/g is less with a bigger bolus size.

Eating habit patterns may predict maximum occlusal force: A preliminary study

Masticatory function is thought to be related to various eating habits, but it is difficult to evaluate overall masticatory function by assessing complex eating habits. Maximum occlusal force is an important indicator of masticatory function that is affected by age and sex. This preliminary study focused on the maximum occlusal force of young women and their eating habits, excluding food and nutritional factors, and investigated whether individual eating habits and eating habit patterns predict maximum occlusal force. We measured the maximum occlusal force for the whole dentition of 53 healthy young women before they ate lunch. The participants also completed a 12-item questionnaire about their eating habits. Scores were determined from the relationship between each item and increased maximum occlusal force. We found a significant but weak relationship between maximum occlusal force and some questions. The total questionnaire scores for the participants’ eating habits showed an almost normal distribution (mean ± standard deviation: 22.7 ± 2.6, median: 23.0, mode: 23.0, range of total scores: 17–28). The accuracy of the linear regression between the total scores for eating habits and maximum occlusal force was high but not perfect (β: standardized regression coefficient = 0.527, P < 0.001). Although further research is needed, our findings confirm that eating habit patterns are significantly associated with maximum occlusal force and may help predict occlusal force. Our results provide important information about eating patterns in humans.

Home-Based Monitoring of Eating in Adolescents: A Pilot Study

Objectives: To investigate eating episodes in a group of adolescents in their home-setting using wearable electromyography (EMG) and camera, and to evaluate the agreement between the two devices. Approach: Fifteen adolescents (15.5 ± 1.3 years) had a smartphone-assisted wearable-EMG device attached to the jaw to assess chewing features over one evening. EMG outcomes included chewing pace, time, episode count, and mean power. An automated wearable-camera worn on the chest facing outwards recorded four images/minute. The agreement between the camera and the EMG device in detecting eating episodes was evaluated by calculating specificity, sensitivity, and accuracy. Main results: The features of eating episodes identified by EMG throughout the entire recording time were (mean (SD)); chewing pace 1.64 (0.20) Hz, time 10.5 (10.4) minutes, episodes count 56.8 (39.0), and power 32.1% (4.3). The EMG device identified 5.1 (1.8) eating episodes lasting 27:51 (16:14) minutes whereas the cameras indicated 2.4 (2.1) episodes totaling 14:49 (11:18) minutes, showing that the EMG-identified chewing episodes were not all detected by the camera. However, overall accuracy of eating episodes identified ranged from 0.8 to 0.92. Significance: The combination of wearable EMG and camera is a promising tool to investigate eating behaviors in research and clinical-settings.

Relationship between chewing features and body mass index in young adolescents

BACKGROUND

Behavioural aspects of chewing may influence food intake, nutritional status and in turn body weight.

OBJECTIVES

The current study aimed to study chewing features in adolescents as they naturally occur in home-based settings, and to test for a possible association with weight status.

METHODS

Forty-two adolescents (15.3 ± 1.3 years) were recruited (21 with healthy-weight/21 with overweight). Using a smartphone-assisted wearable electromyographic device, the chewing features of each participant were assessed over one evening, including the evening meal, in their natural home setting.

RESULTS

The mean (±SD) for chewing pace was 1.53 ± 0.22 Hz, chewing power 30.1% ± 4.8%, number of chewing episodes 63.1 ± 36.7 and chewing time 11.0 ± 7.7 minutes. The chewing pace of the group with overweight was slower than that of healthy weight (-0.20 Hz; 95% CI, -0.06 to -0.33; P = .005) while their chewing time was shorter (-4.9 minutes; 95% CI, 0.2-9.7; P = .044). A significant negative correlation was observed between BMI z-score and chewing pace (R = -.41; P = .007), and between BMI z-score and chewing time (R = -0.32; P = .039).

CONCLUSION

The current study suggests that adolescents who are overweight eat at a slower pace for a shorter period of time than their counterparts who are a healthy weight. This unexpected finding based on objective data appears to conflict with existing questionnaire findings but provides impetus for further work testing the effectiveness of changing eating behaviour as a weight-management intervention in youth.

Mastication in children and adolescents with overweight or obesity: a systematic review

ABSTRACT Studies have shown that changes in mastication are related to overweight in children and adolescents as these changes influence the increase in food consumption. The objective of this article was to characterize, through a systematic review, the mastication in children and adolescents with overweight or obesity. For this, two independent authors performed a systematic review of the electronic databases: Medical Literature Analysis and Retrieval System Online, Scopus, Cumulative Index to Nursing and Allied Health, Web of Science and Latin American and Caribbean Literature in Health Sciences. Masticatory characteristics were considered as primary outcomes; the methods of analyzing mastication, the physical characteristics of the foods/materials used in the analyses and the fasting time were considered as secondary outcomes. This review was prepared in accordance with the items of the preferential reports for systematic analysis and meta-analysis. The systematic review protocol was submitted to the International Prospective Registry of Systematic Reviews. Nine articles were included in this review. The reviewed articles suggest that children and/or adolescents with overweight or obese present masticatory damages because they have worse masticatory performance and altered orofacial myofunctional characteristics.

Impact of asthma on children´s gustatory sensitivity, masticatory and feeding behaviors

Asthma is a chronic inflammatory disease, in which disturbances in breathing, masticatory and swallowing functions may impact the eating behavior. The aim of the study was to evaluate the impact of asthma on taste sensitivity, masticatory behavior and feeding problems in children. The sample consisted of 91 children (6-7y) divided into two groups: asthma (n=46) and control group (n=45). Interviews were held with parents/guardians and clinical examinations were performed to gather information on medical, dental and feeding aspects. The gustatory sensitivity for sucrose and urea (sweet and bitter, respectively) were measured by staircase method designed for this age-range. The respiratory and masticatory functions were evaluated using the Orofacial Myofunctional Evaluation with Scores-expanded (OMES-e) protocol. Feeding problems were assessed using the Montreal Children's Hospital Feeding Scale, exploring oral motor, sensory, appetite, maternal concerns, child's behavior, and strategy aspects after transcultural adaptation to Brazilian Portuguese. The two groups were homogeneous relative to sociodemographic characteristics and nutritional status. Although the total OMES-e scores did not differ between groups, the frequency of changes in food incision and escape were different (p=0.007 and p=0.0011, respectively). The Asthma group required more time and higher number of masticatory cycles to eat the test-food (p<0.05). The gustatory thresholds for sweet and bitter were different, with asthmatic children requiring significantly higher concentrations to perceive the taste (p<0.001). The frequency of children classified by their parents according to feeding difficulties also differed between groups (p=0.001; Fisher's exact test). Asthmatic children showed remarkable changes in taste, chewing and eating behaviors, thereby pointing out the eating problems they may experience, which should be considered when designing and implementing therapeutic interventions.

Lack of agreement between objective and subjective measures in the evaluation of masticatory function: A preliminary study

The evaluation of mastication is important to understand the masticatory behavior and diagnose feeding difficulties. The objective of this preliminary study was to verify if there is agreement between objective and subjective validated methods of chewing evaluation in a convenience sample which consisted of 32 adolescents (mean 15.5years), complete permanent dentition and free of tooth decay. The Quality of Masticatory Function Questionnaire with the Food-Mastication, Habits, Meat, Fruit and Vegetables domains was used in the subjective evaluation. The objective aspects consisted of maximum bite force (BF) and masticatory performance (MP) by mastication of cubes of test-material and sieving to determine the median particle size (X₅₀) and distribution in the sieves ("b"), and by the colorimetric method using colorchangeable chewing gum. Data were submitted to exploratory analysis, normality test and correlation tests (Pearson/Spearman). The correlation between BF and X₅₀ (r=-0.43; p=0.02) and between BF and MP chewing gum (r=0.53; p=0.002) was significant with large effect size. The MP evaluated by chewing gum correlated with X₅₀ (r=-0.34; p=0.055), but not with "b" (r=-0.06; p=0.73), while "b" correlated only with X₅₀ (r=0.52, p=0.002). No significant correlation was observed between the objective measures and the total score of the subjective evaluation; only a negative correlation was observed between "b" and Meat domain (r=-0.40; p=0.023). The objective methods showed moderate correlation with each other and no agreement between the objective and subjective methods was observed in this sample of healthy adolescents, emphasizing the importance of both aspects in the evaluation of masticatory function.