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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 216-219

Evaluation of normal range of maximum mouth opening for Pune Maharashtra adult population


1 Department of Oral Medicine and Radiology, Bharati Vidyapeeth (Deemed to be University), Dental College and Hospital, Pune, Maharashtra, India
2 Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth (Deemed to be University), Dental College and Hospital, Pune, Maharashtra, India

Date of Submission29-Sep-2021
Date of Decision24-Nov-2021
Date of Acceptance26-Nov-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Dr. Vaishali Vasant Koranne
Bharati Vidyapeeth, Deemed to be University Dental College and Hospital Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_260_20

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  Abstract 


Background and Aim: Maximal mouth opening (MMO) is used as a marker of masticatory pathology. MMO varies with age, height, gender, and race. The current study is an attempt to calculate the normal range of maximum mouth opening in an adult Pune Maharashtra population. Materials and Methods: A total of 800 individuals, 400 males and 400 females, in the age group of 18–60 years attending outpatient department in Bharati Dental College and Hospital, Pune were randomly selected and divided into four groups according to their age ranges. In addition to the basic demographic data, MMO was measured in these individuals. The subjects were asked to open their mouth maximally until no further opening was possible. The distance from the incisal edge of the upper incisor teeth to the incisal edge of the lower incisor teeth was measured using a calibrated fiber ruler. Statistical analysis was performed. Results: The mean MMO for males was 50.58 (standard deviation [SD] ± 2.16) mm (Range 37–56 mm) and for females was 48.29 (SD ± 3.12) mm (Range 36–53 mm). There was a statistically significant difference between the mouth opening of male and female in all the age groups with P < 0.05 A linear relationship was observed between the mouth opening and age in both males and females and the mouth opening decreased as the age increased. In the age group of 18–29 years, the mean MMO was 54.34 (SD ± 1.84) mm. The range was 39–56 mm for males and 51.63 (SD ± 2.33) mm. with range 38–53 mm for females. In the age group of 30–39 years, the mean MMO was 52.09 (SD ± 1.72) (range 38–53 mm) and 50.07 (SD ± 2.09) (range 38–51 mm) for males and females, respectively. For the age group 40–49 years, the mean MMO was 48.94 (SD ± 1.66) mm (range 39–54 mm) for males and 46.73 (SD ± 2.84) mm (range 38–50 mm) for females. In the age group of 50–60 years, the corresponding values for males and females were 46.98 (SD ± 2.04) (range 36–50 mm) and 44.76 (SD ± 2.59) mm (range 36–49 mm). Conclusion: The MMO range for different age groups is established for normal adult Pune Maharashtra population.

Keywords: Age, gender, maximal mouth opening


How to cite this article:
Koranne VV, Joshi SA, Patankar AP, Patankar SA. Evaluation of normal range of maximum mouth opening for Pune Maharashtra adult population. Arch Med Health Sci 2021;9:216-9

How to cite this URL:
Koranne VV, Joshi SA, Patankar AP, Patankar SA. Evaluation of normal range of maximum mouth opening for Pune Maharashtra adult population. Arch Med Health Sci [serial online] 2021 [cited 2022 Aug 19];9:216-9. Available from: https://www.amhsjournal.org/text.asp?2021/9/2/216/334013




  Introduction Top


A known normal range of mouth opening is necessary to enable the dentist conduct a thorough oral examination and dental treatment efficiently. The limitation of mouth opening is one of the early signs of many pathological and traumatic conditions. Early recognition of decreased or limited mouth opening is necessary for a prompt and efficient approach to the diagnosis and to plan out the treatment options judiciously. Increasing number of patients of maxillofacial fractures, temporomandibular joint diseases, oral malignancies, oral submucous fibrosis, reconstructed oral defects, and craniofacial syndromes are now reported for the diagnosis and treatment to oral medicine and oral surgery specialty. Mouth opening and its adequacy is an important component in treatment and follow-up of all of these conditions.

In order to make a diagnosis of decreased mouth opening, it is essential to establish what constitutes the normal opening for the population. Normal mouth opening has been defined as the inter-incisal distance at maximal mouth opening (MMO).[1] Mouth opening among different population has been shown to vary considerably and its range is specific for a given population.[2] Research has shown that the measurement of mouth opening varies significantly with age, gender, and race.[3] Numerous studies across the world have characterized the mouth opening in their population. It is fairly common to report the mouth opening in terms of finger breath in our daily practice. However, its numerical value in the Indian population is still not clear. The present study is an attempt to calculate the normal mouth opening in adult Pune Maharashtra population. This will serve as a guide for various studies and will have clinical utility in treatment and diagnosis of diseases which directly or indirectly affect mouth opening.


  Materials and Methods Top


The study protocol was approved by the Institutional Ethics Committee. It was a cross-sectional prospective study. The study was undertaken in the department of oral medicine and radiology. A total sample of randomly selected 800 patients from the outpatient department of Bharati Dental College and Hospital Pune between the age group of 18–60 years representing a sample of dentate adults were included for the study. The sample was stratified into four groups according to the age followed by gender stratification. The age groups were classified as 18–29 years (Group 1), 30–39 years (Group 2), 40–49 years (Group 3), and 50–60 years (Group 4). Written consent was obtained from all the participants for study.

The inclusion criteria of participants for study was completely erupted and functional maxillary, and mandibular central incisors, anterior teeth with normal positioning, attrition on the incisal edges no more than 1 mm, no dental prosthesis on upper and lower anterior teeth.

Patient presenting a history of jaw pain either at rest or during function, maxillofacial trauma, temporomandibular disorders, oral submucous fibrosis, oral malignancy, facial or dental developmental abnormalities were excluded from the study.

The mouth opening was measured using a standardized protocol.[4] The participants were asked to open their mouth maximally till no further opening was possible. The distance from the incisal edge of the upper incisor teeth to the incisal edge of the lower incisor teeth was measured using a calibrated ruler, and the findings were recorded in millimeters [Figure 1]. All four investigators had measured MMO of subject independently and their average was recorded as the final reading.
Figure 1: Figure showing measurement of mouth opening

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Statistical analysis

The data were compiled in MS Office Excel. To determine correlation of mouth opening with age a Pearson correlation analysis was performed. We considered differences to be statistically significant when the P value was below 0.05.


  Results Top


A total of 800 participants were equally divided according to their age into 4 groups consisting of 100 male and 100 female participants in each group. The mean MMO for males was 50.58 mm (standard deviation [SD] ± 2.16). The range was 37–56 mm. The mean MMO for females was 48.29 mm (SD ± 3.12). The range was 36–53 mm, as it is shown in [Table 1]. In the age group of 18–29 years, the mean MMO was 54.34 (SD ± 1.84) mm. The range was 39–56 mm for males and 51.63 (SD ± 2.33) mm. with range 38–53 mm for females. In the age group of 30–39 years, the mean MMO was 52.09 (SD ± 1.72) (range 38–53 mm) and 50.07 (SD ± 2.09) (range 38–51 mm) for males and females, respectively. For the age group 40–49 years, the mean MMO was 48.94 (SD ± 1.66) mm (range 39–54 mm) for males and 46.73 (SD ± 2.84) mm (range 38–50 mm) for females. In the age group of 50–60 years, the corresponding values for males and females were 46.98 (SD ± 2.04) (range 36–50 mm) and 44.76 (SD ± 2.59) mm (range 36–49 mm) as it is summarized in [Table 2].
Table 1: Mean maximum mouth opening, standard deviation, range of maximum mouth opening in mm for all males and females

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Table 2: Maximum mouth opening range in mm, mean maximum mouth opening, standard deviation in relation to age and gender

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There was a statistically significant difference between the mouth opening of male and female in all the age groups with P < 0.05. A linear relationship was observed between the maximum mouth opening and age in both males and females with correlation coefficient of − 0.86 and − 0.9, respectively, which showed that mouth opening decreases as the age increases and this relation was found to be statistically significant (P < 0.05) [Figure 2].
Figure 2: Variation of mouth opening with age

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  Discussion Top


Although the importance of the topic is well known to the dental profession, very less research has been done on this clinically important parameter. It is the first study which provides data about the normal range of mouth opening of Pune Maharashtra adult population.

The conclusion of this study is very important especially for oral surgical work as it gives Indian values of (MMO).

A large number of methods have been described in the literature to measure the mouth opening. The measurement most often used to assess mouth opening is the interincisal distance attained during active opening by the subject.

As pointed by Mezitis et al., the functional opening of the mouth is more important.[5] Wood and Branco examined three methods of measuring interincisal distance and concluded that direct measurement using a ruler was the most accurate.[1] The interincisal distance has been used as a measurement of MMO in this study. An advantage of the incisal edge distance is that the measuring point is relatively more consistent, permanent, and more easily determined.

Research has shown that the mouth opening measurement varies significantly with the age, gender, and stature along with geographical and ethnic variation. In the present study, it was found, that the mean value, and the range of MMO was 50.58 mm (SD ± 2.16 mm) range (32.0–72.0 mm) for males and lesser value of 48.29 mm (SD ± 3.12 mm) range (38.0–67.0 mm) for females which was in the range provided by the other studies done in other parts of the world.[6],[7],[8],[9]

It was found, that the men exhibit marginally greater mean mouth opening then females, this may be due to greater mandibular length in males than in females or due to greater muscle strength in men allowing their maximum jaw opening. By contrast to our study and those reported above, Pullinger et al. stated in his study, that females have greater range of mouth opening and suggested the difference in behavior of mouth opening may be due to greater joint laxity in females.[10]

Eight hundred samples in the present study were stratified into four groups according to age. It was found that the greatest mean MMO was recorded for younger age group (18–29 years) in both males and females, whereas the lowest was recorded in older age group (50–60 years). These findings were similar to those reported by other investigators.[5],[6],[7],[9],[11],[12] This is an important finding which needs further investigation and analysis. Yao et al.[9] estimated that for every 10 years, maximum mouth opening decreased by about 1.4 mm in males and 0.9 mm in females. The reason for this diminution of mouth opening with aging may be related to skeletal muscle atrophy, declining strength, and physical frailty associated with aging.

The findings of the present study are in concordance with the study carried out by Puri et al.[13] While the average range of mouth opening in the study done by Puri et al. is slightly higher than the present study. The present study shows definite decline in the mouth opening with age.

The present study attempts to calculate the mouth opening for Pune Maharashtra adult population. These data are important because without a proper reference value a high number of complex surgical procedures are routinely performed. The mouth opening is clearly different in the different population. Thus, reference of international data while doing surgical procedure is obviously not justified. There seems to be a number of factors which affect mouth opening. We recommend that large multi-center trials should be undertaken to clearly identify these variables and their implications on the mouth opening.


  Conclusion Top


The mean MMO for Pune Maharashtra males is 50.58 mm (SD ± 2.16) (range: 36–56 mm). The mean MMO for females is 48.29 mm (SD ± 3.12) (range: 36–53 mm). The mouth opening seems to decrease with age. The mouth opening of females is significantly less than the males in all the age groups. Further research is needed in other parts of country to have a national data about the subject.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wood GD, Branco JA. A comparison of three methods of measuring maximal opening of the mouth. J Oral Surg 1979;37:175-7.  Back to cited text no. 1
    
2.
Gallagher C, Gallagher V, Whelton H, Cronin M. The normal range of mouth opening in an Irish population. J Oral Rehabil 2003;30:1-7.  Back to cited text no. 2
    
3.
Boozer CH, Ferraro EF, Weinberg R. The effects of age, race and sex on the interincisal measurement. Ann Dent 1984;43:5-7.  Back to cited text no. 3
    
4.
Dijkstra PU, Bont LG, Stegnenga B, Boering G. Angle of mouth opening measurement: Reliability of a technique for temporomandibular joint mobility assessment. J Oral Rehabil 1995;22:263.  Back to cited text no. 4
    
5.
Mezitis M, Rallis G, Zachariades N. The normal range of mouth opening. J Oral Maxillofac Surg 1989;47:1028-9.  Back to cited text no. 5
    
6.
Cox SC, Walker DM. Establishing a normal range for mouth opening: Its use in screening for oral submucous fibrosis. Br J Oral Maxillofac Surg 1997;35:40-2.  Back to cited text no. 6
    
7.
Zawawi KH, Al-Badawi EA, Lobo SL, Melis M, Mehta NR. An index for the measurement of normal maximum mouth opening. J Can Dent Assoc 2003;69:737-41.  Back to cited text no. 7
    
8.
Placko G, Bellot-Samson V, Brunet S, Guyot L, Richard O, Cheynet F, et al. Normal mouth opening in the adult French population. Rev Stomatol Chir Maxillofac 2005;106:267-71.  Back to cited text no. 8
    
9.
Yao KT, Lin CC, Hung CH. Maximum mouth opening of ethnic Chinese in Taiwan. J Dent Sci 2009;4:40-4.  Back to cited text no. 9
    
10.
Pullinger AG, Liu SP, Low G, Tay D. Differences between sexes in maximum jaw opening when corrected to body size. J Oral Rehabil 1987;14:291-9.  Back to cited text no. 10
    
11.
El-Abdin H, Al-Shalan T, Al-Bisher G. Normal mouth opening in the Saudi population. Saudi Dent J 1991;3:99-101.  Back to cited text no. 11
    
12.
Chima O, Obiechina AE. Mouth opening among Nigerians. Odontostomatol Trop 1995;18:22-4.  Back to cited text no. 12
    
13.
Puri VA, Rana RE, Agarwal KA, Suryavanshi SR, Aiyer PM. Measurement of interincisal distance in the Indian population. Ann Plast Surg 2001;46:662-3.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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