Bite Force Assessment in Pediatric Patients With Idiopathic Musculoskeletal Pain

Objectives: The purpose of this study was to assess the bite force in pediatrics patients with idiopathic musculoskeletal pain syndrome (IMPS) and compare to healthy control individuals paired by gender and age.

Methods: Forty consecutive patients (32 girls) from our outpatient paediatric rheumatology pain clinic with diagnosis of IMPS were included in this study. Twenty healthy subjects (16 girls) who were referred for control orthodontic evaluation, were considered the control group. All individuals were interviewed according to a standardized questionnaire concerning the presence of orofacial pain and functional impairment, and were submitted to a clinical evaluation following a structured protocol. After that the bite force was measured.


Results: Twelve patients met the ACR criteria for fibromyalgia (FM), and 28 presented the diagnosis of pain amplification syndrome. The mean age of patients was 13.1 years (range, 6-18 years) and of controls was 12.8 years (range, 6-18 years) with no significant difference (p=0.464)
Orofacial symptoms occurred in 25 patients (62.5%) and in 3 controls (15%) (p<0.0001). Seventeen (37%) patients and four (17.4%) controls presented pain during mandibular function (p=0.095). Although both pain groups presented separately more frequently orofacial symptoms and pain on palpation than the controls, maximal voluntary bite force was similar between patients and controls, between both patient groups and between the two pain groups and controls.

Conclusions: Health professionals who take care of children and adolescents with idiopathic musculoskeletal pain syndrome should always consider the subjective symptoms related to the orofacial region. Our findings indicate the need of an accurate differential diagnosis with temporomandibular disorders and the appropriate management of those signs and symptoms.