Assessment of Masticatory Performance: A Systematic Review of Current Assessment Methods and Measurement Properties

To systematically evaluate the measurement properties of current masticatory performance (MP) assessment methods in adult populations. A systematic search was performed in the PubMed, Cochrane Library, and EBSCOhost databases for studies published from January 2000 to September 2025. This review included adult populations aged ≥18 years and was not restricted to a specific age subgroup. Eligible studies were those that assessed MP by mixing ability, comminution tests, or other objective approaches. The measurement properties and corresponding levels of evidence for each included study were systematically evaluated. Data extraction and methodological quality appraisal were conducted in accordance with the COSMIN guidelines. A total of 40 studies met the inclusion criteria. MP assessment methods can be categorized into mixing ability, comminution, and other tests. The mixing ability tests, particularly those using colour-changeable or two-colour chewing gums, demonstrated the most consistent evidence, with sufficient reliability and strong validity. Comminution tests, including sieving, optical scanning, and gummy jelly-based tests, revealed moderate reliability and validity. Emerging digital and image-based analyses have shown promising potential but remain insufficiently validated. Current MP assessment methods provide partial but insufficient evidence across measurement properties, and no standardized, clinically validated test exists. Future research should prioritize methodological standardization and incorporate digital and image-based technologies with rigorous validation to establish reliable and universally applicable MP assessment tools.