ORAL HABITORAL HABIT“ Correcting bad habits cannot be done by forbidding or punishment”-Robert Baden-Powell

Chinthamani Laser Dental Clinic

DEFINITIONDEFINITION Oral habit is defined as a frequent or constant practice or acquired tendency, which has been fixed by frequent repetition. – Buttersworth (1961)

CONTENTSCONTENTSThumb suckingTongue ThrustingMouth BreathingBruxismLip HabitCheek BitingNail Biting

THUMB SUCKINGTHUMB SUCKING

DefinitionClassificationEtiologyDiagnosisClinical featurePreventionTreatment

DEFINITIONDEFINITION

Thumb sucking is define as placement of the thumb at various depths into the mouth.

CLASSIFICATIONCLASSIFICATIONBased on our clinical observation, 1.NORMAL THUMB SUCKING:• Normal during the first and second year of life.• Disappear as the child matures.• Habit at this age does not generate any

malocclusion.

2.ABNORMAL THUMB SUCKING :• When thumb sucking habit persist beyond the

preschool period then it is consider to be an abnormal habit .

• If not controlled or treated may cause deleterious effects to the dento facial structures .

This can be again :This can be again :

Psychological.Habitual.

Can also be classified by Subtenly as :o Type A : seen in 50% children. Whole

digit is placed inside the mouth with pad of thumb pressing over the palate, at the same time maxillary and mandibular anteriors contact is present.

o Type B : seen in 13-24% children.thumb placed in the mouth without touching the palate maintaining the maxillary and mandibular anterior cantact.

o Type C : seen in 18% children. Thumb is placed into the mouth just beyond the first joint, contacting the hard palate and only the maxillry incisors.

o Type D : seen in 6% children where little portion of thumb is placed into the mouth.

CLINICAL FEATURESCLINICAL FEATURES

PROCLINATION OF MAXILLARY INCISIORS

CONSTRICTION OF MAXILLARY ARCH

ANTERIOR OPEN BITE Maxillary Anterior Proclination and Mandibular Retroclination.

POSTERIOR CROSS BITE

TREATMENTTREATMENT

BLUE GRASS APPLIANCE

QURD HELIX

HABIT BREACKING APPLIANCES

THUMB GUARD

TONGUE THRUSTINGTONGUE THRUSTING

DEFINITIONDEFINITION• Brauer , 1965- A tongue thrust is said

to be present if the tongue is observed thrusting between, and the teeth do not close in centric occlusion during deglutition.

• Tulley , 1969- States tongue thrust as the forward movement of the tongue tip between the teeth to meet the lower lip during deglutition and in sounds of speech, so that the tongue becomes interdental.

• Barber , 1975- Tongue thrusting is an oral habit pattern related to the persistence of an infantile swallow pattern during childhood and adolescence and thereby produces an open bite and protrusion of the anterior tooth segments.

• Schneider , 1982- tongue thrust is a forward placement of the tongue between the anterior teeth and against the lower lip during swallowing,

CLASSIFICATIONCLASSIFICATION1. Physiologic: normal tongue thrust of the

infancy.2. Habitual : the tongue thrust swallow is

present as a habit even after the correction of the malocclusion.

3. Functional : when the tongue thrust mechanism is an adaptive behavior developed to achieve an oral seal, it can be grouped as functional .

4. Anatomic : persons having enlarged tongue can have an anterior tongue posture.

ETIOLOGYETIOLOGY• Retained infantile swallow• Upper respiratory tract infections such as

mouth breathing, chronic tonsillitis , allergies, etc…

• Neurological disturbances- hyposensitive palate , moderate motor disability, disruption of sensory control and coordination of swallowing can lead to tongue thrust.

• Functional adaptability to transient change in anatomy.

• Feeding practices and tongue thrusting• Induced due to other oral habits• Hereditary • Tongue size.

CLINICL FEATURECLINICL FEATUREEXTRAORAL FINDING:

• Lip is incompetent• Mandibular movements during swallowing

are erratic, and no correlation can be found between movement of tongue tip and of mandible.

• Average mandibular movement is upward and backward with tongue moving forward.

• Speech disorder like sibilant distortions ,lisping, problems in articulation of s, n, t, d ,l , th ,z , v sound.

• Increase in anterior facial height.

INTRA ORAL FINDINGS• Swallowing sequences are jerky and

inconsistent .• Tongue movement are also irregular.• Malocclusion a) Features pertaining to the maxilla: - Proclination of maxilla anteriors

resulting in an increase in over jet. -Generalized spacing between the teeth. - Maxillary constriction. b) Features pertaining to the mandible: -Retroclination or proclination of

mandibular teeth. c) Inter maxillary relationships: - Anterior or posterior open bite - Posterior teeth cross bite.

DIAGNOSISDIAGNOSIS

TREATMENTTREATMENT

HABIT BREACKING APPLIANCE

ORTHODONTIC ELASTICS

PRE ORTHODONTIC TRAINER

MOUTH BREATHINGMOUTH BREATHING•Definition•Classification•Etiology•Clinical feature•Diagnosis•Treatment

DEFINITIONDEFINITIONSassouni 1971: defined mouth breathing as habitual respiration though the mouth instead of the nose.

Merle 1980 : suggested the term oro nasal breathing instead of mouth breathing.

CLASSIFICATIONCLASSIFICATIONFinn (1987) has classified

mouth breathing into:A.AnatomicB.ObstructiveC.Habitual

ETIOLOGYETIOLOGY Deviated nasal septum. Nasal polyps. Chronic inflammation of nasal

mucosa. Localized benign tumors. Congenital enlargement of nasal

turbinates. Allergic reaction of the nasal

mucosa. Obstructive adenoids. Short upper lip.

CLINICAL FEATURESCLINICAL FEATURES• Long and narrow face.

• Narrow nose and nasal passage.

• Short and flaccid upper lip.• Posterior cross bite.

Expressionless or blank face.

Anterior marginal gingivitis.

Dryness of the mouth predisposing to caries.

Proclination of anterior teeth.

DIAGNOSISDIAGNOSISHistory : good history should be

recorded from parent and patients.

Clinical examination: a) Mirror test. b) Butterfly test. c) Water holding test. d) Rhinomanometry. e) Cephalometrics.

TREATMENTTREATMENTSYMPTOMATIC TREATMENT:

The gingiva of mouth breathers should be restored to normal health by coatin the gingiva with petroleum jelly, by applying preventive dentistry methods and by clinically correcting periodontal defects thet have occurred during habit.

THE TREATMENT SHOULD BE AIMED AT….

1. ELIMINATION OF THE CAUSE.2.INTERCEPTION OF THE HABIT .

If there is no physiological cause the patient should be instructed for:

a) Lip exercises.b) Physical exercises.c) Maxillothorax myotherapy.

3.CORRECTION OF THE MALOCCLUSION.

a) Children with class l skeletal and dental occlusion and anterior spacing- oral shield appliance.

b) Class ll division l without crowding age 5-9 years- monobloc activator.

c) Class lll malocclusion : chin cap.

BRUXISMBRUXISM•Definition.•Type.•Etiology.•Manifestation.•Treatment.

DEFINITIONDEFINITIONRamfjord (1966): Bruxism is the

habitual grinding of teeth when the individual is not chewing or swallowing.

Rubina (1986): Bruxism is the team used to indicate nonfuntional contact of teeth which may include clenching, grinding, gnashing, and tapping of teeth.

Vanderas(1995): Non funtional movement of the mandible with or without an audible sound occurring during the day or night.

CLASSIFICATIONCLASSIFICATION

1.Day time bruxism / Diurnal bruxism.

2.Night time bruxism / Nocturnal bruxism.

ETIOLOGYETIOLOGY1. Psychological and emotional stresses.2. Occlusal interference.3. Cortical lesion.4. Systemic factor: magnessium

deficiency, chronic abdominal distress.5. Genetics: children of bruxism parents

have an increased incidence of bruxism.6. Allergies: related to nocturnal bruxism.7. Occupational factors: compulsive

overahievers and competitive sports lead to clenching.

CLINICAL FEATURESCLINICAL FEATURES1.OCCLUSAL TRAUMA:

• Tooth mobility, more in mornings.• Spread of gingivitis into deeper

periodontal structures and alveolar bone loss.

2. Tooth structure:• Non functional pattern of occlusal wear is seen as signs.•It can also lead to increased tooth sensitivity from excessive abrasion of the enamel.•Pulp is exposed to attrition leading to dental abscess.•Fracture of tooth crown and restorations can also cause bruxism.

3. HEADACHE:• mostly of muscular contraction •type.

4.OTHER SIGNS AND SYMPTOMS:• grinding and tapping sounds.• soft tissue trauma.• small ulcerations or ridging on the buccal mucosa opposite molar teeth.

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TREATMENT:TREATMENT:

1. Occlusal adjustments: Results in immediate disappearance

of habitual grinding. Any prematurities or occlusal

interferences should be corrected. Coronoplasty plays an important role. Extensive adjustments are

contraindicated. Muscles should be brought back to a

relaxed position before adjustments.

2.2. OCCLUSAL SPLINTS: OCCLUSAL SPLINTS:

Vulcanite splints to cover occlusal surfaces of teeth. A reduction in increased muscle tone is observed.

In children, splint is made on the mandibilar models using Scher Dental Bioplast material.

3. RESTORATIVE TREATMENT:3. RESTORATIVE TREATMENT:

Severe abrasion where penetration into pulp chamber is imminent, pulpal therapy with full coverage crown is indicated.

4. Psychotherapy :4. Psychotherapy :

Counseling the patient and behavioral modality through explanation and arousal and patient’s awareness of the habit.

5. Relaxation training:To relax the muscle group voluntarilyHypnosis, conditioning also indicated.

6. Physical therapy7. Electrical method:Electrogalvanic stimulation for muscle

relaxation.

8. Drugs :8. Drugs :

Vapocoolants such as ethyl chloride for pain

LA injections, tranquilizers, sedatives and muscle relaxants.

Placebos to rule out psychological etiology.

Low doses of tricyclic antidepressants to inhibit amount of REM sleep.

9. Biofeedback.9. Biofeedback.

10. Acupunture techniques for 10. Acupunture techniques for muscle relaxation.muscle relaxation.

11. Orthodontic correction.11. Orthodontic correction.

LIP HABITLIP HABIT

DefinitionClassificationEtiologyManifestationTreatment

DEFINITION:DEFINITION:

Habits that involve manipulation of lips and perioral structures.

CLASSIFICATION:Wetting the lips with the tongue.Pulling the lips into the mouth

between the teeth.

ETIOLOGY:ETIOLOGY:

1. Malocclusion : in angle’s class 2 div.1.2. Habits : occur in conjunction with

other habits such as thumb or digit sucking.

3. Emotional stress : children in stressful situations have an increased salivary output, thus increasing the number of swallows and lip seals required. May become a compulsive and gratificational activity during sleeping hours.

CLINICAL FEATURES:CLINICAL FEATURES:

Protrusion of maxillary incisors and retrusion of mandibular incisors: Action is to

wedge the lip between upper

and lower incisors. This creates a muscular imbalance and cause maxillary incisors to move labially and

upward with interdental spacing.Ulcers :

Lip : reddened, irritated and chapped area below the vermillion border.

the vermillion border may be farther outside the mouth, mostly in lower lips.

in some cases, chronic herpes infection with areas of irritation and cracking of lips.

Malocclusion :

Mentolabial sulcus becomes accentuated.

TREATMENT:TREATMENT:

1.Correction of malocclusion:Class 1 with increased overjet : fixed

or removable appliance to tip the teeth back.

Class 2 : growth modification procedures.

activator if the child has an uncrowded early mixed dentition.

2. Treating the primary habit : digit sucking with hawley’s retainer.

3. Appliance therapy:3. Appliance therapy:Oral shield : useful in class 1 malocclusion. Addition of small loop to the labial oral shield improves the lip tonus by helping in lip exercises-10

minutes, 3 times a day.

Lip bumper : positioned in the vestibule of the mandibular arch and serves to prohibit the lip from exerting excessive force on the mandibular incisors

and reposition the lip away from the lingual aspect of the maxillary incisors.

can be combined, fixed and removable appliance.

CHEEK BITINGCHEEK BITINGDEFINITION:This is an abnormal habit of keeping or biting the cheek muscles in between the upper and lower posterior teeth.

CLINICAL FEATURESCLINICAL FEATURES1. ULCER

2.OPEN BITE

3. TOOTH MALPOSITION IN THE BUCCAL SEGMENT.

TREATMENT :TREATMENT :

Removable crib.

Vestibular screen.

NAIL BITINGNAIL BITING

One of the most common habits in children.

It is a sign of internal tension.AGE OF OCCURENCE : rises

sharply from 4-6 years, constant level between 7&10 years and rises to peak during adolescence.

ETIOLOGY : indicative of an emotional problem.

CLINICAL FEATURESCLINICAL FEATURESINFLAMATION OF THE NAIL AND NAIL

BEDS

DENTAL EFFECTS : crowding, rotation and attrition of incisal edges of mandibular incisors.

TREATMENT :TREATMENT :

Mild cases : no treatment.Avoid scolding, nagging and threats.Treat the emotional factorEncourage outdoor activities.Application of nail polishes, light

cotton mittens as reminder.

SELF INJURIOUS HABITSSELF INJURIOUS HABITS

DEFINITION

ETIOLOGY

DEFINITION :DEFINITION :Repetitive acts that result in

physical damage to the individual.

these habits show an increased incidence in mentally retarded population.

ETIOLOGY :Organic : syndromes and syndrome-

like maladies such as Lesch-Nyhan disease and De Lange’s syndrome.

Functional :o Type A : injuries superimposed on

a pre-existing lesion. E.g; child with nail biting habit is ubder treatment for skin lesion.

o Type B : injuries secondary to another established habit. E.g; rotation of thumb while thumb sucking can harm the soft tissues.

o Type C : injuries of unknown or complex etiology. Has a greater psychogenic component.

FRENUM THRUSTING :FRENUM THRUSTING :If the maxillary incisors are slightly

spaced apart, the child may lock his labial frenum between these teeth and permit it to remain in thus position for several hours.

It may displace the tooth.TREATMENT :o Psychogenic therapy.o Palliative treatment.o Mechanotherapy : oral shields,

restraints and protective padding.

BOBBY PIN OPENING :BOBBY PIN OPENING :

Seen in teen age girls where in opening bobby pin with anterior incisors is done.

Clinically, notched incisors and partially denuded labial enamel are seen.

Calling attention is all that is necessary to stop the habit.

CONCLUSIONCONCLUSION “ Oral habits can manifest themselves

in a variety of ways, and these activities may or may not be a concern for parents. Likewise , the presence of an oral habit may or may not have a marked effect on the child’s developing facial structures and dentition. Hence assessment of these behaviors must include a thorough evaluation of the habit itself and the presence of the potential for oral health repercussions. These judgments must be coupled with a sensitive assessment of the physical and emotional status of the child and the relationship of the parent or caregiver.”

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