ORAL HABITS

HABIT: DEFINITIONS

Dorland: Fixed or constant

practice established by frequent repetition.

Buttersworth : Frequent or constant

practice or acquired tendency, which has been fixed by frequent repetition.

Moyer: Habits are learnt pattern of

muscle contraction of a very complex nature.

CLASSIFICATIONSOBSESSIVE

(DEEP ROOTED)

INTENTIONAL MASOCHISTIC (MEANINGFUL) (SELF

INFLICTING)

NAIL BITING GINGIVAL STRIPPINGLIP BITINGDIGIT SUCKING

NON OBSESSIVE(EASILY LEARNED & DROPPED)

UNINTENTIONAL FUNCTIONAL

ABNORMAL PILLOWING TONGUE THRUSTINGCHIN PROPPING BRUXISM

CLASSIFICATION

James (1923)/ GraberUsefulHarmful

KingsleyFunctional

oral habitMuscular

habitcombined

Finn (1987) Compulsive Non

compulsive Primary

habit Secondary

habit

Klein (1977)Emptymeaningful

THUMB SUCKING DEFINITION:

According to Gellin “It is placement of thumb or one or more finger in varying depth into the mouth”.

THEORIES:

1. PSYCHOANALYTICAL/PSYCHOSEXUAL THEORY:-

by SIGMUND FREUD in 1928. According to which thumb sucking habit evolves from an inherent psychosexual drive where child derives pleasure during thumb sucking.

2. ORAL DRIVE THEORY:- Formulated by SEARS AND WISE 1982. According to this theory prolongation of

nursing strengthen the oral drive & child begins thumb sucking.

INTRA ORAL: Maxillary anterior

proclination Mandibular anterior

retroclination Anterior open bite Constricted intercanine

area‐70% Constriction of maxillary

arch Posterior cross bite

EXTRA ORAL: • Fungal infection on

thumb • Thumb nail exhibit dish

pan appearance. • Upper Lip: short,

hypotonic• Jaw: maxillary protrusion,

mandibular retrusion• Palate: high vault• Nasal floor : narrow• Profile: straight

CLINICAL FEATURES

MANAGEMENT Starts 4 to 6 years 4 different approaches1. Counselling2. Reminder therapy3. Reward system4. Adjunctive therapy

1. COUNSELLING • Explain about habits ill effects• Show photographs, video• Dunlop hypothesis• Discuss with parents

2. REMINDER THERAPY “Wants to stop but needs help”

- Adhesive waterproof bandage- Sock to cover fingers- Paint bitter substances- Acrylic guard or guaze- Removable or fixed appliances

REMOVABLE APPLIANCES :passive appliances which are retained in the oral cavity by means of clasp & usually have of the following additional components:-

1. Tongue spikes 2.Tongue Guard 3. Spur/rake

FIXED APPLIANCES :

1. Quad helix 2. Hay rakes

Habit crib applianceQuad helix

3. Maxillary lingual arch with palatal crib

3. ADJUNCTIVE THERAPY

Wrapping the patient’s arm with elastic bandage Intra oral Palatal crib: Patient without crossbite Retainer 6‐12 months

TONGUE THRUSTING

According to Norton and Gellin "a condition in which the tongue protrudes between the anterior or posterior teeth during swallowing with or without affecting tooth position .”

DEFINITION:

CLASSIFICATION:

“According To MOYER”

A. Normal swallow: (a) Infantile swallow (b) Adult swallow

B. Simple tongue thrust

C. Complex tongue thrust

D. Retained infantile swallow

“According To BACKLUND”

1. Anterior tongue thrust2. Posterior tongue

thrust

Retained infantile swallow Upper respiratory tract infections Neurological disturbances Functional adaptability to transient change

in anatomy Feeding practices and tongue thrusting Induced due to other oral habits Hereditary Tongue size –ex: macroglossia

CLINICAL MANIFESTATIONS Lip‐ short flaccid upper lip Mandibular movements‐ no correlation

between tongue tip and mandible Speech‐ s,n,t,d,l,z, v,th Facial form‐ Increased in anterior facial

height

ETIOLOGY

CLINICAL FEATURESOpen Bite (Anterior and Posterior)Proclination of upper anterior teethProtrusion of anterior segment of both arches with spaces between incisors & caninesNarrow & constricted maxillary arch: Posterior cross bite

DIAGNOSIS: History Examination water test checking contractions of the muscle: Temporalis muscle lower lip

TREATMENT CONSIDERATIONS: Age Presence/absence of associated

manifestations Malocclusion Speech defects Associated with other habits

TREATMENT: Training of correct swallow and posture of

tongue Speech therapy Mechanotherapy Correction of malocclusion Surgical treatment

TRAINING OF CORRECT SWALLOW AND POSTURE OF TONGUE

MYOFUNCTIONAL EXERCISES 40times per day in 2‐3sessions sugarless fruit drop –twice daily 4s exercise other exercises Using appliances as a guide in the correct

positioning of tongue Pre orthodontic Trainer Nance palatal Arch Appliance

SPEECH THERAPY Not before 8 years

MECHANOTHERAPY Removable Appliance Therapy Fixed Habit Breaking Appliance Oral screen

MOUTH BREATHING DEFINITION:

Sassouni (1971) defined Mouth breathing as habitual respiration through the mouth instead of the nose.

CLASSIFICATION: “Given by Finn 1987”

(1) Anatomic : Mouth breather is one whose short upper lip does not permit complete closure without undue effort

(2) Habitual : Persistence of habit even after the elimination of obstructive cause

(3) Obstructive : Increased resistance to complete obstruction of normal airflow to nasal passage

ETIOLOGY: Developmental Anomalies like abnormal

development of nasal cavities . Partial obstruction in deviated nasal

septum and Localized benign tumor. Infection inflammation of nasal mucosa as:- Chronic allergic, chronic atrophic Rhinitis,

Enlarged adenoid tonsils. Traumatic injures of nasal cavity Genetic Pattern

CLINICAL FEATURES: Facial appearance : Adenoid facies. Long narrow face, narrow nose and nasal

passage. Short upper lip. Nose tipped superiorly Expressionless face. DENTAL EFFECT (INTRA ORAL) Protrusion of maxillary incisors Palatal vault is high. Increase incidence of caries. Chronic marginal gingivitis.

DIAGNOSIS : History

Examination CLINICAL TESTS Mirror test Butterfly test Water Holding test inductive plethysmography. Cephalometrics

EXAMINATION:(i) Observe the patient unknowingly while at rest

In a nasal breather – lip touch lightly In mouth breather – Lip are kept apart.

(ii) Patient asked to take deep breath Nasal breather keep the lip tightly closed Mouth breather take deep breath keeping mouth open.

CLINICAL TEST:

Mirror test: Double side mirror is held b/w the nose and

mouth fogging on the nasal side of mirror indicate nasal breathing while fogging toward the oral side indicate oral breathing.

Water test: The patient is asked to fill the mouth with

water,and hold it for a period of time. While nasal breather accomplish with ease, mouth breather find the task difficult.

Cotton test: A butterfly shaped piece of cotton is placed

over the upper lip below the nostril. If cotton flutters down it indicate nasal breathing.

MANAGEMENT: 1) SYMPTOMATIC TREATMENT: The gingiva of the mouth breathers should be

restored to normal health by coating the gingiva with petroleum jelly.

2) ELIMINATION OF THE CAUSE:If nasal or pharyngeal obstruction has been diagnosed then removal of the cause is done by surgery .

3) INTERCEPTION OF THE HABIT : a) Physical Exercise b) Lip Exercise 4) ORAL SCREEN: An effective device during sleeping hours, is a

thin rubber membrane either cut or cast to fit over the labial and buccal surfaces of the teeth and gums included in the vestibule of the mouth. During initial phase, windows are placed on the oral screen so as not to completely block the airway passage. 5)CORRECTION OF

MALOCCLUSION 1) Children with class I skeletal and occlusion and anterior spacing- oral shield appliance. 2)class II division without crowding,age5-9 years-Monobloc activator. 3)classIII malocclusion-interceptive methods are reccommended as a chin cap.

BRUXISMDEFINITION:Ramfjord 1966Bruxism is habitual griding of teeth when the individual is not chewing or swallowing.

CLASSIFICATION:1. Day Time Bruxism/Diurnal Bruxism2. Night Time Bruxism/Nocturnal Bruxism

OCCURRENCE:May commence in infancy with the eruption of the first primary tooth.Common occurrence is during sleepIncidence of bruxismin children varies widely from 7% to 88%.

ETIOLOGY:

(1) CNS: This CNS phenomena was found in children with cerebral palsy & mental retardation.

(2) Psychological: A tendency of grind teeth associated with feeling of hunger and aggression, hate,anxiety etc.

(3) Occlusal discrepancy : Improper interdigitation of teeth lead to bruxism.

(4) Systemic factor : Mg++ deficiency may lead to bruxism.

(5) Genetic. (6) Occupation: Overenthusiastic student or

competitive sports lead to clenching .

.

CLINICAL FEATURES :(1) Occlusal trauma(2) Pain in TMJ(3) Trauma to periodontium. (4) Masticatory muscle soreness. (5) Headache. MANAGEMENT:- (6) ADJUNCTIVE THERAPY:-

Psychotherapy- Aim to lower the emotional disturbances.

Relining exercise - Serve to decrease muscle function

Elimination of oral pain & discomfort by giving ethyl chloride within the tempromandibular joint area

Auto suggestion and Hypnosis: Wherethe patient becomes conscious of his habit and understands the possible consequence

(2) OCCLUSAL THERAPY:

Occlusal adjustments:Biteraising crowns,splintsand elimination of occlusal interference

Bite plates and splints

Occlusal reconstruction and prosthesis

Bite guard: Preventscontinual abrasion of teeth

LIP HABITS

DEFINITION:Habit involve manipulation of lips and perioral structure are termed as lip habits.

ETIOLOGY :•Malocclusion •Habit•Emotional Stress

CLASSIFICATION:- Wetting the Lip with the tongue. Pulling the lip into mouth between the

teeth.

CLINICAL FEATURES: Protrusion of upper anteriors & retrusion of lower anteriors. Lip trap Muscular imbalance Lower incisor collapse with lingual crowding Mentolabial sulcus become accentutated.

TREATMENT: Lip Protector Lip bumper –it is used as a adjustive

therapy in both comprehensive and interceptive treatment . It is positioned in mandibular vestibule and serve to prohibit the lip from exerting excessive force on mandibular incisor and reposition the lip away from lingual aspect of maxillary incisors.

Visual education

NAIL BITING HABITS It is most common habit in children It is sign of internal tension

ETIOLOGY: Persistence nail bitting may be indicative of

emotional problem. Psychosomatic Successor of thumb sucking.

CLINICAL FEATURES: Crowding Rotation. Alteration of incisal edge of incisor Inflammation of nail bed.

MANAGEMENT: Patient is made aware of problem. Treat the basic emotional factor

causing the act. Encouraging outdoor activity which

may help in easing tension. Application of nail polish, light cotton

mittens as reminder.

CONCLUSION:The identification and assessment of an abnormal habits and its immediate and long term effect on the craniofacial complex and dentition should be made as early as possible to minimize the potential deleterious effect on dentofacial Complex.