oral habits
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ORAL ORAL HABITSHABITS
Dr shabeel pn Dr shabeel pn
INTRODUCTIONINTRODUCTION
THEY ARE REPEATED PERFORMANCETHEY ARE REPEATED PERFORMANCE THEY CAN BETHEY CAN BE
- - PART OF NORMAL DEVELOPMENTPART OF NORMAL DEVELOPMENT
- SYMPTOM WITH DEEP ROOTED - SYMPTOM WITH DEEP ROOTED PSYCHOLOGIC PSYCHOLOGIC
BASISBASIS
- ABNORMAL FACIAL GROWTH- ABNORMAL FACIAL GROWTH
DEFINITIONSDEFINITIONS
DORLAND(1957):DORLAND(1957): FIXED OR CONSTANT PRACTICE FIXED OR CONSTANT PRACTICE ESTABLISHED BY FREQUENT REPETITIONESTABLISHED BY FREQUENT REPETITION
BUTTERSWORTH(1961): BUTTERSWORTH(1961): A FREQUENT OR A FREQUENT OR CONSTANT PRACTICE OR ACQUIRED TENDENCY, CONSTANT PRACTICE OR ACQUIRED TENDENCY, WHICH HAS BEEN FIXED BY FREQUENT REPETITIONWHICH HAS BEEN FIXED BY FREQUENT REPETITION
MATHEWSON(1982): MATHEWSON(1982): ORAL HABITS ARE ORAL HABITS ARE LEARNED PATTERNS OF MUSCULAR CONTRACTIONSLEARNED PATTERNS OF MUSCULAR CONTRACTIONS
VARIOUS HABITS AREVARIOUS HABITS ARE• Thumb sucking•Finger sucking•Tongue thrusting•Pacifier or dummy sucking•Lip biting•Nail biting •Cheek biting•Pencil or foreign object sucking•Lip sucking•Clenching•Mouth breathing•Bruxism•Occupational habits
CLASSIFICATIONSCLASSIFICATIONS
OBSESSIVEOBSESSIVE
(DEEP ROOTED)(DEEP ROOTED)
INTENTIONAL INTENTIONAL MASOCHISTICMASOCHISTIC
(MEANINGFUL) (SELF INFLICTING)(MEANINGFUL) (SELF INFLICTING)
NAIL BITING GINGIVAL STRIPPINGNAIL BITING GINGIVAL STRIPPING
DIGIT SUCKINGDIGIT SUCKING
LIP BITINGLIP BITING
NON OBSESSIVENON OBSESSIVE
(EASILY LEARNED & DROPPED)(EASILY LEARNED & DROPPED)
UNINTENTIONAL FUNCTIONAL UNINTENTIONAL FUNCTIONAL HABITSHABITS
ABNORMAL PILLOWING TONGUE THRUSTINGABNORMAL PILLOWING TONGUE THRUSTING
CHIN PROPPING BRUXISMCHIN PROPPING BRUXISM
JAMES (1923)JAMES (1923)
Useful habitsUseful habits:: – This includes habits of – This includes habits of normal functions such as correct tongue normal functions such as correct tongue position, proper respiration, deglutition, position, proper respiration, deglutition, and normal use of lips in speaking.and normal use of lips in speaking.
Harmful habitsHarmful habits: — this includes all the : — this includes all the habits that exert perverted stresses habits that exert perverted stresses against the teeth and dental arches as against the teeth and dental arches as well as those habits such as open mouth well as those habits such as open mouth habits, lip biting, lip sucking, thumb habits, lip biting, lip sucking, thumb sucking etc…sucking etc…
MORRIS & BOHANNA (1969)MORRIS & BOHANNA (1969)
Pressure habitsPressure habits— these include sucking — these include sucking habits such as thumb sucking, lip sucking, habits such as thumb sucking, lip sucking, finger sucking and also tongue thrusting.finger sucking and also tongue thrusting.
Non pressure habitsNon pressure habits— Habits which do — Habits which do not apply a direct force on the teeth or its not apply a direct force on the teeth or its supporting structures are termed as non supporting structures are termed as non pressure habitspressure habits
E.g.: mouth breathing.E.g.: mouth breathing. Biting habitsBiting habits- These includes habits such - These includes habits such
as nail biting, pencil biting and lip biting.as nail biting, pencil biting and lip biting.
KLEIN (1971)KLEIN (1971)
Empty habitsEmpty habits – they are habits that – they are habits that are not associated with any deep are not associated with any deep rooted psychological problemsrooted psychological problems
Meaningful habitsMeaningful habits—they are habits —they are habits
that have a psychological bearing.that have a psychological bearing.
FINN (1987)FINN (1987)
Compulsive habitsCompulsive habits- These are deep rooted - These are deep rooted habits that have acquired a fixation in the habits that have acquired a fixation in the child to the extent that the child retreats to child to the extent that the child retreats to the habits when ever his security is the habits when ever his security is threatened by events which occur around threatened by events which occur around him. The child tends to suffer increased him. The child tends to suffer increased anxiety when attempts are made to correct anxiety when attempts are made to correct the habits.the habits.
Non compulsive habitsNon compulsive habits– They are habits – They are habits which are easily learned and dropped as the which are easily learned and dropped as the child matures.child matures.
PRIMARY HABITSPRIMARY HABITS
SECONDARY HABITSSECONDARY HABITS
KINGSLEY (1958)KINGSLEY (1958)
FUNCTIONAL ORAL HABITSFUNCTIONAL ORAL HABITS
MUSCULAR HABITSMUSCULAR HABITS
COMBINED ONESCOMBINED ONES
THUMB SUCKINGTHUMB SUCKING
PLACEMENT OF THE THUMB INTO PLACEMENT OF THE THUMB INTO VARIOUS DEPTHS INTO THE MOUTHVARIOUS DEPTHS INTO THE MOUTH
THUMB SUCKING + FINGER SUCKING THUMB SUCKING + FINGER SUCKING
= DIGIT SUCKING= DIGIT SUCKINGone of the commonly seen habits. one of the commonly seen habits.
Thumb sucking is observed in the Thumb sucking is observed in the intrauterine life.intrauterine life.
SUCKING – 1SUCKING – 1STST CO—ORDINATED MUSCULAR CO—ORDINATED MUSCULAR ACTIVITY OF THE INFANT ACTIVITY OF THE INFANT
CLASSIFICATIONSCLASSIFICATIONS
NORMAL T S:NORMAL T S: - 1- 1STST & 2 & 2NDND YEAR OF LIFE YEAR OF LIFE
- DON’T GENERATE ANY MALOCCLUSION- DON’T GENERATE ANY MALOCCLUSION
ABNORMAL T S:ABNORMAL T S: a. psychological:a. psychological:
- Deep-rooted emotional factor- Deep-rooted emotional factor
- insecurities, neglect or loneliness- insecurities, neglect or loneliness
b. habitual:b. habitual:
- performs due to habit- performs due to habit
- can cause malocclusion- can cause malocclusion
O’ BRIEN (1996)O’ BRIEN (1996)
NUTRITIVE SUCKING HABITS:NUTRITIVE SUCKING HABITS: - - BREAST/BOTTLE FEEDINGBREAST/BOTTLE FEEDING
NON-NUTRITIVE SUCKING HABITS NON-NUTRITIVE SUCKING HABITS ((NNS HABITSNNS HABITS))
- THUMB , FINGER OR PACIFIER SUCKING- THUMB , FINGER OR PACIFIER SUCKING
SUBTELNY (1973)SUBTELNY (1973)TYPE A: 50%TYPE A: 50% - WHOLE DIGIT INSIDE, PAD OVER PALATE- WHOLE DIGIT INSIDE, PAD OVER PALATE
& CONTACT WITH MAX & MAND ANTERIORS& CONTACT WITH MAX & MAND ANTERIORS
TYPE B: 13 – 24%TYPE B: 13 – 24% - - WITHOUT TOUCHING VAULT & MAINTAIN CONTACTWITHOUT TOUCHING VAULT & MAINTAIN CONTACT
TYPE C: 18%TYPE C: 18% - JUST BEYOND 1- JUST BEYOND 1STST JOINT & CNTCT ONLY WITH MAX JOINT & CNTCT ONLY WITH MAX
ANTANT
TYPE D: 6%TYPE D: 6% - VERY LITTLE PORTION OF THUMB- VERY LITTLE PORTION OF THUMB
ETIOLOGYETIOLOGY
VARIOUS THEORIESVARIOUS THEORIESCAUSATING FACTORSCAUSATING FACTORS
CLASSICAL FREUDIAN THEORY CLASSICAL FREUDIAN THEORY (1905)(1905)
INHERENT PSYCHOSEXUAL URGEINHERENT PSYCHOSEXUAL URGEEROGENOUS ZONEEROGENOUS ZONEHUNGER, SATIETY & SECURITYHUNGER, SATIETY & SECURITY
LEARNING THEORYLEARNING THEORY
DAVIDSON 1967DAVIDSON 1967 TS FRM AN ADAPTIVE RESPONSETS FRM AN ADAPTIVE RESPONSE
ORAL DRIVE THEORYORAL DRIVE THEORY
SEARS & WISE 1982SEARS & WISE 1982T S IS A RESULT OF PROLONGATION T S IS A RESULT OF PROLONGATION
OF NURSING, & NOT THE OF NURSING, & NOT THE FRUSTRATION OF WEANINGFRUSTRATION OF WEANING
SUCKING INCREASES THE SUCKING INCREASES THE EROTOGENESIS OF MOUTHEROTOGENESIS OF MOUTH
BENJAMIN’S THEORYBENJAMIN’S THEORY
T S ARISES FRM THE ROOTING OR T S ARISES FRM THE ROOTING OR PLACING RELEX SEEN IN MAMMALIAN PLACING RELEX SEEN IN MAMMALIAN INFANTSINFANTS
MOVEMENT OF THE INFANT’S HEAD & MOVEMENT OF THE INFANT’S HEAD & TONGUE TOWARDS AN OBJECT TONGUE TOWARDS AN OBJECT TOUCHING HIS CHEEKTOUCHING HIS CHEEK
JOHNSON & LARSON 1993JOHNSON & LARSON 1993
COMBN OF PSYCHOANALYTC & COMBN OF PSYCHOANALYTC & LEARNING THEORIES WHICH EXPLAINS LEARNING THEORIES WHICH EXPLAINS THAT ALL CHILDREN HAVE INHERENT THAT ALL CHILDREN HAVE INHERENT BIOLOGIC DRIVE FOR SUCKING. BIOLOGIC DRIVE FOR SUCKING. ROOTING & PLACING REFLEXES ARE ROOTING & PLACING REFLEXES ARE MERELY A MEANS OF EXPRESSION OF MERELY A MEANS OF EXPRESSION OF THIS DRIVE. ENVIRONMENTAL FACTORS THIS DRIVE. ENVIRONMENTAL FACTORS ALSO MAY CONTRIBUTE TO THIS DRIVE ALSO MAY CONTRIBUTE TO THIS DRIVE TO NON NUTRITIVE SOURCES…..TO NON NUTRITIVE SOURCES…..
CAUSATIVE FACTORSCAUSATIVE FACTORS
PARENT’S OCCUPN: PARENT’S OCCUPN: SOCIOECONOMIC STATUS SOCIOECONOMIC STATUS – SUCKLES INTENSIVELY – EXHAUSTED– SUCKLES INTENSIVELY – EXHAUSTED
- RECHANNELING THE SURPLUS URGE- RECHANNELING THE SURPLUS URGEWORKING MOTHER:WORKING MOTHER: CARETAKER - INSECURITY CARETAKER - INSECURITYNUMBER OF SIBLINGS: NUMBER OF SIBLINGS: ATTENTION DIVIDEDATTENTION DIVIDEDORDER OF BIRTH:ORDER OF BIRTH: LATER THE SIBLING RANK, LATER THE SIBLING RANK,
GREATER D CHANCE – IMITATION IN SUCKLINGGREATER D CHANCE – IMITATION IN SUCKLINGSOCIAL ADJUSTMENT & STRESS: SOCIAL ADJUSTMENT & STRESS: INABILITY INABILITY
TO ADJ – SCOLDING PARENTSTO ADJ – SCOLDING PARENTSFEEDING PRACTICES:FEEDING PRACTICES: MORE IN BREAST FED MORE IN BREAST FED
CHILDREN – ABRUPT WEANINGCHILDREN – ABRUPT WEANING
AGE OF THE CHILD:AGE OF THE CHILD: NEONATES: PREMITIVE DEMANDS LIKE HUNGERNEONATES: PREMITIVE DEMANDS LIKE HUNGER
IISTST FEW WEEKS: FEEDING PROBLMS FEW WEEKS: FEEDING PROBLMS
ERUPTION OF 1ERUPTION OF 10 0 MOLAR: TEETHING DEVICEMOLAR: TEETHING DEVICE
LATER: RELEASE TENSIONLATER: RELEASE TENSION
PHASES OF DEVELOPMENTPHASES OF DEVELOPMENT
PHASE I (NORMAL & SUBCLINICAL): PHASE I (NORMAL & SUBCLINICAL): 11STST 3 YRS OF LIFE 3 YRS OF LIFE
PHASE II (CLINICALLY SIGNIFICANT): PHASE II (CLINICALLY SIGNIFICANT): EXTNDS B/W 3 – 6 EXTNDS B/W 3 – 6 ½ ½ - GREAT ANXIETY - - GREAT ANXIETY -
PHASE III (INTRACTABLE SUCKING): PHASE III (INTRACTABLE SUCKING): BEYOND 4BEYOND 4THTH – 5 – 5THTH YR – CONSULT YR – CONSULT PSYCHOLOGISTPSYCHOLOGIST
CLINICAL FEATURESCLINICAL FEATURES
DEPENDS ON: DEPENDS ON: POSITION OF THE DIGITPOSITION OF THE DIGIT ASSOCIATED OROFACIAL MUSCLE ASSOCIATED OROFACIAL MUSCLE
CONTRACTIONCONTRACTION POSITION OF MAND DURING SUCKINGPOSITION OF MAND DURING SUCKING FACIAL SKELETAL PATTERNFACIAL SKELETAL PATTERN INTENSITY, FREQ & DURN OF FORCEINTENSITY, FREQ & DURN OF FORCE
MAX ANT PROCLINATION & MAND MAX ANT PROCLINATION & MAND RETRORETRO
ANTERIOR OPEN BITEANTERIOR OPEN BITE --INTERFERENCE WITH NORMAL ERUPTIONINTERFERENCE WITH NORMAL ERUPTION
-EXCESSIVE ERUPTION OF POSTERIORS-EXCESSIVE ERUPTION OF POSTERIORS
CONSTRITION OF MAXILLARY ARCHCONSTRITION OF MAXILLARY ARCHPOSTERIOR CROSS BITEPOSTERIOR CROSS BITE
DIAGNOSISDIAGNOSIS
HISTORY: HISTORY: DETERMINE THE PSYCHOLOGICAL DETERMINE THE PSYCHOLOGICAL COMPONENTCOMPONENT
EXTRAORAL: EXTRAORAL: KEY AREASKEY AREAS DIGITSDIGITS – REDDENED , EXCEPTIONALLY CLEAN, – REDDENED , EXCEPTIONALLY CLEAN,
CHAPPED & WT A SHORT FINGERNAIL – CHAPPED & WT A SHORT FINGERNAIL – DISHPAN THUMB – CALLUS – DEFORMATION DISHPAN THUMB – CALLUS – DEFORMATION OF FINGEROF FINGER
LIPSLIPS – UPPER SHORT & HYPOTONIC, LOWER IS – UPPER SHORT & HYPOTONIC, LOWER IS HYPERACTIVE & LEADS TO FURTHER HYPERACTIVE & LEADS TO FURTHER PROCLINATION OF UPPER ANTERIORSPROCLINATION OF UPPER ANTERIORS
FACIAL FORMFACIAL FORM – MAND RETRUSION, MAX – MAND RETRUSION, MAX PROTRUSION, HIGH MANDIBULAR PLANE PROTRUSION, HIGH MANDIBULAR PLANE ANGLEANGLE
INTRA ORAL:INTRA ORAL: TONGUE –TONGUE – SIZE & POSITION AT REST , SIZE & POSITION AT REST ,
TONGUE ACTION DURING SWALLOWINGTONGUE ACTION DURING SWALLOWING
DENTO ALVEOLAR STRUCTURESDENTO ALVEOLAR STRUCTURES
GINGIVA – GINGIVA – EVIDENCE OF MOUTH BREATHING??? GUMLINE ETCHING, DECAYED OR EXCESSIVE STAINING ??
PREVENTIONPREVENTION
MOTIVE BASED APPROACHMOTIVE BASED APPROACHCHILD’S ENGAGEMENT IN VARIOUS CHILD’S ENGAGEMENT IN VARIOUS
ACTIVITIESACTIVITIESPARENT’S INVOLVEMENTPARENT’S INVOLVEMENTDURATION OF BREAST FEEDINGDURATION OF BREAST FEEDINGPHYSIOLOGIC NIPPLEPHYSIOLOGIC NIPPLEUSE OF DUMMY OR PACIFIERUSE OF DUMMY OR PACIFIER
TREATMENTTREATMENT
PSYCHOLOGICAL THERAPYPSYCHOLOGICAL THERAPY
REMINDER THERAPYREMINDER THERAPY
MECHANOTHERAPYMECHANOTHERAPY
PSYCHOLOGICAL THERAPYPSYCHOLOGICAL THERAPY
PROFESSIONAL COUNSELLINGPROFESSIONAL COUNSELLINGB/W 4-8 – REASSURANCE, +VE B/W 4-8 – REASSURANCE, +VE
REINFORCEMENT & FRIENDLY REINFORCEMENT & FRIENDLY REMINDERSREMINDERS
AWARENESS OF DENTOFACIAL AWARENESS OF DENTOFACIAL ANOMALIESANOMALIES
SUPPORT FRM PARENTS DURING SUPPORT FRM PARENTS DURING TREATMENTTREATMENT
DESTRUCTIVE APPROACHES FROM DESTRUCTIVE APPROACHES FROM PARENTSPARENTS
AIM IS TO GAIN CONFIDENCEAIM IS TO GAIN CONFIDENCE+VE BEHAVIOUR MODIFICATION & +VE BEHAVIOUR MODIFICATION &
HYPNOSIS IS EFFECTIVEHYPNOSIS IS EFFECTIVEDUNLOP’S DUNLOP’S BETA HYPOTHESISBETA HYPOTHESIS
REMINDER THERAPYREMINDER THERAPY
EXTRA ORAL APPROACHES: EXTRA ORAL APPROACHES: QUININE, QUININE, ASAFOETIDA (HABIT NOT FIRMLY ASAFOETIDA (HABIT NOT FIRMLY ENTRENCHED)ENTRENCHED)
INTRA ORAL APPROACHES: INTRA ORAL APPROACHES: ORTHODONTIC APPLIANCES TO ATTENUATE ORTHODONTIC APPLIANCES TO ATTENUATE AND EVENTUALLY BREAK THE HABITAND EVENTUALLY BREAK THE HABIT
MECHANOTHERAPYMECHANOTHERAPY
FIXED INTRA ORAL ANTI THUMB FIXED INTRA ORAL ANTI THUMB SUCKI NG APPLIANCESUCKI NG APPLIANCE
BLUE GRASS APPLIANCEBLUE GRASS APPLIANCEQUAD HELIXQUAD HELIX
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