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Oral HabitsMaulee ShethBalraj Shukla

HabitTendency towards an act that has become a repeated performance, relatively fixed, consistent and easy to perform by an individual.

Classification

Various HabitsThumb suckingTongue thrustingMouth breathingBruxismNail biting Lip biting

Thumb and Digit Sucking :Is defined as placement of the thumb or one or more fingers in varying depths into the mouth.The presence of the habit is considered quite normal till the age of 3 and half to 4 years.Persistence beyond this age can lead to various malocclusions.

EtiologyFreudian Theory Oral drive theory of Sears and WiseBenjamins theoryPsychological aspectsLearned pattern

Phases of development

Effects of thumb suckingLabial tipping of the maxillary anterior teeth resulting in proclination of maxillary anteriors.The overjet increases due to proclination of the maxillary anteriors.Anterior open bite can occur as a restriction of incisor eruption and supraeruption of the buccal teeth.The cheek muscles contract during thumb sucking causing Narrow maxillary arch resulting in posterior crossbite.The child may develop tongue thrust habit as a result of the open bite.The upper lip is generally hypotonic while the lower part of the face exhibits hyperactive mentalis activity.

DiagnosisShould be questioned on the frequency and duration of the habit.Childs emotional status should be assessed Presence of clean nails and callus on the fingerIntra oral examination.

Management Psychological approach : Parents should be counseled to provide the child with adequate love and affection. parents and dentist should seek to motivate the child.

Dunlops beta hypothesis : The best way to break the habit is by its conscious, purposeful repetition.

Mechanical aidsReminding appliances that assist the child who is willing to quit the habit but is not able to do so as the habit has entered a subconscious level. Two types :

Chemical Approach

TONGUE THRUSTING HABIT

It is defined as a condition in which the tongue makes contact with any teeth anterior to the molars during swallowing.

Etiology

CLINICAL FEATURES : Extra oral

Lip Posture :- Lip separation is more both at rest & in function Mandibular movement :- Path of mandible movement is upward & backward with tongue movement forward.Speech : Lip sync problem in articulation of s/n/t/d/ l/th/z/v/ sounds.(a) Facial form :- increase anterior facial height

IntraoralTongue posture:- Tongue tip at rest is lower because of anterior open bite present Tongue movement :- Movement is irregular from one swallow to another.Malocclusion:- In maxilla -Proclination of maxillary anterior . An increase over jetMaxillary constrictionGeneralized spacing between teeth.

In Mandible - Retroclination of mandible

Diagnosis :- History :- Determine swallow pattern of siblings & parents to check for hereditary etiologic factor. Information regarding upper respiratory infection, sucking habits Finally past & present information regarding the over all abilities , interest ,motivation of patient should be noted .

Examination :-Patient seated upright :- A little water is placed in patient mouth & patient is asked to swallow it.

During normal swallowing pattern :-Lip touch each other tightly Mandible rise as teeth are brought together Facial muscle do not show any marked contraction.

During abnormal swallowing:- Teeth are apart.Lip do not touch each other.Facial muscles show marked contraction. The lower lip is lightly held with thumb and finger and patient asked to swallow the water .

MANAGEMENTPatient is instructed to put the tip of tongue at correct positions and swallow with Lip pursed and teeth in occlusion.Training to correct swallow and posture of tongue.Flat sugarless fruit drop can be placed on back of the tongue & it is held against the palate in the correct position until it is completely dissolve twice a day.When patient learn normal tongue position this has to be reinforced and made into on unconscious act.Appliance therapy is initiated for child above 9year appliances used can be either fixed with band palatal rake or removable with adams clasp.

AppliancesNance Palatal Arch Appliance in this acrylic button can be used as to guide the tongue in right position.Removable appliance therapy A variety of modifications of Hawleys appliance is used to treat it.Fixed Habit breaking Appliance Crowns and bands are given on the first permanent molar .

Nance palatal Appliance

Cribs

MOUTH BREATHING HABITDefinition:-Sassouni (1971)Mouth breathing as habitual respiration through the mouth instead of the nose.Etiology:-It is estimated that 85% mouth breather suffer from some degree of nasal obstructionDevelopmental 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 4. Traumatic injures of nasal cavity 5. Genetic Pattern

Clinical Features:-

Facial appearance of child with mouth breathing habit is termed as Adenoid facies.Long narrow face, narrow nose and nasal passage. Short upper lip.Nose tipped superiorly Expressionless face. Dental effect (intra oral)Protusion of maxillary incisors Palatal vault is high. Increase incidence of caries. Chronic marginal gingivitis.

Diagnosis :-

History:- The parents can be questioned whether the child adopts frequent lip apart posture. Frequently occurrences of tonsillitis, allergic rhinitis.

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 The most effective way to reestablish nasal breathing is to prevent air entering the oral cavity to do this lip or oral cavity must be closed.

Examination

Observe the patient unknowingly while at rest In a nasal breather lip touch lightly In mouth breather Lip are kept apart.

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.

BRUXISMDefinition:Given by Ramford 1966

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

EtiologyCNS:- This CNS phenomena was found in children with cerebral palsy & mental retardation. Psychological:-A tendency of grind teeth associated with feeling of hunger and aggression, hate,anxiety etc.Occlusal discrepancy Improper interdigitation of teeth lead to bruxism. Systemic factor:- Mg++ deficiency may lead to bruxism. GeneticOccupation:- Overenthusiastic student or competitive sports lead to clenching .

Clinical features:- Occlusal trauma:- occlusal surface is worn considerably with exposing dentin extreme sensitivity. Toothache, mobility. Pain in TMJTrauma to periodontium. Masticatory muscle soreness. Headache.

Management

Adjunctive theory:-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 tempro-mandibular joint area

Occlusal therapy :- (a) Occlusal adjustment Splints-Volcanite splints have been recommended to cover the occlusal surfaces of all teeth.A reduction in increased muscle tone is observed with its use.Night guards.Restorative treatment.(b)Drug vapo coolant such as ethyl chloride for pain in TMJ area, local anesthesia injection directly in TMJ and muscle tranquilizer and sedative are used.

LIP HABITSDefinition Habit involve manipulation of lips and perioral structure are termed as lip habits.

Etiology Malocclusion HabitEmotional StressLip biting

ClassificationWetting the Lip with the tongue.Pulling the lip into mouth between the teeth.

Clinical featuresProtrusion of upper anteriors & retrusion of lower anteriors.Lip trapMuscular imbalanceLower incisor collapse with lingual crowdingMentolabial sulcus become accentutated.

TreatmentLip ProtectorLip 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 BITINGIt is most common habit in children It is sign of internal tension

Etiology :-Persistence nail bitting may be indicative of emotional problem.PsychosomaticSuccessor of thumb sucking.

Clinical features:-CrowdingRotation.Alteration of incisal edge of incisorInflammation of nail bed.

ManagementPatient 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.

ConclusionThe identification and assessment of an abnormal habit 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.

ConclusionThe identification and assessment of an abnormal habit 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.

References :Orthodontics, The Art and Science ,6th Edition by S.I. BhalajhiPediatric Dentistry, 3rd Edition by Nikhil Marwah

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