HABITS

1. HABITS Presented by, G.Raj subakar CRRI

2. INTRODUCTION Oral habits are habits that frequently children aquire that may either temporarily or permanently be harmful to dental occlusion and to the supporting structures. When habit cause defect in orofacial structure it is termed as pernicious oral habit.

3. DEFINITION Habit may be defined as the tendency towards, an act that has become a repeated performance, relatively fixed, consistent and easy to perform by an individual.

4. CLASSIFICATION

5. Grabers (Based on etiology ) Thumb sucking Tongue thrusting Mouth breathing Lip bitting Bruxism Speech defects Nail biting Postural habits Defective occlusal habits

6. EARNEST KLEIN(1971) Intentional habits: it functions as an important psychological problem for the child. E.g.: thumb sucking Un-intentional habit : these are cased by a definite underlying psychological disturbance e.g : mouth breathing

7. WILLIAM JAMES(1923) Useful habits : These includes habits that are considered essential for normal function such as proper position of the tongue,respiration and normal deglutition . Harmful habits: Includes all habits which exerts pressure/stresses on dentofacial structures such as thumb sucking,tongue thrusting,lip bitting etc.

8. KINGSLEY(1958) Functional oral habit eg : mouth breathing Muscular habits eg : lip and cheek biting Combined e g : thumb sucking. Postural habits

9. MORRIS & BOHNNA(1969) Pressure habits eg:thumb sucking, tongue thrusting Non-pressure habits eg:mouth breathing Biting habits eg:nail biting,pencil biting and lip biting

10. FINN & SIM(1987) Compulsive habits Non-compulsive Primary habits Secondary habits

11. SUCKING HABITS Sucking habits can be classified into Nutritive – Nutritive sucking habits will provide essential nutrient to the infant.E.g . breast feeding and bottle feeding Non-nutritive – It is the habit adopted by infant in response to frustration and to satisfy their urge and need for contact. E.g. thumb sucking, finger sucking

12. DEFINITION: It is defined as the placement of thumb or one or more fingers in varying depth into the mouth . CLASSIFICATION : Normal thumb sucking:thumb sucking is normal during first and second year of age. Abnormal thumb sucking :when the habit presists beyond preschool period Psychological -habits having deep rooted emotional factor eg:neglect or loneliness Habitual THUMB SUCKING

13. . Can also be classified by as : 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.

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

15. 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.

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

17. EFFECTS OF THUMB SUCKING SKELETAL High narrow arched palate Prognathic maxilla Retrognathic mandible Open bite tendency DENTAL Proclined upper incisors Retroclined lower incisors Increased overjet Anterior open bite Posterior crossbites

18. SOFT TISSUE Incompetent lips Hypotonic upper lip Hypertonic lower lip Hperactive mentalis muscle OTHER EFFECTS Affects psychological health Deformation of digit Speech defects

19. Diagnosis The frequency and duration of the habit, presence of clean nail and callus on finger should be noted. child's emotional status enquired by asking, - feeding habits - parental care of the child - working parents

20. MANAGEMENT Palatal Crib THUMB CAP

21. PSYCHOLOGICAL THERAPY Screening of patients for underlying psychological disturbances . Once determined—sent to psychologist for counseling. Thumb sucking between 4-8 years, needs only reassurance, positive reinforcement, awareness can be achieved by emphasizing positive aspects of habit cessation. Children and parents are informed about existing dento facial deformities and long term risk of the habit.

22. REMINDER THERAPY Extraoral approaches It employs hot tasting, bitter flavoured preparation or distasteful agents that are applied to finger and thumbs. For example,pepper , asfoetida . Thermoplastic thumb post. Intraoral approaches Various orthodontic appliances are employed to attenuate and eventually break the habit

23. MECHANOTHERAPY Removable appliances palatal crib, rakes, Hawley’s retainer with or without spurs Fixed appliances Blue grass appliance Quad helix Prevents the thumb from being inserted &also corrects the malocclusion by expanding the arch

24. TONGUE THRUSTING DEFINITION: Tongue thrust is defined as a condition in which the tongue makes contact with any teeth anterior to the molars during swallowing

25. CLASSIFICATION Physiologic Normal tongue thrust swallow of infancy Habitual Tongue thrust present as a habit even after correction of the malocclusion Functional When tongue thrust is an adaptive behavior Developed to achieve an oral seal Anatomic Person having an enlarged tongue

26. Simple tongue thrust Anterior open bite Normal tooth contact posteriorly Contraction of lips, mentalis Complex tongue thrust Generalised open bite Absence of contraction of lips, mentalis Lateral tongue thrust Posterior open bite with tongue thrusting laterally

27. ETIOLOGY Retained infantile swallow Upper respiratory tract infection Neurological disturbance Functional adaptability to transient change in anatomy Induced due to other oral habits Tongue size Hereditary Feeding practices

28. CLINICAL FEATURES Proclination of anterior teeth Anterior open bite Bimaxillary protrusion Posterior open bite in case of lateral tongue thrust Posterior crossbite

29. MANAGEMENT Habit interception: Using habit breaker eg:Both fixed and removable cribs or rakes can be used Child is taught of correct method of swallowing Various muscle exercise Treatment of malocclusion: Once the habit is intercepted the malocclusion can be treated by using removable and fixed orthodontic appliances

30. MANAGEMENT Oral Screen

31. MOUTH BREATHING Definition:- Mouth breathing as habitual respiration through the mouth instead of the nose. Usually seen in people with nasal obstruction May also occur as a habit

32. CLASSIFICATION Anatomic Mouth breather is one whose short upper lip does not permit complete closure without undue effort Habitual Persistence of habit even after the elimination of obstructive cause Obstructive Increased resistance to complete obstruction of normal airflow to nasal passage

33. ETIOLOGY Complete or partial obstruction of nasal passage can result in mouth breathing. Some of the causes for obstruction are: Deviated nasal septum Nasal polyps Chronic inflammation of nasal mucosa Localized benign tumors Congenital enlargement of nasal turbinate Allergic reaction of nasal mucosa Obstructive adenoids

34. EFFECTS Forward placement of upper front teeth Gap between upper & lower front teeth Improperly placed teeth

35. TREATMENT Treatment of mouth breathing includes: Elimination of the cause Interruption of the habit Correction of malocclusion Symptomatic treatment USING ORAL SCREEN

36. Bruxism RAMFFORD[1966 ] BRUXISM IS THE HABITUAL GRINDING OF TEETH WHEN THE INDIVIDUAL IS NOT CHEWING OR SWALLOWING

37. ETIOLOGY Psychological and emotional stresses. Occlusal interference. Cortical lesion. Systemic factor: magnessium deficiency, chronic abdominal distress. Genetics: children of bruxism parents have an increased incidence of bruxism. Allergies: related to nocturnal bruxism. Occupational factors: compulsive overahievers and competitive sports lead to clenching.

38. EFFECTS Occlusal trauma:- occlusal surface is worn considerably with exposing dentin extreme sensitivity. Toothache, mobility. Pain in TMJ Trauma to periodontium . Masticatory muscle soreness. Headache.

39. TREATMENT 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. Counseling

40. 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.

41. Lip bitting HABITS THAT INVOLVE MANIPULATION OF THE LIPS AND PERIORAL STRUCTURES ARE TEERMED AS LIP HABITS

42. ETIOLOGY Malocclusion Deep bite malocclusion Large overjet &overbite child wants to produce normal lip seal during swallowing Habits Can occur in conjunction with thumb sucking Emotional stress

43. EFFECTS Protrusion of maxillary incisors & retrusion of mandibular incisors. Reddened irritated & chapped area below the vermillion border Mentolabial sulcus becomes accentuated Mouth ulcers

44. TREATMENT Correction of malocclusion Treating the primary habit Lip habit along with digit sucking can be corrected by hawley’s retainer with labial bow Appliance therapy Oral shield Lip bumper It is positioned in the vestibule of the mandibular arch &serve to prohibit the lip from exerting excessive force on the mandibular incisors

45. 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.

46. Reference Textbook of orthodontics : S.GOWRI SANKAR Orthodontics THE ART and SCIENCE: S.I BHALAJHI http://www.slideshare.net/indiandentalacademy/oral-habits-31764065 http:// www.slideshare.net/search/slideshow?searchfrom=header&q=oral+habits