oral habits final year dentistry orthodontics.pdf

Oral habits topic from Orthodontics, final yr bds.

2. Contents
●Definition
●Classifications
●Thumb sucking habit
●Tongue thrusting habits
●Mouth breathing habits
●Lip habits
●Cheek biting
●Nail biting

3. DEFINITION
Boucher OC defined habit as a tendency towards an act or an act that has
become a repeated performance, relatively fixed, consistent, easy to perform
and almost automatic.

4. New Classification (Morris and Bohanna—1969)

5. THUMB SUCKING
● Thumb sucking is defined as the placement of the thumb in
varying depths into the mouth
●Thumb sucking can be defined as the repeated
forceful sucking of the thumb ith associated
strong buccal and lip contractions.

6. ● Digit sucking and pacifier sucking are the most common oral habits
occurring at some point of time in the majority of children
●Most finger sucking habits begin very early in life
●Thumb sucking in a child causes great concern in the minds of parents
●The incidence of thumb sucking ranges from 16% to 45%

7. Etiological Factors
Associated with
Thumb Sucking
●Socioeconomic Status
●Working Mother
●Number of Siblings
●Social Adjustment and
Stress
●Age of the Child
● Order of Birth of the Child

8. PATHOGENESIS
● Children who sleep in the night with thumb
or finger between the teeth can get
significant malocclusion due to the pressure
produced by sleep of 6h or more
the type of malocclusion that develops is
dependent on a number of factors:
1.Position of the digit
2. Associated orofacial muscle contractions
3.Position of the mandible during sucking
4.Duration degree and intensity of sucking
trident of factors
5.Skeletal morphology

9. CLINICAL FEATURES
● Protraction of the maxillary anterior
teeth
●Mandibular postural retraction if the
weight of the hand forces the
mandible into a retruded position
●Lingual tipping of mandibular
incisors
●Development of anterior open bite
●Because of anterior open bite
associated simple tongue thrust
●Narrowing of the maxillary arch
due to contraction of cheek
muscles
●High palatal vault
●Hypotonic upper lip
● Hypertonic lower lip

10. Diagnosis
History
Once the positive history of habit is determined
the question regarding the frequency, intensity and
duration of the habit is determined.
Extra Oral Examination
Digits that are involved in the habit will appear
reddened, exceptionally clear, chapped and a short
fingernail, i.e. a clean dishpan thumb.

11. Diagnosis
Lips: The position of the lips at rest or during swallowing should be
observed. A short, hypotonic upper lip frequently characterizes chronic
thumb suckers. Lower lip is hyperactive and this leads to further proclination
of upper anterior teeth.
Profile: Usually convex profile
Intraoral Examination The type of malocclusion produced by digit
sucking is dependent on a number of variables like position of the digit,
associated orofacial muscle contractions, mandibular position during
sucking, facial skeletal pattern, intensity, frequency and duration of habit

12. Management
management of thumb sucking should be
started when the child shows any signs
of the habit or whenever a familial
tendency of the habit is discovered
●Preventive Treatment
●Psychological Therapy
●Chemical Treatment
●Mechanical Therapy or Reminder
Therapy

13. Preventive
Treatment
(Hughes, 1941)
Firstly, feed the child whenever he is hungry and
let him eat as much as he wants.
Secondly, feed the child the natural way;
importance of breastfeeding is primarily
psychological and secondarily nutritive.
Thirdly, never let the habit to be started, the
practice must be discontinued at its inception.
Use of a dummy/Pacifier: Encouraging the baby
to suck a dummy instead of his thumb can prevent
him from acquiring the habit.

14. Psychological
Therapy
Nagging, scolding or frightening the child
should be avoided since this could cause
negativism and tend to make him resort
to the habit.
●Six Steps in Cessation of Habit (Larson
and Johnson)
Step 1: Screening for psychological component
Step 2: Habit awareness
Step 3: Habit reversal with a competing
response.
Step 4: Response attention.
Step 5: Escalated DRO (differential
reinforcement of other behaviors).
Step 6: Escalated DRO with reprimands.
(Consists of holding the child, establishing eye
contact and firmly admonishing the child to stop
the habit.

15. Chemical
Treatment
1. Bitter and sour chemicals have been used
over the thumb to terminate the practice but
with very minimal success, e.g. quinine,
asafetida, pepper, caster oil, etc
1.Nowadays new anti thumb sucking
solutions like femite, thumb up, anti thumb
are also being marketed but they have also
had a very moderate success
1.It is the least effective method.

16. Mechanical
Therapy or
Reminder Therapy
Extraoral approach
Intraoral approach
Extraoral approach
Mechanical restraints applied to the hand and
digits like splints, adhesive tapes.
Thumb guard is the most effective extraoral
appliance for control of the habit

17. Intraoral approach:
1.Removable or fixed palatal crib
It breaks the suction force of the digit on the
anterior segment, reminds the patient of his habit
and makes the habit a non pleasurable one.

18. 3.Hay rakes
4.Modified blue grass appliance
2.Oral screen:
It produces its effects by redirecting the
pressure of the muscular and soft tissue curtain
of the cheeks and lips. It prevents the child from
placing the thumb or finger into the oral cavity
during sleeping hours.

19. Tongue Thrusting
Definition:
Tongue thrusting is described as a condition herein
during swallowing the tongue contacts with teeth
in
the anterior region.

20. Classification
Anterior tongue thrust
Lateral tongue thrust
1. Moyer’s classication
a)Simple tongue thrusting
b)Complex thrusting
c)Retained infantile swallow
2. According to area of tongue thrusting
a)anterior tongue thrust
b) lateral tongue thrust

21. Anterior open bite with proclination
3. According to Bahr and Holt
a)Tongue thrust without deformation
b)Tongue thrust causing anterior deformation
anterior open bite
c)Tongue thrust causing buccal deformation
posterior open bite
d)Combined tongue thrust causing both anterior
and posterior open bites

22. Etiology
1. Tongue thrusting is a residuum of
thumb sucking habit
2. Tongue thrusting itself will develop as
a habit
3. Tongue thrusting develops due to
chronic tonsillitis or pharyngitis
4. Continuous bottle feeding

23. 5. Neuromuscular problems can lead
to tongue thrust patterns
6. Persistence of retained infantile
swallow
7. Presence of macroglossia might
contribute to tongue thrust

24. Clinical features
1.Proclamation of anterior teeth
2.Anterior open bite
3.Bimaxillary proclamation
4.Posterior open bite in case of lateral tongue
thrusting
5.Posterior crossbite
●

25. Diagnosis
Place water beneath patient’s tongue tip and ask him
to swallow:
1.Normal: Mandible rises,teeth brought together
but no contraction of lips or facial muscles.
2.Tongue thrusting: Marked contraction of lips
and muscles.
Place hand over temporalis muscle and ask patient to
swallow.
1.Normal: Temporalis contracts and mandible is
elevated
2.Tongue thrusting: No temporalis contraction

26. Hold lower lip and ask patient to swallow
1.Normal: Swallow can be completed
2.Tongue thrusting: patient cannot complete
swallow.

27. Treatment
Tongue crib
1. If there is excessive labioversion
the teeth have to be retracted first if it
is a case of simple tongue thrusting.
2.Swallowing exercises should be
taught to the patients. Patient is
instructed to place the tongue tip on
the palate close the teeth close the
lips and then asked to swallow.
3.A Well-adapted fixed tongue spikes.

28. Mouth breathing
●Mouth breathing has been defined by
Sassouni V as the habitual respiration
through the mouth instead of nose.
● with nasal respiration leads to changes in the
craniofacial growth and position of teeth.
●Mouth breathers are
those who breathe
orally even in
relaxed and restful
conditions.

29. Classification
Anatomic mouth
breathers: Short upper
lip prevents complete
closure without effort.
Obstructive mouth
breathers: Children who
have increased
resistance to the normal
flow of air through the
nose.
Habitual mouth
breathers: Children who
breathe through mouth
by way of habit.

30. Aetiology of mouth breathing
1. Obstructive causes like:
a. Hypertrophied turbinate due to allergy, rhinitis
and chronic infection of nasal mucosa.
b. Deviated nasal septum.
c. Enlarged adenoids.
d. Nasal polyp.
e. Upper respiratory infection.
2. Anatomic causes like:
a. Short upper lip
b. Underdeveloped nasal cavity
3. Ectomorphic individuals are more prone for nasal obstruction
4. Obstructive sleep apnoea
5. Associated with other habits like thumb sucking

31. Pathogenesis of mouth
breathing–compression
theory
MOUTH BREATHING
Alters posture of tongue,jaws and head;tongue occupies
low posture
Mandible drops down,head tips back
Alters the equilibrium of pressure to the jaws and teeth
Forces from buccinator mechanism are not counteracted
Adenoid facies or long face syndrome

32. Clinical features
The different morphologic features associated with
mouth breathing have been described in many
terms. They are:
➤ Respiratory obstruction syndrome
➤ Adenoid facies
➤ Long face syndrome
➤ Vertical maxillary excess
Facial features associated with mouth breathing
are:
➤ Excessive anterior facial height
➤ Narrow face
➤ Incompetent lip posture with lip trap
➤ Protruded maxillary teeth
➤ Widely flared external nares

33. ➤ Constricted maxillary arch
➤ Posterior dental crossbite
➤ High palatal vault
➤ Steep mandibular plane
➤ Supraeruption of posterior teeth
➤ Open bite
➤ Extended head posture
➤ Forward inclination of cervical column
➤ Marginal gingivitis in the anterior region

34. Investigations
1. History
2. Study the patient’s breathing without informing the
patient
3. Ask the patient to take deep breath.
4. Ask the patient to close the lips and take deep breath
5. Clinical tests
6. Cephalometry
7. Rhinomanometry

35. Management of mouth breathing
1. Elimination of the cause
• The first step in the management of mouth
breathing is to rule out any obstruction in the nasal
air passage.
• Patient should be referred to an ENT surgeon.
• Removal of nasal obstruction by medicine or
surgery should be attempted.
• Rapid maxillary expansion is found to increase the
nasal air passage and reduction in nasal air
resistance.

36. 2. Habit interception
• Deep respiratory efforts with the mouth closed
and
lips in contact should be practised.
• Consists of – breathing exercises, lip exercises,
oral
screen – a passive oral screen is used to correct
habitual mouth breather. Breathing holes are placed
first, which are closed gradually.

37. BRUXISM
Definition
●Ramjford(1966)- Bruxism is the habitual
grinding of teeth when the individual is not
chewing or swallowing.
●Vanderas (1995) -Nonfunctional
movement of the mandible with or without
an audible sound occurring during the day
or night.

38. Types-
1. Daytime bruxism/Diurnal bruxism/
Bruxomania.
2. Night time bruxism/Nocturnal bruxism/
Bruxism.

39. Etiology
●Local factors-
Mild occlusal trauma or minor anatomic
defects, traumatic occlusion.
●Systemic factors-
Intestinal parasites, subclinical nutritional
deficiencies, allergies and endocrine
disorders.
●Psychological factor-
Emotional stress, anger, anxiety or
aggression.
●Occupational factor-
Athletes, watch makers, die-makers,
diamond cleaners

40. Clinical manifestation
●Occlusal trauma.
●Tooth mobility.
●Atypical shiny wear facets with
sharp edges.
●Pulpal sensitivity to cold.
●Pulp exposures.
●Muscular tenderness, especially
lateral pterygoid and masseter
muscles.
●Muscular fatigue on waking.
●Muscular hypertrophy.
●TMJ disorders.
●Headache.
●Grinding and tapping sound.
●Soft tissue trauma.

41. Treatment
1. Occlusal adjustments-
Any occlusal interferences should be corrected.
2. Occlusal spilnts-
night guards to cover all the teeth.
3. Restorative treatment-
In severe cases leading to pulp exposures.
4. psychotherapy-
5. Relaxation training.
6. Physical therapy.
7. Drugs (ethyl chloride for pain, local anesthetics,
tranquilizers, sedatives, muscle relaxants.)

42. Lip habit
Definition-
Habits that involve manipulation of the lips
and peri oral structures.
Classification-
1. Lip biting.
2. Lip sucking.
3. Lip wetting.

43. ETIOLOGY
1. Malocclusion-
● Class II div 1 with large overbite and overjet.
● Child wants to produce a normal lip seal during
swallowing by placing the lower lip posterior to
upper incisors.
2. Habits-
In conjunction with thumb sucking habit which may
result in large overjet and overbite.
3. Emotional stress.

44. Clinical
manifestations
●Protrusion of maxillary incisors and
retrusion of mandibular incisors.
●Reddened, irritated, chapped lips with
vermillion border relocated farther
outside the mouth, especially with lower
lip.
●Mentolabial sulcus becomes
accentuated.
●Malocclusion.

45. TREATMENT
1.Correction of malocclusion.
2.Treating the primary habit.
3.Appliance therapy-
●Lip bumper.
● Oral screen.

46. CHEEK BITING
It is an abnormal habit of biting or keeping the
cheek muscles in between upper and lower
posterior teeth.
Clinical features-
● Ulcer at the level of occlusion.
●Open bite.
● Tooth malposition in buccal segment.
Treatment-
●Removable crib.
● Vestibular screen.

47. NAIL BITING
It is one of the most common habits in children and adults.
Etiology-
●Insecurity.
●Nervous tension.
Effects-
●Crowding, rotation and alteration of incisal edges of
incisors.
●Inflammation of nail beds.
Management-
●Patient is made aware of the habit.
●Scolding, nagging and threats are avaoided.
●Encouraging outdoor activities.

48. Previous year questions
1)Define habits, classify oral habits, write about etiology, classification, effects of thumb sucking on oral cavity and it's
management in detail(W-20)
SAQs
1)Tongue exercises for tongue thrust habits(W-23)
2)Discuss role of tongue in malocclusion (W--22)
3)Describe Mouth breathing habits(S-22)

49. Thank
You