Oral habits part 4 bruxism nail biting

Oral habits part 4 bruxism nail biting

1. Oral Habits By - Sudeep Madhusudan Chaudhari MDS 2 nd Year Dept of Paedodontics & Preventive Dentistry

2. Contents Introduction Definitions Classification Prevalence of habit Thumb sucking Pacifier habit Tongue thrusting Mouth breathing Bruxism Lip habit Frenum thrusting Cheek biting Nail biting Postural habit Masochistic habit Conclusion References

3. Definitions :- Bruxism is the habitual grinding of teeth when the individual is not chewing or swallowing. - Ramjford (1966) Nonfunctional movement of the mandible with or without an audible sound occurring during the day or night. - Vanderas (1995) 5)Bruxism :-

4. Classification Daytime bruxism / Diurnal bruxism / Bruxomania. Night time bruxism / Nocturnal bruxism / Bruxism.

5. 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

6. Clinical features Occlusal trauma. Tooth mobility. Atypical shiny wear facets with sharp edges. Pulpal sensitivity to cold. Pulp exposures.

7. Muscular tenderness, especially lateral pterygoid and masseter muscles. Muscular fatigue on waking. Muscular hypertrophy. TMJ disorders. Headache. Grinding and tapping sound. Soft tissue trauma.

8. Treatment considerations Occlusal adjustments- Any occlusal interferences should be corrected. Occlusal spilnts- night guards to cover all the teeth. Restorative treatment- In severe cases leading to pulp exposures. Relaxation training. Drugs (ethyl chloride for pain, local anesthetics, tranquilizers, sedatives, muscle relaxants.) Acupuncture therapy.

9. Normal lip anatomy & function is important for speaking, eating and maintaining the balance occlusion. The lip habit may involve either of the lips, higher predominance towards the lower lip. This is defined as a habits that involve manipulation of the lips and peri oral structures. 6)Lip biting :-

10. Classification Lip biting. Lip sucking. Lip wetting.

11. Etiology- 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. Habits- In conjunction with thumb sucking habit which may result in large overjet and overbite. Emotional stress.

12. 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.

13. Treatment- Correction of malocclusion. Treating the primary habit. Appliance therapy- Lip bumper. Oral screen.

14. It is one of the most common habits in children and adults. 7)Nail biting :-

15. Etiology- Insecurity. Nervous tension. Effects- Crowding, rotation and alteration of incisal edges of incisors. Inflammation of nail beds.

16. Management- Patient is made aware of the habit. Scolding, nagging and threats are avaoided. Encouraging outdoor activities. Application of nail polish, light cotton mittens as reminder.

17. Masochistic habits/ sadomasochistic habits/ self-mutilating habits Definition- Repetitive acts that result in physical damage to the individual. 8)Self-injurious habits :-

18. Etiology- Organic- Lesch-Nyhan disease, De Lange’s syndrome. Functional- Type A- these are injury superimposed on a preexisting lesion. Type B- injuries secondary to another established habit. Type C- injuries of unknown or complex etiology.

19. Clinical features - Biting of fingers, knees, shoulders Frenum thrusting Picking of gingiva Insertion of sharp object into the oral cavity

20. Treatment - First initiated towards psychotherapy because some children experience a feeling of neglect, abandonment and loneliness and thus use this behaviour in an attempt to solicit attention and love. Treatment of self-injurious behaviour generally requires a multidisciplinary approval. Care should be taken in dealing with this form of behaviour of underlying emotional component. Palatal therapy followed by mechanotherapy using protective padding and mouth guards has also been advocated.

21. Conclusion As the mouth is the primary and permanent location for expression of emotions and even is a source of relief in passion and anxiety in both children and adults, stimulation of this region with tongue, finger, nail or other materials can be a palliative action. Though it is difficult to delineate it, but it is important to have differentiation of abnormal from normal because, if normal development get disturbed unknowingly and at the same time, if abnormal growth or underlying psychological cause let continue without interfering at proper time or age it will lead to long lasting effect on growth & development and psychological development of the child.

22. Oral habits can manifest themselves in a variety of ways. The identification of an abnormal habit and assessment of a particular habit and its immediate and long term effect on the craniofacial complex and dentition should be made as early as possible. The assessment of these behavior must include a thorough evaluation of the habit itself and the presence of, or the potential for oral health repercussions. These judgements must be coupled with the sensitive assessment of the physical and emotional status of the child and the relationship of the parent or caregiver.

23. References McDonald RE, Avery DR. Dentistry for the child and adolescent. Mosby Incorporated; 2004. Pinkham JR, Casamassimo PS, Fields HW, McTigue DJ, Nowak A. Pediatric dentistry. Infancy through adolescence. 2005 Sep 20;4. Finn SB, Akin J. Clinical pedodontics. WB Saunders company; 1973. Wei SH. Pediatric dentistry: total patient care. Lea & Febiger ; 1988. Proffit WR, Fields HW, Larson B, Sarver DM. Contemporary orthodontics. Elsevier Health Sciences; 2018 Aug 6. Marwah N. Textbook of pediatric dentistry. Jaypee Brothers, Medical Publishers Pvt. Limited; 2018 Oct 31. Tandon S. Textbook of pedodontics. Paras Medical Publisher; 2009.