SEMINAR ON:

FOR
DEPARTMENT OF PAEDIATRIC &PREVENTIVE
DENTISTRY

PRESENTED BY:
SHALINI MITTAL
ROLL NO. 76
BATCH: 2005-06
 INDEX

TOPICS PAGE NUMBER

Introduction 1
Definition of habit 1
Classification of oral habits 2
Etiology of oral habits 3
Diagnosis & management 3
Various oral habits 5
Thumbsucking 7
Tongue thrusting 12
Mouth breathing 16
Bruxism 19
Lip habit 23
Cheek biting 24
Nail biting 25
Self injurious habits 26
Frenum thrusting 28
Bobby pin opening 29
Conclusion 29
Bibliography 30
 INTRODUCTION

Habit is a voluntary or involuntary act performed by a peson,

repeatedly and compulsively. Habits of sufficient frequency,
duration and intensity are associated with various dento-alveolar and
skeletal abnormalities. Persistent oral habits may result in long term
problems hence evaluation of habits has been recommended for
children beyond the age of 3 years.

DEFINITION OF HABITS

According to Boucher O.C.

Habit is a tendancy towards an act or an act that has become a

repeated performance, relatively fixed, consistent, easy to perform
and almost automatic.

According to Dorland(1957)

Habit is a fixed or a constant practice established by frequent

repetition.

According toButtersworth(1961)

Habit os a frequent or constant practice or an acquired

tendancy which has been fixed by frequent repetition.

According to Matthewson(1982)

Oral habits are learned pattern of muscular contractions.

 CLASSIFICATION

ACCORDING TO OTHER AUTHORS:

James(1923) 1.useful habits
2.harnful habits
Kingsley(1958) 1.functional oral habits
2.muscular habits
3.combined habits
Morris & bohanna(1969) 1.pressure habits
2.non pressure habits
3.biting habits
Klein(1971) 1.empty habits
2.meaningful habits
Finns(1987) a) compulsive habits
b) non compulsive habits
2. a) primary habits
b) secondary habits
ETIOLOGY

• family conflicts
• jealousy
• school pressure
• stress
• lack of satisfaction through nourishment
• limitations associated with tooth eruption
• occlusal interference
• breathing obstruction
• overprotection
• loneliness
• isolation
• problems of communication

DIAGNOSIS &MANAGEMENT

Management of oral habits is indicated whenever habits cause

damage or there is a reasonable indication that oral habits will have
infavourable sequelae in developing permanent dentition.

Treatment modalities include:

• behaviour modification
• appliance therapy
• referral to other dental or medicine specialists

according to Melvinmoss, skull consists of a series of functional

components each of which supports or protects the functional
matrices.
All skeletal and structural attributes reflect morphogenic prio
demands of their matrices. Due to deleterious oral habits there
occurs an inbalance between various soft tissue matrices, exerting
abnormal pressure on jaw and causing altered growth of dentofacial
complex.

Oral habits & Melvimoss concept of growth

Buccinator, superior constrictor, tongue

Pterygomandibular raphae

lips

harmonious pressure balance

habits abnormal tissue

pressure altered
muscular
contraction.

Altered
dentofacial &
skeletal growth
VARIOUS ORAL HABITS

1. digit sucking
2. tongue thrusting
3. mouth breathing
4. bruxism
5. clenching
6. nail biting
7. lip biting
8. lip sucking
9. cheek biting
10. occupational habits
11. dummy sucking
12. pencil or foreign object sucking
13. frenum sucking
 THUMB SUCKING

Definition: thumb sucking may be defined as placement of

thumb into various depths in the mouth.

CLASSIFICATION

Based on clinical observation:

1. normal thumbsucking : thumbsucking is considered to be
normal in first & second year of life. This habit usually
disappears as the child matures. Habit at this age doesn’t
generate any malocclusion.
2. abnormal thumbsucking: when this habit persists beyond
preschool period, then it could be considered to be abnormal
thumbsucking habit. If the habit is not treated at this stage, it
may cause deteriorations in the dentofacial structures.

Abnormal thumbsucking may be classified into

1. psychological: there may be a deep emotional factor
associated with the habit like insecurities, neglect or
loneliness.
2. habitual: habit doesn’t have psychological bearing.

Sucking habits can also be classified as:

• nutritive: e.g. breast feeding & bottle feeding
• non- nutritive: e.g. thumbsucking, etc.
Causative factors
1. parents’ occupation
2. working mother
3. number of siblings
4. order of birth of child
5. social adjustment & stress
6. feeding practices
7. age of child

Clinical findings

Due to sucking habits, various malocclusions occur in primary and

permanent dentition.

According to Nanda(1989), type of malocclusion produced by digit

sucking is dependant on number of variables:
• position of digits
• associated orofacial muscle contractions
• mandibular position during sucking
• facial skeleton patterns
• intensity, frequency & duration of force applied

Commonly observed clinical problems

- maxillary anterior proclination and mandibular

retroclination
- anterior open bite
- constriction of maxillary arch
- posterior cross bite
TREATMENT

a) psychological therapy
b) reminder therapy
c) mechano therapy
Psychological therapy

Thumbsucking children between ages of 4 and 8 yrs. Need

only reassurance positive reinforcement and friendly
reminders.
Children and parents are informed about the problem and
long term risks of the habit.
During treatment adequate emotional support and concern
should be provided to the child by parents.

Reminder therapy

a)Extraoral approaches

It employs hot tasting, bitter flavored preparations to the

digits.
Thermoplastic thumb post was devised by Allen in 1991
where a total of 6 wks of time was reqd. for elimination of
habits.

b)intraoral approaches

removable appliances like palatal cribs, rakes, palatal and

lingual spurs, Hawley’s retainers with or without spurs are
used.
Fixed appliances such as upper lingual tongue screen appear
to be effective in breaking these habits.

d) mechanotherapy

quad helix: this appliance prevents thumb from being

inserted and also correct malocclusin by expanding the arch.
Bluegrass appliance: Haskell(1991) introduced an appliance
for childre with a continued thumbsucking habit. It consists
of a modified size-sided roller slipped over a 0.048 stainless
steel wire solderedto molar ortho. Bands. This appliance is
placed for a period of 3-6 mths.

TONGUE THRUSTING

The lower jaw of infants is usually behind upper jaw.

During infantile swallowing tongue is between gumpads in
close approximation with lips and its contraction alongwith
the facial muscles help to stabilise the mandible.

Definition:

According to Braver(1965)
A tongue thrust was said to be present if tongue was
observed thrusting between, and the teeth didn’t close in
centric occlusion during deglutition.

According to Tulley(1969)
States tongue thrust as forward movement of tongue tip
betweenteeth to meet lower lip during deglutition and in
sounds of speech, so that tongue becomes interdental.

According to Barber(1975)
Tongue thrust is an oral habit pattern related to persistence
of an infantile swallow pattern during childhood and
adolescence and thereby produces an open bite and
protrusion of anterior tooth segments.

According to Schneider(1982)
Tongue thrrust is a forward placement of tongue between
anterior teeth and against lower lip during swallowing.

CLASSIFICATION
1. physiologic: comprisesof normal tongue thrust
swallow of infancy.
 2. habitual: tongue thrust swallow is present as a habit
even after correction of malocclusion.
3. functional: when tongu thrust mechanism is an
adaptive behaviour developed to achieve an oral seal,
it can be grouped as functional.
4. anatomic: person having enlarged tongue can have an
anterior tongue posture.

ETIOLOGY
1. retained infantile swallow
2. upper respiratory tract infection
3. neurologic disturbances
4. functional adaptibility to transient change in anatomy
5. feeding practices and tongue thrusting
6. other oral habits
7. hereditary
8. tongue size

CLINICAL MANIFESTATIONS
- anterior open bite
- protrusion of maxillary incisors
- high arched v-shaped palate
- malocclusion
- pronunciation difficulties
- malformation of jaws

TREATMENT
-appliances are recommended for treatment of tongue
thrust, however myofunctional therapy should be attempted
first.
-Treat swallow pattern which may help to correct
pronunciation and correction of dental problems. Tongue
thrust therapy focuses on correct positionig of jaws at rest,
the muscular strength of chewing muscles and developing a
new swallowing pattern.
- use of sugarless mint: the child is asked to use tip of
tongue to hold a mint in the roof of mouth until it melts.
As mint is held, saliva flows and makes it necessary for
the child to swallow. Once the child is trained , tongue
muscles function proper during swallowing. A
mandibular lingual arch with a rib or an acrylic retainer
with a fence may be constructed.
MOUTH BREATHING

Definition
According to Sassouni (1971)
Habitual respiraton through mouth instead of nose.

According to Merle(1980)
suggested the term oro-nasal breathing instead of mouth
breathing.

CLASSIFICATION
Finn(1987) classified mouth breathing into:
1. anatomic: anatomic mouth breather is one short upper
lip doesn’t permit complete closure without undue
effort.
2. obstructive: children who have increased resistance to
or a complete obssruction of normal flow of air in
nasal passages. Child is forced to breathe through the
mouth.
3. habitual: chilg continually breathes through the mouth
by force of habit although abnormal obstruction has
been removed

ETIOLOGY

1. enlarged turbinates
2. deviated septum and other naso-pharyngeal
abnormalities
3. allergic rhinitis, nasal polyp.
 4. enlarged adenoid or tonsilsabnormally short upper lip
preventing proper lip seal
5. obstruction in bronchial tree or larynx
6. obstructive sleep apnoea syndrome
7. thumbsucking or similar oral habits
8. genetically predisposing factors

CLINICAL MANIFESTATIONS

- increased anterior face height

- increased mandibular plane angle
- retrognathic mandible and maxilla
- upper and lower incisors retroclined
- psterior cross bite
- open bite
- nasal tone in voice
- atrophied nasal mucosa.
- inflammed and irritated gingival tissue in anterior
maxillary arch.
- Otitis media

CLINICAL TESTS

1. MIRROR TEST: a double sided mirror is kept on

philtrum. If fog is formed on the mirror facing the mouth,
then patient is a mouth breather.
2. BUTTERFLY TEST: take a piece of cotton and shape it
into a butterfly. Place it on the philtrum and check for the
movement of cotton fibres. If they are moving in the
direction of nose, the patient is a mouth breather.
3. WATER HOLDING TEST: patient is asked to hold a
mouthful of water for few minutes without swallowing it.
If the patient is a mouth breather, he wont be able to hold
the water in mouth for a long period.
4. INDUCTIVE PLATHYSMOGRAPHY: reliable way to
quantify extent of mouth breathing is ti establish how
much of total airflow goes through mouth using
platysmography.
5. CEPHALOMETRIES: to establish the amount of
nasopharyngeal space size of adenoids and to know the
skeletal pattern of patient by taking various
cephalometric angles.

MANAGEMENT

-rule out nasal airway impairment

-child is taught certain exercises for breathing through nose
-an oral screen may be given.

BRUXISM

DEFINITION
According to Ranifjord(1966)
Bruxism is habitual grinding of teeth when individual is not
chewing or swallowing.

According to Rubina(1986)
Bruxism is the term used to indicate non functional contact
of teeth which may include clenching, grinding, gnashing
and tapping of teeth.

According to Vanderas((1995)
Non functional movement of mandible with or without an
audible sound occuring during day or night.

TYPES
1. DAYTIME BRUXISM/ DIURNAL BRUXISM
It is conscious or subconscious grinding of teeth usually
during the day.
2. NIGHT TIME /NOCTURNAL BRUXISM
It is subconscious grinding of teeth char. By rhythmic
pattern of EMG activity.

ETIOLOGY

1. CNS- cerebral palsy, mental retardation

2. psychological factors- anxiety, rage, hate, aggression
3. occlusal discrepencies
4. genetics
5. allergies
6. systemic factors- magnesium deficiency
7. occupational factors

MANIFESTATIONS
Signs and symptoms of bruxism depend on:
• frequency of bruxing
• intensity
• age which may be associated with duration

following clinical features are seen:

• occlusal trauma
 • headache
• muscular tenderness
• TMJ disoders
• Tooth structures
• Soft tissue trauma

TREATMENT

Shephard recommended contruction of a palatal bite plate,

which allows continuous eruption of posterior teeth. This is
desirable if teeth are abraded due to this habit. A vinyl
plastic bite guard that covers occlusal srfaces of all teeth,
place 2mm. Of buccal and lingual surface can be worn at
night to prevent abrasion.
 LIP HABITS

DEFINITION: habits that involve manipulation of lips and

periotal structures are lip habits.

CLASSIFICATION:
a) wetting the lips with tongue
b) pullin lips into mouth between the teeth

ETIOLOGY
-malocclusion
-oral habits like digit sucking
-emotional stress

CLINICAL MANIFESTATIONS
- protrusion of maxillary incisors and retrusion of
mandibular incisors
- mentolabial sulcus becomes accentuated
- malocclusion

TREATMENT
- correction of malocclusion
- treating the primary habit
- appliance therapy like oral shield

Lip bumper: it is positioned in vestibule of mandibular arch and

serves to profit lip from exerting extraforce on mandibulkar incisors
and to reposition lip away from lingual aspect of maxillary incisors.
This results in distal repositioning of maxillary incisors and
reducing the overjet and overbite.
CHEEK BITING

This is an abnormal habit of keeping or biting cheek muscles in

between upper nd lower posterior teeth. It may injure soft tissue and
may cause an open bite or an individual tooth malposition I buccal
segment where a persistent cheek biting habit exists.

CINICAL FEATURES
- ulcers at the level of occlusion
- open bite
- tooth malposition in buccal segment

TREATMENT
A removable crib may be constructed to break the habit. A
vestibular screen may also be used.

NAIL BITING

One of the most common habits in children and adults. It is a sign

of internal tension.

ETIOLOGY

Persistent nail biting may be indicative of an emotional problem.

After the age of 15 yrs. Nail biting is replaced by pencil biting, hair
twirling or gum chewing.

EFFECTS

Dental effects: crowding, retraction and attrition of incisal edges of

incisos.
Effects on nails: inflammation of nail beds and of nails.

MANAGEMENT

- mild cases need no treatment.

- Treat basic emotional factor causing the habit.
- Application of nail polish, light cotton mittens as a
reminder
- Avoid primitive methods like scolding, nagging or
threatening.
SELF INJURIOUS HABITS

Also known as masochistic, sadomasochistic and self-mutillating

habits.
These are the habits in which the patient enjoys deliberately
damaging himself. It is seen in mentally ill or psychologically
disturbed children

DEFINITION: repetitve acts that result in physical damage to the

individual.

ETIOLOGY
• organic: in lesch nyham disease and De Lenge’s
syndrome in which symptoms such as repetitive
lip, finger, tongue, knee and shoulder biting are
common
• functional:
a) type A: a child with a finger nail
biting habit is under a treatment for a
skin lesion which are superimposed
or pre-existing.
b) Type B: these are secondary to other
estd.habits. rotation of thumb while
thumbsucking can harm the tissues.
c) Type C: this type of behaviour has a
greater psychogenic component and
child may resort to various self
injurious habits as a form of stress
release.
FRENUM THRUSTING

It is an example of self injurious habits. If maxillary incisors are

slightly spaced apart. Child may lock his labial frenum between
these teeth and permit it to remain in this positon for hours. On
constant repetition this may become a habit which may displace the
tooth.

TREATMENT

a) palliative treatment: adjunctive therapy in form

of bandage for any oral ulcerationwill help in
healing of wouns and serve as habit reminder.
b) Mechanotherapy: an oral shield will also deter
the cild from unconscious continuation of habit.
Treatment for self mutilation may also include
use of restraints snd protective padding.

BOBBY PIN OPENING

Usually seen in teenage girls wherein opening of bobby pin with

anterior incisors is done. Clinically, we see notched incisors and
partially denuded labial enamel. Treatment invoves stoppage of the
habit.

CONCLUSION
Identification and assessment of an abnormal habit and its
immediate and long term effects on craniofacial complex and
dentition should be made as early as possible to minimze the
potential deterious effects on dentofacial complex.
BIBLIOGRAPHY
 Text book of pedodontics by Shobha Tandon
 Textbook of pedodontics by S.G. Damle
 Textbook of pedodontics by Aarthi Rao
 Textbook of orthodontics by T.M. Graber
 Textbook of orthodontics by Balajhi
 Internet