Community Dentistry

Prevention of Oral Habits

By

Dr. Mohamed Farouk

Lecturer of Pediatric Dentistry, NRC, ACU

2022

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 Oral habits

―Any repetitive behavior pattern which utilizes the oral cavity‖.

 Its presence at 3-6 years is an important clinical finding and no longer

considered normal at the end of this age.

 Intervention is mandatory in case of primary teeth movement before

eruption of perm. incisors.

 ―Habits are the most frequent cause of dento-facial malformations mostly

seen in the early childhood and mixed dentition stages‖.

 ―Oral habits may apply negative forces to the teeth and dento-alveolar
structures.

 Habits of sufficient intensity, duration and frequency, may be associated

with dentoalveolar or skeletal deformations such as increased overjet,
reduced overbite, posterior crossbite, or long facial height.‖

 Intensity: the amount of force applied to the teeth while performing the
habit.

 Duration: the amount of time spent performing the habit

 Frequency: the number of times the habits practiced throughout the day.

Frequency plays the most critical role in tooth movement (>4-6 hours/day).

Some important questions to consider/ask

• How long has the child had the habit? Duration.

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 • When does he indulge in the habit? day? night? Frequency.

• Does he make slight or great force? Intensity.

• Does anyone ridicule the child regarding the habit? Motivation.

• Does the child want to stop the habit? Motivation.

Oral habits, usually seen in the children are:

•Digit sucking

•Tongue thrusting habit

•Mouth breathing

•Finger nail biting

•Lip biting habit

•Bruxism

• Pacifier sucking

• Self mutilation

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 Digit or Thumb sucking:

 It is reported as one of the most common oral habits, starting in the

intrauterine life.

 Thumb sucking habit can be defined as ―the repeated forceful sucking of the
thumb with associated strong buccal and lip musculature contraction;
orbicularis oris and buccinator muscles”.

Etiology:

 Inherent biologic derive for sucking ―Oral stage‖.

 Prolonged breast /bottle feeding.

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  Emotional disturbance.

 Working mother.

 SES problems.

 Increased number of siblings

Adverse effects:

1. Anterior open bite.

2. Increased overjet (rabbit like).

3. Lingual inclination of lower incisors and labial inclination of upper incisors.

4. Deep palate and constricted maxillary arch Posterior cross bite.

5. Compensatory tongue thrust.

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 6. Finger and speech defects.

Phases of developing thumb sucking:

1- Subclinical /Normal: Begins from birth up to 3 years of age which is

considered normal and does not require any intervention.

2- Clinically significant: This phase extends from 3-6 years of age and is
associated with clinically significant sucking. It requires dentist intervention in
an effort to manage the habit at this stage (reversible dental changes).

3- Intractable sucking: when the habit proceeds beyond 6-7 years, child will
require both parents and dentist attention and may need to be given
psychotherapy (irreversible dental changes).

Management: (The child must be motivated to stop the habit)

1. Psychotherapy

• Psychological stability: Mothers should give maximum care to the infant

with adequate feeding.

• Distraction: Engage children in activities such as playing outdoors and

buying new toys.

• Positive reinforcement :( Reward therapy) after habit cessation (preceded by

explanation of habit deleterious effects in a contract between the child and
the parent or the dentist.

• Dunlop exercise: the child is asked to sit in front of a large mirror and asked
to suck his thumb observing himself involved in the habit.

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 2. Reminder therapy (for those who want to stop the habit but need some
help)

A. Applying some non-harmful pastes/chemicals that tastes bad on the thumb,

making it less satisfying like Mavala stop.

B. 3-Alarm system: it is often effective in children from 3-7years

C. Extra oral electronic appliance: A simple device, which gives alarm when
the child puts the finger into the mouth.

D. Thumb-Home concept: A small bag is tied around the wrist of the child
during sleep (adhesive bandage).

3. Mechanotherapy (Appliance therapy)

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 Habit breaking devices like palatal crib, tongue spurs, tongue spikes, blue grass
appliance and Quad helix (in cases of posterior cross bite due to constricted
maxilla).

 Appliance therapy is used after failure of reminder and reward therapy but
not punishment.

 Duration: 6 months.

 Side effects:

Eating difficulties

Speech problems

Disturbed sleep

TONGUE THRUSTING:

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  ―It is the placement of the tongue tip forward between incisors during
swallowing‖.

 Incidence (Phases):

97% newborns (infantile type of swallowing), 80% 5-6yrs, 3% 12 yrs

Diagnosis & Examination:

1. Place water beneath the tongue tip and ask him to swallow

2. Place hand over temporalis muscle and ask to swallow

3. Hold the lower lip with thumb: Difficult swallowing

Adverse effects:

1. Anterior open bite.

2. Increased overjet (rabbit like).

3. Labial inclination of upper and lower incisors (bimaxillary protrusion).

4. Posterior cross bite.

5. Spacing.

6. Speech defects.

Treatment considerations:

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 Self correcting by 8-9 years: by the time permanent teeth erupt.

If associated with other habits: should be treated first

Treatment is generally not recommended when tongue thrust is present without

malocclusion or a speech problem.

1) Myofunctional therapy

2) Orthodontic elastics tongue tip is held against the palate and sugarless fruit
drop.

3) Lemon candy exercise

Mechanotherapy: Like thumb sucking

II-Lip habit:

Definition:

Habit that involves manipulation of lips and perioral structures which is most

common in the mixed and permanent dentitions.

Classification:

1. Frequent wetting the lips with tongue.

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2. Lip pulling or biting: Pulling the lip into the mouth between teeth.

3. Mentalis Habit: The vermillion border of the lower lip is often everted with the

lingual aspect elevated into the mouth along with the appearance of sub-labial

contracture line between the lip and chin (if the entire lip everted it is called lip

sucking).

Etiology

1. Malocclusion

Class II division I, deep bite malocclusion: due to increased overbite and overjet,

this habit develops when the child wants to produce a normal lip seal during

swallowing by placing the lower lip posterior to the maxillary incisors.

2 Habits

In conjunction with other habits such as thumb sucking, digit sucking; which will

further increase the overjet and overbite.

3. Emotional stress

Increased salivary output, thus increasing the number of swallows and increased

lip seals required.

Clinically:
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Dental:

i. Protrusion of maxillary incisors with interdental spacing and retrusion of

mandibular incisor with crowding.

ii. Malocclusion: Can maintain an exisiting malocclusion (increased overjet and

open bite).

Soft tissues:

i. Lip: reddened, irritated and chapped area below the vermillion border which will

be relocated farther outside the mouth due to constant lips wetting in addition to

probability of infection and scarring.

ii. Mentolabial sulcus : Becomes accentuated.

iii. Elevated upper lip and retruded chin.

Management:

1. Emotional therapy: involves self discipline, not to perform the habit again in

near future.

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2. Lip moisteners

3. Correction of malocclusion—class II division I.

4. Treating the primary habits.

5. Appliance therapy: Oral shield (screen) helps to stop habit and also the incisal

alignment. The addition of a small loop to the labial oral shield to improve the lip

tonus by helping in lip exercises, i.e. 3-10 min a day.

6. Lip Bumper:

Placed in the vestibule of mandibular arch and serves to prohibit the lips from

exerting excessive force on mandibular incisors and to repositioning the lip away

from lingual surface of maxillary incisor; this prevent the distal movement of

maxillary incisor resulting in decreased overjet and overbite.

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 MOUTH BREATHING:

―Habitual respiration through the mouth instead of the nose.‖

May be obstructive or anatomical (refer to ENT) 3. Habitual ( only type related

to dentistry)

Adenoid faces:

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 Dental and skeletal changes: (similar to tongue thrust)

 Anterior open bite.

 Low tongue position.

 Deep palate and constricted maxillary arch Posterior cross bite.

 Labial inclination of upper and lower incisors

 Increased: caries, plaque and marginal gingivitis.

Diagnosis: Visual test and fog test.

Management: Elimination of the cause, Lip exercises, Oral screen (modified by

adding vents and handle) , Correction of malocclusion.

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 IV-Bruxium (clenching)

‗The habitual grinding of teeth when the individual is not chewing or

swallowing (nonfunctional movement)‘.

Types:

1. Day time/diurnal bruxism

2. Night time/Nocturnal bruxism (most damaging).

Etiology:

1. Emotional problem.

2 .Occlusal interference due to faulty restoration, malocclusion, etc.

3. Systemic factors

Clinical Features:

I. On primary teeth:

The occlusal wear of primary teeth is more than the normal. Enamel and
dentine are worn away with chance of pulp exposure.

II. On permanent dentition:

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 1. Attrition pattern do not coincide with normal wear pattern.

2. Teeth sensitivity.

3. Unexpected fracture of teeth or restorations.

4. Hypertrophy of masticatory muscles leading to muscle tenderness.

5. Patient usually complain of jaws pain or locking of jaws when they wake
up in the morning

6. TMJ pain and headache.

7. Audible occlusal grinding.

8. Trauma to the periodontium (mobility and periodontitis).

Management:

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 a-Preliminary evidence that juvenile bruxism is a self-limiting condition that
does not progress to adult bruxism

In cases of stress:

1- Munching on an apple or carrot →as exercise to jaw muscles that relax

them a little before sleep.

2- Giving him a warm bath before sleep.

3- Give him a cup of warm milk.

4- Try reading him a bedtime story that he likes.

5- Have little talks with him to find out what bothers him (school or home),
and try to come up with solutions

b. Psychotherapy and alternative medicines like relaxation exercise,.

c. Physiotherapy: Massage of masticatory muscles and heat.

d. Pharmacotherapy – muscle relaxants and anti anxiety drugs.

e. Occlusal therapy:

1. Occlusal adjustment

2. Stainless steel crowns may be used in posterior teeth

3. Night guard or caps splint

V-Self mutilation (injury):

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Definition:

Repetitive act that result in physical damage to the individual. These habits are rare

in normal children but show increased incidence in mentally retarded population;

10-20%

Etiology:

Associated with developmental delay or disabilities, psychiatric disorders,

traumatic brain injuries, and some syndromes like Lesch- Nyhan disease

(syndrome) in which symptoms such as repetitive lip, finger, tongue, knee and

shoulder biting is common.

Lesch- Nyhan disease:

Rare X-linked recessive genetic disorder that most often affects males suffers from

renal failure and mental and motor disability; may die in early childhood

Clinically:

1-With the eruption of deciduous teeth, they begin to bite their fingers and lips.

2-Pricking gingiva with fingernails which may be completely ripped.

3-Excessive lip-licking and lip-pulling. Child may continue lip biting even after lip

injury occurs.

4-Biting and chewing blades.

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Management:

• Treatment first initiated towards psychotherapy.

Some children experience a feeling of neglect and loneliness and through the use

of self-injurious behaviour attempt to bring the attention and love.

• Pallative treatment—Bandages for oral ulceration which will help healing of

wounds as well as serve as habit reminder and recently botox injection

• Mechanotherapy—Oral shields, lip-bumper and occlusal bite appliances.

•Use of restraints, protective padding, sedation and extraction of selected teeth

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