COMMONLY OCCURING ORAL HABITS IN

CHIlDREN

DEFINITIONSDorland:

Habit can be defined as a fixed or constant

practice established by frequent repetition.

Mathewson:

Oral habits are learned patterns of muscular

Contraction.

Buttersworth:

Defined a habit as a frequent or constant

practice or acquired tendency,which has

been fixed by frequent repetition.

DEVELOPMENT OF HABIT

First,infant makes an effort by frequent

learning and practice.

Later, muscles start responding more

readily.

BASIC ETIOLOGY OF HABIT

OverprotectionLonelinessIsolationPain and discomfortAbnormal physical size of partsImitation or imposition of others

BASIC EFFECT OF HABIT

Brings unbalanced pressure on immature, highly malleable alveolar ridges.

All the clinical features are consequences of this effect

CLASSIFICATION

OBSESSIVE:

Intentional:

Nail biting

Digit sucking

Lip biting

Masochistic:

Gingival stripping

NON-OBSESSIVE

Unintentional:

Abnormalpillowing

Chin propping

Functional habits:

Mouth breathing

Tongue thrusting

Bruxism

Habits significant to dental surgeon

Thumb suckingTongue thrustingMouth breathingBruxismNail bitingLip biting

THUMB SUCKING

Definition:

Thumb sucking can be defined as

placement of the thumb at various depths

into the mouth.

Other names:

Finger sucking

Digit sucking

SUCKING REFLEX

One of baby’s inherent reflex

Natural normal infant habit which gives the baby a feeling of security, pleasure and nutritional satisfaction.

Babies restricted from sucking,adapt to sucking a available object,mostly thumb.

CLASSIFICATION

Normal:

During 1st and 2nd yrs

Disappears as child

matures

Abnormal:

Persist beyond

preschool age or 3yrs

Divided into:

Psychological:

Habitual

Sucking habits can also classified as

Nutritive sucking habit

Breast-feeding

Bottle-feeding

Non-nutritive sucking habit

Thumb sucking

Subtelny classification of thumb sucking

Type A: More common

Whole digit is placed inside the mouth with

the pad of the thumb pressing over the

palate and thumb contact with max. and

man. Anteriors is maintained.

Type B:

Thumb is placed into the oral cavity without touching the vault of the palate and thumb contact with max. and man. Anteriors is maintained.

Type C:

Thumb is placed into the mouth just beyond

the first joint,contacting the hard palate and

thumb contact is maintained with only

max.anteriors.

Type D:

Little portion of the thumb is placed into the

mouth

Etiology of thumb suking

Parents from high socioeconomic statusWorking motherIncreased number of siblingsLater order of birth of childSocial adjustment and stress-scolding

parentsFeeding practicesAge of child

Clinical findings Maxillary anterior proclination and mandibular

retroclination. The anterior open bite Constriction of maxillary arches Posterior cross bite Increased maxillary arch length Increased trauma to maxillary central incisors Increased mandibular intermolar distance Increased overjet Decreased overbite

TONGUE THRUSTING

Definition:

Brauer:

A tongue thrust is said to be present if the

tongue is observed thrusting between, and

the teeth do not close in centric occlusion

during deglutition.

Tulley:

States tongue thrust as the forward

movement of the tongue tip between the

teeth to meet the lower lip during deglutition

and in sounds of speech, so that the tongue

becomes interdental.

ClassificationPhysiologic:

Due to retained infantile swallow

Habitual:

Present as a habit even after the correction of malocclusion.

Functional:

Adaptive behaviour developed to achieve an oral seal.

Anatomic:

Persons having enlarged tongue.

Etiology of tongue thrust

Retained infantile swallowUpper respiratory tract infectionsNeurological disturbancesFunctional adaptability to transient change

in anatomyFeeding practicesOther oral habitsHereditaryTongue size

Clinical manifestations

Extra oral findings:Seperated lipsNo corelation between the movements of

tongue tip and mandible.Mandibular movement is upward and

backward with tongue moving forwardProblems in articulation of

/s/,/n/,/t/,/d/,/i/,/th/,/z/,/v/ soundsIncrease in anterior facial height

Intraoral findings Tongue movements are irregular Swallowing sequences are seen to be jerky and

inconsistent Lowered tongue tip at rest Malocclusion:

maxilla:Proclination of anteriors

Generalized spacing

Maxillary constriction

mandible:Retroclination or proclination

intermaxillary relationships:

Anterior or posterior open bite

Posterior cross bite

MOUTH BREATHING

Definition:

sassouni:

Defined mouth breathing as habitual

respiration through the mouth instead of

nose,.

Merle:

Suggested the term oronasal breathing

instead of mouth breathing.

Classification(Finn)Anatomic:

In persons whose short upper lip does not permit complete closure.

Obstructive:

Children who have increased resistance to or complete obstruction of,normal flow of air through the nasal passages.

Habitual:

Child who continually breathes through his mouth by force of habit.

Etiology Nasal insufficiency in most of the children Allergies,physical obstructions and chronic

infections Airway obstruction due to

-Enlarged turbinates

-Deviated septum

-Obstruction in bronchial tree or

larynx

-Obstructive sleep apnea

syndrome

-Ectomorphic children

Clinical featuresGeneral effects:No purification of inspired airPoor pulmonary compliance and pigeon chest

appearanceEsophagitisLow % of oxygen in air inhaled through mouth

Effects on dentofacial structures:Increased facial height,retrognathic maxilla

and mandibleAdenoid facies

Retroclined upper and lower incisors and posterior cross bite

Nasal tone in voice is seenLip apart posture,short thick incompetent

upper lip and a voluminous curled over lower lip

Slit like external nares with a narrow noseHyperplastic gingiva and classic rolled

margin in gingiva Enlarged interdental papillaOtitis media

BRUXISMDefinition:

Ramfjord:

Habitual grinding of teeth when the

individual is not chewing or swallowing.

Vanderas:

Nonfunctional movement of the mandible

with or without an audible sound occuring

during the day or night.

Types of bruxism

Day time bruxism/Diurnal bruxism:

Night time bruxism/Nocturnal bruxism:

EtiologyCNS-cortical lesions,children with cerebral

palsy and mental retardationPsychological factors-feelings of anger

and aggressionImproper interdigitation of teethGeneticsMg++ deficiency and other systemic

factorsAllergies Overenthusiastic student or compulsive

overachievers

ManifestationsOcclusal trauma-tooth mobilityIncreased tooth sensitivity from an

excessive abrasion of the enamelFracture of the tooth crown or restorationsMuscular tenderness,muscular fatigueTMJ disturbances and painChronic headacheSoft tissue trauma Small ulcerations on the buccal muosa

opposite the molar teeth

Lip habitDefinition:

Habits that involve manipulation of the lips

and perioral structures are termed as lip

Habits

Classification:

-Wetting the lips with the tongue

-Pulling the lips into the mouth between the teeth

Etiology Angle’s class II division 1 malocclusion with

large overbite and overjet Other habits-thumb sucking Emotional stress

Manifestations: Protrusion of max.incisors and retrusion of man.

Incisors Interdental spacing in max.incisors Crowding in man.incisors Dislocated vermilion border Malocclusion

Cheek bitingDefinition:

Abnormal habit of keeping or biting the

cheek muscles in between the upper and

lower posterior teeth

Clinical features:Ulcer at the level of occlusionOpen biteTooth malposition in the buccal segment

Nail bitingEtiology-Internal tension

Effects:

-Crowding,rotation and attrition of incisal edges of man.teeth

-Inflammation of nail and nail beds

Self injurious habitsDefinition:

In these habits, the patient enjoys inflicting

damage to himself.

Etiology:

Organic-Lesch nyhan disease

-De Lange’s syndrome

Functional-Superimposed on pre existing

lesion

-Secondary to an habit

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