ORAL ORAL HABITSHABITS

Dr shabeel pn Dr shabeel pn

INTRODUCTIONINTRODUCTION

THEY ARE REPEATED PERFORMANCETHEY ARE REPEATED PERFORMANCE THEY CAN BETHEY CAN BE

- - PART OF NORMAL DEVELOPMENTPART OF NORMAL DEVELOPMENT

- SYMPTOM WITH DEEP ROOTED - SYMPTOM WITH DEEP ROOTED PSYCHOLOGIC PSYCHOLOGIC

BASISBASIS

- ABNORMAL FACIAL GROWTH- ABNORMAL FACIAL GROWTH

DEFINITIONSDEFINITIONS

DORLAND(1957):DORLAND(1957): FIXED OR CONSTANT PRACTICE FIXED OR CONSTANT PRACTICE ESTABLISHED BY FREQUENT REPETITIONESTABLISHED BY FREQUENT REPETITION

BUTTERSWORTH(1961): BUTTERSWORTH(1961): A FREQUENT OR A FREQUENT OR CONSTANT PRACTICE OR ACQUIRED TENDENCY, CONSTANT PRACTICE OR ACQUIRED TENDENCY, WHICH HAS BEEN FIXED BY FREQUENT REPETITIONWHICH HAS BEEN FIXED BY FREQUENT REPETITION

MATHEWSON(1982): MATHEWSON(1982): ORAL HABITS ARE ORAL HABITS ARE LEARNED PATTERNS OF MUSCULAR CONTRACTIONSLEARNED PATTERNS OF MUSCULAR CONTRACTIONS

VARIOUS HABITS AREVARIOUS HABITS ARE• Thumb sucking•Finger sucking•Tongue thrusting•Pacifier or dummy sucking•Lip biting•Nail biting •Cheek biting•Pencil or foreign object sucking•Lip sucking•Clenching•Mouth breathing•Bruxism•Occupational habits

CLASSIFICATIONSCLASSIFICATIONS

OBSESSIVEOBSESSIVE

(DEEP ROOTED)(DEEP ROOTED)

INTENTIONAL INTENTIONAL MASOCHISTICMASOCHISTIC

(MEANINGFUL) (SELF INFLICTING)(MEANINGFUL) (SELF INFLICTING)

NAIL BITING GINGIVAL STRIPPINGNAIL BITING GINGIVAL STRIPPING

DIGIT SUCKINGDIGIT SUCKING

LIP BITINGLIP BITING

NON OBSESSIVENON OBSESSIVE

(EASILY LEARNED & DROPPED)(EASILY LEARNED & DROPPED)

UNINTENTIONAL FUNCTIONAL UNINTENTIONAL FUNCTIONAL HABITSHABITS

ABNORMAL PILLOWING TONGUE THRUSTINGABNORMAL PILLOWING TONGUE THRUSTING

CHIN PROPPING BRUXISMCHIN PROPPING BRUXISM

JAMES (1923)JAMES (1923)

Useful habitsUseful habits:: – This includes habits of – This includes habits of normal functions such as correct tongue normal functions such as correct tongue position, proper respiration, deglutition, position, proper respiration, deglutition, and normal use of lips in speaking.and normal use of lips in speaking.

Harmful habitsHarmful habits: — this includes all the : — this includes all the habits that exert perverted stresses habits that exert perverted stresses against the teeth and dental arches as against the teeth and dental arches as well as those habits such as open mouth well as those habits such as open mouth habits, lip biting, lip sucking, thumb habits, lip biting, lip sucking, thumb sucking etc…sucking etc…

MORRIS & BOHANNA (1969)MORRIS & BOHANNA (1969)

Pressure habitsPressure habits— these include sucking — these include sucking habits such as thumb sucking, lip sucking, habits such as thumb sucking, lip sucking, finger sucking and also tongue thrusting.finger sucking and also tongue thrusting.

Non pressure habitsNon pressure habits— Habits which do — Habits which do not apply a direct force on the teeth or its not apply a direct force on the teeth or its supporting structures are termed as non supporting structures are termed as non pressure habitspressure habits

E.g.: mouth breathing.E.g.: mouth breathing. Biting habitsBiting habits- These includes habits such - These includes habits such

as nail biting, pencil biting and lip biting.as nail biting, pencil biting and lip biting.

KLEIN (1971)KLEIN (1971)

Empty habitsEmpty habits – they are habits that – they are habits that are not associated with any deep are not associated with any deep rooted psychological problemsrooted psychological problems

Meaningful habitsMeaningful habits—they are habits —they are habits

that have a psychological bearing.that have a psychological bearing.

FINN (1987)FINN (1987)

Compulsive habitsCompulsive habits- These are deep rooted - These are deep rooted habits that have acquired a fixation in the habits that have acquired a fixation in the child to the extent that the child retreats to child to the extent that the child retreats to the habits when ever his security is the habits when ever his security is threatened by events which occur around threatened by events which occur around him. The child tends to suffer increased him. The child tends to suffer increased anxiety when attempts are made to correct anxiety when attempts are made to correct the habits.the habits.

Non compulsive habitsNon compulsive habits– They are habits – They are habits which are easily learned and dropped as the which are easily learned and dropped as the child matures.child matures.

PRIMARY HABITSPRIMARY HABITS

SECONDARY HABITSSECONDARY HABITS

KINGSLEY (1958)KINGSLEY (1958)

FUNCTIONAL ORAL HABITSFUNCTIONAL ORAL HABITS

MUSCULAR HABITSMUSCULAR HABITS

COMBINED ONESCOMBINED ONES

THUMB SUCKINGTHUMB SUCKING

PLACEMENT OF THE THUMB INTO PLACEMENT OF THE THUMB INTO VARIOUS DEPTHS INTO THE MOUTHVARIOUS DEPTHS INTO THE MOUTH

THUMB SUCKING + FINGER SUCKING THUMB SUCKING + FINGER SUCKING

= DIGIT SUCKING= DIGIT SUCKINGone of the commonly seen habits. one of the commonly seen habits.

Thumb sucking is observed in the Thumb sucking is observed in the intrauterine life.intrauterine life.

SUCKING – 1SUCKING – 1STST CO—ORDINATED MUSCULAR CO—ORDINATED MUSCULAR ACTIVITY OF THE INFANT ACTIVITY OF THE INFANT

CLASSIFICATIONSCLASSIFICATIONS

NORMAL T S:NORMAL T S: - 1- 1STST & 2 & 2NDND YEAR OF LIFE YEAR OF LIFE

- DON’T GENERATE ANY MALOCCLUSION- DON’T GENERATE ANY MALOCCLUSION

ABNORMAL T S:ABNORMAL T S: a. psychological:a. psychological:

- Deep-rooted emotional factor- Deep-rooted emotional factor

- insecurities, neglect or loneliness- insecurities, neglect or loneliness

b. habitual:b. habitual:

- performs due to habit- performs due to habit

- can cause malocclusion- can cause malocclusion

O’ BRIEN (1996)O’ BRIEN (1996)

NUTRITIVE SUCKING HABITS:NUTRITIVE SUCKING HABITS: - - BREAST/BOTTLE FEEDINGBREAST/BOTTLE FEEDING

NON-NUTRITIVE SUCKING HABITS NON-NUTRITIVE SUCKING HABITS ((NNS HABITSNNS HABITS))

- THUMB , FINGER OR PACIFIER SUCKING- THUMB , FINGER OR PACIFIER SUCKING

SUBTELNY (1973)SUBTELNY (1973)TYPE A: 50%TYPE A: 50% - WHOLE DIGIT INSIDE, PAD OVER PALATE- WHOLE DIGIT INSIDE, PAD OVER PALATE

& CONTACT WITH MAX & MAND ANTERIORS& CONTACT WITH MAX & MAND ANTERIORS

TYPE B: 13 – 24%TYPE B: 13 – 24% - - WITHOUT TOUCHING VAULT & MAINTAIN CONTACTWITHOUT TOUCHING VAULT & MAINTAIN CONTACT

TYPE C: 18%TYPE C: 18% - JUST BEYOND 1- JUST BEYOND 1STST JOINT & CNTCT ONLY WITH MAX JOINT & CNTCT ONLY WITH MAX

ANTANT

TYPE D: 6%TYPE D: 6% - VERY LITTLE PORTION OF THUMB- VERY LITTLE PORTION OF THUMB

ETIOLOGYETIOLOGY

VARIOUS THEORIESVARIOUS THEORIESCAUSATING FACTORSCAUSATING FACTORS

CLASSICAL FREUDIAN THEORY CLASSICAL FREUDIAN THEORY (1905)(1905)

INHERENT PSYCHOSEXUAL URGEINHERENT PSYCHOSEXUAL URGEEROGENOUS ZONEEROGENOUS ZONEHUNGER, SATIETY & SECURITYHUNGER, SATIETY & SECURITY

LEARNING THEORYLEARNING THEORY

DAVIDSON 1967DAVIDSON 1967 TS FRM AN ADAPTIVE RESPONSETS FRM AN ADAPTIVE RESPONSE

ORAL DRIVE THEORYORAL DRIVE THEORY

SEARS & WISE 1982SEARS & WISE 1982T S IS A RESULT OF PROLONGATION T S IS A RESULT OF PROLONGATION

OF NURSING, & NOT THE OF NURSING, & NOT THE FRUSTRATION OF WEANINGFRUSTRATION OF WEANING

SUCKING INCREASES THE SUCKING INCREASES THE EROTOGENESIS OF MOUTHEROTOGENESIS OF MOUTH

BENJAMIN’S THEORYBENJAMIN’S THEORY

T S ARISES FRM THE ROOTING OR T S ARISES FRM THE ROOTING OR PLACING RELEX SEEN IN MAMMALIAN PLACING RELEX SEEN IN MAMMALIAN INFANTSINFANTS

MOVEMENT OF THE INFANT’S HEAD & MOVEMENT OF THE INFANT’S HEAD & TONGUE TOWARDS AN OBJECT TONGUE TOWARDS AN OBJECT TOUCHING HIS CHEEKTOUCHING HIS CHEEK

JOHNSON & LARSON 1993JOHNSON & LARSON 1993

COMBN OF PSYCHOANALYTC & COMBN OF PSYCHOANALYTC & LEARNING THEORIES WHICH EXPLAINS LEARNING THEORIES WHICH EXPLAINS THAT ALL CHILDREN HAVE INHERENT THAT ALL CHILDREN HAVE INHERENT BIOLOGIC DRIVE FOR SUCKING. BIOLOGIC DRIVE FOR SUCKING. ROOTING & PLACING REFLEXES ARE ROOTING & PLACING REFLEXES ARE MERELY A MEANS OF EXPRESSION OF MERELY A MEANS OF EXPRESSION OF THIS DRIVE. ENVIRONMENTAL FACTORS THIS DRIVE. ENVIRONMENTAL FACTORS ALSO MAY CONTRIBUTE TO THIS DRIVE ALSO MAY CONTRIBUTE TO THIS DRIVE TO NON NUTRITIVE SOURCES…..TO NON NUTRITIVE SOURCES…..

CAUSATIVE FACTORSCAUSATIVE FACTORS

PARENT’S OCCUPN: PARENT’S OCCUPN: SOCIOECONOMIC STATUS SOCIOECONOMIC STATUS – SUCKLES INTENSIVELY – EXHAUSTED– SUCKLES INTENSIVELY – EXHAUSTED

- RECHANNELING THE SURPLUS URGE- RECHANNELING THE SURPLUS URGEWORKING MOTHER:WORKING MOTHER: CARETAKER - INSECURITY CARETAKER - INSECURITYNUMBER OF SIBLINGS: NUMBER OF SIBLINGS: ATTENTION DIVIDEDATTENTION DIVIDEDORDER OF BIRTH:ORDER OF BIRTH: LATER THE SIBLING RANK, LATER THE SIBLING RANK,

GREATER D CHANCE – IMITATION IN SUCKLINGGREATER D CHANCE – IMITATION IN SUCKLINGSOCIAL ADJUSTMENT & STRESS: SOCIAL ADJUSTMENT & STRESS: INABILITY INABILITY

TO ADJ – SCOLDING PARENTSTO ADJ – SCOLDING PARENTSFEEDING PRACTICES:FEEDING PRACTICES: MORE IN BREAST FED MORE IN BREAST FED

CHILDREN – ABRUPT WEANINGCHILDREN – ABRUPT WEANING

AGE OF THE CHILD:AGE OF THE CHILD: NEONATES: PREMITIVE DEMANDS LIKE HUNGERNEONATES: PREMITIVE DEMANDS LIKE HUNGER

IISTST FEW WEEKS: FEEDING PROBLMS FEW WEEKS: FEEDING PROBLMS

ERUPTION OF 1ERUPTION OF 10 0 MOLAR: TEETHING DEVICEMOLAR: TEETHING DEVICE

LATER: RELEASE TENSIONLATER: RELEASE TENSION

PHASES OF DEVELOPMENTPHASES OF DEVELOPMENT

PHASE I (NORMAL & SUBCLINICAL): PHASE I (NORMAL & SUBCLINICAL): 11STST 3 YRS OF LIFE 3 YRS OF LIFE

PHASE II (CLINICALLY SIGNIFICANT): PHASE II (CLINICALLY SIGNIFICANT): EXTNDS B/W 3 – 6 EXTNDS B/W 3 – 6 ½ ½ - GREAT ANXIETY - - GREAT ANXIETY -

PHASE III (INTRACTABLE SUCKING): PHASE III (INTRACTABLE SUCKING): BEYOND 4BEYOND 4THTH – 5 – 5THTH YR – CONSULT YR – CONSULT PSYCHOLOGISTPSYCHOLOGIST

CLINICAL FEATURESCLINICAL FEATURES

DEPENDS ON: DEPENDS ON: POSITION OF THE DIGITPOSITION OF THE DIGIT ASSOCIATED OROFACIAL MUSCLE ASSOCIATED OROFACIAL MUSCLE

CONTRACTIONCONTRACTION POSITION OF MAND DURING SUCKINGPOSITION OF MAND DURING SUCKING FACIAL SKELETAL PATTERNFACIAL SKELETAL PATTERN INTENSITY, FREQ & DURN OF FORCEINTENSITY, FREQ & DURN OF FORCE

MAX ANT PROCLINATION & MAND MAX ANT PROCLINATION & MAND RETRORETRO

ANTERIOR OPEN BITEANTERIOR OPEN BITE --INTERFERENCE WITH NORMAL ERUPTIONINTERFERENCE WITH NORMAL ERUPTION

-EXCESSIVE ERUPTION OF POSTERIORS-EXCESSIVE ERUPTION OF POSTERIORS

CONSTRITION OF MAXILLARY ARCHCONSTRITION OF MAXILLARY ARCHPOSTERIOR CROSS BITEPOSTERIOR CROSS BITE

DIAGNOSISDIAGNOSIS

HISTORY: HISTORY: DETERMINE THE PSYCHOLOGICAL DETERMINE THE PSYCHOLOGICAL COMPONENTCOMPONENT

EXTRAORAL: EXTRAORAL: KEY AREASKEY AREAS DIGITSDIGITS – REDDENED , EXCEPTIONALLY CLEAN, – REDDENED , EXCEPTIONALLY CLEAN,

CHAPPED & WT A SHORT FINGERNAIL – CHAPPED & WT A SHORT FINGERNAIL – DISHPAN THUMB – CALLUS – DEFORMATION DISHPAN THUMB – CALLUS – DEFORMATION OF FINGEROF FINGER

LIPSLIPS – UPPER SHORT & HYPOTONIC, LOWER IS – UPPER SHORT & HYPOTONIC, LOWER IS HYPERACTIVE & LEADS TO FURTHER HYPERACTIVE & LEADS TO FURTHER PROCLINATION OF UPPER ANTERIORSPROCLINATION OF UPPER ANTERIORS

FACIAL FORMFACIAL FORM – MAND RETRUSION, MAX – MAND RETRUSION, MAX PROTRUSION, HIGH MANDIBULAR PLANE PROTRUSION, HIGH MANDIBULAR PLANE ANGLEANGLE

INTRA ORAL:INTRA ORAL: TONGUE –TONGUE – SIZE & POSITION AT REST , SIZE & POSITION AT REST ,

TONGUE ACTION DURING SWALLOWINGTONGUE ACTION DURING SWALLOWING

DENTO ALVEOLAR STRUCTURESDENTO ALVEOLAR STRUCTURES

GINGIVA – GINGIVA – EVIDENCE OF MOUTH BREATHING??? GUMLINE ETCHING, DECAYED OR EXCESSIVE STAINING ??

PREVENTIONPREVENTION

MOTIVE BASED APPROACHMOTIVE BASED APPROACHCHILD’S ENGAGEMENT IN VARIOUS CHILD’S ENGAGEMENT IN VARIOUS

ACTIVITIESACTIVITIESPARENT’S INVOLVEMENTPARENT’S INVOLVEMENTDURATION OF BREAST FEEDINGDURATION OF BREAST FEEDINGPHYSIOLOGIC NIPPLEPHYSIOLOGIC NIPPLEUSE OF DUMMY OR PACIFIERUSE OF DUMMY OR PACIFIER

TREATMENTTREATMENT

PSYCHOLOGICAL THERAPYPSYCHOLOGICAL THERAPY

REMINDER THERAPYREMINDER THERAPY

MECHANOTHERAPYMECHANOTHERAPY

PSYCHOLOGICAL THERAPYPSYCHOLOGICAL THERAPY

PROFESSIONAL COUNSELLINGPROFESSIONAL COUNSELLINGB/W 4-8 – REASSURANCE, +VE B/W 4-8 – REASSURANCE, +VE

REINFORCEMENT & FRIENDLY REINFORCEMENT & FRIENDLY REMINDERSREMINDERS

AWARENESS OF DENTOFACIAL AWARENESS OF DENTOFACIAL ANOMALIESANOMALIES

SUPPORT FRM PARENTS DURING SUPPORT FRM PARENTS DURING TREATMENTTREATMENT

DESTRUCTIVE APPROACHES FROM DESTRUCTIVE APPROACHES FROM PARENTSPARENTS

AIM IS TO GAIN CONFIDENCEAIM IS TO GAIN CONFIDENCE+VE BEHAVIOUR MODIFICATION & +VE BEHAVIOUR MODIFICATION &

HYPNOSIS IS EFFECTIVEHYPNOSIS IS EFFECTIVEDUNLOP’S DUNLOP’S BETA HYPOTHESISBETA HYPOTHESIS

REMINDER THERAPYREMINDER THERAPY

EXTRA ORAL APPROACHES: EXTRA ORAL APPROACHES: QUININE, QUININE, ASAFOETIDA (HABIT NOT FIRMLY ASAFOETIDA (HABIT NOT FIRMLY ENTRENCHED)ENTRENCHED)

INTRA ORAL APPROACHES: INTRA ORAL APPROACHES: ORTHODONTIC APPLIANCES TO ATTENUATE ORTHODONTIC APPLIANCES TO ATTENUATE AND EVENTUALLY BREAK THE HABITAND EVENTUALLY BREAK THE HABIT

MECHANOTHERAPYMECHANOTHERAPY

FIXED INTRA ORAL ANTI THUMB FIXED INTRA ORAL ANTI THUMB SUCKI NG APPLIANCESUCKI NG APPLIANCE

BLUE GRASS APPLIANCEBLUE GRASS APPLIANCEQUAD HELIXQUAD HELIX