Oral Habits & Habits Breaking Appliances

Presented By: Rahaf Najjar

Lecture Outline: Introduction. Prevalence of oral habits. Thumb sucking habit & its management. Tongue Thrusting habit & its management. Lip habit & its management. Bruxism & its management. References.

Lecture Outline: Introduction. Prevalence of oral habits. Thumb sucking habit & its management. Tongue Thrusting habit & its management. Lip habit & its management. Bruxism & its management. References.

Introduction

1957 Dorland

• Habit can be defined as a fixed or constant practice established by frequent repetition

1982Mathewso

n

• Oral habits are learned patterns of muscular contractions

Lecture Outline: Introduction. Prevalence of oral habits. Thumb sucking habit & its management. Tongue Thrusting habit & its management. Lip habit & its management. Bruxism & its management. References.

Prevalence of Oral Habits

Lecture Outline: Introduction. Prevalence of oral habits. Thumb sucking habit & its management. Tongue Thrusting habit & its management. Lip habit & its management. Bruxism & its management. References.

Thumb Sucking HabitGellin (1978)

It is placement of thumb or one or more fingers in varying depths into the mouth.

Common in infants .

23% to46% of children aged 1 to 4years.

Develops ‐Between birth and 3 months of age.

Intensity increases ‐till 7 months and then declines.

Discontinue the habit by 3‐4 years of age.

Parents should discourage the habit after age 4 years if not stopped .

Severity depending on frequency, duration, Intensity .

Thumb Sucking Habit

Clinical features

Treatment:

Starts 4 to 6 years

4 different approaches1) Counselling2) Reminder therapy3) Reward system4) Adjunctive therapy5) Appliance therapy

Appliance therapyIntra Oral Appliances :

1) Quad Helix Patient with posterior cross bite As a reminder

2) Bluegrass Appliance This is the least intrusive appliance and easiest for the

patient to wear and tolerate.

Ideal for patients that want to quit, but need a reminder to help them.

3) Palatal crib Patient without cross bite Retainer 6‐12 months

More aggressive than the Blue Grass. It blocks the thumb, so the patient can’t suck them.

The cribs are long vertical cribs, made in the anterior palatal aspect, resting lingual to upper anterior.

They are long enough , but not interfere with mandible.

It is made up of .020” ss wire, lies 3-4 mm from the incisors with length of 6 – 12 mm.

The cribs act as: break the suction and force ofthe digit on the anterior segment. To remained the pt of his habit. To make the habit non- pleasurable

Fabrication:

.04” SS wire

4) Hayrake

This is the most aggressive appliance to prevent Thumb sucking.

Prongs are added to this appliance to make it as uncomfortable as possible when the patient tries to suck their thumb.

5) Removable Habit Appliance

Habit Loops can be added to any removable appliance. This appliance acts as a reminder to help break the habit

with cooperative patients. It is a great option for patients to wear while they sleep to

break a Tongue or Thumb Habit

Lecture Outline: Introduction. Prevalence of oral habits. Thumb sucking habit & its management. Tongue Thrusting habit & its management. Lip habit & its management. Bruxism & its management. References.

Tongue thrusting  (also called reverse swallow or immature swallow)

It is a common name of orofacial muscular imbalance, a human behavioral pattern in which the tongue protrudes through the anterior incisors during swallowing, speech, and while the tongue is at rest.

Clinical Feature Short flaccid upper lip Mandibular movements‐no correlation between tongue tip

and mandible Speech: s, n, t, d, l, z, v, th. Increase anterior facial height.

Intraoral Findings Tongue movements–irregular Malocclusion Maxilla–Proclination, increase in overjet Mandible proclination Anterior open bite

TreatmentTreatment Consideration:Self correcting by age 8 – 9 Y old

Treatment Modalities:1. Training of correct swallow and posture of tongue 2. Speech therapy3. Mechanotherapy4. Correction of malocclusion

Training of Correct Swallow and Posture of Tongue1. Ask the pt to put tongue tip in the rugae area for 5 minutes

, thin ask him to swallow.

2. Tongue tip hold against the palate using orthodontic elastics or sugarless fruit drops.

3. 4S exercise.

4. Whistling

5. Count from 60 -69

Training of Correct Swallow and Posture of TongueUsing appliances as a guide in the correct positioning of tongue Preorthodontic Trainer: It aids in correct positioning of the tongue with the help on

tongue tags. The tongue guards prevent tongue thrusting when in

place.

Nance palatal Arch Appliance

Speech Therapy

Not before 8 years

To trine the correct position of the tongue.

Mechanotherapy

Fixed Appliances

Palatal crib MYOFUNCTIONAL BEAD Tongue-Thrusting Device

Removable Appliances

Hawley Appliance Oral Screen

1. Restriction of tongue thrusting habit2. Alignment of maxillary anterior teeth 3. Correction of open bite4. Lip muscle exercises performed with ring

attached in anterior part of appliance

Lecture Outline: Introduction. Prevalence of oral habits. Thumb sucking habit & its management. Tongue Thrusting habit & its management. Lip habit & its management. Bruxism & its management. References.

Lip HabitHabits that involve manipulation of the lips and perioral structures are termed as lip habits .

Manifestations Protrusion of maxillary incisors and retrusion of mandibular

incisors Lip The mentolabial sulcus becomes accentuated

Treatment 1. Correction of malocclusion2. Treating the primary habit 3. Appliance therapy : Lip bumper / Oral screen

Lecture Outline: Introduction. Prevalence of oral habits. Thumb sucking habit & its management. Tongue Thrusting habit & its management. Lip habit & its management. Bruxism & its management. References.

Bruxism

Bruxism is the habitual grinding of teeth when the individual is not chewing or swallowing.

Prevalence: Commence in infancy with the eruption of the

first primary tooth.

Common occurrence is during sleep.

Incidence of bruxism in children varies widely from 7% to 88%.

Clinical features Occlusal Trauma Tooth structure loss Muscular tenderness T.M.J. disorders Headache

Treatment

1) Adjunctive Therapy: Psychotherapy: Aimed at lowering emotional or psychic

tension

Auto suggestion and Hypnosis: Where the patient becomes conscious of his habit and understands the possible consequence

2) Elimination of oral pain and discomfort:Pain associated with periodontal disease, lip and cheek should be eliminated

Treatment

3) Occlusal therapy: Occlusal adjustments: Bite raising crowns, splints and

elimination of occlusal interference

Occlusal reconstruction and prosthesis

Bite guard : Prevents continual abrasion of teeth

References:

Dentistry for the child and adolescent, McDonald, 8thedition Pediatricdentistry : Scientific foundations and Clinical practice –

Stewart barber Text book of pediatricdentistry, S.G. Damle, 3rd edition Principles and practice of pediatricdentistry, ArathiRao pg:147‐

162 Pediatricdentistry –infancy through adolescence, 4thedition

pinkhampg:431‐439 Text book of pedodontics–shobhatandon2ndedition pg:492‐526 Prevalence of pacifier sucking habits and successful methods to

eliminate them –a preliminary study. Viviane, Regina. Journal of dentistry for children –71:2, 2004. Pg 148‐151.

http://www.jdtunbound.com/files/pdf-files/havingtheblues0304.pdf

Feeding, artificial sucking habits and malocclusions in 3 year old girls in different regions of the world. Esberet al. JDC –72:1, 2005. Pg 25‐30

Bluegrass appliance (AAPD vol13 no 2, Haskell et al) Sucking habits: clinical management in dentistry, Gabriel etal.

JCPD, vol15, no 3/1991, pg 137‐155 Thumb sucking (journal of applied behaviour analysis 2000, 33,

41‐52, Elingsonet al) Association between early weaning, non nutritive sucking habits

and occlusal anomalies in 3 year old Finnish children. Karjalainen, Ronning, Lapinleimu, Simell. IJPD 1999;9. Pg 169‐173

http://www.orthodonticproductsonline.com/2007/02/on-the-market-2007-02-11/

http://ohlendorfappliancelab.com/habit-correction-appliances/