2. Introduction
Habits are said to consist of a complex system of reflexes, either inherited or
acquired, which begin to express/function when a child or an adult is confronted
by an appropriate stimulus. Habits are either instinctive (thumb sucking in an
infant), obstructive (mouth breathing in a child with enlarged adenoids) or
learned behavioral patterns (tongue thrusting).
Most oral habits exert abnormal forces on the teeth and perioral structures, thus,
adversely affect the optimum growth and the development of the dentofacial
structures. The facial bones are not densely calcified in early childhood, so the
abnormal pressures from oral habits can create abnormal developmental forces,
which result in malocclusion.
3. Deleterious oral habits, such as thumb/digit sucking, lip sucking and biting,
tongue thrusting, mouth breathing contribute directly or indirectly to the
occurrence of different types of malocclusion and an imbalance of facial
components, thus affecting esthetics, phonetics, mastication and
swallowing. Th e consequences can be grave and immediate measures
should be undertaken to break the deleterious habits.
4. THUMB SUCKING
Thumb/finger sucking collectively called as digit sucking is one of the most
commonly observed oral habits among children which define as “ the
placement of thumb or one or more fingers in varying depth into the
mouth.”
5. There are essentially two forms of sucking:
Nutritive sucking
It is the sucking observed during breast/bottle feeding, which provides nutrition
to the infant.
Non-nutritive sucking
Is the earliest sucking habit adopted by infants in response to frustration and to
satisfy their need for contact. Children who are deprived of unrestricted breast-
feeding and do not have an access to pacifier may develop digit/sucking habit in
order to satisfy their emotional needs.
6. Clinical Features
Intraoral Features
1. Proclination of upper anteriors and retroclination of lower incisors and
increased maxillary arch length
2. Increased SNA angle and decreased SNB angle
3. Increased overjet and decreased overbite
4. Anterior open bite and posterior crossbite and increased chances of
developing class II molar and canine relationship.
7. Extraoral Features
1. Lip is incompetence
2. Upper lip short and hypotonic
3. Hyperactive lower lip
4. Lower lip placement lingual to upper anteriors
8. Management
Psychological Approach and Behavior Modification
Reminder Therapy: this is for those children who wish to stop the habit but
need assistance to do so.
Mechanical methods: These include the following:
Thermoplastic thumb post that covers the offending digit, taping of the
offending digit or tying it to the elbow
Chemical methods: These include the following:
Hot tasting or bitter flavored preparations or distasteful agents are applied to the
offending finger/thumb.
Appliance Therap.
9. TONGUE-THRUSTING HABIT
It is an abnormal tongue activity in which the tongue is thrust between the
upper and lower teeth during swallowing
CLASSIFICATION
According to aetiology tongue thrust habit can be classified into following four
types:
I. Physiologic
II. Habitual
III. Functional
IV. Anatomic
10. Clinical Featues
Extraoral Features :
1. Lips: Incompetent lips
2. Anterior facial height: Increased
3. Nasolabial angle is decreased .
Intraoral Features :
1. Maxillary anterior proclination
2. Generalized spacing between
the teeth
3. Constricted arches near molar
region—due to lowered posture
of tongue.
11. Management
Self-correcting tongue thrusting: Tongue thrust habit does not require any
orthodontic treatment. It often self-corrects by 7–8 years of age by the time the
permanent anterior teeth erupts completely.
Tongue thrusting without malocclusion or speech disturbance: Treatment is
generally not recommended when tongue thrust is present without any kind of
malocclusion to any speech disturbances.
Tongue thrusting with malocclusion: Orthodontic correction of the malocclusion
caused by tongue thrusting will usually eliminate the tongue thrusting habit.
12. MOUTH-BREATHING HABIT
“Mouth breathing is defined as habitual respiration through the mouth instead
of the nose.” Mouth-breathing can cause malocclusion by disrupting the
orofacial equilibrium of pressures on teeth and jaws.
Aetiology
Common cause of mouth breathing is some form of obstruction to nasal airways.
Nasal insufficiency can be due to facial form or other causes.
13. Clinical Features
Extraoral Features
1. Adenoid facies: Patients typically exhibit “Adenoid facies” characterized by
long, narrow face with narrow nose and nasal passages.
2. Dolichocephalic facial form and Increased facial height.
3. Incompetent lips , Short and flaccid upper lip with heavy and everted lower lip
and there is Gummy smile
Intraoral Features
1. Proclination of maxillary anteriors and lower anterior may be retroclined
2. Increased overjet and Posterior crossbite.
3. Gingiva: Gingiva is hyperplastic, especially in relation to maxillary anterior
teeth due to continuous exposure of the tissue to dry air.
14. Diagnosis
Ask the patient to take a deep breath: Most mouth breathers respond to this
request by inspiring through the mouth without changing the size or shape of
external nares.
Mirror test: a double-sided mirror is held between the nose and mouth. Fogging
on the nasal side of the mirror indicates nasal breathing while fogging on oral
side indicates mouth breathing.
Cotton test/Massler's butterfly test: butterfly shaped cotton strand is placed over
the upper lip below nostrils. If the cotton flutters down, it is a sign of nasal
breathing. This test can be used to determine unilateral nasal blockage.
Water test: the patient is asked to fill the mouth with water and retain it for a
period of time. Mouth breathers find this task difficult.
15.
16. Treatment
1. Age of the child: Mouth breathing is in many instances self-correcting after
puberty.
2. ENT referral: ENT referral for the management of pharyngeal obstruction.
3. Correction of mouth breathing: Mouth breathing should be corrected
during mixed dentition period to prevent or correct its harmful effects on
occlusion.
4. Symptomatic treatment: Symptomatic treatment of gingival and periodontal
tissue should be done.
17. NAIL-BITING HABIT
Nail-biting habit is one of the most common habits in children and adults .
Clinical Features
1. Crowding
2. Rotation
3. Attrition of lower incisors or upper anteriors
4. Effect on nails: Inflammation of nailbeds and also nails.
18.
19. Management
Mild cases—no treatment
Avoid punitive methods, such as Scolding
Treat the basic emotional factors causing the habit
Encourage outdoor activities, which may help in easing tension
As a reminder, nail polish, tight cotton, mittens can be applied on nails.
20. BRUXISM
Ramfjord (1966) define Bruxism “ is habitual grinding of teeth when the
individual is not chewing or swallowing “ .
Types
Bruxism is of two types:
1. Diurnal bruxism/day-time bruxismIt is conscious or subconscious grinding of
teeth usually during the day.
2. Nocturnal bruxism/night-time bruxism :It is the subconscious grinding of
teeth characterized by rhythmic pattern of masseter EMG activity.
23. Treatment
Occlusal adjustments: These include:
1. Correction of restoration
2. Coronoplasty
Occlusal splints: Vulcanite splints have been recommended to cover the occlusal
surface of all teeth as treatment of bruxism.
Restorative treatment: Restorative treatment should be performed in case of
abrasion.
Psychotherapy: Counseling the patient can lead to decrease in tension and also
create habit awareness.
Orthodontic correction: Malocclusions such as class II and class III when
associated with functional malocclusion may create a predisposition to bruxism,
such malocclusions are corrected by removable or fixed orthodontic appliance.
