Habits / dental crown & bridge courses

HABITS
www.indiandentalacademy.com

Habit:
The concise oxford English dictionary defined
a habit as a ‘settled regular tendency or practice’
and a ‘practice that is hard to give up’.

CONTENTS:
 INTRODUCTION
 DEFINITIONS
 DEVELOPMENT OF HABIT
 CLASSIFICATION OF HABIT
 DIGIT SUCKING
 TONGUE THRUSTING
 MOUTH BREATHING
 BRUXISM
 LIP HABITS
 FINGER NAIL BITING HABIT
 SELF INJURIOUS HABIT
 CONCLUSION
 REFRENCES www.indiandentalacademy.com

Introduction:
 Though it is difficult to delineate it, but it is important
to have differentiation of abnormal from normal
because, If normal development get disturbed
unknowingly and at the same time, If abnormal
growth or underlying psychological cause let continue
without interfering at proper time/age it will lead to
long lasting effect on stomatognathic system its
growth & development and psychological
development of child.

Definitions of habits:
 Johnson (1938) – A habit is an inclination or aptitude
for some action acquired by frequent repetition and
showing itself in increased facility to performance and
reduced power of resistance.
 Maslow (1949) – A habit is a formed reaction that is
resistant to change, whether useful or harmful,
depending on the degree to which it interferes with
the child’s physical emotional and social functions.
 Dorland (1957) – Dorland defined habit in general
“as a fixed or constant practice established by
frequent repetition.”

 Buttes worth (1961) - defined habit as a frequent or
constant practice or acquired tendency which has
been fixed by frequent repetition.
 Finn (1972) - a habit is an act, which is socially
unacceptable.
 Mathewson(1982)- particularly highlighted the
muscular involvement in oral habit. According to him,
oral habit can be defined as learned pattern of
muscular contractions.
 Moyers - Habits are learned patterns of muscle
contraction, which are complex in nature.
 Stedman - Habit is an act, behavioral response,
practice or custom estaiblished in one’s repertoire by
frequent repetitions of the same act.

Development of habit:
 Development of habit should not be confused with
one normal developmental phenomenon Instinct.
 Newborn infant develops some Instincts composed of
elementary reflexes. An instinct is one where the
pattern and order are inherited while in habit, pattern
and order are acquired.
 If these acquired pattern and order are repeated over
a long Period of time, it becomes habit.

Classification of habits:
 Obsessive habits (deep rooted)
- Intention habits e.g. digit sucking, nail biting
- Masochistic/self injurious habits e.g. gingival
stripping habit
 Non-obsessive (easy learned and easy to drop)
-Unintentional e.g. chin propping
-Functional habit e.g. mouth breathing, Bruxism,
Tongue thrusting etc

 Various Authors have classified habits e.g.
 William James (1923) - useful habits
- harmful habits
 Kingsley (1958) - Functional oral habits
- Muscular habits
- Combined
 Morris and Bohana (1969)
-Pressure/non Pressure habits
-Biting habits
 Klein (1971) - empty habits
-meaningful habits
 Finn (1987) -Compulsive habit
-Non-compulsive habit
-Primary habit
-Secondary habitwww.indiandentalacademy.com

Deleterious oral habits:
 These habits are sometime called pernicious oral
habits. But this is misnomer as word pernicious mean
fatal which may risk life as in medical field one
common example is pernicious anemia. Though oral
habits may cause marked damage to structure and
function of stomatognathic system, but in strict sense
it cannot be considered as pernicious.

Common harmful or deleterious habits seen in
children which affect the dento-facial complex
and which in turn leads to malocclusion are:
 Improper bottle feeding
 Thumb sucking
 Mouth breathing
 Tongue thrusting
 Lip biting
 Bruxism

DIGIT/THUMB SUCKING:
 Digit sucking may be defined as placement
of digit (thumb/finger) into various depths into
mouth.

 Possible etiologic factors:
 e.g. if a child starts digit sucking habit in first few
weeks of life it is typically related to feeding problem.
Few children develop digit sucking at time of eruption
of primary teeth as teething device particularly during
painful eruption of primary molars; still later few
children develop this habit to relieve emotional and
psychological stress.
 Habits may be related to hunger, satisfying sucking
instinct, Insecurity, or even as a desire to attract
attention.

Theories of various causative
factors in thumb sucking:
1. Classic Freudian theory. (Sigmund Freud,
1905)
2. Oral derive theory. (Sears and Wise 1982)
3. Learning theory. (Davidson 1967)
4. Rooting and placing reflex theory. (Johnson
and Larson1993)

Grades of digit sucking:
 Subtelny (1973) has graded thumb sucking
into 4 types:
 Type A
 Type B
 Type C
 Type D

Factors influencing the effect of
digit sucking on dentition:
 There are various factors which will modify
the effect of habit performance on dentition.
 These factors are
1. Pattern of habit performance
2. Various parameters of habit i.e. frequency,
duration and intensity.

Effect of digit sucking:
 Labial flaring of maxillary incisors which lead to
spacing between these teeth.
 Lingually collapsed mandibular incisors with
crowding.
 These factors lead to increased over jet & decreased
overbite.
 Less frequent but quite possible is bilateral posterior
cross bite due to collapsed maxillary arch under the
influence of buccal forces.
 Deep palatal vault because of direct pressure.

 Apart from malocclusion in few cases, prolong
sucking may cause skeletal change. E.g mandibular
postural retraction may develop if weight of hand or
arm continuously force mandible to assume retracted
position in order to comfortably perform habit.
 Open bite developed due to thumb sucking habit may
predispose to simple tongue thrust habit.
 Upper lip becomes hypotonic and lower lip
hyperactive since orbicularis oris muscle has to
elevate lower lip between malposed incisors during
swallow.

 Development of habit is divided into 3
distinct phases:
 PHASE I: normal and subclinically significant sucking.
 PHASE II: clinically significant sucking.
 PHASE III: intractable sucking.

Diagnosis:
1. History:
 Enquire the feeding pattern and parental care.
 Questions regarding the frequency, intensity and
duration of habit.
 Presence of other related habits e.g. tongue thrust
etc should be evaluated.

2. Clinical findings:
 Clean pulp of thumb and short nail.
 Dento-alveolar pattern i.e. typical flaring of maxillary
incisors and collapsed crowded lower anterior.
 Excessive /vigorous thumb sucking may cause
irritated and reddened palatal rugae area.

Management:
 The single most important factor to be considered in
management is age of child, up to age of 3-4 years
this habit is considered normal.
 Control of habit –usually begin in phase II problem.
 Dunlop’s Beta-hypothesis. He believed that if any
child in asked to concentrate on the performance of
act (i,e habit) at the time he practice , it will slowly
force the child to stop that particular act.

 Phase III
 It is better to have psychologist consultation because
most of children in this phase of habit practice have
underlying psychological problems.

 Choice of appliances:
 Ideal appliance, which will be used for this purpose-
a) Should offer no restraint to normal muscular function
and growth
b) Should not involve parents
c) Should not attach shame with its use
 Removable appliances
 Fixed mechanotherapy

Swallow:
 Swallow is a complex integrated physiologic
process which is entirely a muscular activity.
As various muscles are involved, specific and
definite stress patterns are observed in
swallowing.
25www.indiandentalacademy.com

Methods of swallow
examination:
 Patient is asked to sit upright with
unsupported back and head.
 Observe unnoticed various swallow.
 Then small amount of water is placed in
mouth and patient is asked to swallow.

 Various events that occur in mature swallow are :
 Mandible raises to bring teeth together during
swallow.
 Lips touch lightly without any obvious movements.
 Facial muscles do not show any obvious
contractions.
 Hand is placed over temporalis muscle and patient is
asked to swallow. If Contraction of temporalis felt, it
indicates that stabilization and elevation of mandible
during swallow is brought by contraction of muscle of
mastication.
 Lower lip is held gently with fingers or a tongue
depressor is placed over lower lip. Individuals with
normal swallowing completes the swallowing cycle
with no movement of lip. 27www.indiandentalacademy.com

 The classification of swallowing pattern was
carried out while the children were swallowing
saliva or small amounts of water. First the
mandibular movement and the use of perioral
muscles were observed during swallowing.
The temporalis and the masseter muscles
were then palpated during unconscious
swallowing, as this could be different from a
“swallow on command.”

TONGUE THRUSTING:
 Tongue thrusting and infantile swallow habits are
related so closely to each other that it is very difficult
to differentiate and describe them individually.
infantile swallow is a complex muscular function
aberration in which tongue thrusting is one
component.

Definitions:
 Brauer (1965): A tongue thrust is said to be present
if tongue is observed thrusting in-between and teeth
did not close in centric occlusion during deglutition.
 Tulley (1969) : He states tongue thrust as the
forward movement of tongue tip between the teeth to
meet the lower lip during deglutition and in phonation,
so that tongue becomes interdental.

 Barber (1975): Tongue thrust is an oral habit with
persistence of an infantile swallow pattern during
childhood and adolescence and thereby produces an
open bite and protrusion of anterior teeth.
 Schneider (1982): Tongue thrust is a forward
placement of tongue between the anterior teeth and
against the lower lip during swallowing.

Classification of tongue thrust:
 Etiologic classification:
 Physiologic
 Habitual
 Functional
 Anatomic

 Clinical classification:
 (James S. Brauer & Holt) classified tongue thrust
habit depending on deformity it cause
 Type 1: non deforming tongue thrust
 Type 2: deforming anterior tongue thrust
 Type 3: deforming lateral tongue thrust
 Type 4: deforming anterior + lateral tongue thrust

Etiology of tongue thrust:
1. Learned behavior
2. Maturation
3. Mechanical restrictions
4. Enlarged tonsils and adenoids
5. Neurologic disturbances
6. Psychogenic factors
7. Genetic factors

 Normal swallow proceeds as follow :
 Tongue tip placed just behind maxillary incisors.
 Midpoint of tongue is raised to top of oral cavity i.e
against hard palate.
 Tongue moves against hard palate in posterior
direction tipping at 45°so that posterior part of tongue
will lie against the pharyngeal wall.
 Simultaneous with tongue action, buccinator and
masseter, Muscle exert lateral forces against
dentition.
 Orbicularis oris generates posterior force against
maxillary anterior teeth.
 Hence 3 major muscle groups are activated

Various forms of tongue thrust
habits:
 SIMPLE TONGUE THRUST:
 It is defined as tongue thrust with teeth together
swallow.
 It is usually associated with history of thumb / digit
sucking habit even though this predisposing habit no
longer being practiced.
 Malocclusion associated with simple tongue thrust is
well circumscribed anterior open bite.

 COMPLEX TONGUE THRUST:
 Defined as tongue thrust with teeth apart swallow
Complex tongue thrust is likely to be associated with
chronic nasorespiratory distress, tonsilitis etc.
 Malocclusion associated with complex tongue thrust
has two distinguished features
 -Poor occlusal fit. There is no firm intercuspation
when study models are oriented together.
 -Generalized anterior open bite unlike simple anterior
tongue thrust, open bite produced by complex tongue
thrust is diffuse.

 ABNORMAL TONGUE POSTURE
 There are two forms of protracted abnormal tongue
posture.
 1. Endogenous
 2. Acquired
 Endogenous type abnormal posture -Usually during
eruption of teeth, tongue adapts a posture confined
within dental arches. This abnormal posture may
produce marked open bite.
 Acquired abnormal tongue posture -This usually
result from chronic pharyngitis, tonsillitis etc. but may
also present in cases with narrow maxilla.

 RETAINED INFANTILE SWALLOW:
 Infantile / visceral swallow is normal for infants upto
age of 1 ½ year beyond which this immature type of
swallowing pattern get change to mature swallow
through transition period.

 Tongue-thrust and the Stability of Overjet
Correction
 Mary V. Andrianopoulos
 Marvin L. Hanson
 Long-term study of incidence of tongue-thrust
from age 4 to 18 finds the dysfunction
disappearing in some individuals and
appearing in others. A small study of the
effect of tongue-thrust therapy on stability of
overjet correction suggests a beneficial effect.

 UHDE (1981) examined 72 orthodontically-treated
patients a minimum of 12 years after treatment to
evaluate treatment and posttreatment changes in
occlusion and evaluate their relationship to the type
of original malocclusion and to therapeutic extraction.
 Uhde found a tendency for overjet, overbite, maxillary
and mandibular arch widths, and maxillary and
mandibular arch crowding to return toward their
pretreatment values during the posttreatment period,
reporting “unacceptable” occlusions in half of the
subjects after 12 years. These tendencies toward
relapse were not statistically related to the type of
original malocclusion or to extraction.

Effect of altered tongue
movement:
 Simple anterior swallow -is characterized by anterior
position of tongue during swallow. Tongue may be
hitting against the upper incisor or protruding in
between upper and lower incisors.
 Complex swallowing problem -In this type, the
abnormality of musculature extends from molar to
moral. Malocclusion seen is open bite which is not
limited to anterior region. Unilateral swallowing
problem .
 Bilateral swallowing problem -Characterized by
bilateral depression in molar areas but some
occlusion may be present in anterior region.www.indiandentalacademy.com

Clinical features:
 Proclination and spacing of anterior teeth
 Anterior open bite / incomplete over bite
 Bimaxillary protrusion
 Posterior open bite in lateral tongue thrust

 The role played by the tongue during growth and
development is still unresolved ( VANLINBORG
1970, LOWE AND JOHNSTON 1979).
 Clinically, whenever the tongue is seen as the
primary etiologic factor in a given malocclusion, it
must be known whether volume, posture, or function
is primarily responsible in order to choose the most
appropriate corrective treatment, such as
glossectomy or myofunctional therapy ( GRABER
1963, LOWE 1980, PEAT 1968).

 Among the numerous reports dealing with this
subject, only a few have used animal models. After
partial glossectomy was performed on growing rats,
LAMORLETTE (1973) found that tongue reduction
was followed by a significant decrease in several
dimensions of both the upper and the lower arches.
 On the other hand, experimental microglossia in
primates has shown that the surgical reduction on the
tongue was followed by crowding of the lower
incisors, increased overjet and overbite, and a
decrease in several dimensions of both the upper
and lower arches ( HARVOLD 1968, BERNARD
1980).

 It is possible to explain the observation reported here
by a relatively oversized tongue, growing in a normal
sized structural environment, forced to find the
necessary space outside the mouth. The increasing
openbite and the unusual feeding habit are both part
of such an adaptation.
 In this scenario, the openbite would act as a
spontaneously developed outlet to protect structures
against excessive tongue pressure. A glossectomy
could act as a pressure releasing device that leads to
the spontaneous disappearance of this space that is
no longer used.

Diagnosis:
 History - should include following :
 Information regarding any other oral habits eg thumb
sucking, mouth breathing, any infection of upper
respiratory system, inflammed tonsils for long
duration.
 Information regarding the swallowing pattern of
sibling for possible hereditary etiologic factors.

 Examination:
 Tongue and lip functions are synchronized in their
activities. Thus it is possible to get idea about
abnormal tongue function from observed lip
musculature.
 Eg : In infantile swallow pattern with tongue thrust,
lower lip also shows marked activity.
 Tongue is examined for posture while mandible is at
physiologic rest position.
 One way is to trace this posture from cephalogram
taken with mandible at rest position.
 Clinically it is evaluated by asking Patient to sit in
upright position, & then tongue and lip relationship
examined gently

Management:
1. Age
2. Associated manifestations
3. Malocclusion
4. Associated other habits
5. Associated problems of orofacial system
6. Speech defects

Treatment modalities:
 Training for correct swallow and posture /position of
tongue:
1. Myofunctional exercises
2. Mechanotherapy for habit breakage
3. Surgical treatment
4. Speech therapy
 Myofunctional exercises :
 For tongue
 For masseter
 For lips
 For swallow

1. For tip of tongue:
 One elastic swallow
 Tongue hold exercise
2. Exercise for the mid portion of the tongue:
 Two elastic swallow
 Hold pull exercise
3. Exercise for the posterior part of the tongue:
 Three elastic swallow

4. Exercise for masseter:
 Masseter count to ten exercise.
5. Exercise for lips:
 Tug of war and button pull exercise.
6. Exercise for swallow:
 Once patient has mastered muscle exercises for
tongue, lips and masseter, this integrated muscular
activity is brought into normal mature swallowing
pattern.
 Elastic for tongue exercises are replaced by liquid
food and patient is guided to perform mature
swallow act. Once patient becomes comfortable with
liquid food, solid food replaces liquid food.www.indiandentalacademy.com

7. Mechanotherapy:
 Both fixed and removable appliances can be used
to restrain the various tongue movement.
 Removable appliances
 Eg: tongue rake, tongue crib, tongue spikes
 Oral screen
 Fixed habit breaking appliance
8. Surgical optionswww.indiandentalacademy.com

MOUTH BREATHING:
 Mouth breathing is always abnormal, whether it is a
habit or necessity due to blockage of normal upper
respiratory passage.
 New born infants are obligate nasal breather and
slowly this pattern shifts to facultative nasal breathing
i.e. a child/person may breathe through mouth but
primary breathing is through nasal route.

Definitions:
 Sassouni (1971) defined mouth breathing as
habitual respiration through mouth instead of
nose.
 Merele (1980) suggested term oro–nasal
breathing instead of mouth breathing
because according to him, breathing is never
100% through mouth whatever may be the
cause for mouth breathing.

 Mouth breathing dental malocclusions. has
been a controversial topic in the
pathogenesis of some dental malocclusions.
 An early account on the maladies associated
with mouth breathing was proposed
approximately 130 yrs ago by a well known
american artist, George Catlin, in his book
entitled “malrespiration or breath of life.”
 His ideas on mouth breathing were very
advanced for this time, and many remain
today as hypothesis.

Classifications:
 FINN (1987) classified mouth breathing into:
1. Anatomic
2. Obstructive
3. Habitual

Etiology:
 Apart from anatomically short upper hip, the other
cause for mouth breathing is nasal obstruction.
 This airway obstruction may be due to
 enlarged turbinates
 Deviated nasal septum (DNS)
 Allergic rhinitis, nasal polyps
 Obstructive sleep apnea.
 Adenoid faces characterized by long narrow face and
nasal passage are also associated with mouth
breathing, but it is not very clear that whether this
particular pattern is due to mouth breathing or it
develops to facilitate mouth breathing.www.indiandentalacademy.com

 Breathing through the mouth rather than the nose,
could change the posture of the head, jaw and
tongue.
 This in turn could alter the equilibrium of pressures
on the jaws and teeth and affect both jaw growth and
tooth position.
 With these postural changes were maintained, face
height would increase and posterior teeth would
super errupt, unless there was unusual vertical
growth of the ramus, the mandible would rotate down
and back, opening the bite anteriorly and increasing
overjet and increased pressure from the stretched
cheeks might cause a narrower maxillary dental arch.

 Exactly this type of malocclusion is
associated with mouth breathing. The
descriptive term adenoid facies has appeared
in the english literature for at least a century.
 The classic adenoid facies consists of
- Narrow width dimensions
- Protruding teeth
- Lips seperated at rest

Clinical features:
 Long narrow face
 Narrow nose and nasal passage
 Short & flaccid upper lip
 Anterior marginal gingivitis
 Anterior open bite can occur

 In case of disagreement on classification among
investigators, a examination was performed.
 The mode of respiration was determined
independently by the two investigators before the
dental examination, and further confirmed by
questioning. The child was observed in a relaxed
position and it was noted whether a competent lip
closure was present. If this was not the case, the
child was asked to close the lips and breathe deeply
through the nose. If this resulted in a distinct tension
of the perioral muscles and pronounced difficulty in
breathing, the children were asked whether they
usually breathed through their nose or through their
mouth.

 Dental maturity and malocclusion symptoms were
recorded ( BJÖRK, KREBS AND SOLOW 1964).
The well-defined malocclusion traits observed by
this systematic qualitative determination were
assigned predetermined code numbers, as was
the information obtained from the clinical
examination of swallowing and respiration. The
results were tabulated by means of a computer
program. The frequency of the following
symptoms was analyzed for each sex for each
group of children characterized by different
swallowing patterns and mode of respiration.

Sagittal anomalies
 Distal occlusion (bilateral molar relationship). Grade 1, 1/2–1
cusp. Grade 2, full cusp.
 Mesial occlusion (bilateral molar relationship) > 1/2 cusp.
 Extreme maxillary overjet. Grade 1, 6–9 mm. Grade 2, > 9 mm.
Vertical anomalies
 Deep bite. Grade 1, 5–7 mm. Grade 2, > 7 mm.
 Frontal openbite, no vertical overlapping of incisors.
Transverse anomalies
 Crossbite right or left, including one or more pairs of teeth.
 Scissors bite right or left, including one or more pairs of teeth.
 Crowding or spacing, space discrepancy of more than 2mm in
the incisor segment or one cuspid-bicuspid segment.
 The malocclusion frequencies were compared by means of a
Student’s t-test and, in the case of small samples, by Fisher’s
exact test.

Diagnosis:
 History: Parents should be asked whether child had /
have frequent occurrence of tonsillitis, allergic rhinitis
etc; or if child frequently adopt lip apart posture.
 Examination of mouth breathing:
 In normal relax individual, lips are touching lightly. But
in mouth breather, lips will be definitely apart at rest
for passage of air. Lips will be dry, scaly because of
continuous drying and this may predispose to lip
wetting habit. Same drying effect predispose for
mouth breathing gingivitis and increased risk of
dental caries

 Functional examination:
 Ask the patient to take a deep breath. A mouth
breather when asked to close his / her lips and take
deep breath, there will be no appreciable change in
size and shape of external nares in contrast to
normal nasal breather which show dilatation of nares
during lips closed deep breathing because nasal
breathers normally demonstrate good reflex control of
alar muscle which control the size and shape of
external nares.

 Various clinical tests may be performed to
demonstrate absence of nasal breathing and also to
differentiate between blocked right or left nostril.
1. Water holding test
2. Mirror test -
3. Butterfly test –

 Inductive Plethysmography
(Rhinomanometry)
 Cephalometrics

Management:
 Treatment consideration
 Age – self-correction of mouth breathing could be
expected as child mature unless there is an obvious
and marked nasal obstruction. This is due to the fact
that there is an increase in nasal passage as child
grows especially if obstruction was due to enlarged
adenoids.
 E.N.T Consultation
 Almost all the time cause of mouth breathing is nasal
obstruction, so any E.N.T pathology should be ruled
out before any habit correction attempt.

 Interception of habit :
 Even after removal of causative factor if habit
persist, following measures should be taken
 Exercises:
 Physiologic exercises
 Deep breathing exercises are done in morning and
evening. Child is instructed to raise arms sideways
and take deep inhalation through nose. After a short
period of time, arms are dropped to sides and air is
exhaled through mouth.
 Lip exercises
 Lip elongating/ stretching exercise

 Wilson’s exercise (by william E. Wilson)
 Technique:
 Child is instructed to perform this technique as follow
 - Stand in front of mirror
 - Close teeth and lips without forcefull action
 - Contract the muscles at left corner of mouth
causing left corner to be pulled backward and
upward.
 Palmer surface of left hand fingers are placed on
right cheek, and now press this cheek tissue forward
and to left, at the same time holding the right nostril
closed with index figure of left hand. Tissues at left
corner of mouth must continue in contraction all
through this muscle pulling with left hand fingers.

 While tissues at left corner are still contracted and
right cheek is under pressure by fingers, breathe
deeply 3 times through the left nostril.
 - Relax the muscle and remove left hand.
 - Perform similar procedure on opposite sides.
 - Perform this habit 3 times thrice a day.
 Appliances for the correction of mouth breathing:
 Oral/vestibular screen
 Maxillothorax therapy (by Macaray 1960)

BRUXISM:
 Bruxism is grinding of teeth especially at night.
Strictly speaking it can not be considered habit
because almost all the times there is a definite
underlying etiologic factor e.g occlusal discrepancies.
 But if habitual grinding continues even after removal
of causative factor, then it can be considered as
habit.

Definitions:
 Ramfjord (1966) –Ramfjord defines bruxism as a
habitual grinding of teeth where individual is not
chewing or swallowing.
 Vanderas (1995) defined bruxism as non functional
movement of mandible with or without an audible
sound occurring during day or night.

 Manifestations:
 Signs and symptoms of bruxism depend on
frequency, intensity, duration of habit and age of
patient.
1. Occlusal Trauma
2. Attrition
3. Muscle tenderness
4. T.M.J Disorders

Etiology:
1. CNS
2. Occlusal discrepancies
3. Psychological factors
4. Genetics
5. Occupational factors
6. Systemic factors
7. Gingival and periodontal factors

Diagnosis:
 History is very important. Patient is asked
about muscular tenderness in morning.
Occasionally patient may not be aware of
habit if only nocturnal bruxism in present. In
those cases parents may provide information
regarding habit.

Examination:
 Typical wear facets on occlusal table are
evident. By using articulating paper,
underlying occlusal disharmony may be find
out.

Treatment:
1. Occlusal splints and occlusal adjustments are
usually sufficient to correct habit.
Occlusal splints are indicated to reprogramme the
existing muscular pattern. Soft splints are advisable
with flat occlusal surfaces so that mandibular
movements will be free in all planes which breaks
the reflex response of muscles established during
habit.

2. Restorative therapy
3. Psychotheraphy/ relaxation training
4. Physiotherapy
5. Symptomatic treatment

LIP HABITS:
 Normal lip anatomy and function are important for
speaking, eating and maintaining a balanced
occlusion. Lip habit may involve either of lips but
predominantly lower hip is involved.
 Definition:
 Lip habit may be defined as those habits that involve
manipulation of lip/ lips and perioral structures.

 Types of lip habits:
 Two types of lip habits
 - wetting the lips with tongue
 - pulling the lips into mouth between the teeth
(Schneider 1982)

LIP SUCKING:
 It is commonly associated with lower lip where lip is
pulled between teeth and clinically lips are
characterized by reddened, irritated areas below
vermilion border.
 An important but distinct variation of lip sucking habit
is Mentalis habit.

Etiology:
1. Malocclusion.
2. Habits.
3. Emotional stress.

Management:
 Associate factors which predispose to habit e.g class
II Div 1 malocclusion or increased overjet due to
previous thumb sucking should be eliminated.
 A self disciplinary approach where child reinforces
himself that he will not indulge in habit is very
effective because most of them are adolescent.
 Lip Bumper
 Lip bumper acts as both reminding device and habit
interrupting appliance by making it difficult to draw
the lip between anterior teeth.


FINGER NAIL BITING HABIT:
 This is the most common habit in adolescent and
adults.
 Nail biting is absent before age of 3, incidence rises
from 4-6 year of age and remain stable between 7
and 10 year and rises to peak during adolescence.
Persistent nail biting may be indicative of emotional
problem. In teenage, nail biting habit may be
substituted by pen / pencil biting etc.

Diagnosis:
 History and examination of finger nail will
reveal the habit.

Management:
 Psychologic counseling is sufficient in most of cases.
Avoid punitive methods eg: Scolding, nagging etc
because as habit is commonly due to emotional
disturbance, these punitive methods may exaggerate
the emotional problems.
 If child is cooperative, various reminding methods
may be used eg: nail polish, application of mild bitter
substances on fingers and nails.


SELF INJURIOUS HABIT:
 These are self injurious habits where patient
enjoys inflicting damage to himself. It is very
rare in normal children but can be seen in
mentally retarded children.
 Definition:
 These habits may be defined as Repetitive
acts that result in physical damage to
individual.

Etiology:
 Functional- can be further divided into:
1. Type A
2. Type B
3. Type C

Treatment:
 Always with these habits, treatment should be
initiated with psychotherapy because almost all these
patient have strong emotional or psychopathic
features.
 Palliative Treatment
 It is the adjunctive therapy eg: bandages for
ulceration etc.
 Mechanotherapy
 Vestibular screen will prevent unconscious damaging
act e.g. cheek biting while sleeping. Mechanotherapy
may also include use of restraints and protective
padding.

Conclusion:
 Oral habits are essentially certain abnormal muscular
pattern acquired by child at conscious or
subconscious level.
 Once a deleterious habit is being identified, treatment
should be carefully executed with full cooperation of
child. At no stage child should be ignored in terms of
his/her comfort and emotional feeling.
 Success of any habit breaking therapy ultimately
depends on patient cooperation.

Refrences:
1. Robert E Moyers: Handbook of orthodontics; 4th
edition; Year book medical publishers.
2. Profit WR: Contemporary orthodontics 3rd
edition;
Elsevier publication.
3. T. M. Graber: Orthodontics Principles And Practice;
3rd
edition; W. B. Saunders co. 1996.
4. Graber: The three m : muscles, malformation and
malocclusion AJO 1983; 418-450.

5. Jacobson: Psychology and early orthodontic
treatment AJO 1979; 511-529.
6. Field, Warren and Black: Vertical morphology and
respiration AJO 1991; 147-154
7. Tulley: Adverse muscle forces and their diagnostic
significance AJO 1956; 801-814
8. Bresolin, Shapiro: Mouth breathing in allergic
patients AJO 1983; 334-340
9. Daniel J. Rinchus, Donald J. Rinchuse:
Overcoming Finger sucking Habits - JCO 1986 Jan
46-47 www.indiandentalacademy.com

10. Klein: Pressure habits etiologic factors in
malocclusion AJO 1952; 569-587.
11. Arno H. Geis, Diane H. Piarulle: Psychological
Aspects of Prolonged Thumb sucking Habits - JCO
1988 Aug 492-495
12. Arthur C. Hawkins: A Constructive Approach to
Thumb sucking Habit -JCO 1978 Dec 846-848
13. Joseph L. Wasson: Correction of Tongue-Thrust
Swallowing Habits - JCO 1989 Jan 27-29

14. Birte Melsen, Laura A.; relationship between
swallowing pattern, mode of respiration and
development of malocclusion – Angle orthod. 1987;
113-120.
15. James L. Goldsmith, Sylvan E. stool; George
Catlin’s concepts on mouth breathing; Angle
orthod. 1994; 75-78.

Thank you

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