2. ORAL HABITS
Oral habits may be a part of normal
development, a symptom with a deep rooted
psychological basis or may be the result of abnormal
facial growth.
Eg:
Digit sucking
Lip and nail biting
Tongue thrusting
Mouth breathing
3.
4. DEFINITION
• Habit can be defined as a fixed or constant
practice established by frequent repetition.
DORLAND 1957
• It is defined as frequent or constant practice or
acquired tendency, which has been fixed by
frequent repetition. BUTTERSWORTH 1961
• Oral habits are learned patterns of muscular
contractions. MATHEWSON 1982
6. By Klein
(1971)
Empty
habits
Habits that are not
associated with any
deep rooted
psychological
problems
Meaningful
habits
Habits that have a
psychological
bearing
9. Oral habits in infancy and early child hood can be
considered normal.
Habits beyond 3-4 years may become a symptom
and may produce harmful effects on the
development of maxillofacial complex.
11. It can be defined as the placement of thumb at
various depth in to the mouth.
Many children suck their thumb or fingers for short
periods during infancy or early childhood with the
habit considered normal during the first two years of
life.
Persistence of the habit beyond 3-4 years can leads
to various malocclusions.
12. 1. Freudian theory:
proposed by ‘sigmond freud’.
He suggested that a child passes through
various distinct phases of psychological
development of which the oral and anal phases
are seen in the first 3 years of life
In the oral phase the mouth is believed to be an
oro-erotic zone
The child has the tendency to place his/her
fingers or any other object into the oral cavity
13. 2. Oral drive theory of SEARS AND WISE
By sears and wise in 1950
Proposed that prolonged suckling could lead to
thumb sucking
14. 3. Benjamin’s Theory
Benjamin suggested that thumb sucking arises
from the rooting or placing reflex seen in all
mammalian infants
Rooting reflex is the movement of the infant’s head
and tongue towards an object touching his cheek
This rooting reflex disappears in normal infants
around 7-8 months of age
15. 1.Psychological Aspects
Children deprived of parental love, care and
affection are believed to resort to this habit due to a
feeling of insecurity
2.Learned Pattern
According to some authors thumb sucking is merely
a learned pattern with no underlying cause or
psychological bearing
16. Phase 1:
Seen during first 3 yrs of life
Thumb sucking during this phase is considered
to be quite normal
Usually terminate at the end of phase 1
PHASES OF DEVOLOPMENT
17. Phase 2- clinically significant sucking
Extends between 3-6 1/2 yrs of age
Presence of sucking during this age is an
indication that the child is under great anxiety
Treatment should be initiated to correct dental
problems
18. Phase 3- Intractable sucking
Any thumb sucking persisting beyond the 4-5th yr
of life
A psychologist might have to be consulted
during this phase
19. CAUSATIVE FACTORS
• Parent’s occupation
• Working mother
• Number of siblings
• Order of birth of child
• Social adjustment and stress
• Feeding practices
• Age of the child
20. NUTRITIVE SUCKING HABIT
• Eg: breast feeding, bottle feeding
NON-NUTRITIVE SUCKING HABIT
• eg: thumb or finger sucking, pacifier sucking
CLASSIFICATION
21. • STANLEY 1973- has graded thumb sucking in to 4
types.
TYPE A: seen in 50% of children
• The whole digit is placed inside the mouth, with
the pad of the thumb pressing over the palate at
the same time maxillary and mandibular contact
is present.
TYPE B: 13-24%
• Thumb is placed in the oral cavity without
touching the vault of the palate, and maxillary and
mandibular contact is maintained.
22. TYPE C: 18% of children.
• Thumb is placed in the mouth just beyond the
first joint contacting the hard palate and only the
maxillary incisors but there is no contact with the
mandibular incisors.
TYPE D: 6% children.
• Very little portion of the thumb is placed in the
mouth.
23. Effects of thumb sucking
• The severity of the malocclusion caused
depends on trident of factors.
1. Duration
2. Frequency and
3. Intensity
24. Effects includes
Labial tipping of maxillary anterior teeth resulting
in proclination.
Overjet increases
Anterior open bite as a result of restricted incisor
eruption and supra eruption of the buccal teeth
cheek muscles contract resulting in a narrow
maxillary arch and posterior crossbites
May develop tongue thrust habit as a result of
open bite
Upper lip is generally hypotonic , while the lower
part of face exhibit hyperactive mentalis activity
25. DIAGNOSIS
History
Questioned on the frequency and duration of
the habit
Feeding habits
Parental care of the child
Whether the parents are working etc
Intra-oral clinical examination
Proclination, open bite etc
Extra- oral examination
Digits, facial form etc
26. MANAGEMENT
PSYCHOLOGICAL APPROACH
Parent’s involvement in prevention
Divert the child’s attention to other things
DUNLOP suggests that the child should be asked to
sit in front of large mirror and asked to suck his
thumb observing himself as he indulges the habit.
This is very effective if the child is asked to do the
same when he is involved in an enjoyable activity.
27. Appliances usually consist of a crib placed palatal to
the maxillary incisors.
Palatal crib to be used if no posterior cross bite exits.
Post cross bite-Maxillary expansion appliance to be
added along with palatal crib.
MECHANICAL AIDS
28. Habit breakers can be of 2 types;
1. Removable habit breakers
Passive removable appliances that
consist of a crib and is anchored to the oral cavity
through clasps
29. 2. Fixed habit breakers
Heavy gauge stainless steal wire designed to
form a frame that is soldered to bands on the
molars
30.
31. Other aids include bandaging the thumb and
bandaging the elbow
32. 3. Chemical approach.
Use of bitter tasting and foul smelling preparation
placed on the thumb.
The medicaments used includes;
Pepper dissolved in a volatile medium
Quinine
Asafoetida
33. TONGUE THRUSTING
It is defined as a condition in which the
tongue makes contact with any teeth anterior to the
molars during swallowing.
34. ETIOLOGY
Genetic factor
specific neuromuscular or anatomic variations in
the orofacial region.
Eg; hypertonic orbicularis oris activity.
Learned behaviour
Predisposing factors includes
a) Improper bottle feeding
b) Prolonged thumb sucking
c) Prolonged tonsilar and upper respiratory tract
infections
d) Prolonged duration of tenderness on gums or
teeth
35. • Maturational
If the infantile swallow persists for a longer duration
of time
• Mechanical restrictions
Presence of certain conditions like macroglossia,
constricted dental arches, enlarged adenoids etc.
• Neurological disturbance
Like hyposensitive palate and moderate motor
disability
• Psychogenic factors
As a result of forced discontinuation of other habits
like thumb sucking
36. Simple
classification
of tongue
thrust
Simple
tongue
thrust
1.Normal tooth contact during
swallowing act
2.Anterior open bite
3.exhibit good intercuspation of teeth
4. Tongue is thrusting forward during
swallowing help in anterior lip seal
5.Abnormal mentalis muscle activity
Complex
tongue
thrust
1.Teeth apart swallow
2.Anterior open bite is diffuse or absent
3.Absence of temporal muscle
constriction and contraction of
circumoral muscles during swallowing
4.Occlusion of tooth may be poor
37. CLINICAL FEATURES
Proclination of anterior
teeth.
Anterior open bite.
Bimaxillary protrusion.
Posterior open bite in case
of lateral tongue thrust.
Posterior crossbite.
crossbite
38. MANAGEMENT
Involves interception of the habit followed by
treatment to correct the malocclusion.
HABIT INTERCEPTION
1. Use of habit breakers
2. child is taught the correct method of swallowing
3. Various muscle exercises of tongue
The child is asked to place the tip of the tongue
in the rugae area for 5 min and is asked to
swallow
.
39. 4s exercise :-
This includes identifying the spot, salivating,
squeezing the spot and swallowing.
Spot is on the incisive papillae and is
should be against the tip of the tongue at
rest. Place the tongue on the spot,
salivate, squeeze against the spot and
swallow.
42. MOUTH BREATHING can be classified into 3 types.
a) OBSTRUCTIVE-
Complete or partial obstruction of nasal passage
result in mouth breathing.
Causes of obstruction
includes
1. Deviated nasal
septum
2. Nasal polyps and
benign tumors
3. Chronic
inflammation of
nasal mucosa etc.
43. b) HABITUAL
Continues to breaths
through mouth even after
the removal of nasal
obstruction.
c) ANATOMIC
Lip morphology does not
permit complete closure of
the mouth such as a patient
having short upper lip.
44. CLINICAL FEATURES
Long face syndrome or classic adenoid facies:-
Malocclusion most often associated with mouth
breathing.
1. long narrow face
2. Narrow nose and nasal passage
3. Short and flaccid upper lip
4. Contracted upper arch
45. 5. Expressionless face
6. Increased overjet due to flaring of incisors
7. Anterior marginal gingivitis
8. Caries and anterior open bite
46. DIAGNOSIS
History
Clinical examination: mirror test, water test etc are
used
Cephalometrics: helps in establishing the amount
of nasopharyngeal space, size of adenoids, and
shape of face
Rhinomanometry: helps in estimation of airflow
through the nasal passage and nasal resistance
47. MANAGEMENT
Removal of nasal or pharyngeal obstruction.
Interception of habit.
Use of vestibular screen
Adhesive tapes to establish lip seal
48. Rapid maxillary expansion.
In patients with narrow constricted maxillary
arches
Expansion increase the nasal airflow and
decrease nasal air resistance
50. ETIOLOGY
1. Psychological and emotional stresses
2. Occlusal interference between centric relation
and centric occlusion
3. Pericoronitis and periodontal pain
CLINICAL FEATURES
Occlusal wear facets on
the teeth
Fractures of teeth and
restorations
Mobility of teeth
51. Tenderness and
hypertrophy of
masticatory muscles
Muscle pain on
waking up in the
morning
TMJ pain and
discomfort
52. DIAGNOSIS
History and clinical examination.
Articulating papers for occlusal prematurities.
Electro-myographic examination to check for
hyperactivity of muscles of mastication.
53. TREATMENT
Psychological counselling.
Hypnosis, relaxing exercises, and massage in
relieving muscle tension.
Occlusal adjustments to eliminate maturities.
Night guards or occlusal splints that cover the
occlusal surfaces of teeth.
55. Lip biting most often involves the lower lip. Turned
inwards and pressure is exerted on the lingual
surface of maxillary incisors
CLINICAL FEATURES
Proclined upper anteriors and retroclined lower
inscisors
Hypertrophic and rebundant lower lip
Cracking of lips
56. MANAGEMENT
Lip bumpers
Keep the lips away.
Improve the axial
inclination of
anterior teeth due to
unrestrained action
of the tongue.
58. Nail biting produces minor local tooth irregularities
such as rotation, wear of incisal edge, and minor
crowding
Nut notch - wear of teeth in the form of notch, is a
result of cracking open and eating hard nuts using
incisal edge of anteriors.
59. POSTURE
Frequently suggested that poor posture can lead
to malocclusion.
Stooping with chin on the chest causes
mandibular retrusion.
Child resting head on hand or sleeping on arm or
fist can develop malocclusion.
