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ORAL HABITS
Buttersworth (1961):defined a habit as a frequent or constant practice or acquired tendency, which has been fixed by frequent repetition.
Various habits are:-
- Thumb sucking.
- Tongue thrusting.
- Mouth breathing
- Bruxism
- Nail biting
- Lip biting
THUMB SUCKING
According to Gellin “It is placement of thumb or one or more finger in varying depth into the mouth”
DIAGNOSIS OF THUMB SUCKING
(1) History:-
- Determine the psychological component involved.
- Question regarding the frequency, intensity and duration of habit.
- Enquire the feeding patterns, parental care of the child.
- The presence of other habits should be evaluated.
(2) Extraoral Examination :-
- The digits:-
- Will appear reddened, exceptionally clean, chapped & short fingernail (dishpan thumb)
- Fibrous roughened callus may be present on superior aspect of finger.
- Lips:-
- Upper lip may be short and hypotonic.
- Lower lip is hyperactive .
- Facial form analysis:-
- Check for mandibular retrusion.
- Maxillary protusion.
- High mandible plane angle .
(3) intraoral examination
CLINICAL FEATURES
Intra oral
- Labial flaring of maxillary anterior teeth.
- Lingual collapse of mandibular anterior teeth.
- Increased overjet.
- Hypotonic upper lip and hyperactive lower lip.
- Tongue placed inferiorly leading to
- Posterior cross bite due to maxillary arch contraction.
- High palatal vault.
Extra oral
- Fungal infection on thumb
- Thumb nail exhibit dish pan appearance.
MANAGEMENT
(2). REMINDER THERAPY:
(3) MECHANO THERAPY:--
TONGUE THRUST
States tongue thrust as forward movement of tongue tip between the teeth to meet the lower lip during deglutition and in sounds speech so that tongue becomes interdental. (Tulley 1969)
Etiology
(1) Retained infantile swallow:-
With eruption of incisor at six months of age, tongue does not drop back as it should & continues to thrust forward.(2)Upper respiratory tract infection:-
Such as mouth breathing, allergies etc(3) Neurological disturbances:-
Hyposensitive palate, disruption of sensory control & co ordination of swallowing .(4) Feeding practice:-
Bottle feeding is more contributory than breast feeding to tongue thrust development.(5) Induced due to other oral habits :-
Thumb sucking & finger sucking may prevalent in many children Habits created malocclusion (anterior open bite) Tongue is protrude between anterior teeth during swallowing, when habit corrected than change in protrusive tongue activity take place.(6) Heriditary
(7) Tongue size:- macroglossia
Clinical features
Extra oral
- Lip Posture :- Lip separation is more both at rest & in function
- Mandibular movement :- Path of mandible movement is upward & backward with tongue movement forward.
- Speech : Lipsing problem in articulation of s/n/t/d/ l/th/z/v/ sounds.
- Facial form :- increase anterior facial height
Intraoral
1) Tongue posture:-
Tongue tip at rest is lower because of anterior open bite present
(2) Malocclusion:- In Maxilla :- Proclination of maxillary anterior .
- An increase over jet
- Maxillary constriction
- Generalized spacing between teeth.
In Mandible :- Retroclination ofmandibular teeth
DIAGNOSIS
History
- Determine swallow pattern of siblings & parents to check for hereditary etiologic factor.
- Information regarding upper respiratory infection, sucking habits.
- Finally past & present information regarding the over all abilities , interest ,motivation of patient should be noted.
Examination
(1) Patient seated upright :-
A little water is placed in patient mouth & patient is asked to swallow it.During normal swallowing pattern :-
- Lip touch each other tightly
- Mandible rise as teeth are brought together
- Facial muscle do not show any marked contraction.
During abnormal swallowing:-
- Teeth are apart.
- Lip do not touch each other.
- Facial muscles show marked contraction.
(2) The lower lip is lightly held with thumb and finger and patient asked to swallow the water .
- During normal swallowing process patient is able to swallow normally.
- In abnormal the swallow will be inhibited as strong mentalis and lip contraction are needed for mandibular stabilization & water will spill out mouth
MANAGEMENT
MOUTH BREATHING
Etiology
85% mouth breather suffer from some degree of nasal obstructionClinical features
- Adenoid facies
- Long narrow face, narrow nose and nasal passage.
- Short upper lip.
- Nose tipped superiorly Expressionless face.
- Dental effect (intra oral)
- Protusion of maxillary incisors Palatal vault is high.
- Increase incidence of caries. Chronic marginal gingivitis.
Management
1) Symptomatic treatment- The gingiva of the mouth breathers should be restored to normal health by coating the gingiva with petroleum jelly.
- If nasal or pharyngeal obstruction has been diagnosed then removal of the cause is done by surgery 2) Elimination of the cause.
3) Interception of the habit-
a) Physical Exercise
b) Lip Exercise
4) Oral Screen
- If nasal or pharyngeal obstruction has been diagnosed then removal of the cause is done by surgery 2) Elimination of the cause.
3) Interception of the habit-
a) Physical Exercise
b) Lip Exercise
4) Oral Screen
BRUXISM
Etiology
(1) CNS:- This CNS phenomena was found in children with cerebral palsy & mental retardation.(2) Psychological:- A tendency of grind teeth associated with feeling of hunger and aggression, hate, anxiety etc.
(3) Occlusal discrepancy:- Improper interdigitation of teeth lead to bruxism.
(4) Systemic factor:- Mg++ deficiency may lead to bruxism.
(5) Genetic.
(6) Occupation:- Overenthusiastic student or competitive sports lead to clenching
Clinical features:-
Management:-
- Adjunctive theory:-
- Psychotherapy- Aim to lower the emotional disturbances.
- Elimination of oral pain & discomfort by giving ethyl chloride within the tempro-mandibular joint area.
(2) Occlusal therapy :-
(a) Occlusal adjustment- Splints-Volcanite splints have been recommended to cover the occlusal surfaces of all teeth. A reduction in increased muscle tone is observed with its use.
- Night guards
- Restorative treatment.
(b) Drug –vapo coolant such as ethyl chloride for pain in TMJ area, local anesthesia injection directly in TMJ and muscle tranquilizer and sedative are used.
LIP HABITS
NAIL BITING HABITS
- It is most common habit in children
- It is sign of internal tension
Etiology
- Persistence nail bitting may be indicative of emotional problem.
- Psychosomatic
- Successor of thumb sucking.
Clinical features
- Crowding
- Rotation.
- Alteration of incisal edge of incisor
- Inflammation of nail bed.
Management
- Patient is made aware of problem.
- Treat the basic emotional factor causing the act.
- Encouraging outdoor activity which may help in easing tension.
- Application of nail polish, light cotton mittens as reminder
MCQs
1.Factors resulting in bruxism include all except:
a. Occlusal discrepanciesb. Psychological factors
c. Chronic abdominal distress
d. Respiratory distress
Aanswer D
Etiology (1) CNS:- cerebral palsy & mental retardation.
(2) Psychological:-feeling of hunger and aggression, hate, anxiety etc.
(3) Occlusal discrepancy
(4) Systemic factor:- Mg++ deficiency
2. In which of the following conditions oral screen should not be used?
a. Nail biting habitb. Acute infections of tonsils&adenoids
c. Tongue thrusting
d. Thumb sucking
Answer B
If nasal or pharyngeal obstruction has been diagnosed with mouth breathing habit then removal of the cause is done by surgery
