ORAL HABITS Dr. Thamer Alkhadra BDS, MS, PhD 341 PDS

341 PDS
Dr. Thamer Alkhadra
If a habit that causes dental changes is not
eliminated before the permanent incisors
erupt, they too will be affected
On the other hand, these are not
irreversible changes
If the habit is stopped during the mixed
dentition years, the adverse dental changes
will begin to be reversed naturally
Thumb & Finger Habits
Make up the majority of oral habits
About two thirds are ended by 5 years of age.
The types of dental changes that a digit habit
may cause vary with the intensity, duration, and
frequency of the habit as well as the manner in
which the digit is positioned in the mouth
Thumb & Finger Habits
Intensity is the amount of force that is
applied to the teeth during sucking.
Duration is defined as the amount of time
spent sucking a digit
Frequency is the number of times the
habit is practiced throughout the day
Thumb & Finger Habits
Clinical and experimental evidence suggests
that 4 to 6 hours of force per day are
probably the minimum necessary to cause
tooth movement
A child who sucks intermittently wit high
intensity may not produce much tooth
movement at all, whereas a child who sucks
continuously (for more than 6 hours) can
cause significant dental change
The most common dental signs of an active
habit are reported to be the following:
Anterior open bite
Facial movement of the upper incisors and
lingual movement of the lower incisors
Maxillary constriction
Thumb & Finger Habits
Anterior open bite, the lack of vertical
overlap of the upper and lower incisors
when the teeth are in occlusion, develops
because the digit rests directly on the
Anterior open bite may also be caused by
intrusion of the incisors
Thumb & Finger Habits
Faciolingual movement of the incisors depends on
how the thumb or finger is placed and how many
are placed in the mouth
Usually, the thumb is placed so that it exerts
pressure on the lingual surface of the maxillary
incisors and on the labial surface of the
mandibular incisors
The result is an increased overjet and, by virtue of
the tipping, decreased overbite
Thumb & Finger Habits
Maxillary arch constriction is probably due
to the change in equilibrium balance
between the oral musculature and the
Thumb & Finger Habits
Timing of treatment must be gauged
 If parents or the child do not want to
engage in treatment, it should not be
 It is generally undertaken between the ages
of 4 and 6 years
 Delay until the early school age years
allows for spontaneous discontinuation of
the habit by many children
Thumb & Finger Habits
Counseling with the patient
This involves discussion between the
dentist and the patient of the problems
created by non-nutritive sucking (NNS)
This approach is best aimed at older
children who can conceptually grasp the
issue and who may be feeling social
pressure to stop the habit
Thumb & Finger Habits
The second approach, reminder therapy, is
appropriate for those who desire to stop the
habit but need some help
An adhesive bandage secured with
waterproof tape on the offending finger can
serve as a constant reminder
Another approach is to paint a commercially
available bitter substance on the fingers
that are sucked
Thumb & Finger Habits
A third treatment for oral habits is a reward
A contact is drawn up between the child and the
parent or between the child and the dentist.
The contract simply states that the child will
discontinue the habit within a specified period of
time and in return will receive a reward.
Thumb & Finger Habits
Placing stick-on stars on a homemade
calendar when the child has successfully
avoided the habit for an entire day.
If the habit continues to persist after
reminder and reward therapy and the child
truly wants a method to physically
interrupt the habit a reminder of the
patient can be used.
Thumb & Finger Habits
Involves either wrapping the patient’s arm in
an elastic bandage so it cannot be flexed and
the hand inserted in the mouth, or placing
an appliance in the mouth that physically
discourages the habit by making it difficult to
suck a thumb or finger.
The appliance is not a punishment but rather
a permanent reminder not to place the finger
in the mouth.
Thumb & Finger Habits
The two appliances used most often to
discourage the sucking habit are the quad helix
and the palatal crib
The quad helix is a fixed appliance commonly
used to expand a constricted maxillary arch – a
common finding accompanied by posterior
crossbite in NNS patients.
The palatal crib is designed to interrupt a digit
habit by interfering with finger placement and
sucking satisfaction.
Thumb & Finger Habits
The palatal crib is generally used in children in whom
no posterior crossbite exists
It may, however, also be used as a retainer after
maxillary expansion with a quad helix in a child who
has not stopped sucking with quad helix
For a palatal crib, bands are fitted on the permanent
first molars or primary second molars. A heavy
lingual arch wire (38 mil) is bent to fit passively in
the palate and is soldered to the molars bands
Thumb & Finger Habits
The parent and child should be informed that
certain side effects appear temporarily after the
palatal crib is cemented
Eating, speaking, and sleeping patterns may be
altered during the first few days after appliance
These difficulties usually subside within 3 days to
2 weeks. An imprint of the appliance usually
appears on the tongue as an indentation
Thumb & Finger Habits
The major problem with the palatal crib is
the difficulty of maintaining good oral
The appliance traps food and is difficult to
clean thoroughly.
Thumb & Finger Habits
Habit discouragement appliances should be left in
the mouth for 6 to 12 months as a retainer.
The palatal crib usually stops sucking immediately
least another 6 months of wear to extinguish the
habit completely.
The quad helix also requires a minimum of 6
months of the treatment. Three months are
needed to correct the crossbite, and 3 months are
required to stabilize the movement.
Pacifier Habits
Dental changes created by pacifier habits are
largely similar to changes created by thumb
habits, and no clear consensus indicates a
therapeutic difference
Anterior open bite and maxillary constriction
occur consistently in children who suck pacifiers
Pacifier habits appear to end earlier than digit
Lips Habits
Habits that involve manipulation of the lips and
perioral structures are called up lip habits
Lip licking and lip pulling habits are relatively
benign as far as dental effects are concerned.
Red, inflamed, and chapped lips and perioral
tissues during cool weather
Little can be done to stop these habits effectively,
and treatment is usually palliative and limited to
moisturizing the lips some have used appliances to
Lips Habits
The result is a proclination of the maxillary
incisors, a retroclination of the mandibular
incisors, and an increased amount of
This problem is mot common in the mixed
and permanent dentitions.
Tongue thrust is characteristic of the infantile and
transitional swallows.
Therefore, tongue thrusting should be considered
a finding and not a problem to be treated.
Mouth breathing and its association with
malocclusion is a complex issue.
It is normal for a 3-to-6-year old to be slightly lipincompetent.
Nail biting is a rare habit before 3 to 6 years
of age.
The number of person who bite their nails is
reported to increase until adolescence.
There is no evidence that nail biting can
cause malocclusion or dental change other
than minor enamel fractures, therefore,
there is no recommended treatment.
Bruxism is a grinding of teeth and is usually reported
to occur while a child is sleeping.
Children grind their teeth when awake, most
children engage in some bruxism that results in
moderate wear of the primary canines and molars
capped persons.
Masticatory muscle soreness and temporomandibular
joint pain have also been attributed to bruxism.
The exact cause of significant brusixm is unknown,
although most explanations center around local,
systemic, and psychological reasons.
The local theory suggests that bruxism is a
reaction to an occlusal interference, high
restoration, or some irritating dental condition.
Systemic factors implicated in bruxism include
intestinal parasites, subclinical nutritional
deficiencies, allergies, and endocrine disorders.
The psychological theory submits that bruxism is
the manifestation of a personality disorder or
increased stress.
Treatment should begin with simple measures.
Occlusal interferences should be identified and
equilibrated if necessary
If occlusal interferences are not located or
equilibration is not successful, referral to appropriate
medical personnel should be considered to rule out
any systemic problems.
If neither of these two steps is successful a
mouthguard like appliance can be constructed of soft
plastic to protect the teeth and attempt to eliminate
the grinding habit.
Repetitive acts that result in physical damage to the person,
is extremely rare in the normal child.
It has been suggested that self-mutilation is a learned
A frequent manifestation of self-mutilation is biting of the
lips, tongue and oral mucosa.
Any child who willfully inflicts pain or damage to himself
should be considered psychologically abnormal.
Such children should be referred. Besides behavior
modification treatment for self mutilation includes use of
restraints, protective padding and sedation.