Download to read offline
More Related Content
Similar to HABITS in orthodontics and treatment.pptx
HABITS in orthodontics and treatment.pptx
- 1. HABITS PRESENTED BY :DR. VIPUL GUPTA. MDS 1ST YEAR
- 2. CONTENTS • Introduction • Definition •Classification • Thumb sucking • Mouth breathing • Tongue thrusting • Bruxism
- 3. INTRODUCTION • Oral habitsin children have a definite bearing on the development of occlusion. • Frequently children acquires certain habits that may either temporarily or permanently be harmful to dental occlusion and to the tooth supporting structures. • Digit sucking, tongue thrusting, mouth breathing, lip biting and nail biting, bruxism etc are the common oral habits seen in the children.
- 4. • These habitsbring about harmful unbalanced pressure to bear upon the immature, highly malleable alveolar ridges, the potential changes in the position of teeth, and occlusion. • These habits should be eliminated as an interceptive orthodontic procedure before they produce damage to the developing dentition. • Habits are thus acquired as a result of repetition. • In the initial stages there is a conscious effort to perform the act, later the act become less conscious and if repeated often may continue even unconsciously.
- 5. GENERAL CONSIDERATIONS • Factorsinfluencing dento-alveolar skeletal deformation: 1. Frequency 2. Duration 3. Intensity 4. Direction and type
- 6. DEFINITIONS OF HABIT •Boucher .O.C(1974) Habit can be defined as the tendency towards an act that has become a repeated performance, relatively fixed, consistent and easy to perform by an individual. • Thompson 1927 “A habit is a fixed practice produced by constant repetition of an act. At each repetition the act becomes less conscious and if repeated often enough may be relegated to the subconscious mind entirely”
- 7. • Johnson (1938): Ahabit 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 - depending on the degree to which it interferes with the child's physical, emotional and social functions.
- 8. • Dorland(1957): Fixed orconstant practice established by frequent repetition. • Moyers: Habits are learned patterns of muscle contraction, which are complex in nature. • Finn (1972): A habit is an act, which is socially unacceptable
- 9. ORAL HABITS OBSESSIVE (Deep Rooted) Intentional Or meaningful Digit sucking Lip biting Nailbiting Masochistic Or Self inflicting Gingival stripping NON-OBSESSIVE (Easily Learned and Dropped) Unintentional Or empty Abnormal pillowing Or Chin Propping Functional habits Mouth breathing Tongue thrusting Bruxism
- 10. CLASSIFICATION OF HABITS •WILLIAM JAMES (1923) 1. Useful habit e.g. correct tongue posture Deglutition, respiration 2. Harmful habit e.g. lip sucking, nail biting, Mouth breathing
- 12. ACC. TO MORRISAND BOHANNA ( 1969 ) • PRESSURE HABIT Apply direct force on the teeth and its supporting structures. Thumb sucking, lip sucking, finger sucking, and tongue thrusting • NON-PRESSURE HABITS Do not apply direct force on the teeth and its supporting structures. Mouth breathing • BITING HABITS Nail , pencil, lip biting
- 13. EARNEST KLIEN (1971) 1.Intentional/Meaningful Habits 2. Unintentional/Empty Habits
- 14. GRABER 1.Thumb / digitsucking 2. Tongue thrusting 3. Lip/nail biting, bobby pin opening 4. Mouth breathing 5. Abnormal swallow 6. Speech defects 7. Postural defects 8. Psychogenic habits-bruxism 9. Defective occlusal habits.
- 15. • FINN ANDSIM (1975) 1. Compulsive oral habits 2. Non-compulsive oral habit • ACCORDING TO THE CAUSE OF THE HABIT 1. Physiologic Habits eg: nasal breathing and infantile suckling. 2. Pathologic Habits eg: mouth breathing • BASED ON THE ORIGIN OF THE HABIT 1.Retained Habits: carried out from childhood to adulthood. 2.Cultivated Habits : cultivated during the association.
- 16. THUMB SUCKING ANDDIGIT SUCKING
- 17. DEFINITIONS Gellin (1978): Defines digit-suckingas placement of thumb or one or more fingers in varying depths into the mouth. Moyers: Repeated and forceful sucking of thumb with associated strong buccal and lip contractions
- 18. THEORIES AND CONCEPTOF THUMB SUCKING • CLASSIC FREUDIAN THEORY (1919) (PSYCHO ANALYTIC THEORY) Orality in the infant is related to pre-genital organization, thus the object of thumb sucking is nursing. Thumb sucking may be due to insecurity or deep seated internal conflicts.
- 19. ORAL DRIVE THEORY- SEARS AND WISE (1950) Their work suggest that strength of oral drive is in part of function of how long a child continue to feed by sucking. Thus it is not frustration of weaning that produces thumb sucking. But, rather oral drive, which has been strengthened by the prolongation of nursing.
- 20. HARYETT ET AL(1957) Strongly supported the theory that digital sucking habit in humans are simple learned response. ROOTING REFLEX- BEJAMIN (1962) Which says that thumb sucking arises very simply from the rooting and placing reflexes common to all mammalian infants. These primitive reflexes are maximal during first three months of life.
- 21. SUCKING REFLEX (ERGEL—1962) Theprocess of sucking is a reflex occurring in the oral stage of development and is seen even at 29 weeks of intrauterine life and may disappear during normal growth between the ages of 1 to 3 and half years. It is the first coordinated muscular activity of the infant. This deprivation may motivate the infant to suck the thumb and finger for additional gratification. LEARNING THEORY (Davidson—1967) This theory advocates that non-nutritive sucking stems from an adaptive response. The infant associates sucking with feelings like pleasure and hunger and recalls these events by sucking the suitable objects available, which is mainly thumb or finger.
- 22. CLASSIFICATION OF THUMBSUCKING O’Brien,1996 • Nutritive Suckling Habit eg. Bottle feeding, breast feeding • Non- Nutritive Habit eg. Thumb sucking, Finger sucking, Pacifier sucking.
- 23. COOK (1958) • Alfagroup Pushed palate in a vertical direction and displayed only little buccal wall contractions • Beta group Registered strong buccal wall contractions and a negative pressure in the oral cavity show posterior cross bite • Gamma group Alternate positive and negative pressure; least effect on anterior occlusion.
- 24.
- 25. SUBTELNY ET AL(1973) TYPE A 50% Thumb was inserted into the mouth considerably beyond the first joint. The thumb occupies a large area of hard palate vault pressing against the palatal mucosa and alveolar tissue. Lower incisors press out the thumb and contacted it beyond the first joint.
- 26. TYPE B 24%The thumb extended into mouth around the first joint or just anterior to it. No palatal contact, contacts only maxillary and mandibular anteriors.
- 27. TYPE C 18% Thumbplaced fully into mouth in contact with the palate as in group I; without any contact with the mandibular incisors
- 28. TYPE D 8% Thelower incisors made contact approximately at the level of thumb nail
- 29. CAUSATIVE FACTORS • Socialadjustment and stress • Feeding practices • Age of the child
- 30. Feeding practices • Bottlefeeding was the most prevalent habit at 12 months- 87.5% 18 months- 90% 30 months- 96.25% • Breastfeeding at 12 months-40% 18 months-25% 30 months-12.50%
- 31. •Pacifier sucking habitat 12, 18 and 30 months of age was associated with overjet and open bite; and at 30 months, an association with overbite was also observed. •Finger sucking habit and breastfeeding at 12, 18 and 30 months were also associated with overjet and open bite. •The posterior crossbite was associated with bottle feeding at 12 and 30 months, and nocturnal mouth breathers at 12 and 18 months.
- 32. Age of thechild In the neonate: Insecurities are related to primitive demands as hunger. During the first few weeks of life: Related to feeding problems. During the eruption of the primary molar: It may be used as a teething device. . Still later: Children use the habit for the re leases of emotional tensions with which they are unable to cope.
- 33. CLINICALASPECTS OF DIGIT-SUCKING •Phase I From birth to 3 yrs of age • Phase II exhibit digit sucking especially during weaning. From 3 - 6/7 years Sucking practice during this time deserves more serious attention from the dentist for two reasons. It is a possible indication of clinically significant anxiety. It is best time to solve dental problems, related to digital sucking
- 34. • Phase III Intractablesucking A thumb sucking presenting after the fourth year may be the proof of problems other than simply malocclusion. Such cases require dental and psychological therapy. Consultation with the physician and psychologist may be made in order to develop an integrated approach.
- 35. EFFECT OF DIGIT-SUCKING Effectson Maxilla • Proclination of maxillary incisors • Increased overjet • Open bite • Constricted maxillary arch- V shaped palate • Posterior crossbite • Decreased width of palate. • Muscular imbalance
- 36. Effects on Mandible •Retroclination of mandibular incisors. • Increased mandibular inter-molar width. • Mandible is more distally placed relative to the maxilla. • Mandibular incisors experience a lingual and apical force.
- 38. • Ideal widepalate and nice “U” shaped arch of an adult that was breastfed. • Narrow “V’ shaped maxillary arch and high palate of an adult that was bottle fed and was a thumb sucker
- 39. INTER-ARCH RELATIONSHIP 1. Decreasedinter-incisal angle 2. Increased overjet 3. Decreased overbite 4. Posterior Cross Bite 5.Anterior open-bite 6. Narrow nasal floor and high palatal vault 7.Uni/bilateral class II occlusion
- 40. EFFECT ON LIPPLACEMENT AND FUNCTION 1. Increased lip incompetence 2. Hypotonic upper lip 3. Hyperactive lower lip: Since it must be elevated by contractions of orbicularis oris and mentalis muscle to a position between malposed incisors during swallowing.
- 41. OTHER EFFECTS • Riskto psychological health • Increase deformation of digits • More prone to trauma • Speech defects especially lisping
- 42. JOHN J WARREN •Children with non-nutritive sucking habits that continued to 48 months of age or beyond demonstrated many significant differences from children with habits of shorter durations: • Narrower maxillary arch widths, greater overjet and greater prevalence of open bite and posterior crossbite. • Prevalence of anterior open bite, posterior crossbite and excessive overjet increased with duration of habits. December 2001 Journal of the American dental association
- 43. TREATMENT • Psychological therapy •Reminder therapy • Extra oral approaches • Intraoral approach • Appliances therapy • Non appliance therapy • Corrective therapy
- 44. PSYCHOLOGICAL THERAPY • Screenthe patient • Dunlop's beta hypothesis Best way to break the habit is by conscious, purposeful repetitions, i.e the subject should sit in front of a large mirror and suck observing as he does so.
- 45. • Six Stepsin Cessation of Habit (Larson and Johnson) Step 1: Screening for psychological component. Step 2: Habit awarenesss Step 3: Habit reversal with a competing response. Step 5: Escalated DRO (differential reinforcement of other behaviors). Step 6: Escalated DRO with reprimands. (Consists of holding the child, establishing eye contact and firmly admonishing the child to stop the habit.
- 46. VARIOUS MEASURES USEDFOR CORRECTING THE THUMB SUCKING HABIT • Apply bitter and sour chemicals have been used over the thumb to terminate the practice e.g. quinine, pepper, caster oil, etc. • Apply a bandage to the thumb, finger or the entire palm • Cover the palm with socks • Explain the child with the help of audio-visual aids, to show that they might develop crooked teeth if the habits are continued.
- 47. • Three-alarm system– it is effective in a mature child in the age group of 8 years and above. During the time when the child engages in sucking habit ask him to tie an adhesive tape. When he feels the tape in the mouth it act as first alarm and reminds him to stop. At the same time, elbow of the arm of the offending thumb, is firmly but not tightly wrapped in a two-inch elastic bandage. One pin is placed lengthwise in the medial bend of the elbow. When he sucks, pin mildly jabbing indicates second alarm. If the child continues, elastic bandage will be tightened and his hand falls asleep as a third and final alarm.
- 48. Rapp, Miltenberger, andLong (1998) developed an automated device, called the awareness enhancement device (AED), that produces a tone each time an individual raises a hand to the head. This device successfully treated hand-to-head habit behaviors (i.e., finger sucking and hair pulling).
- 49. 1. Removable –Cribs is used along with Hawley’s appliance. (i) It breaks suction on the anterior segment. (ii) It distributes pressure to posterior teeth as well (iii) Reminds patient not to indulge in habit. (iv) it makes habit non pleasurable.
- 50. 2. RAKES • Itmay be removable or fixed just as crib. • This punishes the child rather than reminder.
- 51. • It hasblunt wire spurs projecting from acrylic retainer into palatal vault. • The spurs discourage not only thumb sucking but also tongue thrusting and improper swallowing habit. • The habit appliance is worn for 4 to 6 months in most of the cases.
- 53. • 1- FIXED– An intraoral appliance attached to primary second molar or the first Permanent molar. A palatal arch forms the base of appliance that prevents thumb sucking and setting negative behaviour.
- 54. 2- BLUE-GRASS APPLIANCE: Itcan also be used to discourage the thumb sucking habit. It consists of Teflon roller on a Palatal bar. • Instructions are given to turn the roller instead of sucking the digit. • It is given for 3-6 months.
- 55. MODIFIED BLUE GRASSAPPLIANCE • It encourages neuromuscular stimulations by using multiple beads. Between 4–6-year- old children can be instructed to play with the beads with the tongue immediately after placement. This allows the child to accept the appliance and learn the neuromuscular activity to normalize the tongue position.
- 56. • When aspinning roller is placed in close proximity to the tip of the tongue, “fascinating” response is quickly implemented due to neuromuscular and sensitive nature of tongue. • Within few days, the tongue establishes new nonharmful habit of playing with roller. Hence, this appliance works through counter conditioning response to the original conditioned stimulus for thumb sucking.
- 57. • 3- QUAD- HELIX: This appliance prevents the thumb from being inserted and also corrects the malocclusion by expanding the arch.
- 58. Corrective appliances areindicated only when it can be determined that the child wants to discontinue the habit and needs only a reminder to accomplish the task. The appliance should not be painful or interfere with malocclusion. Instead, it should merely acts as a reminder.
- 59.
- 60. “The tongue isan important organ contributing to deglutition, speech, growth and development of the jaws, and alignment of the teeth in occlusion”. ( Graber, 1972 ).
- 61. • Swallowing occursabout 800 times each day. • Each time we swallow, one to six pounds of pressure is applied to the inside structures of the mouth. • Normally when a person swallows, the middle section of the tongue is placed on the roof of the mouth. When the tongue is placed between and behind the teeth, this pressure pushes the teeth apart and out, causing distortions of the face and teeth.
- 62. MOYER’S CLASSIFICATION OFSWALLOWING PATTERN Type Inference Normal infantile swallow During this swallow the tongue lies between the gum pads and mandible is stabilized by contraction of facial muscles especially buccinator. This type of pattern disappears on eruption of the buccal teeth of primary dentition Transitional swallow Intermixing of normal infantile swallow and mature swallow during the primary dentition and early mixed dentition period Normal mature swallow During this swallow there is very little lip and cheek activity. Mainly there is contraction of mandibular elevators Simple tongue thrust swallow During this swallow there is contraction of lips, mentalis muscle and mandibular elevators. Tongue protrudes into an open bite that has a definite beginning and ending Complex tongue thrust swallow This is characteristically known as teeth apart swallow. There are marked contractions of the lip, facial and mentalis muscles but absence of temporal muscle contraction during swallow. Anterior open bite is also present
- 63. DEFINITION • Brauer -1965 A tongue thrust was said to be present if the tongue was observed thrusting between, and the teeth did not close in centric occlusion during deglutition • Tulley 1969 - States tongue thrust as the forward movement of the tongue tip between the teeth to meet the lower lip during deglutition and in sounds of speech, so that the tongue becomes interdental
- 64. • Barber (1975)- is an oral habit“ pattern related to the persistence of an infantile swallow pattern during childhood and adoles cence and thereby produces an open bite and pro trusion of the anterior tooth segments. • Norton &Gellin (1978) - Condition in which "the tongue protrudes between anterior and posterior teeth during swallowing with or without effecting tooth position.
- 65. • Schneitfer 1982- is a forward placement of the tongue between the anterior teeth and against the lower lip during swallowing • Proffit – as placement of the tongue tip forward between the incisor during swallowing
- 66. ETIOLOGY FLETCHER (1975) • RetainedInfantile Swallow • Learned behavior • Protracted period of soreness / tenderness of gum • Prolonged thumb sucking. • Natural exfoliation/ extractions. • Prolonged tonsillar/upper respiratory tract infection. • Tongue held in open spaces during mixed dentition
- 67. • OPEN SPACESDURING MIXED DENTITION Rogers proposed that diastema caused by loss of primary teeth would entertain the tongue to interpose in their open spaces-an adaptive tongue thrusting tendency. • OTHER FACTORS • Macroglossia • Feeding practices
- 68. CLASSIFICATION Backlund 1963 • Anteriortongue thrust :Forceful anterior thrust. • Posterior tongue thrust : Lateral thrusting in case of missing teeth.
- 69. • Pickett's 1966 1.Adaptive:Tongue adapts to an open bite caused by missing teeth/ thumb sucking. 2.Transitory :Tongue is put forward only for a short period. Forceful and rapid. 3.Habitual : Due to postural problem.
- 70. Moyers, 1970 • Simpletongue thrust • Complex tongue thrust • Retained infantile swallow
- 71. James Braner andHolt • Type I Non-deforming tongue thrust. • Type II Deforming anterior tongue thrust Sub-group 1 : Anterior open-bite Sub-group 2: Anterior proclination . Sub-group 3: Posterior cross-bite
- 72. Type III Deforminglateral tongue thrust: Sub-group 1: posterior open-bite Sub-group 2: posterior cross-bite Sub-group 3: Deep over-bite. •Type IV Deforming anterior and lateral tongue thrust. Sub-group 1: Anterior and posterior open-bite' Sub-group 2 : Proclination of anterior teeth Sub-group 3 : posterior cross-bite
- 73. INTRA ORAL FINDINGS •Tongue posture During rest, dorsum of the tongue touches the palate, while its tips rests against the cingula of mandibular incisors.
- 74. MALOCCLUSION • Anterior orposterior open bite based on the type of tongue thrust. • Proclination of upper anterior teeth resulting in increased overjet. • Generalized spacing between the teeth. • Maxillary arch constriction. • Proclination of mandibular anteriors. • Posterior teeth crossbites.
- 75. SIMPLE TONGUE THRUST •Contraction of lips, mentalis and mandibular elevators • Teeth are in occlusion • Well circumscribed open bite • History of digit sucking • Also found with hypertrophy of tonsils • Diminishes with age COMPLEX TONGUE THRUST Combined contractions of lip, facial and mentalis muscles Teeth apart More diffuse open-bite History of Mouth breathing or chronic naso-reperatory diseases and allergies
- 76. INVESTIGATIVE METHODS FORIDENTIFYING TONGUE THRUST Methods of examination • Water swallowing examination During normal swallow • The mandible rises as teeth are brought together. • The lips touch each other lightly showing scarcely any contraction. • Facial muscles don't show any contraction.
- 77. • Temporalis muscleexamination During normal swallow the temporalis muscle contracts as the mandible is elevated.
- 78. THREE PHASES (MOYERS): 1.Conscious learning of new reflex-cognitive approach 2. Transferring to subconscious level-reflexive approach 3. Reinforcement of new reflex Management
- 79. COGNITIVE APPROACH Muscle Exercises Barnet'stongue positioning exercises Use of sugarless mint Single elastic swallow of gardiner using 1/4’ or 5/16’ elastics Double elastic swallow
- 80. Lip exercise • Lippull exercise • Lip over lip exercise 4s exercise Other exercises such as whistling, counting sixtys, gargling, yawning.
- 81. • Appliance: 1.Removable or Fixed cribs. It is a variation of finger sucking appliance that tends to force the tongue downwards and backwards during swallowing. the patient should be trained and educated on the correct technique of swallowing
- 82. The appliance attemptsto do 2 things (i) Eliminate the strong anterior thrust and plunger like action during deglutition. (ii) Re-educate tongue posture so that the dorsum of tongue approximates the palatal vault and the tip of tongue contacts the palatal rugae during deglutition instead of sneaking incisors
- 83. • The spursare bent down so that it forms a sort of picket fence behind the lower incisors during full occlusal contact of the posterior teeth, which is a more effective barrier to tongue thrust assure.
- 84. • 2. NANCEPalatal Arch Appliance: In this acrylic button can be used as a guide to place the tongue in correct position.
- 85.
- 86. DEFINITION • Sassouni (1971)defined mouth breathing as habitual respiration through the mouth instead of nose.. • Merle(1980) suggested the term oronasal breathing instead of mouth breathing.
- 87. CLASSIFICATION • Finn in1987 • Obstructive: Increased resistance to or complete obstruction of normal airflow through nasal passage. • Habitual: As a matter of habit or persistence of the habit even after elimination of the obstructive cause. • Anatomical: Short upper lip leads to incompetence of lips and hence mouth breathing.
- 88. ETIOLOGY • Developmental andmorphologic anomalies like abnor mal development of nasal cavity, nasal turbinates, and short upper lip. • Partial obstruction due to deviated nasal septum, locali zed benign tumors. • Infection and chronic allergic stomatitis, chronic atropic rhinitis, enlarged adenoids and tonsils, nasal polyps. • Traumatic injuries to the nasal cavity. • Thumb sucking and other oral habits. • Genetic pattern—ectomorphic children having a genetic type of tapering face and nasopharynx are prone to nasal obstruction.
- 89. CLINICAL FEATURES • Generaleffect • Purification of inspired air is affected. • Pigeon chest appearance as the pulmonary compliance is poor due to the lacking of nasal resistence created by the abnormal mouth breathing. • Dry oral pharynx due to lack of lubrication from mouth breathing. • Blood gas studies revealed that mouth breathers have 20% more carbon dioxide and 10% less oxygen.
- 90. APPEARANCE Adenoid facies •Long narrow face with narrow nose and nasal passage. • Flaccid lips with short upper lip • Nose tipped superiorly. • Expessionless face
- 91. DENTALAND SKELETAL •Low tongue posture • Narrow maxillay arch • V- shaped palate and high palatal arch. • Protrusion of maxillary and mandibular incisors. • Anterior open bite.
- 92. DIAGNOSIS • Mirror test •Massler’s water holding test • Jwemen’s butterfly test
- 93. TREATMENT • Elimination ofthe cause. • Interception of the habit • Physical exercise: Deep breathing exercise are done with deep inhalation during day and night. • Lip exercise: Extend the upper lip as far as possible to cover the vermilion border under and behind the upper incisors for 15-30 min for 4-5 months.
- 94. USE OF ORALSCREEN
- 95. BRUXISM • Ramfjord in1966 defined bruxism as the habitual grinding of teeth when an individual is not chewing or swallowing.
- 96. CLASSIFICATION • Daytime: Diurnalbruxism/Bruxomania. It can be conscious or subconscious and may occur along with para-functional habits. • Night time bruxism: Nocturnal bruxism. Subconscious grinding of teeth characterized by rhythmic patterns of masseter.
- 97. ETIOLOGY • Central nervoussystem: It could be a manifestation of cortical lesions, e.g. in children cerebral palsy. • Psychological factors: A tendency to gnash and grind the teeth has been associated with feeling of anger and aggression or be a manifestation of the inability to express emotions such as anxiety and hate.
- 98. • Occlusal discrepancies. •Genetics. • Systemic factors: Magnesium deficiency, chronic abdominal distress, intestinal parasites. • Occupational factors: An over enthusiastic student and • compulsive overachievers may also develop the habit.
- 99. CLINICAL MANIFESTATIONS • Occlusaltrauma: This include tooth ache, mobility mainly in morning. • Tooth structure: Extreme sensitivity due to loss of enamel, atypical wear facets, pulp may be exposed and many fractured teeth can also occur. • Muscular: Tenderness of the jaw muscles on palpation, muscular fatigue on waking up in the morning, hyper- trophy of masseter. • Temporomandibular Joint: Pain, crepitation, clicking in joint, restriction of mandibular movements. • Associated features: Headache.
- 101. TREATMENT • Occlusal adjustmentsof any premature contacts • Occlusal splints/night guards • Restorative treatment • Relaxation training • Physiotherapy
- 102. • Drugs: Localanesthetic injections, tranquilizers, muscle relaxants • Biofeedback • Electrical method: Electrogalvanic stimulation for muscle relaxation • Acupuncture • Orthodontic correction.
- 103. REFERENCES • Orthodontics Principlesand Practice,T M Graber, 3rd edition • McDonald and Avery’s Dentistry for the child and adolescent 11th edition • Shobha tandon Pediatric dentistry 3rd edition • Handbook of Orthodontics robert e. moyers 4th edition