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oral habits lec oral habits sex sux oral habits
- 1.
- 2. Oral Habitsrefers to certain actions involving the teeth and other oral or perioral structures which are repeated often enough by some patients to have a profound and deleterious effect on the positions of teeth and occlusion.
- 3. DEFINITIONS- DORLAND(1957)- Habit canbe defined as a fixed or constant practice established by frequent repetition. BUTTERSWORTH(1961)- Defined a habit as a frequent or constant practice or acquired tendency which has been fixed by frequent repetition. MATHEWSON(1982)-Oral habits are learned patterns of muscular contractions.
- 4.
- 5. COMPULSIVE HABITS Acquiredas a fixation in the child to the extent that he retreats to the practice whenever his security is threatened Eg: thumb sucking, mouth breathing NON COMPULSIVE HABITS Children appear to undergo continuing behavior modification, which permit them to release certain undesirable habit patterns and form new ones which are socially accepted Eg: nail biting, pencil chewing etc. MEANINGFUL HABIT: Habit with a deep-rooted psychological problem. EMPTY HABIT : Meaningless habit that can be treated easily by a dentist using reminder therapy SECONDARY HABIT: Habit that is due to a supplemental problem, e.g. large tongue causes tongue thrusting habit
- 6. New Classification (Morrisand Bohanna—1969) A)NON-PRESSURE HABIT Eg: Mouth breathing B)PRESSURE HABITS • Sucking habit • Lip sucking • Thumb and digit sucking • Biting habit • Nail biting/Needle holding •Pillow rest C) POSTURAL HABIT • Chin rest D) MISCELLANEOUS • Bruxism
- 7. The presenceof an oral habit in the 3 to 6 year old is an important finding in the clinical examination. An oral habit is no longer considered “normal” for children near the end of this age group. If the habit has resulted in movement of the primary incisors, some form of intervention is warranted prior to the eruption of the permanent incisors. The types of changes in the dentition that an oral habit may cause vary, depending on the intensity, duration, and frequency of the habit.
- 8. Intensity Intensityis the amount of force that is applied to the teeth while performing the habit (i.e. Sucking). Duration Duration is defined as the amount of time spent sucking a digit. Frequency Frequency is the number of times the habit is practiced throughout the day.
- 9.
- 10. Sucking reflex 29week of I.U. life 1st coordinated neuromuscular activity of infant Purpose: Nutritional gratification Emotional gratification 1st month: muscular co-ordination develops: “Infantile digit sucking” Normal - 1- 3.5 years
- 11. CLASSIFICATION Based onclinical observation 1. Normal thumb sucking 2. Abnormal thumb sucking a. Psychological b. Habitual According to O’ Brien 1996 1. Nutritive sucking habits 2. Non-nutritive sucking habits ( NNS habits )
- 12. By subtelny(1973) TypeA: Whole digit is placed inside the mouth with the pad of the thumb pressing over the palate. Maxillary and mandibular anteriors contact is present. Seen in 50% of the children.
- 13. Type B:Thumb is placed into the oral cavity without touching the vault of palate. Maxillary and mandibular anteriors contact is present. Seen in 13-24% of the children.
- 14. Type C:Thumb is placed into the mouth just beyond the first joint and contacts the hard palate and only the maxillary incisors. There is no contact with the mandibular incisors. Seen in 18% of the children.
- 15. Type D: Verylittle portion of the thumb is placed into the mouth. Seen in almost 6% 0f the children.
- 16. 1.) Freudian theory– Child passes through various phases of psychological development of which oral and anal phases are seen in first three year of life. In oral phase, child has tendency to place his fingers or any other object into the oral cavity. Prevention of such an act result in emotional insecurity. 2.) Oral drive theory of Sears and Wise Prolonged nursing can lead to thumb sucking.
- 17. BENJAMIN’S THEORY-According to this theory thumb sucking arises from the rooting reflex common to all mammalian infants. The primitive reflex is maximal during the first 3 months of life. If it persists into later life it can lead to an abnormal habit. Rooting reflex- is the movement of an infant’s head and tongue towards a stimulus touching an infant’s cheek. LEARNING THEORY – According to this theory habit stems from an adaptive response and assumes no underlying psychological cause and aquired as a result of learning. (Davidson)
- 18. PHASES OF DEVELOPMENT Phase I - (Normal and sub-clinically significant) Seen during first 3 years of life. Phase II – (Clinically significant sucking) Extends between 3-6½ years of age. Phase III – (Intractable sucking) Thumb sucking persists beyond 4th or 5th year of life.
- 19. CAUSATIVE FACTORS: 1. Parentsseparation: (Harlow 1976) •Working mothers: feeling of loneliness & insecurity. • Increase in incidence of thumb sucking in industrialized areas when compared to rural areas.
- 20. 2. Number ofsiblings: •Directly related •Division of parents attention •Feeling of insecurity •Thumb sucking a way to attract parents attention 3. Order of birth of the child: •Overindulgent parents
- 21. 4. Social adjustmentand stress (Graber 1972) •Emotion based behavior •Difficulty with social adjustment or stress. •Peer pressure •Punitive and scolding parents.
- 22. 5. Age ofchild: Neonate: Insecurities are related to primitive demands as hunger. Eruption of primary molar : Teething device Younger children : Release of emotional tensions Gaining parents attention
- 23. DIAGNOSIS Extra oral andIntraoral Examination will reveal…………….
- 24. History –Determine the psychological component involved. Question regarding the frequency, intensity and duration of the habit. Enquire the feeding patterns, parental care of the child. Presence of other habits should be evaluated. Diagnosis of habit can also be obvious when the child is actively performing the habit.
- 25. EXTRAORAL EXAMINATION LIPS Upper lip: Short and hypotonic Passive or incompetent during swallowing Lower lip : Hyperactive
- 26. DIGITS Appear reddened, exceptionallyclean, chapped and with a short fingernail i.e. a clean dishpan thumb. Fibrous roughened callus on superior aspect of finger. Deformation of finger in some cases.
- 27. Facial form analysis Maxillaprotrusion Mandibular retrusion Excessive mentalis muscle contraction during swallowing. Facial profile- straight / convex Speech of the child - normal / altered Saddle nose (due to pressure of index finger)
- 28. Other features Otherhabits- habitual mouth breathing, tongue thrust swallow Middle ear infections Enlarged tonsils GI disturbances Speech defects (lisping)
- 29. Effects on Maxilla: Proclined maxillary incisors Increased trauma to maxillary central incisors Increased maxillary arch length Anterior placement of apical base of maxilla Decreased palatal arch width Increased atypical root resorption in primary central incisors INTRAORAL EXAMINATION
- 31. Effects on Mandible: Increased retroclination / proclination of mandibular incisors Retroclination : direct apical & lingual force from digit. Proclination: indirect force from tongue beneath digit. Increased mandibular inter molar distance.
- 32. Effects on theinterarch relationship: Decreased inter- incisal angle Proclined maxillary & mandibular anteriors Increased over jet Decreased over bite Increased posterior cross bite Increased unilateral and bilateral Class II malocclusion.
- 33. Effect on lipplacement and function: Increased lip incompetence Increased lower lip function under the maxillary incisors Effect on tongue placement and function: Increased tongue thrust Increased lower & lateral tongue position
- 34.
- 35. Psychological Therapy Refer toprofessionals for counselling. Destructive approaches in the form of nagging, shamming and belitting ought to be strictly avoided.
- 36. Constant reassurance andencouragement should be provided to the patient to gain his confidence.
- 37. Dunlop’s beta hypothesis: Conscious purposeful repetitions Child made to sit in front of large mirror and made to observe himself when he sucks his digit at the time of his pleasurable activity (playing) Child gets to know his social appearance when performing the act Child gets a desire to quit the habit For mature children (> 8 yrs)
- 38. REWARD THERAPY A contractis agreed upon between the child and parent or between the child and dentist. the child will discontinue the habit for a specified period of time and in return he/she will receive a reward not extravagant but special enough to motivate the child. The more involvement the child can take in the project, the more likely the project will succeed.
- 39. Reminder Therapy Reminder therapyis appropriate for those who want to stop the habit but need some help to stop completely. An adhesive bandage taped to the offending finger can serve as a constant reminder not to place the finger/digit in the mouth. The “reminder” must be neutral and not perceived as any form of punishment
- 40. Reminder therapy Extra oralapproaches: 1. Chemical preparations: Hot tasting, bitter flavored preparations or distasteful agents that are applied to finger or thumbs. eg; cayenne peper, quinine, asafetida
- 41. Denatonium benzoate 1%solution
- 42. 2. Mechanical non-appliance reminders: Long sleeve nightgown Finger elastics Band – aids Tape or bandage in mid-arm to elbow 3 – 6 weeks of treatment time required Ace bandage Boxing gloves
- 43. Thermoplastic thumb post(Allen 1991) It is removed after the child has gone 24 hours without trying to suck a thumb. The device is put back if the child starts to suck his or her thumb again. Thumb devices need to be fitted by a health professional.
- 44. Reminder calendar Daily dairyby child Dentist call weekly In the end: reward – most important
- 45. Appliance Therapy Appliancetherapy should only be used when reminder and reward therapy have failed. Not a punishment but rather a permanent reminder.
- 46. ◦ The parentand the child should be informed that certain side effects may temporarily appear after the delivery of an appliance. These include: Eating difficulties. Speaking/speech problems. Disturbed sleeping patterns.
- 47. There aretwo major categories of commonly used appliances: 1. Removable 2. Fixed Appliance Therapy Removable Appliance Example: Modified Hawley
- 48. Fixed Appliance Examples: HayrakeAppliance > 3YRS Palatal Crib
- 49. The parent andchild should be informed that certain side effects appear temporarily after the palatal crib is cemented. Palatal Cribs
- 50. Eating, speaking,and sleeping patterns may be altered during the first few days after appliance delivery. These difficulties usually subside within 3 days to 2 weeks. An imprint of the appliance usually appears on the tongue as an indentation.
- 51. The major problemwith the palatal crib is the difficulty of maintaining good oral hygiene. The appliance traps food and is difficult to clean thoroughly.
- 52. Habit discouragement appliancesshould 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.
- 53. QUAD HELIX Maxillaryexpansion Posterior cross bite correction Alignment of maxillary and mandibular anteriors Reminder Therapy Treatment time: Habit cessation in 3 weeks - 6 months Retention time: 3 months after habit truly ceases
- 54. Bluegrass Appliance(Haskell & Mink 1991) Indicated for thumb sucking habits(7 – 13 yr age) Utilizes the principles of positive reinforcement Six sided roller made of Telfon attached with 0.045 stainless steel wire soldered to molar orthodontic bands. Patient instructed to turn the roller instead of sucking the digit. Appliance Therapy
- 55. MODIFIED BLUE GRASSAPPLIANCE acrylic beads Adv: reduced bulk Less obstruction, attractive for children Used in age group 5 - 12 years Modification: Attachment with quad helix Removal time: 6 months after habit cessation
- 56.
- 57. Definitions Profitt 1972: Itis the placement of the tongue tip forward between incisors during swallowing. Schneider (1982) : Tongue thrusting is a forward placement of the tongue between the anterior teeth and against the lower lip during swallowing
- 59. Classification Physiologic –infantile swallow Habitual – persist even after malocclusion correction Functional – adaptive behavior to achieve oral seal Anatomic – enlarged tongue
- 60. CLASSIFICATION Backlund 1963: Anterior tonguethrust Posterior tongue thrust (lateral) Moyers (1970): Simple tongue thrust swallow Complex tongue thrust swallow Retained infantile tongue thrust swallow
- 61. Different types of complexityof the tongue thrust Different types of complexity of the tongue thrust are: Simple tongue thrust Lateral tongue thrust Complex tongue thrust
- 62. Simple Tongue Thrust Normal toothcontact in posterior region Anterior open bite Contraction of the lips, mentalis muscle and mandibular elevators
- 63. Complex Tongue Thrust Generalized open bitewith the absence of contraction of lip and muscle
- 64. Lateral Tongue Thrust Posterioropen bite with tongue with thrusting laterally.
- 65. Etiology Retained Infantile swallow Upperrespiratory tract infection Neurological disturbances Functional adaptability to transient change Feeding practices and tongue thrusting Induced due to other oral habits Hereditary Tongue size
- 66. Clinical Manifestation Tongue thrustswallow depends on variables such as: Intensity Duration Frequency Type of tongue thrust Extraoral findings Lip Posture Mandibular movements Speech Facial form Intraoral findings Tongue movements Tongue posture Malocclusion
- 67. EXTRA-ORAL FINDINGS Lip posture Lipseparation is greater in tongue thrust group both at rest and in function,due to lack of compensatory lip activity during swallowing in such persons
- 68. Mandibular movements- More erraticmovements,no co-relation between movement of tongue-tip and mandible.Mandibular movement is upward and backward with tongue movement forward Speech- Variant speech disorders are found such as sibilant distortions,lisping,problems in articulation of sounds,s,n,t,d,l,th,z,v Facial forms- Increase in anterior facial height, expressionless face
- 69. INTRA-ORAL FINDINGS Tongue movements- swallowingsequences are seen to be jerky and inconsistent in tongue thrust group
- 70. Malocclusion Various malocclusions havebeen reported to be caused due to tongue thrust. These can be further subdivided as: Features pertaining to the maxilla Proclination of maxillary anterior and resulting in an increase over-jet Generalized spacing between the teeth Maxillary constriction
- 72. Features pertaining tothe mandible Retroclination or proclination of mandibular teeth depending on the type of tongue thrust present Intermaxillary relationships Anterior or posterior open bite based on the posture of the tongue Posterior teeth crossbite
- 73. EXAMINATION Study posture oftongue while mandible is in postural position Observe tongue during various swallowing procedures, unconscious swallow, command swallow of water, complexity of tongue thrust. Tongue thrust features should be checked. Information regarding upper respiratory tract infection, sucking habits.
- 74. Treatment Considerations Age Presence /Absence of associated manifestations Malocclusion Speech Defects Associated with other habits
- 75.
- 76. Training of correct swallowand posture of the tongue Myofunctional Exercise 1.Child is asked to place tip of tongue in rugae area for 5 minutes and is asked to swallow 2.Orthodontic elastic and sugarless fruit drop exercise
- 77. 3. 4S Exercise-this includes identifying the spot, salivating, squeezing the spot and swallowing 4.Other exercises- child is asked to perform a series of exercises such as whistling, reciting count from sixty to sixty nine ,gargling, yawning, etc.to tone respective muscles
- 78. Using appliances asa guide in the correct positioning of tongue Pre-Orthodontic trainer for Myofunctional Training Nance Palatal Arch Appliance
- 79. Pre-orthodontic trainer andmyofunctional appliances
- 80. Speech Therapy •To trainthe correct positioning of the tongue. •This therapy is not indicated before the age of 8 years. •The child is asked to pronounce words beginning with “s”.
- 81. Various other appliancesused are:- Removable appliance therapy Fixed Habit Breaking Appliance Oral screens Mechanotherapy
- 82. Removable appliances: Hawley’sappliance Hawley’s appliance modifications: • Acrylic cut in anterior hard palate region • Cribs or rakes employed in anterior part
- 83. Correction of Malocclusion Tonguethrust habit pre treatment Habit corrected- post t/t Habit breaking appliance with tongue cribs
- 84. Fixed Habit breakingappliance: • Crowns and bands on first perm. molar • 0.040inch stainless steel ‘U’-shaped lingual bar adapted at the level of gingival margin. • Crib formed (3-4 ‘V’shaped projections) • 4-9 months are required for correction.
- 85. ORAL SCREEN It isa modified acrylic plate Combined oral and vestibular screen used to control muscle forces both inside and outside dental arches
- 86. Correction of malocclusion Iftongue thrusting is due to previously existing anterior open bite, the solution is correction of malocclusion.
- 87.
- 88. DEFINITION OF MOUTH BREATHING Sassouni(1971): It is the habitual respiration through the mouth instead of the nose. Merle (1980); Suggested the term oro-nasal breathing instead of mouth breathing
- 89. Classification Obstructive mouthbreathing- Children with an increased resistance to or a complete obstruction of flow of air through the nasal passages. Habitual mouth breathing-Child who continually breathes through the mouth by force of habit, although the obstruction has been removed. Anatomical mouth breathing- Short upper lip does not permit closure without undue effort. Given by FINN (1987)
- 90. Etiology of mouthbreathing Nasal obstruction Hypertrophy of nasal turbinates due to Allergies Chronic respiratory infections Pollution Hot and dry climatic conditions Hypertrophy of pharyngeal lymphoid tissue- tonsils and adenoids
- 91. Intranasal defects- Deviated nasalseptum Subluxation of septum Thickness of septum Bony spurs Polyps
- 92. Facial type –ectomorphs, long faced, tall, slender persons with long narrow pharyngeal space. Genetic predisposition Short hypotonic or flaccid upper lip Other habits- thumb sucking
- 93. Clinical features of mouthbreathing Normal respiration Cleansing, humidification and moisturisation of inspired air.The quality of the air required by the lungs may influence the health & function of lungs. Nasal resistance for proper functioning of the diaphragm and intercostal muscles Lubricates oesophagus
- 94. Contd.. General effects- Pigeon chestdeformity Low grade esophagitis Altered blood gas levels Nose and associated structures Reduced ciliary activity Decreased sense of smell Poorly developed sinuses
- 95. Focal infections Tonsils andadenoids External nares- Slit like Collapse on inspiration
- 96. Effects on Dentofacial structures: Facial form – long face Increase anterior face height Increased mandibular plane angle
- 97. Long andnarrow face ( Classic Adenoid facies) Narrow nose and nasal passage Short and flaccid upper lip, everted lower lip An expressionless or blank face Nose tipped superiorly in front External nares - Disuse atrophy Slit like external nares with a narrow nose
- 98. Dental effects Proclination andspacing of anterior teeth Constricted maxillary arch (high arched ‘V’shaped palate) , posterior crossbites Decreased vertical overlap of anteriors Gingiva Inflammed gingival tissue in upper anterior region, hyperplastic
- 99. Mouth breathing gingivitis Constantdrying and wetting Increased viscosity of saliva loss of cleansing action and resultant bacterial plaque deposits Lips Thick, everted lower lip Lip apart posture Gummy smile Speech-nasal tone
- 100. DIAGNOSIS 1. History 2. Examination:lip position, contraction of external nares 3. Clinical tests Double mirror test Butterfly test (Massler’s) Water Holding test 4. Inductive plethysmography (Rhinomanometry) 5. Cephalometrics
- 101. MANAGEMENT 1) Treatment isrequired at an early age 2) Treatment considerations Age of the child- self corrected after puberty ENT examination 3) Timing for treatment Mixed dentition period 4) Treatment modalities a) Elimination of the cause Surgery Local medication Rapid maxillary expansion Remove nasal obstructiom
- 102. b) Symptomatic treatmentfor gingiva Petroleum jelly Nocturnal moisture appliance c) Interception of habit Physical exercises Deep breathes in the morning and at night Lip exercises Extending upper lip Lower lip exercise Playing a wind instrument Celluloid strip or metal disk Maxillothoracic myotherapy By Macaray in 1960 Macaray activator Oral screen
- 103. d) Correction ofmalocclusion CLASS I-Oral shield appliance CLASS II-Monobloc activator CLASS III-Chin cap e) Surgery Septoplasty Tonsillectomy Removal of adenoids
- 104.
- 105. Definition: -- Bruxism isthe habitual grinding of teeth when the individual is not chewing or swallowing (Ramfjord 1966) -- Bruxism is the term used to indicate non-functional contact of teeth which may include clenching, gnashing, grinding & tapping of teeth (Rubina 1986) -- Non functional movement of mandible with or without an audible sound occuring during day & night (Vanderas 1995)
- 106. Types: Day time bruxism/diurnal bruxism Night time bruxism / nocturnal bruxism Incidence: Bruxism in children --- 7% to 88%
- 107. Etiology 1) Local: -- mildocclusal disturbances -- high restoration -- any irritating dental condition 2) Systemic: -- gastrointestinal disturbances -- subclinical nutritional deficiency -- allergic condition -- endocrine disturbances
- 108. 3) Psychological: -- anypersonality disorders -- increased stress 4) Occupational : -- over enthusiastic student or compulsive overachievers -- children chewing –gums, or objects such as tooth picks or pencils 5) Musculosketal disorders 6) Allergies 7) Genetic
- 109. Signs & symptomsof bruxism depends on: Frequency of bruxing Intensity with which pt is bruxing Age of pt which may be associated with the duration of the habit
- 110. Clinical features: 1) Teeth: --tooth mobility due to occlusal trauma -- non functional pattern of occlusal wear -- increased sensitivity -- atypical facets -- dull percussion sounds -- fracture of crown/ restorations -- more prone to caries -- sharp edges irritate to lips, cheek & tongue
- 112. 2) Facial muscles: --muscular facial pain -- muscle tiredness or tightness & fatigue on rising in morning -- tenderness of jaw muscles to palpation -- compensatory hypertrophy of muscles -- muscular incoordination
- 113. 3) TMJ: -- pain --osteoarthritis -- crepitus/clicking -- restricted jaw movements -- jaw deviations 4) Malocclusion can occur 5) Headache – pain in muscle is the underlying cause
- 114. Management Eliminating theunderlying cause Psychotherapy includes – - counselling - hypnosis - relaxation exercises Drugs – vapocoolants(ethyl chloride), LA injections, tranquilizers & sedatives & muscle relaxants restoration of lost vertical dimensions by cast crowns & stainless steel crowns
- 115. Occlusal adjustments: -Prematurities correction(coronoplasty, Enameloplasty) -Interferences of restoration Occlusal splints: -Soft splints with Biostar (Vulcanite) Pre – orthodontic trainer
- 116. TENS –transcutaneous electricalnerve stimulation Acupressure – for relaxation Other methods- oral exercises - desensitizing agents - counselling on nutrition - supplement deficiences - hot packs /massage
- 117. Pacifier Habits Dental changescreated 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 habits
- 118. SELF INJURIOUS HABITS Repetitiveacts 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 behavior . Enjoys inflicting harm to oneself Mentally disabled individuals
- 119. Classification Organic: associated withsyndromes Functional: Type A: Injuries superimposed upon existing lesion e.g. Herpetic lesion & finger nail habit Type B: Injuries secondary to another established habit e.g. rotates thumb while sucking- palatal ulceration Type C: Injuries of complex Etiology e.g. underlying psychogenic component
- 120. Lip biting Cheek biting Nail biting Bobby pin opening Frenum thrusting Gingival stripping
- 121. Treatment Medical consultation Pharmacological Diazepam Opiod antagonists: Naloxane, Naltrexone Behavioral Positive reinforcement of non injurious behavior Restrictive behavior modification: ammonia, lemon Physical restraints Alternate activities: distraction
- 122. Frenum thrusting habit Lockinglabial frenum in-between spaced maxillary incisors Constant repetition : tooth displacement Orthodontic correction of spacing Frenectomy
- 123. Bobby Pin opening Habitualopening of pins with incisors Notched incisors Loss of labial Enamel Treatment: counseling, Composite restoration
- 124. Lips Habits Habits thatinvolve manipulation of the lips and perioral structures are called up lip habits Classification: 1)Lip wetting habit 2)Lip sucking habit 3)Mentalis habit 4)Lip biting habit
- 125. Etiology: • Malocclusion (increasedoverjet) • Other Habits (thumb sucking) • Emotional stress Manifestations : Lips: • Reddened irritated and chapped areas below the vermilion border • Attenuations of mentolabial sulcus
- 126. Intraoral findings: • Protrusionof maxillary incisors • Retrusion of mandibular incisors • Crowding in mandibular anterior segment • Mucocele – lip biting
- 127. Treatment: Correction of malocclusion Treatingthe primary habit Appliance therapy • Lip bumper • Oral shield • Palatal cribs, rakes, spikes Lip exercises: • With oral screen ring
- 128. NAIL BITING Nail bitingis a rare habit before 3 to 6 years of age. The number of person who bite their nails is reported to increase until adolescence.
- 129. ETIOLOGY: Confusing and hardto identify. Emotional stress (Period of perceived rejection, during exams, and while watching emotional programme on television) Psychological impact of weaning of another habit (thumb sucking) Psychological insecurity (child's security is threatened)
- 130. Clinical features: Finger nails: Short& ragged borders Abrasions on surrounding skin Damage to nail beds of fingers Intraoral: Marked attrition of anterior teeth No gross malocclusion
- 131. Methods: Mild cases: notreatment indicated. Positive reinforcement (affection ,sympathy ,and understanding ) No negative means: e.g. scolding ,nagging and threat Others: Grooming of finger nails Oil application (no ragged borders)
- 132. Reminders: Application of fingernail polish Light cotton mittens Finger posts Band aids
Editor's Notes
- #4 Useful-deglutition, pressure- thumb sucking, tongue trusting Non pressure- mouth breathing Compulsive habits-Deep rooted habits that have acquired a fixation in the child and tends to suffer increased anxiety when attempts are made to correct the habit. Non compulsive habits-Habits that are easily learned and dropped as the child matures.
- #9 Definition by- (Gellin 1978) Thumb sucking is defined as placement of the thumb or one or more fingers in varying depths into the mouth.
- #27 Other features – Higher incidence of middle ear infections and enlarged tonsils accompanied by mouth breathing.
- #37 Adequate emotional support and concern should be provided
- #42 denatonium benzoate is a bitter compound which prevents children from sucking their digits,on application.It should be applied on the skin and nails and allowed to dry for 10 minutes. A new coat should be applied in morning and evening till the habit is broken.
- #44 A thumb device is usually made of nontoxic plastic and is worn over the child's thumb.
- #57 Patient got a new toy to play with tongue & got distracted .Time : 3- 6 months
- #60 Braver (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
- #68 Controversial , upper respiratory tract infections are tonsillitis, allergies Hereditary- high palatal vault ,imbalance in size and number of teeth
- #71 expressionless face coz mandible is stabilized by facial muscles n not by muscles of mastication.
- #74 Proclination, increase overjet, spacing, maxillary constriction
- #77 Self corrected by 8-9 yrs
- #89 1mm wire
- #103 Rolled out margins and enlarged interdental papilla
- #116 Mg defficiency in nutrition
- #132 SELF INJURIOUS HABITS( MASOCHISTIC HABITS) -Deliberate destruction or alteration of body tissue without conscious, suicidal intent and occurs in conjunction with a variety of psychiatric disorders (Roberts 1997)
- #138 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 & some have used appliances.
- #144 There is no evidence that nail biting can cause malocclusion or dental change other than minor enamel fractures, therefore, there is no recommended treatment.