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Prevention of oral habits
This document discusses various common oral habits including lip biting, tongue thrusting, bruxism, nail biting, thumb sucking, and mouth breathing. It describes the dental effects of these habits, which vary depending on the intensity, duration, and frequency of the habit. For habits lasting 4-6 hours per day, tooth movement can occur. The document outlines different treatment approaches for habits, including reminder therapy, reward therapy, and appliance therapy. Duration is identified as playing the most critical role in causing tooth movement. The goal of treatment is to interrupt the habit before permanent teeth erupt.
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Prevention of oral habits
- 1. Prevention of Oral Habits ASS. PROF.RANDA YOUSSEF
- 2. Any repetitive behaviourthat utilizes the oral cavity.
- 3. COMMON ORAL HABITS LIPBITING TONGUE THRUSTING BRUXISM NAIL BITING • Pencil chewing • Bobby pin opening • Bottle opening • Needle biting • Improper brushing • Wire Chewing ( Electricians) MOUTH BREATHING THUMB SUCKING
- 4. • The presenceof an oral habit in the 3 to 6 year old is an important finding. • 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 teeth, some form of intervention is warranted prior to the eruption of the permanent teeth.
- 5. The types ofchanges in the dentition that an oral habit may cause vary, depending on the intensity, duration, and frequency of the habit. • Intensity – Intensity is 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.
- 6. DURATION PLAYS THEMOST CRITICAL ROLE IN TOOTH MOVEMENT!!! Clinical and experimental evidence suggests that 4 to 6 hours of force per day are necessary to cause tooth movement.
- 7. •Badgering the child aboutthe habit tends to negatively reinforce the habit.
- 8. • Depending onthe willingness of the child to stop the habit, three different approaches to treatment have been advocated. They are: 1. Reminder Therapy 2. Reward Therapy 3. Appliance Therapy
- 9. CLASSIFICATION • Sucking: Nutritive /Non-nutritive • Non-sucking:
- 10. Sucking Habits • NutritiveSucking Habits Prolonged bottle feeding…………………..ECC
- 11. Non-nutritive Sucking •Sucking isa normal baby reflex, beginning around the 29th week of gestation. •Almost 100% of normal babies engage in non-nutritive sucking. •Babies may suck their thumb, fingers, hand, a pacifier, or other inanimate object such as a blanket or toy. •
- 12. •Sucking tends tooccur more often when the child is tired, bored, anxious, or upset. •Although most children discontinue non-nutritive sucking between 2 and 4 years of age, more than 20% still engage in the habit at age 3. •Older children are often motivated to quit by peer pressure at school.
- 13. 13 THUMB SUCKING Thumb andfinger habits are seen in children from very small ages. Develops as a habit or due to sense of insecurity. It is defined as the placement of thumb or one or more fingers in varying depth into the mouth
- 14. • Thumb andfinger habits make up to majority of oral habits. • The classic symptoms of an active habit are reported to be the following: 1. Anterior open bite. 2. Facial movement of the upper incisors. 3. lingual movement of the lower incisors. 4. Maxillary constriction.
- 15. • Maxillary archconstriction is due to the change in equilibrium balance between the oral musculature and the tongue. • When the thumb is placed in the mouth, the tongue is forced down and away from the palate. • The obicularis oris and buccinator muscles continue to exert a force on the buccal surfaces of the maxillary dentition. • Without the tongue’s counterbalancing force on the lingual surfaces, the posterior maxillary arch collapses into crossbite.
- 16. 16 WHAT HAPPENS TOYOUR CHILD’S TEETH & THUMB???
- 17. • Timing oftreatment is critical. • The child should be given every opportunity to stop the habit spontaneously before the eruption of the permanent teeth. • Treatment is usually undertaken by age 6 years.
- 18. HOW DO ISTOP THUMB SUCKING??? • Reminder Therapy – Reminder therapy is 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
- 19. 19 REMINDER THERAPY Extraoralapproaches: It employs hot tasting, bitter flavoured preparation or distasteful agents that are applied to finger and thumbs. For example, cayenne, pepper, Thermoplastic thumb post. Intraoral approaches: Various orthodontic appliances are employed to attenuate and eventually break the habit THUMB CAP
- 20. • Reward Therapy –A contract is agreed upon between the child and parent or between the child and dentist. – The contract simply states that the child will discontinue the habit for a specified period of time and in return he/she will receive a reward if the requirements of the contract are met. The more involvement the child can take in the project, the more likely the project will succeed.
- 21. • Appliance Therapy –Appliance therapy should only be used when reminder and reward therapy have failed. – The dentist should explain to the patient and parent that the appliance is not a punishment but rather a permanent reminder. – The parent and 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. – Habit discouragement appliances should be left in the mouth for six months.
- 22. • There aretwo major categories of commonly used appliances: 1. Removable 2. Fixed • Removable – Easily misplaced or lost – Patient compliance is a major factor • Fixed – “Cemented” in-place using a dental cement/adhesive – Does not rely on patient compliance
- 23. Oral Habits --Appliance Therapy-- •Removable Appliance – Example: Modified Hawley
- 24. • Fixed Appliance Examples:Palatal Crib Blue grass appliance
- 25. --Pacifier Habits-- • Dentalchanges created by pacifier habits are similar to changes created by thumb habits. • Anterior open bite and maxillary constriction are seen consistently in pacifier suckers. • Labio-lingual movement of incisors may not be as pronounced as with a digit habit. • Manufacturers have developed orthodontic pacifiers that claim to be more like a mother’s nipple and not as deleterious to the dentition as a thumb or conventional pacifier.
- 27. • Pacifier habitsare theoretically easier to stop than digit habits. • The pacifier can be discontinued gradually or at one point in time under the control of the parent. • In a few cases, the child may subsequently start sucking a finger or thumb.
- 28. MOUTH BREATHING Usually seenin people with nasal obstruction. May also occur as a habit.
- 29. Habitual respirationthrough the mouth instead of the nose CLASSIFICATION FINN(1987) Anatomic-short upper lip permits incomplete closure Obstructive-complete obstruction of the normal flow of air through nasal passages Habitual-continual breathing from mouth by force of habit although abnormal obstruction has been removed
- 30. WHAT CAN HAPPENDUE TO THIS??? DENTAL EFFECTS Forward placement of upper front teeth Gap between upper & lower front teeth Improperly placed teeth
- 31. Effects on thefacial structures Facial form Large face height Large mandibular plane angle Retrognathic mandible &maxilla Adenoid facies Long narrow face with long narrow nose, nasal passage & flaccid lips Nose tipped superiorly Infront so an observer can look directly into the nares 31
- 32. Gingiva Inflamed &irritatedgingival tissue in the anterior maxillary arch Gingiva is hyperplastic due to continuous exposure of the tissues to air Gingiva exhibits classic rolled margin with an enlarged interdental papilla Lip Short thick incompetent upper lip and a voluminous curled over lower lip On smiling, patients reveal large amounts of gingiva producing a ‘gummy smile’
- 33. TREATMENT Treatment of mouthbreathing includes: Elimination of the cause Interruption of the habit Correction of malocclusion Symptomatic treatment
- 34. ORAL SCREEN Thisis the most effective way to reestablish nasal breathing, by preventing air from entering oral cavity. It is curved corresponding to the curvature of the arch and is made of acrylic. It works on the principle of both force application and force elimination The appliance has to be worn for 2-3 hrs during the day and during the sleep at night. If patient feels difficult to breathe, then multiple holes can be made that are closed one by one over a period of time.
- 35. TONGUE THRUSTING Tongue thrustis the forward movement of the tongue tip between the teeth to meet the lower lip during deglutition & in sounds of speech, so that the tongue lies inter-dental (Tulley1969)
- 36. CLASSIFICATION Physiologic Normal tonguethrust swallow of infancy Habitual Tongue thrust present as a habit even after correction of the malocclusion Functional When tongue thrust is an adaptive behavior Developed to achieve an oral seal Anatomic Person having an enlarged tongue
- 37. TONGUE THRUST Simpletongue thrust Anterior open bite Normal tooth contact posteriorly Contraction of lips, mentalis Complex tongue thrust Generalised open bite Absence of contraction of lips, mentalis Lateral tongue thrust Posterior open bite with tongue thrusting laterally 37
- 38. CLINICAL MANIFESTATIONS Extra oralfindings Lip posture- lip separation is greator in tongue thrust, both at rest and in function. Mandibular movements- More erratic, no correlation between the movement of tongue and mandible. Speech- speech disorders such as lisping, problems in articulation of s, n, t, d, l, z, and v sounds. Intra oral findings- Tongue movements- swallowing movements are seen to be jerky and inconsistent. Chin point is posterior as compare to normal position. Tongue posture- tongue tip at rest is lower in tongue thrust group.
- 39. 39 Malocclusion- Features pertaining tomaxilla- Proclination of maxillary anteriors resulting in an increase overjet Generalized spacing Maxillary constriction Features pertaining to mandible- Retroclination or proclination of mandibular teeth depending on type of tongue thrust present Intermaxillary relationship- Anterior or posterior open bite Posterior teeth crossbite
- 40. TREATMENT Tongue thrust oftenself corrects by 8 or 9years of age by the time the permanent anteriors completely erupts TRAINING OF CORRECT SWALLOW & POSTURE OF THE TONGUE:- Myofunctional exercises 2S EXERCISES – Using the pressure point on the papilla the SPOT is shown .the tip is against this spot at rest position SQUEEZE is done by squeezing the tongue vigorously against this spot with the teeth closed , followed by relaxing. 4S EXERCISES SPOT ,SALIVATE,SQUEEZE & SWALLOW
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- 42. 42 BRUXISM Bruxism is thegrinding or gnashing of teeth, usually occuring at night Causes ‘ ’
- 43. ETIOLOGY 1. PSYCHIC TENSIONASSOCIATED WITH ANY KIND OF STRESS. 2. OCCLUSAL INTERFERENCE SUCH AS DUE TO MALOCCLUSION. 3. INTESTINAL PARASITES. 4. SUBCLINICAL NUTRITIONAL DEFICIENCY 5. ALLERGY 6. ENDOCRINE DISTURBANCE.
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- 46. HABITS THAT INVOLVEMANIPULATION OF THE LIPS AND PERIORAL STRUCTURES ARE TEERMED AS LIP HABITS 46 LIP HABIT
- 47. Mouth ulcers Spacing &flaring of upper front teeth Protrusion of maxillary incisors & retrusion of mandibular incisors. Reddened irritated & chapped area below the vermillion border Mentolabial sulcus becomes accentuated
- 48. HOW DO ISTOP??? Correction of malocclusion Treating the primary habit Lip habit along with digit sucking can be corrected by hawley’s retainer with labial bow Appliance therapy Oral screen Lip bumper It is positioned in the vestibule of the mandibular arch &serve to prohibit the lip from exerting excessive force on the mandibular incisors 48 Use of LIP BUMPER
- 49. NAIL BITING BELOW 3YEARS – ABSENT 4 TO 6 YEARS – INCIDENCE RISES SHARPLY 7 TO 10 YEARS – REMAINS CONSTANT REACHS ITS PEAK AT ADOLSCENCE 49
- 50. 50 EFFECTS Chapping of fingernails Fungal Infection of fingers Prevention Application of bitter substances onto finger nails
- 51. O THER O RAL H ABITS Bobby pin opening Needlebiting by tailors Pencil Chewing Wire chewing by electricians Bottle Opening
- 52. EFFECTS Chipping of tooth edge Notchingof tooth edge Loss of tooth vitality
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