Oral Habits

Theory and Practice of Pediatric Dentistry

Lecture Overview

Definition

Oral Habits

Effects on the Oral Cavity

Prevention

Treatment Options

Oral Habits

Definition - any repetitive behavior pattern which utilizes the oral cavity.

Two schools of thought

Old - undesirable, abnormal, & needs to be corrected immediately

New - reflection of growth and maturing oral apparatus

Learned patterns of muscular contraction

Abnormal habits can interfere with regular facial growth (Functional Anatomy Theory)

Oral Habits

A relationship exists between the physiologic development of the oral cavity and

The nature

The onset and

The duration of the oral habit

Arise from:

Reflex and instinct - seen in infancy

Complex and Controlled behavior - seen later in life

Generally, the longer the habit is practiced

The harder it will be to break

The more the pathology seen in the oral cavity

Non-compulsive v/s Compulsive Oral Habits

Non-compulsive

Naturally modified or eliminated through the maturation process.

Not so entrenched in the child’s behavior that they cannot be not changed in response to the child’s changing physiologic/ psychologic profile.

Resolve on their own and child “grows” out of!

No detrimental effects seen.

Compulsive

Fixated in a child’s behavior pattern.

Malocclusion frequently results due to persistent and intense habit.

Generally reflects a psychologic dependency on certain behavior.

Compelling reason for the behavior to continue

Insecurities

Fears

Lack of ego-defense mechanism development

Sucking Mechanism

During infancy, it is the most well-developed sensation

Helps with sustenance as well as deriving sensory pleasures.

Gives a feeling of security, warmth, and euphoria.

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures.

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification.

Malocclusion and Habits

The type of malocclusion produced by the habit is dependant on the following variables

Position of the digit/pacifier etc.

Associated orofacial muscle contraction force

Mandibular position during sucking

Facial skeletal genetic pattern

Amount, frequency, & duration of force applied

Malocclusion and Age

During the first 3 yrs, the damage from the habit is mainly confined to the anterior segment, producing an anterior open bite.

Damage can be detrimental if the habit is continued beyond the age of 3.5 yrs.

After 4 years of age, the habit becomes strongly established. The damage seen is more significant.

After the eruption of the permanent incisors, the worst amount of damage seen.

Damage caused by Habits

The permanency of the damage to the Oral Structure is dependant on three factors

Duration

Frequency

Intensity

I = FxD

Different Oral Habits

Finger Sucking

Pacifier

Nail Biting

Lip Sucking

Abnormal Swallowing or Tongue Thrusting

Abnormal Muscle habits

Mouth Breathing

Finger Sucking Habit

Most commonly seen non-nutritive habit in children.

Normal for newborns to engage in digit sucking.

Commonly develop in the first year of life.

Psychological factors contribute to the continuation of this habit past 6-7 months of age.

Most habits abandoned prior to the eruption of the permanent incisors.

No Tx needed if habit stopped by 6-7 years of age.

Earlier Tx instituted if maxillary arch constricted or parent/child is concerned.

Clinical Manifestations of Digit Sucking Habit

Offending digit

Redness

Calluses

Wrinkled skin

Fingernail exceptionally clean

Malocclusion

Pacifier/Binkie Habit

Includes the physiologic pacifiers like the NUK.

Nearly identical to thumb sucking.

Similar clinical findings, only not that pronounced!

Tx - throw away the pacifier!

Caution - child may substitute missing pacifier with a digit!

Nail biting Habit

Usually seen in older children, but may be observed as early as 2-3 years.

Incidence increases through puberty.

Stress-related

Emotional distress

Anxiety

No malocclusion seen.

Damage to the nail and nail bed.

Lip Sucking Habit

Implication in the development of malocclusion is debated.

Includes

Wetting

Licking

Pulling

Sucking

Reddened and irritated lips, more severe in the winter months.

Abnormal Swallowing/ Tongue Thrust Habit

Protrusion of the tongue against or between the anterior dentition and excessive circum-oral activity during deglutition.

Innate behavior

Universal infant oral behavior for children under the age of 6 years.

Not a causative factor for anterior open bite.

Tongue Thrust Habit

Delayed transition between the infantile and adult swallowing pattern.

Transition usually begins to happen around the age of 2 years.

By the age of 6 years, 50% have completed the transition.

10-15% estimated never to fully complete the transition.

Commonly associated with mouth breathing and anterior open bite.

Functional adaptation of malocclusion and not the etiology.

Can cause speech problems - lisping.

Most cases (80%) will self correct by 12 years of age.

Abnormal Muscle Habits

Abnormal muscle habits like Mentalis Habit - muscle arises from the mandible near the apices of the incisors and inserted into the soft tissue of the chin, puckering the skin and the lower lip is folded behind the maxillary incisors with the inner surface of the lip elevated upwards.

Placing the lower lip between the maxillary and mandibular incisors.

Frequently arises following development of anterior open bite.

Can be accompanied by skeletal Class I and II relationships.

Mouth Breathing

Mouth Breathing - can be caused by physiologic or anatomic conditions, can be transitional when exercise induced or due to a nasal obstruction.

True mouth breathing when the habit continues after the obstruction is removed.

Mouth Breathing Habit

Adenoid Facies

Long narrow face

Narrow nose and nasal airway

Flaccid lips with short upper lip

Upturned nose exposing nares frontally

Skeletal Open Bite or “Long Face Syndrome”

Excessive eruption of posteriors

Constricted maxillary arch

Excessive overjet

Anterior openbite

Mandubilar down/forward growth is poor

Constricted Arches of Mouth Breathers

Enlarged Tonsils

Prevention

Usually starts with proper nursing

on the part of the parent

Time

Patience

Holding the baby while nursing,

using a physiologically designed nursing nipple and pacifier to augment normal functional and deglutitional maturation.

Consideration for Oral Habit Therapy

Age of the patient

7 yrs

Maturity of the patient

understands the problem, desires to correct it!

Parent cooperation

Support and encouragement

Timely deliberation

Alert to suggestive psychologic problems

Assessment of deformity

Degree and the presence/absence of other complexities

Treatment Options

Accurate assessment in context of the child’s physiologic and psychologic state of development for proper and effective management.

Dentist-Patient Discussion

Reminder Therapy

Reward System

Appliance Therapy

Dentist-Patient Discussion

Straight-forward discussion

Express concern and explain why the habit should be dropped.

Encourage them to call the office and speak to you if the habit urge returns.

Parents can help monitor only.

Reminder Therapy

Tx principles of Aversive conditioning

Association of unpleasant stimuli with a particular behavior.

Unpleasant and more difficult method

Reminder and not a punishment!

Adhesive bandage

Cotton glove

Fingernail polish

Bitters

Arm wraps

Reward System

Highly recommended as it is effective.

Consult parents to find out what are the child’s likes and what prizes are suitable and special to the child.

Above the age of 5 yrs, use self esteem rewards.

Formulate a contract between the child and parent for a short period of time (1-2 weeks).

Greater the involvement of the parent and child, the more successful the outcome.

Appliance Therapy

Intra-oral appliance

Child must welcome continued assistance

Permanent reminder

Habit Correcting Appliances

Finger Sucking Appliances

Palatal Crib

Habit Correcting Appliances

Tongue/Thumb Retainer

Fixed Tongue Crib

Habit Correcting Appliances

Lip Habit Correction Appliance

Lip Bumper

Summary

Abnormal habits typically interfere with regular facial development.

The longer a habit is practiced, the harder it is to break.

Duration, frequency and intensity play important roles in the permanency of the damage seen.

When considering treatment, make sure the child wants to break the habit.

Placing fixed appliances should be the last resort for habit cessation.


	Definition
	Oral Habits
	Effects on the Oral Cavity
	Prevention
	Treatment Options


	Definition - any repetitive behavior pattern which utilizes the oral cavity.
	Two schools of thought
		Old - undesirable, abnormal, & needs to be corrected immediately
		New - reflection of growth and maturing oral apparatus
	Learned patterns of muscular contraction
	Abnormal habits can interfere with regular facial growth (Functional Anatomy Theory)


	A relationship exists between the physiologic development of the oral cavity and
		The nature
		The onset and
		The duration of the oral habit
	Arise from:
		Reflex and instinct - seen in infancy
		Complex and Controlled behavior - seen later in life
	Generally, the longer the habit is practiced
		The harder it will be to break
		The more the pathology seen in the oral cavity


Non-compulsive
	Naturally modified or eliminated through the maturation process.
	Not so entrenched in the child’s behavior that they cannot be not changed in response to the child’s changing physiologic/ psychologic profile.
	Resolve on their own and child “grows” out of!
	No detrimental effects seen.
Compulsive
	Fixated in a child’s behavior pattern.
	Malocclusion frequently results due to persistent and intense habit.
	Generally reflects a psychologic dependency on certain behavior.
	Compelling reason for the behavior to continue
		Insecurities
		Fears
		Lack of ego-defense mechanism development


	During infancy, it is the most well-developed sensation
			Helps with sustenance as well as deriving sensory pleasures.
			Gives a feeling of security, warmth, and euphoria.
	An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures.
	This deprivation may motivate the infant to suck on the thumb or finger for additional gratification.


	The type of malocclusion produced by the habit is dependant on the following variables
		Position of the digit/pacifier etc.
		Associated orofacial muscle contraction force
		Mandibular position during sucking
		Facial skeletal genetic pattern
		Amount, frequency, & duration of force applied


	During the first 3 yrs, the damage from the habit is mainly confined to the anterior segment, producing an anterior open bite.
	Damage can be detrimental if the habit is continued beyond the age of 3.5 yrs.
	After 4 years of age, the habit becomes strongly established. The damage seen is more significant.
	After the eruption of the permanent incisors, the worst amount of damage seen.


The permanency of the damage to the Oral Structure is dependant on three factors
	Duration
	Frequency
	Intensity
		I = FxD


	Finger Sucking
	Pacifier
	Nail Biting
	Lip Sucking
	Abnormal Swallowing or Tongue Thrusting
	Abnormal Muscle habits
	Mouth Breathing


	Most commonly seen non-nutritive habit in children.
	Normal for newborns to engage in digit sucking.
	Commonly develop in the first year of life.
	Psychological factors contribute to the continuation of this habit past 6-7 months of age.
	Most habits abandoned prior to the eruption of the permanent incisors.
	No Tx needed if habit stopped by 6-7 years of age.
	Earlier Tx instituted if maxillary arch constricted or parent/child is concerned.


	Offending digit
		Redness
		Calluses
		Wrinkled skin
		Fingernail exceptionally clean
	Malocclusion


	Includes the physiologic pacifiers like the NUK.
	Nearly identical to thumb sucking.
	Similar clinical findings, only not that pronounced!
	Tx - throw away the pacifier!
	Caution - child may substitute missing pacifier with a digit!


	Usually seen in older children, but may be observed as early as 2-3 years.
	Incidence increases through puberty.
	Stress-related
		Emotional distress
		Anxiety
	No malocclusion seen.
	Damage to the nail and nail bed.


	Implication in the development of malocclusion is debated.
	Includes
		Wetting
		Licking
		Pulling
		Sucking
	Reddened and irritated lips, more severe in the winter months.


	Protrusion of the tongue against or between the anterior dentition and excessive circum-oral activity during deglutition.
	Innate behavior
	Universal infant oral behavior for children under the age of 6 years.
	Not a causative factor for anterior open bite.


	Delayed transition between the infantile and adult swallowing pattern.
	Transition usually begins to happen around the age of 2 years.
	By the age of 6 years, 50% have completed the transition.
	10-15% estimated never to fully complete the transition.
	Commonly associated with mouth breathing and anterior open bite.
	Functional adaptation of malocclusion and not the etiology.
	Can cause speech problems - lisping.
	Most cases (80%) will self correct by 12 years of age.


	Abnormal muscle habits like Mentalis Habit - muscle arises from the mandible near the apices of the incisors and inserted into the soft tissue of the chin, puckering the skin and the lower lip is folded behind the maxillary incisors with the inner surface of the lip elevated upwards.
	Placing the lower lip between the maxillary and mandibular incisors.
	Frequently arises following development of anterior open bite.
	Can be accompanied by skeletal Class I and II relationships.


	Mouth Breathing - can be caused by physiologic or anatomic conditions, can be transitional when exercise induced or due to a nasal obstruction.
	True mouth breathing when the habit continues after the obstruction is removed.


	Adenoid Facies
			Long narrow face
			Narrow nose and nasal airway
			Flaccid lips with short upper lip
			Upturned nose exposing nares frontally
	Skeletal Open Bite or “Long Face Syndrome”
			Excessive eruption of posteriors
			Constricted maxillary arch
			Excessive overjet
			Anterior openbite
			Mandubilar down/forward growth is poor


Usually starts with proper nursing
	on the part of the parent
		Time
		Patience
		Holding the baby while nursing,
		using a physiologically designed nursing nipple and pacifier to augment normal functional and deglutitional maturation.


	Age of the patient
			7 yrs
	Maturity of the patient
			understands the problem, desires to correct it!
	Parent cooperation
			Support and encouragement
	Timely deliberation
			Alert to suggestive psychologic problems
	Assessment of deformity
			Degree and the presence/absence of other complexities


	Accurate assessment in context of the child’s physiologic and psychologic state of development for proper and effective management.
		Dentist-Patient Discussion
		Reminder Therapy
		Reward System
		Appliance Therapy


	Straight-forward discussion
	Express concern and explain why the habit should be dropped.
	Encourage them to call the office and speak to you if the habit urge returns.
	Parents can help monitor only.


Tx principles of Aversive conditioning
	Association of unpleasant stimuli with a particular behavior.
Unpleasant and more difficult method
Reminder and not a punishment!
		Adhesive bandage
		Cotton glove
		Fingernail polish
		Bitters
		Arm wraps


	Highly recommended as it is effective.
	Consult parents to find out what are the child’s likes and what prizes are suitable and special to the child.
	Above the age of 5 yrs, use self esteem rewards.
	Formulate a contract between the child and parent for a short period of time (1-2 weeks).
	Greater the involvement of the parent and child, the more successful the outcome.


	Intra-oral appliance
	Child must welcome continued assistance
	Permanent reminder


	Abnormal habits typically interfere with regular facial development.
	The longer a habit is practiced, the harder it is to break.
	Duration, frequency and intensity play important roles in the permanency of the damage seen.
	When considering treatment, make sure the child wants to break the habit.
	Placing fixed appliances should be the last resort for habit cessation.