Shetty et al International Journal of Public Health Dentistry

RESEARCH ARTICLE

Oral Habits in children of Rajnandgaon, Chhattisgarh, India- A prevalence study

Raghavendra Manjunath Shetty, Manoj Shetty, Nailady Sridhar Shetty, Hanumanth Reddy,
Sunaina Shetty, Anil Agrawal.

Abstract

Background: Early diagnosis of abnormal habits may allow both dentists and parents to discourage
these habits and avoid negative consequences. Aim: The present study was undertaken to assess
the prevalence of oral habits in 6 to 11 year old children in Rajnandgaon city, Chhattisgarh, India.
Methods: A total of 1891 school children aged 6 to 11 years from the city of Rajnandgaon reporting to
the department of pedodontics were selected for the study. A thorough history was obtained on a
specially designed proforma and presence or absence of oral habits like thumb/finger sucking, tongue
thrusting, mouth breathing, lip biting, nail biting and bruxism were recorded. Data was analysed using
chi-square test. Results: Prevalence of oral habits was found to be 33.2% in the total sample studied.
Tongue thrust was the most prevalent habit affecting 17.4% of children, whereas 13% of children had
mouth breathing habit followed by 1.7% of children with thumb/finger sucking. Prevalence of lip biting,
nail biting and bruxism was found to be 0.4%, 0.3% and 0.4% respectively. Age and prevalence of
thumb/finger sucking, tongue thrusting and mouth breathing were found to be statistically highly
significant (p<0.001). No significant differences were found in any oral habits between boys and girls.
Conclusions: Oral habits, especially if they persist beyond the preschool age, have been implicated
as an important environmental etiological factor associated with the development of malocclusion. So,
early diagnosis and proper treatment planning of these habits will reduce the occurrence of
malocclusion.

Keywords: Thumb sucking; Tongue thrusting; Mouth breathing; Oral habits; Prevalence.

Introduction etiological factor associated with the

development of malocclusion (2-4).
A wide variety of oral habits in infants and
Thumb and finger sucking habits, or non
young child has been the centre of much
nutritive sucking are considered to be the most
controversy for many years. Parents,
prevalent of oral habits, with a reported
pediatricians, psychologist, speech
incidence ranging from 13% to almost 100% at
pathologists and pedodontists have discussed
some time during infancy (5,6). The finger-
and argued the significance of these habits,
sucking habit, normal in the first two or three
each from the view point of expertise and
years of life, may cause permanent damage if
responsibility. Early diagnosis of abnormal
continued beyond this time (7). Reported
habits may allow both dentists and parents to
maxillary changes associated with a prolonged
discourage these habits to avoid negative
sucking habit are proclination of the maxillary
consequence (1). Oral habits, especially if they
incisors increased maxillary arch length,
persist beyond the preschool age, have been
anterior placement of the maxillary apical
implicated as an important environmental
base, increased sella-nasion-point Angle
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Shetty et al
(SNA) and decreased palatal arch width (8,9).
Effects on the mandible include proclination of
the mandibular incisors, decreased sella-
nasion-point B angle and increased intermolar
distance (8,9). Other dental alterations are
increased overjet, decreased overbite and
posterior crossbite. The tongue and lips are
also affected by sucking. Lip incompetence
and tongue thrust are usually associated with
sucking habits (10).
Prolonged tongue thrusting habit has been
shown to be associated with open bite,
however if the open bite is a cause or an effect
is not well established. While it has been noted
that anterior position of the tongue may result
in open bite (11). Tongue thrust with an open
bite has been shown to be associated with
long facial pattern and proclination of upper
anterior teeth (12). Other associated features
with tongue thrust have been high and/or
narrow maxillary arch and Class II div I
malocclusion. It also may lead to lisping or
impaired speech.
During adolescence, the habit of mouth
breathing may develop from recurrent throat
infections, allergic rhinitis or nasal obstruction
due to factors such as a deviated nasal
septum or other anatomical causes. Long
standing mouth breathing and
obstruction can adversely affect dentofacial
growth (13).
In India overall prevalence of oral habits has
been reported to be as low as 3% among the
children of Ambala- North India (14) and
29.7% in Mangalore-South India
respectively. Hence, present study
undertaken to obtain the prevalence of oral
habits in children of 6-11 years age group in
Rajnandgaon city, Chhattisgarh.
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International Journal of Public Health Dentistry
Materials and Methods
A total of 1891 school children reporting to the
Department of Pedodontics of age 6-11 years
between July 2009 and June 2010 were
included in the study. Selection criteria
included absence of previous orthodontic
treatment, premature loss of primary teeth,
trauma or surgery in the dentofacial region,
mental retardation and any systemic diseases.
Written informed consents were obtained from
all the parents. The study was approved by the
ethical committee of Chhattisgarh dental
college and research institute, Rajnandgaon,
Chattisgarh, India.
Each child was asked to sit comfortably on a
dental chair and was subjected to a thorough
history and clinical examination. A thorough
history was obtained on a specially designed
proforma which included the personal data
(age, sex, and residence), presence or
absence of oral habits like thumb/finger
sucking, tongue thrusting, mouth breathing, lip
biting, nail biting and bruxism. As there was a
possibility that the children or parents were not
aware of the tongue thrusting and mouth
breathing, the children were diagnosed for
these habits on the dental chair. The child was
asked to swallow saliva first and then 10 ml of
nasal water. Position of the tongue during
swallowing was evaluated by depressing the
child’s lower lip with the operator’s thumbs and
simultaneously feeling the masseter muscle
activity with the index fingers. Child was
diagnosed as a tongue thruster if he/she
(15) fulfilled any one of the following criteria
was established by Weiss and Van Houten (16).
1. He/she thrusted his/her tongue
against the upper central incisors or
between the upper and lower central
incisors during swallowing.
Shetty et al International Journal of Public Health Dentistry

2. Swallowed with his/her teeth apart, mouth breathing were found to be statistically
and/or highly significant (p<0.001). However, no
3. Had excessive lower lip activity during significant differences were found in lip biting,
swallowing. nail biting and bruxism when associated with
Child was diagnosed as mouth breather by the age. Prevalence of various oral habits in
double ended mirror and water holding test relation to the gender was tabulated [Table 3].
similar to previous studies reported (14,15). A However, no significant differences were found
single calibrated examiner recorded the in any of the oral habits between boys and
2
presence or absence of habits. Kappa value girls (χ =3.6, p=0.72).
2
was 0.89. Chi-square statistic ( ) was used to Discussion
analyze the data. The threshold for the Oral habits are common in children. These
statistical significance was set at p<0.05. The habits include: non-nutritive sucking habits
statistical package for social sciences (SPSS (thumb, finger and pacifier sucking habits),
11.5 for windows) was used. tongue-thrusting, and lip or nail biting habits.
Results The majority of oral habits are called non-
Out of the 1891 children included in the study, nutritive sucking habits. Near the end of early
1043 were males and 848 were females childhood and the beginning of grade school,
[Table 1]. any prolonged oral habit is considered socially
Table 1: Distribution of children according to unacceptable and can lead to undesirable
age and sex dental effects. Present study was conducted to
Age Sex know the prevalence of oral habits in 6-11 year
Total
(Years) Male Female
6 156 126 282
old children of Rajnandgaon city, so that
7 181 109 290 deleterious effects of same can be prevented.
8 142 130 272
9 135 156 291 The findings of the present study showed that
10 197 119 316 33.2% of the children examined had oral habit
11 232 208 440
Total 1043 848 1891 of some or the other kind. This finding is in
agreement with the results of Dacosta et al
Prevalence of oral habits among children was (17), who found 34.1% of the children
found to be 33.2% in the total sample studied. examined presented with an oral habit.
Tongue thrust was the most prevalent habit Prevalence of oral habits in Mangalore-South
affecting 17.4% of children, whereas 13% of India was reported to be 29.7% (15) whereas
children had mouth breathing habit followed by 25.5% in Delhi –North India (18). However,
1.7% of children having thumb/finger sucking Guaba et al (14) reported that only 3% of
habit. Prevalence of lip biting, nail biting and children demonstrated oral habits, which is
bruxism was found to be 0.4%, 0.3% and 0.4% very much in disagreement with our findings.
respectively [Table 2]. Similar low prevalence (9.9%) of oral habits
Association between various habits and age has been reported by Onyeoso (19), who
were tabulated and analyzed [Table 2]. The studied the prevalence of oral habits in
association between the age and prevalence Nigerian children of age 7-10 years.
of thumb/finger sucking, tongue thrusting and
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 Shetty et al International Journal of Public Health Dentistry

Table 2: Prevalence of oral habits according to age

Age (years)
Oral Habit Significance

6 7 8 9 10 11 Total 2 p value

Thumb-
14(5.0%) 13(4.5%) 5(1.8%) 0(0%) 1(0.3%) 0(0%) 33(1.7%)
Sucking 46.4 <0.001**
Tongue
78(27.7%) 71(24.5%) 61(22.4%) 43(14.8%) 34(10.8%) 42(9.5%) 329(17.4%) 65.5 <0.001**
Thrusting
Mouth
0(0%) 3(1.0%) 40(14.7%) 61(21.0%) 70(22.2%) 72(16.4%) 246(13.0%) 123.5 <0.001**
Breathing
Lip Biting 0(0%) 1(0.3%) 1(0.4%) 0(0%) 3(0.9%) 2(0.5%) 7(0.4%) 5.0 0.405
Nail Biting 1(0.3%) 0(0%) 0(0%) 2(0.7%) 1(0.3%) 2(0.5%) 5(0.3%) 4.8 0.435
Bruxism 2(0.7%) 0(0%) 2(0.7%) 1(0.3%) 1(0.3%) 1(0.2%) 7(0.4%) 3.2 0.667
Total
( in each age 94(15.0%) 88(14.0%) 109(17.4%) 107(17.1%) 110(17.5%) 119(19.0) 627(33.2%) 262.6 <0.001**
group)
*Statistically significant

Table 3: Prevalence of oral habits according to sex

Oral Habit Significance

Sex
Thumb- Tongue Mouth Nail
N Lip Biting Bruxism 2 p value
sucking Thrusting Breathing Biting

Male 1043 19(1.8%) 180(17.3%) 146(14.0%) 4(0.4%) 2(0.2%) 4(0.4%)

Female 848 14(1.7%) 149(17.6%) 100(11.3%) 3(0.4%) 3(0.4%) 3(0.4%) 3.6 0.72 †

Total 1891 33(1.7%) 329(17.4%) 246(13.0%) 7(0.4%) 5(0.3%) 7(0.4%)

† Not significant at p< 0.05

Tongue thrusting and mouth breathing were
the most prevalent oral habits in the present
study sample. Our findings are concurrent with
the findings of Guaba et
Kharbanda et al (18). In contrast digit sucking
was the most frequently occurring oral habits
seen in 50% of the children in the study
reported by Dacosta et al (17).
Present study revealed that tongue thrusting
habit was prevalent in 17.4% of the children.
Similar finding was reported by Kharbanda et
al (18) who reported 18.1% prevalence of
tongue thrust in their study. However, the
present study differed with the findings of
Shetty and Munshi (15)
comparatively low prevalence (3.02%) of
tongue thrust among 560 children in the age
group of 3-16 years.
al (14) and Mouth breathing habit was the second most
prevalent habit in the present sample with the
prevalence rate of 13%. This prevalence was
higher when compared to the findings of the
previous studies (15,18). Abou-EI-Ezz et al
(20) reported that, 40% of the cases had no
habits, 31% were mouth breathers, 12% had a
combined habit tongue thrust and mouth
breathing, 4% bit their lips, 5% sucked their
thumbs and 7% were tongue thrusters in a
sample of 1120 children. In the present study,
who found a thumb/finger sucking habit was seen only in

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Shetty et al
1.7% of children and was most prevalent habit
after tongue thrusting and mouth breathing.
However various prevalence rates of 0.7%,
3.1%, 8.1% and 16.7% have been reported in
the literature (1,15,18,19).
thumb/finger sucking habit can
undesirable tooth movement
malocclusions. The prevalence of bruxism and
lip biting was found to be 0.4%. Similar low
prevalence were reported by Kharbanda et al
(18). However, the previous literature on the
oral habits also suggests highest prevalence
of bruxism from 6.2% to 30.2% and lip biting
from 1.2% to 6% (1,15,19). Nail biting was
reported to be the least common oral habit
with the prevalence of 0.3%. This observation
is in disagreement with the findings of Shetty
and Munshi (15) who reported 12.7% of
children with nail biting.
There existed difference in prevalence of oral
habits in different age. Oral habits were more
prevalent in 11 year old children with 19%
prevalence, whereas least prevalence of 14%
was found in 7 year old children. A very
significant finding in the present study was
decrease in thumb sucking and tongue
thrusting habit with increase in the age, and
reverse trend in case of mouth breathing
where the habit increased with increase in the
age. Gellin (21) studied the prevalence of
tongue thrusting in American children. He
reported that 97% of the newborns had tongue
thrust and this figure declined to 80% at 5-6
years and then to 3% at 12 years of age. He
concluded that tongue thrusting significantly
decreased with age. A steady decrease in oral
habits with an increase in age was also
observed by Dacosta et al (17).
Karbhanda et al (18) observed that thumb
sucking was more common in girls than boys
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International Journal of Public Health Dentistry
whereas mouth breathing was more common
in boys compared to girls. The reason behind
the gender wise difference in the occurrence
of oral habits may be due to the fact that oral
Prolonged habits in boys are more persistent for longer
lead to period than girls because boys tend to openly
and fight against family’s or surrounding society’s
rules than girls, including when they are told to
stop practicing oral habits (22,23). However no
significant gender differences were found in
relation to the oral habits in the present study.
The same pattern was observed among the
seven to ten year old Nigerian children (19).
However, the cross-sectional nature of the
present study may fail to find more accurate
causal relationship that may existed. Hence,
an analytical and prospective study is required
to find out associations and risk factors for the
occurrence oral habits.Oral habits, especially if
they persist beyond the preschool age, have
been implicated as an important environmental
etiological factor associated with the
development of malocclusion. So, early
diagnosis and proper treatment planning of
these habits will reduce the occurrence of
malocclusion.
Affiliations of the authors: 1. Dr. Ragvendra
Manjunath Shetty, PhD Scholar, 2. Dr. Manoj
Shetty, Professor, PhD Guide 3. Dr. Nailady
Sridhar Shetty, Professor, PhD Co-guide, Nitte
University, Mangalore, Karnataka, India 4. Dr.
Hanumanth Reddy, Associate Professor,
Department of Orthodontics, 5. Dr. Sunaina
Shetty, Assistant Professor, Department of
Periodontics,6. Dr. Anil Agrawal, Sr. Lecturer ,
Department of Community Dentistry, Chhattisgarh
Dental College and Research Institute,
Rajnandgaon, Chhattisgarh, India.
Conflict of Interest:
The author(s) declared no conflict of interests.
Source of Funding: Nil.
Shetty et al
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Corresponding author
Dr. Ragvendra Manjunath Shetty,
PhD Scholar, Nitte University, Mangalore,
Karnataka, India.
e-mail: raghavendra77@yahoo.com

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