Bad Oral Habits

Prof.Dr.Nidhal.H.Ghaib
 Bad Oral Habit

Habit: is a fixed or constant practice established

by frequent repetition

Bad habits can interfere with the child’s

physical, emotional and social functions
 Bad Oral Habit
Digit Sucking Habit (Thumb/Finger-Sucking)
Tongue Thrusting Habit
Mouth Breathing Habit
Bruxism
Lip-Sucking and Lip-Biting
Nail Biting Habit
Etiological Agents in the Development of
Oral Habits

1. Anatomical
2. Mechanical Interferences
3. Pathological
4. Emotional
5. Imitation
6. Random Behavior
Etiological Agents in the Development of Oral Habits

Anatomical
Etiological Agents in the Development of Oral Habits

Mechanical Interferences
Etiological Agents in the Development of Oral Habits

Pathological
Etiological Agents in the Development of Oral Habits

Emotional
 Digit Sucking Habit
(Thumb/Finger-Sucking)
 Digit Sucking Habit (Thumb/Finger-Sucking)

Repeated and forceful sucking of thumb/finger with associated strong

buccal and lip contractions
Almost all children take up this habit, but eventually discontinue it
spontaneously with age and maturation
 Digit Sucking Habit (Thumb/Finger-Sucking)

There are essentially two forms of sucking:

Nutritive sucking
Non-nutritive sucking
 Digit Sucking Habit (Thumb/Finger-Sucking)

Main Effects of Digit Sucking

Extra oral effects: the offending digit is exceptionally clean, reddened or

sometimes deformed. Fibrous roughened callus may be present on the digit and
sometimes there may be viral or fungal infection

Intra oral effects:

• Proclination and spacing of upper incisors
• Retroclination of lower incisors
• Anterior openbite (usually asymmetrical)
• Narrow maxillary arch (posterior cross bite)
 Digit Sucking Habit (Thumb/Finger-Sucking)

Extra oral effects

 Digit Sucking Habit (Thumb/Finger-Sucking)

Intra oral effects

 Digit Sucking Habit (Thumb/Finger-Sucking)

Intra oral effects

 Digit Sucking Habit (Thumb/Finger-Sucking)

The severity of malocclusion caused by digit sucking

depends on several factors:

• Frequency: number of times/ day habit is

practiced
• Duration: amount of time spent on habit
• Intensity: amount of force applied to the teeth
during sucking
Digit Sucking Habit (Thumb/Finger-Sucking)

Diagnosis of Digit Sucking

History
Extra oral effect/examination
Intra oral effect/examination
 Treatment of Digit Sucking

Discussion
Reminder therapy
Reward system
Appliance therapy
 Treatment of Digit Sucking
Reminder therapy
 Treatment of Digit Sucking
Appliance therapy
 Treatment of Digit Sucking
Appliance therapy
 Treatment of Digit Sucking
Appliance therapy
 Treatment of Digit Sucking
Younger than 3 years, no active intervention
Most children outgrow the habit by 5 years of age
Malocclusion is self-correcting if ceased by the time of eruption of
permanent teeth
The patient should be at least 7 years old to receive an appliance
therapy to reason and understand the need for an appliance
Always parents support and encouragement is necessary to help the
child through the treatment period
When sucking ceases, appliance should be retained for approximately
3 months to ensure that the habit has truly stopped
Tongue Thrusting Habit
 Tongue Thrusting Habit

Is a condition in which the tongue protrudes

between the anterior or posterior teeth during
swallowing with or without affecting tooth position.
 Classification of Tongue Thrusting

Etiologic Classification
Physiologic tongue thrust
Habitual tongue thrust
Functional (adaptive) tongue thrust
Endogenous tongue thrust
Anatomic tongue thrust
 Classification of Tongue Thrusting

Backlund Classification
Anterior tongue thrust
Forceful anterior thrust leading to anterior open bite

Posterior tongue thrust

Lateral thrusting in case of missing posterior teeth leading to posterior open bite
 Anterior tongue thrust

Posterior tongue thrust

 Classification of Tongue Thrusting

Moyer’s Classification
Simple tongue thrust (teeth are together)
Complex tongue thrust (teeth are apart)
Retained infantile thrust (endogenous tongue thrust)
Persistence of infantile swallowing reflex even after permanent teeth appear
 Classification of Tongue Thrusting

Features of Endogenous Tongue Thrust

 It is a basic neuromuscular mechanism. This so-called 'endogenous'
tongue thrust
 Wide anterior openbite
 It sometimes associated with an anterior lisp during speech
 The upper and lower incisors may be proclined
 There is a familiar tendency
 It is not common, appearing in only 3.1% of the population
 Have a tendency to relapse after orthodontic treatment
 Management of Tongue Thrusting

3-11 years: normal occurrence, not to be concerned, reassures parents.

Conservative approach, demonstrate correct swallow and observe the
child.

11 years or older: tongue thrust is not a normal pattern. Treatment

options may include; correction of malocclusion, myofunctional therapy,
muscle exercises, and habit breaking appliances.

Note: treatment of endogenous tongue thrust has poor prognosis

Mouth Breathing Habit
 Mouth Breathing Habit

It is the habitual respiration through the mouth instead of the nose.

The main causes of mouth breathing habit

Nasal obstruction
Habitual
 Effects of Mouth Breathing Habit

1. 'Adenoid Facies'
2. Increased facial height
3. Mandible would rotate down and back
4. Posterior teeth would overerupt
5. Anterior openbite and increased overjet
6. Posterior crossbite, with narrow shaped palate
7. Incompetent, dry, and fissured lips
8. Gingival hypertrophy
 Diagnosis of Mouth Breathing Habit

1. Ask the patient to take a deep breath

2. Mirror test 3. Cotton test 4. Water test

 Management of Mouth Breathing Habit

ENT referral for management of nasopharyngeal obstruction is

necessary before any orthodontic treatment
Bruxism
 Bruxism

Non functional contact of the teeth which may include clenching,

grinding and tapping of the teeth

The main etiological factors are:

Occlusion defects
Psychological factors
 Bruxism
Effects
Occlusal wear
Sensitivity
Teeth mobility
Fracture
TMJ problems
 Management of Bruxism

1. Determine the underlying cause and eliminate it

2. Occlusal adjustment including restoration and occlusal splints/bite
guards
3. Psychotherapy like relaxation exercises
4. Drugs like local anesthetic injections into TMJ for muscles,
sedatives, and muscle relaxants
Lip-sucking and Lip-biting
 Lip-sucking and Lip-biting

Lip-sucking may appear by itself or it may be seen with thumb-sucking

or as a compensatory activity that results from an excessive overjet and
the relative difficulty of closing the lips properly during deglutition.
In almost all-instances, it is the lower lip that is involved in sucking and
biting, although biting habits of the upper lip are observed as well.
 Lip-sucking and Lip-biting

When the lower lip is repeatedly held beneath the maxillary anterior
teeth, the result is
Proclination the upper anterior teeth
Often an openbite
Sometimes retroclination of the lower anterior teeth
Sometimes there may be eczematous appearance of the skin below the
lower lip
 Lip-sucking and Lip-biting

Management
Lip over lip exercises
Lip bumper
 Lip-sucking and Lip-biting
Lip bumper
Nail Biting Habit
 Nail Biting Habit

It is one of the most common habits in children and adults which may
be due to emotional and social problems that may affect the
psychology of the individual.
 Nail Biting Habit

Clinical Features
Crowding
Rotation
Attrition of lower or upper incisors
Effect on nails: inflammation of nailbeds and heavily cut nails
 Nail Biting Habit

Management
No treatment in mild cases
Treat the basic emotional factor causing the habit
Encourage outdoor activities
Reminders like nail polish
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