Prevention and Treatment of

Oral Habits
 •"A habit is a fixed practice produced by constant
repetition of an act".

Definition of •Pernicious oral habit.

•When the habit involving the oral cavity becomes

habit: fatal, causes defects in orofacial structures it is

termed as pernicious oral habit.
 • Useful habits
• Habits that considered essential for
normal function such as proper
• Positioning of tongue,

Type of
• Respiration,
• Normal deglutition.
• Nasal breathing)
habits • Harmful habits
• Habits that have deleterious effect on
the teeth and their supporting
structures.
• Thumb sucking, Tongue thrusting
1- Digit sucking:

•Thumb sucking and finger sucking are more generally termed "digit sucking" habits.
•One of the most common oral activities of the infant and young child.
•Thumb sucking is more prevalent than finger sucking.
 1.Physiological:
• The infant sucks on any object brought into contact with
the lips.
• This reflex behavior lasts for the first several months of
postnatal life.

Etiology: • It is an adaptive reflex common to mammals.

2.Imitation of other children.
3.Feeding problems: rapid feeding or transition from
liquid to solid feeding.
4.Emotional disturbance or social problems.
 •Phase I:
• In infancy (birth to 2 years).
• It is a normal activity which may be ignored in
infancy.
•Phase II:
• In the preschool child (2 to 5years) mild sucking

Classification: before retiring or when fatigued is normal.

• This results in temporary malformation of the jaws or
displacement of the teeth.
•Phase III:
• In the school child (6 to·12 years).
• It is usually a manifestation of a general emotional &
social immaturity.
• This is active thumb sucking resulting in malocclusion.
Malocclusion
from thumb
sucking:

1.Anterior open bite

2.Proclination of upper incisors and retroclination of the lower incisors.
3.Tongue thrust anterior open bite favours the forward positioning of the tongue.
4.Posterior cross bite due to over activity of buccinator compressing the maxilla.
 •I- Psychobiological:
• Direct conversation with child or reward system.
•II- Chemical means:
• bitter-flavored preparations or distasteful agents
Control of that are applied to the fingers or thumbs.
•III- Mechanical:
thumb or finger • 1- Application of adhesive tape to thumb or finger.
• 2- Hawley appliance with a palatal bar may be
sucking: fitted as a habit reminder. At instances thumb and
finger sucking habits are at the subconscious level
of the individual's attention.
• 3- Active oral screen: corrects the habit and
corrects the protruded incisors.
 • It is also advocated in children who are aware of the
ill effects and want to discard the habit.
Reminder • Patient cooperation is very important.

Therapy • Habit reminders reminds the child of the habit

whenever he puts his thumb into the mouth.
• Thumb guard made of acrylic or gauze will remind
the child as the thumb is taken to the mouth and also
the child does not derive any pleasure sucking the
thumb guard.
• A) Extra oral approach:-

• Employed bitter flavored preparations

• It should be applied on skin and nails allowed to dry for 10 min.

• A new coat should be applied in mornings and evening till habit

is broken.

• A commercially available product can also be used.

• (B) Ace bandage approach:-

• Ace bandage approach involve nightly use of an

elastic bandage wrapped across the elbow pressure exerted by the

bandage remove the digit from the mouth as child tries and falls
asleep.

• (C) Use of long sleeve night gown.

• (2) Intra oral approaches:-
• Various orthodontic appliances are employed
to break the habit.
• Removable appliance palatal crib, rakes,
palatal , lingual spur and oral screen is more
effective.
• Fixed appliances
 3) Mechanotherapy

• (A) Fixed intra oral

anti thumb sucking appliances-
An intraoral appliance attached to the upper teeth by
means bands fitted to the primary second molar or
first permanent molar.
• (B) Blue grass appliances –
Consist of modified six-sided roller
machined from Teflon to permit purchase of the
tongue.
• (C) Quad helix –
prevents the thumb from being inserted and also
corrects the malocclusion by expanding the arch.
 • Should-:
Ideal appliance for • Offer no restraint to normal muscular activity
correction of thumb • Have no shame attached to its use

sucking • Not or minimally involve parents for

placement and removal
• Well adapted, out of the way of normal oral
functioning
 The habit will usually be broken by
the end of 3 weeks and the child
must be rewarded at the end.

Note: Habit reminders should be left in the

mouth for 6 months as retainer.

Next 3 months are needed to correct

posterior cross bite with quad helix
and 3 months are required for
stabilization.
 •Definition:
• Nonfunctional grinding on teeth during
sleep
•Etiology: may be due to
2- Bruxism: • Emotional disturbance.
• Cuspal interference (high restorations).
• G.I.T. disturbance
• Parasites.
• Handicapped e.g. epilepsy, cerebralpalsy.
 Effect:

• traumatic occlusion.
• T. M. J. troubles.
• Abrasion (decreased vertical dimension).
 Treatment:

• Elimination of cuspal interference

• Tranquilizers.
• Stainless steel crowns on primary molars to correct the
vertical dimension.
• Night guard (soft rubber splint or acrylic splint to
wear at night).
• Refer to psychiatrist.
3- Mouth breathing:

•Etiology:
• Respiratory obstructions e.g. adenoids,
deviated nasal septum, enlarged tonsils.
• Habitual mouth breathing.
•Effect:
• Protrusion of upper incisors
• High arched palate.
• Chronic gingivitis.
 (a) Mirror test:-
• Double side mirror is held b/w the nose and mouth
• fogging on the nasal side of mirror indicate nasal
breathing while fogging toward the oral side indicate oral
breathing.
(b) Water test:-

Clinical test The patient is asked to fill the mouth with water, and hold it
for a period of time. While nasal breather accomplish with
ease, mouth breather find the task difficult.
(c) Cotton test:-
• A butterfly shaped piece of cotton is placed over the
upper lip below the nostril. If cotton flutters down it
indicate nasal breathing.
Treatment:
 •Etiology:
• Stress and psychological disturbance.
• Excessive overjet.
• Class II division I.
• Associated with finger sucking habit
•Effect:
4- Lip biting • Anterior open bite.
• Proclination of upper incisor and
and sucking: retroclination of lower incisors.
•Treatment:
• Treatment of the cause
• Self-discipline not to perform the habit.
• Habit breaking appliance ( lip bumper).
• Oral screen may be used.
5- Tongue thrusting:

•Etiology:
• 1- Persistence of infantile type of swallowing.
•2- Associated with thumb sucking.
•3- Respiratory obstruction.
•4- Macroglossia as in acromegaly.
•5- Muscular imbalance as in cerebral palsy.
•Effect:
1. Protrusion of maxillary incisors.
2. Increased overjet and open bite.
3. Lisping & speech problems.
5- Tongue thrusting:

•Treatment:
• Learning of the new reflex.
• Tongue guard.
• Correction of malocclusion:-
• Treatment of open bite after age of 10 years.
• Treatment of protruded incisors with active oral screen.