Pedia oral habit


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Pediatric Dentistry I
Forth Year

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Pedia oral habit

  1. 1. Oral habits • Habit is a fixed practice produced by constant repetition of an act. • Undesirable habits which may interfere with the regular pattern of facial growth & result into malocclusion.
  2. 2. Types of oral habits 1- Digit sucking 2- Tongue thrust 3- Mouth breathing 4-Lip biting & sucking 5- Nail biting 6-Cheek biting 7- Bruxisum & clenching 8- Franum thrusting 9-Ubnormal posture 10- Self mutilaion
  3. 3. A natural & normal reflex of infants use thumbs, fingers, pacifiers and other objects to suck. This brings about a feeling of security especially during difficult periods. Most stop by age 2 and should be discouraged if not be age 4. Prolonged thumb-sucking can cause crowded crooked teeth, or bite problems. Breaking the Habit: 1. Wait till the time is right. (low stress) 2. Praise them when they are not 3. Focus on the cause (underlying anxiety) 4. Motivate your child 5. Use a reward system 6. Reminders (band-aid around the thumb)
  4. 4. ____ _______ ____ _______ _____ _______
  5. 5. Digit habit -This is the majority of oral habits. Finger sucking is more than thumb sucking. -2/3 of these stop by age 5. -The dental changes occur with digit sucking are based on: .Intensity (force). • Duration (amount of time). • Frequency (how often) . • Position of thumb during sucking • Associated muscles contraction • State of child’s health. • Associated hand pressure. • Stage of osteogenic development. 4-6 hours of force /day necessary to cause tooth movement Intermittent sucking with high intensity less harm than continuous sucking more than 6 hour
  6. 6. Etiology of sucking habit:- 1. Physiological ( mouth used to investigate everything). 2. Imitation of other children. 3. Feeding problems ( bottle feeding, deficient feeding & transition from liquid to solid food). 4. Attract attention (when the presence of new baby). 5. Emotional problems (child’s insecurity or maladjustment )
  7. 7. Effects on the jawbone -Upper front teeth flare out and tip upward while lower front teeth move inward. - "open bite". -If a child stops thumb sucking before loss of primary front teeth & permanent front tooth eruption, most or all harmful effects disappear within six months. -If the habit persists through permanent front tooth eruption lead to lasting damage: flared or protruded upper teeth, delayed eruption of upper or lower front teeth, and open bite. - Result in chewing difficulties, speech abnormalities, and an unattractive smile.
  8. 8. Thumb sucking classified into: - 1.Phase I: - ( subclinical significant change) form 3 months to 2 years. As the infant use rubber pacifier & considered normal. 2.Phase II: - from 2 years- 4 years of age cause temporary changes as decrease overbite & increase over jet. 3.Phase III: -( active sucking habit) persistence of the habit after 4 years & cause malocclusion.
  9. 9. -Dental changes are similar to the digit habit (maxillary incisor flaring, constricted maxilla often associated with a post cross-bite, lingualization of lower incisors, and an anterior open bite). -Dental changes resolve with early discontinued usage. -Most children discontinue the use of the pacifier on their own by the age of 3-4 yrs. -Pacifier use usually ends earlier than digit sucking, but it’s uncommon that a child will stop using the pacifier and replace it with a digit. Treatment 1. Manufacture pacifier similar to mother’s nipple. 2. Discontinued pacifier gradually under the control of parent. Pacifier habit
  10. 10. 1. Displacement of the child’s permanent teeth due to the uneven forces placed on the teeth by the thumb. 2. The upper and lower front teeth may not approximate with each other. 3. The upper front teeth may flare out. 4. The open bite or lack of approximation of upper and lower front teeth may result in speech difficulties during pronunciation. 5. As a result of the flared out or protruding front teeth the child may end up fracturing these teeth more often. 6. Protruding and uneven teeth change the facial appearance. This can cause an inferiority complex in the young mind SYMPTOMS
  11. 11. DIAGNOSIS :- 1. Child above the age of 4 with protruding anterior teeth affected by thumb sucking. 2. A detailed history about the habit. 3. The frequency and duration of this habit help in evaluating the extent of the habit. 4. Presence of callous formation on the back of thumb or finger & low grade of virus infection on the skin. The thumb used by the child normally appears to be very clean compared to the other finger.
  12. 12. Types of intervention:  Counseling  Reminder therapy (like a bandage around the digit)  Distraction therapy (doodling when board)  Fixed or removable crib appliance with palatal acrylic  Quad helix with a palatal crib (usually worn for 6 months)
  13. 13. 1.Psychological Method: Guided the child consciously over a period. This is possible only if the child is psychologically willing and wants to stop the habit. Children often combine thumb-sucking habit with other secondary habits such as hair pulling or nose probing. Frequently making the secondary habit impossible to perform can break the primary habit. It is very important not to criticize the child. The child needs a lot of support and affection. He should be told about the ill effects of sucking the thumb to reinforce his determination to stop thumb sucking. 2.Substitute for sucking habit using chewing gum 3.Visual aids the effect of habits video tap, film poster
  14. 14. 4. Reminder therapy: - A . Extra oral method:  Painting the child’s thumb or finger with an unpleasant tasting substance.  Tapping the thumb with plaster.  Glove can be taped to wrist.  Painting the girl’s finger or thumb by nail polish. B. Reward therapy C. Intra oral methods: This is done by fabricating appliances, fixed or removable
  15. 15. Reward therapy Personalized calendar used to motivate the child to stop sucking habit. By putting stick or stars on the days that child avoid sucking.
  16. 16. Home reminder treatment:- - Placing gloves on child’s finger before bedtime. - Paint thumbs and fingers with various foul- tasting substances. - Wrap bandages around the offending digits. - One method which might help is to tie/roll a used x ray film on the elbow of the child so that child can not bend the hand after tape the edges of the film to avoid sharp ends.
  17. 17. 1. Child understanding 2. Parents’ cooperation 3. Maturity of child ( stage of teeth eruption). 4. Good orientation 5. Friendly rapport.
  18. 18. “Fixed palatal crib“ The crib consists of semicircular stainless steel wires connected to supporting steel bands or rings. The half-circle of wires fits behind the child's upper front teeth, barely visible in normal view. The bands are fastened to the upper primary second molars. Used for 4-6 months & check every 2-4 weeks Crib construction , and cements the appliance. 8 to 10 millimeters of open bite, can close within a few months. - Crib wires prevent the thumb or finger from touching the gums behind the front teeth and on the palate (roof of the mouth), turning a pleasant experience into an unpleasant one. Deriving no satisfaction from the activity, the child has no incentive to continue. - Instructions (avoiding gum chewing, hard and sticky candy, popcorn, peanuts). Not pull on the crib with fingers. Thorough tooth brushing after each meal.
  19. 19. -After crib placement, is checked in 2-4 weeks, and then seen every 1-2 months until the appliance is removed. -Improvement in front tooth position is typically noted within two weeks after crib placement. It takes 4-6 months for the open bit to close and the front teeth to straighten. However, is left 9- 12 months to prevent relapse of the habit. - The ideal time is when upper front primary teeth become loose, just prior to eruption of permanent front teeth. This usually occurs just before or after age six. “Fixed palatal crib“
  20. 20. The appliance is used in early & late mixed dentition in child who desire to stop the habit. • A modified six sided roller from Teflon is constructed to slip over stainless steel wire which is soldered to molar orthodontic bands ( maxillary first permanent molar or second primary molar). • The roller is placed in the most superior aspect of the palate to avoid eating or speech disturbance. • The child can turn the roller instead of sucking. • The appliance used for 3-6 months
  21. 21. • Oral screen • Active oral screen ( for anterior or posterior region). • Passive oral screen • Double oral screen • Oral screen with anterior ring • Oral screen with holes •
  22. 22. In normal swallowing the tongue touch the palate papillae of anterior teeth & dorm surface of the tongue in contact with the palate and lips are tightly closed together While abnormal swallowing teeth are separated, tongue thrust forward between upper & lower anterior teeth, dorm surface of the tongue away from the palate and lips are separated.
  23. 23. Etiology of tongue thrust, • Associated with sucking habit. • Open mouth with protruded anterior teeth. • Premature loss of deciduous anterior teeth. • Respiratory obstruction due to large tonsile • Macroglossia as in acromegaly. • Ankyloglossia. • Prolonged artificial feeding. • Muscular imbalance.
  24. 24. Tongue thrust classified into • Simple tongue thrust (tongue thrust & teeth in occlusion). • Complex tongue thrust (tongue thrust & teeth apart). • Retained infantile swallowing (abnormal swallowing reflex). Diagnosis: - • Contraction of temporalis muscles during swallowing. • Defect in the arch
  25. 25. Tongue thrust -This a characteristic of the infantile and transitional swallowing which are normal for neonates. -Tongue thrust often sustains an open bite, but does not cause one. Protrusion of anerior teeth open bite Lisping Narowing of maxillary arch
  26. 26. Treatment 1. Functional therapy: - The child practice to swallow with the tip of tongue place against incisor papillae. The holding sugarless mint against the incisor papillae until it melt. 2. Appliance therapy: - the use of mandibular lingual arch with horizontal crib or spurs for 4-9 months according to the severity of the case. Double oral screen. Correction of protruded teeth by active oral screen or extra oral force. 3. Speech therapy to correct speech disturbance.
  27. 27. -Due to mandibular posture/lip incompetence or nasal airway obstruction. 1. Obstructive mouth breathing • In respiratory obstruction as atrophic rhinitis. • Hypertrophy of turbinate caused by allergies. • Deviated nasal septum. • Narrow nasal passage. • Adenoids. • Enlarged tonsils. • Chronic infection of mucous membrane of nasal passage. 2. Habitual mouth breathing As a habit persist after removal of nasal obstructions 3. Anatomical mouth breathing • Hypotonic upper lip • Protruded anterior teeth. • Associated with class II division I. • Secondary to sucking habit.
  28. 28. Diagnosis Mouth breather has a typical appearance of adenoid face have :- • long narrow face • protruded anterior teeth • open & dry lips • lower lip extend behind upper teeth To differentiate between habitual & obstructive mouth breather ask the child to breath with his eyes closed with a cotton piece in front of the nostrils.
  29. 29. In nasal breather the mirror will could with condensed moisture during expiration In nasal breather the size of the external nares are changed Oronasal breather the size of the external nares not are changed & alar muscles inactive
  30. 30. 1.Treatment of the cause before correction of malocclusion 2.Passive oral screen in habitual moth breather. 3.Active oral screen to correct protruded anterior teeth Myofunctional exercises Lip exercises with a piece of cardboard held loosely in horizontal position to improve lip seal
  31. 31. Etiology • Psychological disturbance • Hypotonic lower lip • Associated with thumb sucking • Compensatory activity from excessive over jet or open bite • Abnormal relation between the upper lower & jaws class II d I.
  32. 32. Diagnosis 1. Abnormal mentalis muscles activity (puckering up of chin during swallowing. 2. Hyperactive vermillion border. 3. Accentuated labio-mental sulcus. 4. Chronic herpes with red inflamed & chapped lip. Treatment 1. Treat cause. 2. Lip exercise by extending upper lip over incisors & placing the lower lip forcibly over the upper lip. 3. Oral screen . 4. Lip plumber to drawing the lower lip away
  33. 33. -Uncommon before age of 3 years -Causes : • release normal tension due to increase stress. • gain attention of parents. Effects :- No malocclusion may be attrition in severe case. The finger nail beds may be damage. Treatment :- Chewing gum, taping finger, the use of nail protect materials.
  34. 34. Bruxism:- It is unconscious and involuntary habit of clenching or grinding teeth. It is usually done on a subconscious, reflex-controlled level with the patient unaware of doing it. It can take place at night when asleep or during the day. As it is related to stress. It can affect the teeth, muscles, jaw joints (Temporomandibular joints) & the appearance of the face.
  35. 35. The causes of bruxism The etiology of bruxism is a combination of psychic stress (overwork, worry, and tension), as well as various irregularities in the biting surfaces of the teeth, high restoration or deep bite, malocclusion. Emotional bases, nervous & irritable child. Excessive tooth wear caused by bruxism is not the same as normal tooth wear.
  36. 36. The symptoms of bruxism 1. Attrition of teeth (worn down, and become shorter). Occlusal wear: The constant grinding of the teeth can cause a significant loss of tooth structure from the biting surfaces of the teeth. 2. The teeth will become flattened, and the creamy/yellow dentine will be visible. 3. If bruxism is not treated, the teeth may be worn down to the level of the gums. 4. Teeth have a tendency to chip as a result of the grinding. 5. Tenderness and pain may be felt in the muscles and jaw joints on waking in the morning.
  37. 37. 6. Eating become painful (restricted jaw movement). 7. Teeth become sensitive, painful & loose, as results of worn down or cracked by grinding. 8. Extensive tooth wear cause the jaws to close down too far, resulting in facial changes. 9. Unsightly creasing at the corners of the mouth. 10. Development of prominent jaw muscles. The jaw muscles become painful due to their constant contraction. 11. The sound of grinding teeth can disturb other people. 12. Headache--is caused by a disturbance in the circulation in the muscles. 13. TMJ pain. The symptoms of bruxism
  38. 38. 1.Relieve the causes of the stress (psychological and medical) Behavior modification relaxation training/ tranquilizer. 2. The dental treatment directed to preventing further damage to the teeth, and to the repair of the worn down teeth. Occlusal adjustment of high filling or malocclusion. 3. The preventive treatment is to use a night guard. 4. The use of muscle relaxants. 5. Moist heat applied to the affected jaw muscles and anti-inflammatory drugs. Night plastic mouth guard is constructed. to prevent the teeth from grinding against each other. Treatment of Bruxism
  39. 39. Night guard: 1.Impressions are taken of the upper and lower teeth. 2.Night guards are designed to cover the biting and chewing surfaces of the teeth usually the upper. 3.They made from a soft plastic or a hard acrylic material.
  40. 40. It is repetitive acts result in physical damage to the child as pushing away gingival tissue from labial surface of anterior teeth. It is rare habit in normal child but in 20% of mentally retarded child. Emotional disturbance play a role in this habit. Effect : - Stripping of free & attached gingiva and bone may be exposed. Treatment: - 1.Behavior modification. 2.Use of restrain, protective padding & sedation. 3.Extraction of affect tooth.
  41. 41. It is holding upper labial frenum between permanent teeth . Effect :- Increase the diastma between interior teeth Treatment 1. Frenectomy 2.Passive oral screen.
  42. 42. It is biting of cheek opposite to the occlusal plane of the teeth. -Causes : 1.In nervous child. 2.Cuspal interference 3.High restoration. Effect :- Trauma to the cheek causing ulceration & pain Treatment:- 1.Remove the cause. 2.Vestibular oral screen.
  43. 43. In teenage girl Effect :- Notched upper incisor tooth or teeth. Treatment Calling attention to harmful results.