Oral Habits

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Oral Habits

  1. 1. ORAL HABITS Dr shabeel pn
  2. 2. INTRODUCTION <ul><li>THEY ARE REPEATED PERFORMANCE </li></ul><ul><li>THEY CAN BE </li></ul><ul><li>- PART OF NORMAL DEVELOPMENT </li></ul><ul><li>- SYMPTOM WITH DEEP ROOTED PSYCHOLOGIC </li></ul><ul><li>BASIS </li></ul><ul><li>- ABNORMAL FACIAL GROWTH </li></ul>
  3. 3. DEFINITIONS <ul><li>DORLAND(1957): FIXED OR CONSTANT PRACTICE ESTABLISHED BY FREQUENT REPETITION </li></ul><ul><li>BUTTERSWORTH(1961): A FREQUENT OR CONSTANT PRACTICE OR ACQUIRED TENDENCY, WHICH HAS BEEN FIXED BY FREQUENT REPETITION </li></ul><ul><li>MATHEWSON(1982): ORAL HABITS ARE LEARNED PATTERNS OF MUSCULAR CONTRACTIONS </li></ul>
  4. 4. VARIOUS HABITS ARE <ul><li>Thumb sucking </li></ul><ul><li>Finger sucking </li></ul><ul><li>Tongue thrusting </li></ul><ul><li>Pacifier or dummy sucking </li></ul><ul><li>Lip biting </li></ul><ul><li>Nail biting </li></ul><ul><li>Cheek biting </li></ul><ul><li>Pencil or foreign object sucking </li></ul><ul><li>Lip sucking </li></ul><ul><li>Clenching </li></ul><ul><li>Mouth breathing </li></ul><ul><li>Bruxism </li></ul><ul><li>Occupational habits </li></ul>
  5. 5. CLASSIFICATIONS <ul><li>OBSESSIVE </li></ul><ul><li>(DEEP ROOTED) </li></ul><ul><li>INTENTIONAL MASOCHISTIC </li></ul><ul><li>(MEANINGFUL) (SELF INFLICTING) </li></ul><ul><li>NAIL BITING GINGIVAL STRIPPING </li></ul><ul><li>DIGIT SUCKING </li></ul><ul><li>LIP BITING </li></ul>
  6. 6. <ul><li>NON OBSESSIVE </li></ul><ul><li>(EASILY LEARNED & DROPPED) </li></ul><ul><li>UNINTENTIONAL FUNCTIONAL HABITS </li></ul><ul><li>ABNORMAL PILLOWING TONGUE THRUSTING </li></ul><ul><li>CHIN PROPPING BRUXISM </li></ul>
  7. 7. JAMES (1923) <ul><li>Useful habits : – This includes habits of normal functions such as correct tongue position, proper respiration, deglutition, and normal use of lips in speaking. </li></ul><ul><li>Harmful habits : — this includes all the habits that exert perverted stresses against the teeth and dental arches as well as those habits such as open mouth habits, lip biting, lip sucking, thumb sucking etc… </li></ul>
  8. 8. MORRIS & BOHANNA (1969) <ul><li>Pressure habits — these include sucking habits such as thumb sucking, lip sucking, finger sucking and also tongue thrusting. </li></ul><ul><li>Non pressure habits — Habits which do not apply a direct force on the teeth or its supporting structures are termed as non pressure habits </li></ul><ul><li>E.g.: mouth breathing. </li></ul><ul><li>Biting habits - These includes habits such as nail biting, pencil biting and lip biting. </li></ul>
  9. 9. KLEIN (1971) <ul><li>Empty habits – they are habits that are not associated with any deep rooted psychological problems </li></ul><ul><li>Meaningful habits —they are habits that have a psychological bearing. </li></ul>
  10. 10. FINN (1987) <ul><li>Compulsive habits - These are deep rooted habits that have acquired a fixation in the child to the extent that the child retreats to the habits when ever his security is threatened by events which occur around him. The child tends to suffer increased anxiety when attempts are made to correct the habits. </li></ul><ul><li>Non compulsive habits – They are habits which are easily learned and dropped as the child matures. </li></ul>
  11. 11. <ul><li>PRIMARY HABITS </li></ul><ul><li>SECONDARY HABITS </li></ul>
  12. 12. KINGSLEY (1958) <ul><li>FUNCTIONAL ORAL HABITS </li></ul><ul><li>MUSCULAR HABITS </li></ul><ul><li>COMBINED ONES </li></ul>
  13. 13. THUMB SUCKING <ul><li>PLACEMENT OF THE THUMB INTO VARIOUS DEPTHS INTO THE MOUTH </li></ul><ul><li>THUMB SUCKING + FINGER SUCKING </li></ul><ul><li>= DIGIT SUCKING </li></ul><ul><li>one of the commonly seen habits. Thumb sucking is observed in the intrauterine life. </li></ul><ul><li>SUCKING – 1 ST CO—ORDINATED MUSCULAR ACTIVITY OF THE INFANT </li></ul>
  14. 14. CLASSIFICATIONS <ul><li>NORMAL T S: </li></ul><ul><li>- 1 ST & 2 ND YEAR OF LIFE </li></ul><ul><li>- DON’T GENERATE ANY MALOCCLUSION </li></ul><ul><li>ABNORMAL T S: </li></ul><ul><li>a. psychological: </li></ul><ul><li>- Deep-rooted emotional factor </li></ul><ul><li>- insecurities, neglect or loneliness </li></ul><ul><li>b. habitual: </li></ul><ul><li>- performs due to habit </li></ul><ul><li>- can cause malocclusion </li></ul>
  15. 15. O’ BRIEN (1996) <ul><li>NUTRITIVE SUCKING HABITS: </li></ul><ul><li>- BREAST/BOTTLE FEEDING </li></ul><ul><li>NON-NUTRITIVE SUCKING HABITS ( NNS HABITS ) </li></ul><ul><li>- THUMB , FINGER OR PACIFIER SUCKING </li></ul>
  16. 16. SUBTELNY (1973) <ul><li>TYPE A: 50% </li></ul><ul><li>- WHOLE DIGIT INSIDE, PAD OVER PALATE </li></ul><ul><li>& CONTACT WITH MAX & MAND ANTERIORS </li></ul><ul><li>TYPE B: 13 – 24% </li></ul><ul><li>- WITHOUT TOUCHING VAULT & MAINTAIN CONTACT </li></ul><ul><li>TYPE C: 18% </li></ul><ul><li>- JUST BEYOND 1 ST JOINT & CNTCT ONLY WITH MAX ANT </li></ul><ul><li>TYPE D: 6% </li></ul><ul><li>- VERY LITTLE PORTION OF THUMB </li></ul>
  17. 17. ETIOLOGY <ul><li>VARIOUS THEORIES </li></ul><ul><li>CAUSATING FACTORS </li></ul>
  18. 18. CLASSICAL FREUDIAN THEORY (1905) <ul><li>INHERENT PSYCHOSEXUAL URGE </li></ul><ul><li>EROGENOUS ZONE </li></ul><ul><li>HUNGER, SATIETY & SECURITY </li></ul>
  19. 19. LEARNING THEORY <ul><li>DAVIDSON 1967 </li></ul><ul><ul><li>TS FRM AN ADAPTIVE RESPONSE </li></ul></ul>
  20. 20. ORAL DRIVE THEORY <ul><li>SEARS & WISE 1982 </li></ul><ul><li>T S IS A RESULT OF PROLONGATION OF NURSING, & NOT THE FRUSTRATION OF WEANING </li></ul><ul><li>SUCKING INCREASES THE EROTOGENESIS OF MOUTH </li></ul>
  21. 21. BENJAMIN’S THEORY <ul><li>T S ARISES FRM THE ROOTING OR PLACING RELEX SEEN IN MAMMALIAN INFANTS </li></ul><ul><li>MOVEMENT OF THE INFANT’S HEAD & TONGUE TOWARDS AN OBJECT TOUCHING HIS CHEEK </li></ul>
  22. 22. JOHNSON & LARSON 1993 <ul><li>COMBN OF PSYCHOANALYTC & LEARNING THEORIES WHICH EXPLAINS THAT ALL CHILDREN HAVE INHERENT BIOLOGIC DRIVE FOR SUCKING. ROOTING & PLACING REFLEXES ARE MERELY A MEANS OF EXPRESSION OF THIS DRIVE. ENVIRONMENTAL FACTORS ALSO MAY CONTRIBUTE TO THIS DRIVE TO NON NUTRITIVE SOURCES….. </li></ul>
  23. 23. CAUSATIVE FACTORS <ul><li>PARENT’S OCCUPN: SOCIOECONOMIC STATUS – SUCKLES INTENSIVELY – EXHAUSTED </li></ul><ul><li>- RECHANNELING THE SURPLUS URGE </li></ul><ul><li>WORKING MOTHER: CARETAKER - INSECURITY </li></ul><ul><li>NUMBER OF SIBLINGS: ATTENTION DIVIDED </li></ul><ul><li>ORDER OF BIRTH: LATER THE SIBLING RANK, GREATER D CHANCE – IMITATION IN SUCKLING </li></ul><ul><li>SOCIAL ADJUSTMENT & STRESS: INABILITY TO ADJ – SCOLDING PARENTS </li></ul><ul><li>FEEDING PRACTICES: MORE IN BREAST FED CHILDREN – ABRUPT WEANING </li></ul>
  24. 24. <ul><li>AGE OF THE CHILD: </li></ul><ul><li>NEONATES: PREMITIVE DEMANDS LIKE HUNGER </li></ul><ul><li>I ST FEW WEEKS: FEEDING PROBLMS </li></ul><ul><li>ERUPTION OF 1 0 MOLAR: TEETHING DEVICE </li></ul><ul><li>LATER: RELEASE TENSION </li></ul>
  25. 25. PHASES OF DEVELOPMENT <ul><li>PHASE I (NORMAL & SUBCLINICAL): 1 ST 3 YRS OF LIFE </li></ul><ul><li>PHASE II (CLINICALLY SIGNIFICANT): EXTNDS B/W 3 – 6 ½ - GREAT ANXIETY - </li></ul><ul><li>PHASE III (INTRACTABLE SUCKING): BEYOND 4 TH – 5 TH YR – CONSULT PSYCHOLOGIST </li></ul>
  26. 26. CLINICAL FEATURES <ul><li>DEPENDS ON: </li></ul><ul><li>POSITION OF THE DIGIT </li></ul><ul><li>ASSOCIATED OROFACIAL MUSCLE CONTRACTION </li></ul><ul><li>POSITION OF MAND DURING SUCKING </li></ul><ul><li>FACIAL SKELETAL PATTERN </li></ul><ul><li>INTENSITY, FREQ & DURN OF FORCE </li></ul>
  27. 27. <ul><li>MAX ANT PROCLINATION & MAND RETRO </li></ul><ul><li>ANTERIOR OPEN BITE </li></ul><ul><li>- INTERFERENCE WITH NORMAL ERUPTION </li></ul><ul><li>-EXCESSIVE ERUPTION OF POSTERIORS </li></ul><ul><li>CONSTRITION OF MAXILLARY ARCH </li></ul><ul><li>POSTERIOR CROSS BITE </li></ul>
  28. 28. DIAGNOSIS <ul><li>HISTORY: DETERMINE THE PSYCHOLOGICAL COMPONENT </li></ul><ul><li>EXTRAORAL: KEY AREAS </li></ul><ul><li>DIGITS – REDDENED , EXCEPTIONALLY CLEAN, CHAPPED & WT A SHORT FINGERNAIL – DISHPAN THUMB – CALLUS – DEFORMATION OF FINGER </li></ul><ul><li>LIPS – UPPER SHORT & HYPOTONIC, LOWER IS HYPERACTIVE & LEADS TO FURTHER PROCLINATION OF UPPER ANTERIORS </li></ul><ul><li>FACIAL FORM – MAND RETRUSION, MAX PROTRUSION, HIGH MANDIBULAR PLANE ANGLE </li></ul>
  29. 29. <ul><li>INTRA ORAL: </li></ul><ul><li>TONGUE – SIZE & POSITION AT REST , TONGUE ACTION DURING SWALLOWING </li></ul><ul><li>DENTO ALVEOLAR STRUCTURES </li></ul><ul><li>GINGIVA – EVIDENCE OF MOUTH BREATHING??? GUMLINE ETCHING, DECAYED OR EXCESSIVE STAINING ?? </li></ul>
  30. 30. PREVENTION <ul><li>MOTIVE BASED APPROACH </li></ul><ul><li>CHILD’S ENGAGEMENT IN VARIOUS ACTIVITIES </li></ul><ul><li>PARENT’S INVOLVEMENT </li></ul><ul><li>DURATION OF BREAST FEEDING </li></ul><ul><li>PHYSIOLOGIC NIPPLE </li></ul><ul><li>USE OF DUMMY OR PACIFIER </li></ul>
  31. 31. TREATMENT <ul><li>PSYCHOLOGICAL THERAPY </li></ul><ul><li>REMINDER THERAPY </li></ul><ul><li>MECHANOTHERAPY </li></ul>
  32. 32. PSYCHOLOGICAL THERAPY <ul><li>PROFESSIONAL COUNSELLING </li></ul><ul><li>B/W 4-8 – REASSURANCE, +VE REINFORCEMENT & FRIENDLY REMINDERS </li></ul><ul><li>AWARENESS OF DENTOFACIAL ANOMALIES </li></ul><ul><li>SUPPORT FRM PARENTS DURING TREATMENT </li></ul>
  33. 33. <ul><li>DESTRUCTIVE APPROACHES FROM PARENTS </li></ul><ul><li>AIM IS TO GAIN CONFIDENCE </li></ul><ul><li>+VE BEHAVIOUR MODIFICATION & HYPNOSIS IS EFFECTIVE </li></ul><ul><li>DUNLOP’S BETA HYPOTHESIS </li></ul>
  34. 34. REMINDER THERAPY <ul><li>EXTRA ORAL APPROACHES: QUININE, ASAFOETIDA (HABIT NOT FIRMLY ENTRENCHED) </li></ul><ul><li>INTRA ORAL APPROACHES: ORTHODONTIC APPLIANCES TO ATTENUATE AND EVENTUALLY BREAK THE HABIT </li></ul>
  35. 35. MECHANOTHERAPY <ul><li>FIXED INTRA ORAL ANTI THUMB SUCKI NG APPLIANCE </li></ul><ul><li>BLUE GRASS APPLIANCE </li></ul><ul><li>QUAD HELIX </li></ul>

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