common oral baits like tongue thrusting,nail biting,thumb sucking, lip biting, mouth breathing have been described in detail with their clinical features,oral manifestations and treatment and prevention part. removable and fixed appliances have been described in brief for various habits.

1. ORAL HABITS

2.  Dorland:
Fixed or constant practice
established by frequent repetition.
 Buttersworth :
Frequent or constant practice
or acquired tendency, which has
been fixed by frequent repetition.
 Moyer:
Habits are learnt pattern of
muscle contraction of a very
complex nature.

3. OBSESSIVE
(DEEP ROOTED)
INTENTIONAL MASOCHISTIC
(MEANINGFUL) (SELF INFLICTING)
NAIL BITING GINGIVAL STRIPPING
LIP BITING
DIGIT SUCKING
NON OBSESSIVE
(EASILY LEARNED & DROPPED)
UNINTENTIONAL FUNCTIONAL
ABNORMAL PILLOWING TONGUE THRUSTING
CHIN PROPPING BRUXISM

4.  James (1923)/
Graber
 Useful
 Harmful
 Kingsley
 Functional
oral habit
 Muscular
habit
 combined
 Finn (1987)
 Compulsive
 Non
compulsive
 Primary habit
 Secondary
habit
 Klein (1977)
 Empty
 meaningful

5. DEFINITION:
 According to Gellin “It is placement of
thumb or one or more finger in varying
depth into the mouth”.
THEORIES:
1. PSYCHOANALYTICAL/PSYCHOSEXUAL
THEORY:-
 by SIGMUND FREUD in 1928.
 According to which thumb sucking habit
evolves from an inherent psychosexual drive
where child derives pleasure during thumb sucking.
2. ORAL DRIVE THEORY:-
 Formulated by SEARS AND WISE 1982.
 According to this theory prolongation of
nursing strengthen the oral drive & child
begins thumb sucking.

6. INTRA ORAL:
 Maxillary anterior proclination
 Mandibular anterior
retroclination
 Anterior open bite
 Constricted intercanine
area‐70%
 Constriction of maxillary arch
 Posterior cross bite
EXTRA ORAL:
• Fungal infection on thumb
• Thumb nail exhibit dish pan
appearance.
• Upper Lip: short, hypotonic
• Jaw: maxillary protrusion,
mandibular retrusion
• Palate: high vault
• Nasal floor : narrow
• Profile: straight
CLINICAL FEATURES

7.  Starts 4 to 6 years
 4 different approaches
1. Counselling
2. Reminder therapy
3. Reward system
4. Adjunctive therapy
1. COUNSELLING
• Explain about habits ill effects
• Show photographs, video
• Dunlop hypothesis
• Discuss with parents
2. REMINDER THERAPY
 “Wants to stop but needs help”
- Adhesive waterproof bandage
- Sock to cover fingers
- Paint bitter substances
- Acrylic guard or guaze
- Removable or fixed appliances

8. REMOVABLE APPLIANCES :
passive appliances which are retained in the oral cavity
by means of clasp & usually have of the following additional
components:-
1. Tongue spikes 2.Tongue Guard 3. Spur/rake
FIXED APPLIANCES :
1. Quad helix 2. Hay rakes
Habit crib applianceQuad helix
3. Maxillary lingual arch with
palatal crib

9. 3. ADJUNCTIVE THERAPY
 Wrapping the patient’s arm with
elastic bandage
 Intra oral
 Palatal crib: Patient without
crossbite
 Retainer 6‐12 months

10.  According to Norton and Gellin "a condition in
which the tongue protrudes between the
anterior or posterior teeth during swallowing
with or without affecting tooth position .”
DEFINITION:
CLASSIFICATION:
“According To MOYER”
A. Normal swallow:
(a) Infantile swallow
(b) Adult swallow
B. Simple tongue thrust
C. Complex tongue thrust
D. Retained infantile swallow
“According To BACKLUND”
1. Anterior tongue thrust
2. Posterior tongue thrust

11.  Retained infantile swallow
 Upper respiratory tract infections
 Neurological disturbances
 Functional adaptability to transient change in
anatomy
 Feeding practices and tongue thrusting
 Induced due to other oral habits
 Hereditary
 Tongue size –ex: macroglossia
CLINICAL MANIFESTATIONS
 Lip‐ short flaccid upper lip
 Mandibular movements‐ no correlation between
tongue tip and mandible
 Speech‐ s,n,t,d,l,z, v,th
 Facial form‐ Increased in anterior facial height
ETIOLOGY

12. Open Bite (Anterior and Posterior)
Proclination of upper anterior teeth
Protrusion of anterior segment of both
arches with spaces between incisors &
canines
Narrow & constricted maxillary arch:
Posterior cross bite

13. DIAGNOSIS:
 History
 Examination
 water test
 checking contractions of the muscle:
 Temporalis muscle
 lower lip
TREATMENT CONSIDERATIONS:
 Age
 Presence/absence of associated manifestations
 Malocclusion
 Speech defects
 Associated with other habits
TREATMENT:
 Training of correct swallow and posture of tongue
 Speech therapy
 Mechanotherapy
 Correction of malocclusion
 Surgical treatment

14. MYOFUNCTIONAL EXERCISES
 40times per day in 2‐3sessions
 sugarless fruit drop –twice daily
 4s exercise
 other exercises
 Using appliances as a guide in the correct
positioning of tongue
 Pre orthodontic Trainer
 Nance palatal Arch Appliance
SPEECH THERAPY
 Not before 8 years
MECHANOTHERAPY
 Removable Appliance Therapy
 Fixed Habit Breaking Appliance
 Oral screen

15. DEFINITION:
Sassouni (1971) defined Mouth breathing as
habitual respiration through the mouth instead of the
nose.
CLASSIFICATION:
 “Given by Finn 1987”
(1) Anatomic : Mouth breather is one whose short
upper lip does not permit complete closure
without undue effort
(2) Habitual : Persistence of habit even after the
elimination of obstructive cause
(3) Obstructive : Increased resistance to complete
obstruction of normal airflow to nasal passage
ETIOLOGY:
 Developmental Anomalies like abnormal
development of nasal cavities .
 Partial obstruction in deviated nasal septum and
Localized benign tumor.
 Infection inflammation of nasal mucosa as:-
 Chronic allergic, chronic atrophic Rhinitis,
Enlarged adenoid tonsils.
 Traumatic injures of nasal cavity
 Genetic Pattern

16. CLINICAL FEATURES:
 Facial appearance : Adenoid facies.
 Long narrow face, narrow nose and nasal passage.
 Short upper lip.
 Nose tipped superiorly
 Expressionless face.
 DENTAL EFFECT (INTRA ORAL)
 Protrusion of maxillary incisors
 Palatal vault is high.
 Increase incidence of caries.
 Chronic marginal gingivitis.
DIAGNOSIS :
 History
 Examination
 CLINICAL TESTS
 Mirror test
 Butterfly test
 Water Holding test
 inductive plethysmography.
 Cephalometrics

17. EXAMINATION:
(i) Observe the patient unknowingly while at rest
In a nasal breather – lip touch lightly
In mouth breather – Lip are kept apart.
(ii) Patient asked to take deep breath
Nasal breather keep the lip tightly closed
Mouth breather take deep breath keeping mouth
open.
CLINICAL TEST:
 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.
 Water 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.
 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.

18. MANAGEMENT:
1) SYMPTOMATIC TREATMENT:
The gingiva of the mouth breathers should be
restored to normal health by coating the gingiva with
petroleum jelly.
2) ELIMINATION OF THE CAUSE:
If nasal or pharyngeal obstruction has been
diagnosed then removal of the cause is done by
surgery .
3) INTERCEPTION OF THE HABIT :
a) Physical Exercise b) Lip Exercise
4) ORAL SCREEN:
 An effective device during sleeping hours, is a thin
rubber membrane either cut or cast to fit over the
labial and buccal surfaces of the teeth and gums
included in the vestibule of the mouth. During initial
phase, windows are placed on the oral screen so as
not to completely block the airway passage.
5)CORRECTION OF
MALOCCLUSION
1) Children with class I skeletal and
occlusion and anterior spacing- oral
shield appliance.
2)class II division without
crowding,age5-9 years-Monobloc
activator.
3)classIII malocclusion-interceptive
methods are reccommended as a
chin cap.

19. BRUXISM
DEFINITION:
Ramfjord 1966
Bruxism is habitual griding of teeth when the individual is
not chewing or swallowing.
CLASSIFICATION:
1. Day Time Bruxism/Diurnal Bruxism
2. Night Time Bruxism/Nocturnal Bruxism
OCCURRENCE:
May commence in infancy with the eruption of the first
primary tooth.
Common occurrence is during sleep
Incidence of bruxismin children varies widely from 7% to
88%.
ETIOLOGY:
(1) CNS: This CNS phenomena was found in children
with cerebral palsy & mental retardation.
(2) Psychological: A tendency of grind teeth associated
with feeling of hunger and aggression, hate,anxiety
etc.
(3) Occlusal discrepancy : Improper interdigitation of
teeth lead to bruxism.
(4) Systemic factor : Mg++ deficiency may lead to
bruxism.
(5) Genetic.

20. CLINICAL FEATURES :
(1) Occlusal trauma
(2) Pain in TMJ
(3) Trauma to periodontium.
(4) Masticatory muscle soreness.
(5) Headache.
MANAGEMENT:-
(1) ADJUNCTIVE THERAPY:-
 Psychotherapy- Aim to lower the emotional
disturbances.
 Relining exercise - Serve to decrease muscle
function
 Elimination of oral pain & discomfort by giving
ethyl chloride within the tempromandibular joint
area
 Auto suggestion and Hypnosis: Wherethe patient
becomes conscious of his habit and understands
the possible consequence
(2) OCCLUSAL THERAPY:
 Occlusal adjustments:Biteraising crowns,splintsand
elimination of occlusal interference
 Bite plates and splints
 Occlusal reconstruction and prosthesis
 Bite guard: Preventscontinual abrasion of teeth

21. DEFINITION:
Habit involve manipulation of lips and perioral structure
are termed as lip habits.
ETIOLOGY :
•Malocclusion
•Habit
•Emotional Stress
CLASSIFICATION:-
 Wetting the Lip with the tongue.
 Pulling the lip into mouth between the teeth.

22. CLINICAL FEATURES:
 Protrusion of upper anteriors
& retrusion of lower anteriors.
 Lip trap
 Muscular imbalance
 Lower incisor collapse with lingual
crowding
 Mentolabial sulcus become accentutated.
TREATMENT:
 Lip Protector
 Lip bumper –it is used as a adjustive therapy in
both comprehensive and interceptive treatment
. It is positioned in mandibular vestibule and
serve to prohibit the lip from exerting excessive
force on mandibular incisor and reposition the
lip away from lingual aspect of maxillary
incisors.
 Visual education

23.  It is most common habit in children
 It is sign of internal tension
ETIOLOGY:
 Persistence nail bitting may be indicative of
emotional problem.
 Psychosomatic
 Successor of thumb sucking.
CLINICAL FEATURES:
 Crowding
 Rotation.
 Alteration of incisal edge of incisor
 Inflammation of nail bed.

24.  MANAGEMENT:
 Patient is made aware of problem.
 Treat the basic emotional factor causing the
act.
 Encouraging outdoor activity which may
help in easing tension.
 Application of nail polish, light cotton
mittens as reminder.
CONCLUSION:
The identification and assessment of an
abnormal habits and its immediate and long
term effect on the craniofacial complex and
dentition should be made as early as possible
to minimize the potential deleterious effect on
dentofacial Complex.