Power Point Presentation on Orthodontics topic Self Inflicting Habits

1. BY – Dr. NISHANT SINGH
DEPARTMENT OF ORTHODONTICS AND
DENTOFACIAL ORTHOPEDICS

2. 
 Definition
 Classification Of Habits
 Self Inflicting Habits
 Incidence
 Classification of Self Inflicting Habits
 Clinical Features
 Treatment
 Conclusion
 Reference
INDEX

3. 
 Dorland(1957): Habit can be defined as a fixed
or constant practice established by frequent
repetition
 Buttersworth(1961): Defined habit as a
frequent or constant practice or acquired
tendency, which has been fixed by frequent
repetition
 Mathewson(1982): Oral habits are learned
patterns of muscular contraction
HABITS

4. 
• Intentional or Meaningful
E.g. Digit sucking
• Masochistic or Self-Inflicting
Habit E.g. Gingival Stripping
Obsessive
(Deep
Rooted)
• Unintentional or Empty E.g.
Chin propping
• Functional Habit E.g.
Bruxism
Non-
Obsessive
CLASSIFICATION

5. 
 Self injurious habits are those in which the patient
enjoys inflicting damage to himself. It is rare in
normal children but is mostly seen in mentally
retarded children (10-20%) and children with
psychological disorder.
SELF INFLICTING
HABITS

6. 
 Extremly rare in normal child
 It is between 10-20% in normal population
 Prevalence : More in Female
 In the general population, prevalence is estimated at
750 in 1,00,000
 Increasing in developmentally disabled individual
from 7.7 to 22.8 % and reaching profoundly retarded
individuals
INCIDENCE

7. 
 Ayer and Levin
(Based on the etiology)
 Organic : Syndromes and syndrome like maladies
such as Lesch-Nyhan disease and De Lange’s
syndrome in which symptoms such as repetitive lip,
finger , tongue , knee and shoulder biting are
common
CLASSIFICATION

8. 
 Functional
 This is subdivided Stewart and Kernohan into :
 TYPE A behavior is injuries superimposed on a
preexisting lesion perpetuated by skin biting
 TYPE B are injuries secondary to another established
habit. E.G. Rotating the thumb during sucking
causes ulcerations on the palatal gingiva. If the
established habit is discontinued lesion disappears.
CLASSIFICATION

9. 
 TYPE C Injuries of unknown or complex etiology.
This has a grater psychogenic component . There may be
multiple symptoms of great intensity. These habits may
serve as a form of stress release. Mallston and Robertson
have concluded castration fears , failures to resolve
oedipal complex conflicts, represented homosexual
impulses , severe guilt and self punishment is ubiquitous
phenomena in Type C behavior
CLASSIFICATION

10. 
 It has been observed that some
children experience a feeling of
neglect, abandonment, and
loneliness, and through the use of
self-injurious behavior they
attempt to solicit attention and
love. They usually consists of
putting fingernails or foreign
objects in the gingival sulcus,
digital pressure on the oral
structures or biting of tissue
CLINICAL FEATURES

11. 
 These may produce factitial injuries,
75% of which are located in the
head and neck region.
 Oral structures such as gingiva,
oral mucosa, tooth supporting
structures or teeth maybe
affected. Factitial oral lesions
(FOL) include factitial
gingivitis factitial periodontitis,
factitial ulcer , and self-
extraction.
CLINICAL FEATURES

12. 
 The symptoms of both the functional and organic
categories of self-injurious behavior appear to be
exacerbated during stressful situation
 Thus, some form of emotional stress, such as
personal unhappiness, loss of security, or an
unresolved pain producing dental condition is an
important etiological factor
CLINICAL FEATURES

13. 
 It has been suggested that self-mutilation is a learned
behavior.
 This maybe because attention is always gained,
reinforcing the behavior.
 But any child who willingly inflicts pain to himself
should be considered psychologically abnormal
CLINICAL FEATURES

14. 
 Requires multidisciplinary approach.
 The role of pediatric dentist and orthodontist in
treatment is to elicit a thorough social and medical
history and correctly diagnose the condition so as to
distinguish it from one of physiological etiology solely.
 After the diagnosis has been determined, referral to
primary care physician usually pediatrician is done.
TREATMENT

15. 
 Adjunctive therapy maybe initiated
by the dentist to aid in the healing of
oral ulcerations.
 A squib oral bandage is beneficial to
healing of oral tissues, as well as
serving as a Habit Reminder
PALLIATIVE
TREATMENT

16. 
 In addition, an ORAL SHIELD maybe
fabricated and inserted into the mouth at
night.
 This appliance will deter the child from
unconscious continuation of the habit.
 This therapy should not be instilled
alone, but used as partof the
multidisciplinary approach to the
treatment of self- injurious behavior.
MECHANOTHERAPY

17. 
 The technique used for behavior
modification includes:
 Continuous positive reinforcement
while self-mutilative responses are
absent.
 Withdrawal of positive reinforcement
upon self-mutilation.
BEHAVIOR
MANAGEMENT

18. 
 At each consultation, the patient should receive
instructions regarding the importance of habit
interruption for the maintenance of gingival health
until total removal of the appliance.
 Restraints may be the reliable means of preventing
injury to the self-injurious behavior-affected
individual, physical restraints include mittens, arm-
boards, facial masks, helmets and restrictive
clothing, but requires constant wear if they are to be
successful
BEHAVIOR
MANAGEMENT

19. 
 Although the diagnosis of self-inflicted oral
mutilation may be a challenge for the pediatric
dentist and orthodontist , this should not prevent
the consideration of this possibility when
idiopathic lesions are present in a child.
 Appropriate preventive methods need to be
developed for each patient based on reasonable
consideration
CONCLUSION

20. 
• Masochistichabitsinachildpatient:Acasereportanditsmanagement
JohnBabyJohn,VilvanathanPraburajan,AriudainambiStalin,andMuraliKrishnan
(InternationalJournalof CriticalIllnessandInjuryScience2013Jul-Sep;3(3):211–
213)(PMCID:PMC3883201)
• Orthodontics The Art and Science , Bhalajhi Seventh Edition
Page :135
• Textbookof Pediatric Dentistry , ShobhaTandon,3rd edition,
Page: 906
• Textbookof Pediatric Dentistry , Nikhil Marwah,3rd
edition,Page:374
• Clinical Pedodontics,Finn,4th
Edition , Page : 370
REFERENCE

21. 