ORAL HABITS- Dr.Mufeedha K Nazar

2. ORAL HABIT ???
Any repetitive behaviour
that utilizes oral cavity

3. When to intercept??
• Behaviour continues longer
• Interferes physical, social or cognitive
development
• Dentoskeletal effects

4. DEFINITION OF HABITS
• Dorland: Fixed or constant practice established by
frequent repetition.
• Boucher: Defined habit as a tendency towards an act or
as act that has become a repeated performance relatively
fixed, consistent, easy to perform and almost automatic.
• Finn: defined habit as an act, which is socially
unacceptable.

5. CLASSIFICATION OF ORAL HABITS
• WILLIAM JAMES 1923
• USEFUL HABITS: Includes all those habits of normal
function such as correct tongue position, proper
respiration, deglutition and normal usage of lips while
speaking.
• HARMFUL HABITS: Includes all those that produce
abnormal stress on teeth and dental arches.
Eg: Mouth breathing, Tongue thrusting

6. Kingsley, 1956
• Mouth breathing
FUNCTIONAL ORAL
HABIT
• Tongue thrusting, cheek/lip
biting
MUSCULAR HABITS
• Thumb and finger sucking
COMBINED
MUSCULAR HABITS
• Chin propping <Face leaning on
hand, Abnormal pillowing>
POSTURAL HABITS

7. • BY FINN 1987
• COMPULSIVE HABIT: It is a habit that has acquired
fixation in the child to the extent that he reverts to the
practice of this habit whenever his security is threatened
by the events which occur around him.
• NON COMPULSIVE HABIT: Are those habits that are easily
dropped from the child’s behavior pattern as he matures.

8. • BY KLEIN 1971
• MEANINGFUL HABITS: Habits associated with a
psychological cause
• May need a consultation with pediatrician /
psychologist before any treatment.
• EMPTY HABITS: Are simple habits without a
detectable cause.

9. • BY MORRIS & BOHANNA 1969
• NON PRESSURE HABITS – MOUTH BREATHING
• PRESSURE HABITS – a. SUCKING HABITS
LIP SUCKING
THUMB/DIGIT SUCKING
b. BITING HABITS
NAIL BITING
NEEDLE HOLDING
• POSTURAL HABITS – CHIN REST
• MISCELLANEOUS - BRUXISM

10. THUMB SUCKING-
placement of thumb or one or more
fingers in varying depths into the mouth

11. • Type A Thumb was inserted into the mouth beyond
the first joint, pressing against the palatal mucosa and
alveolar tissue. Lower incisors press out the thumb
and contact it beyond the first joint (50%)
• Type B The thumb extended into mouth around the
first joint or just anterior to it. No palatal contact,
contacts only maxillary and mandibular anteriors
(24%)
CLASSIFICATION- Subtleny et al (1973)

13. • Type C Thumb placed fully into mouth in contact
with the palate as in group I; without any contact
with the mandibular incisors (18%)
• Type D Thumb did not progress appreciably into
the mouth. The lower incisors made contact
approximately at the level of thumb nail (8%)

15. PSYCHOLOGY OF NON-NUTRITIVE DIGIT
SUCKING
• CLASSICAL FREUDIAN THEORY
• Acc to Psychosexual theory, child goes thr’ various phases.
• In Oral phase where mouth is the zone of focus, child takes
everything into the mouth.
• It is believed that any kind of deprivation in this phase can
cause fixation, leading to habits like thumb sucking

16. • ORAL DRIVE THEORY – Sears & Wise
• Suggests that the strength of the oral drive depends on
how long the child continues to feed by sucking
• It is not the frustration of weaning that produces thumb
sucking but in fact it is the prolonged nursing that causes
it.
Learning theory-Davidson (1967) NNS stems from an
adaptive response. No underlying psychological cause

17. Pathophysiology
• Equilibrium theory
– Weinstein et al (1963) observed: "An object subjected
to an unequal force will get accelerated and thereby will
move to a different position in space. Hence, any object
subjected to a set of forces remains in place if forces are
balanced”
– In dentition, small imbalance of forces maintained for a
long time (6 years) can upset the equilibrium

18. • Lower tongue position: Tongue is
displaced inferiorly towards the floor of
mouth and laterally between posterior
teeth
• Horizontal vector lengthening and
anterior displacement of the anterior
maxillary base, proclination of the
maxillary incisors and spacing and
splaying of the upper incisors, all resulting
in an increase in over jet

19. • Vertical vector delays the vertical growth of the
anterior maxillary base, hindering the eruption of
the anterior teeth while simultaneously allowing
the posterior segments to over-erupt open bite

20. DIAGNOSIS OF THUMB SUCKING HABIT
• HISTORY
– Frequency
– Duration
– Intensity
– Remedies tried at home
– Emotional status

21. • EXTRAORAL EXAMINATION:
• DIGITS : digit involved in active sucking
habit appears reddened, exceptionally
clean, chapped and a short finger nail –
DISHPAN THUMB
• Severe chronic thumb sucker frequently
has a fibrous roughened callus on the
superior aspect of finger being sucked.

22. • LIPS: The position of the lips at rest or during
swallowing should be observed.
• Chronic thumb suckers are frequently characterized
by short hypotonic upper lip.
• Others features are
– enlarged tonsils accompanied by mouth breathing,
– higher incidence of middle ear infections.

23. • DENTOFACIAL CHANGES ASSOCIATED WITH THUMB SUCKING
• EFFECTS ON MAXILLA
• Proclination of maxillary incisors
• Anterior placement of apical base of maxilla
• Increased maxillary arch length
• High palatal vault
• Narrowing of maxillary arch
• Increased trauma to maxillary incisors
• EFFECTS ON MANDIBLE
• Retroclination of mandibular anteriors
• Retrusion of mandible

24. • EFFECTS ON INTERARCH RELATIONSHIP
• Increased overjet
• Decreased overbite
• Posterior crossbite
• Anterior openbite
• Lips and tongue
• Development of tongue thrust
• Lower tongue position
• Hypotonic upper lip
• Increased lower lip function under maxillary anteriors

25. TREATMENT OF THUMB SUCKING HABIT
According to Pinkham there are four categories of
treatment
Counseling
Reminder therapy
Reward system
Appliance therapy

26. • PSYCHOLOGICAL THERAPY
• Screen the patient for underlying psychological
disturbances that sustain thumb sucking habit.
• If suspected, refer to professionals for counseling.
• Creating awareness of the habit by emphasizing existing
dentofacial deformities, long term risks of the habit and
positive aspects of cessation.
• Various visual aids, study models can be used for the
purpose.

27. • Importance of emotional support and concern
from parents should be emphasized. Destructive
approaches in the form of nagging, shamming
should be strictly avoided.
• Behavior modification techniques like positive
reinforcement in the form of a reward of favorite
new toy will be encouraging in stopping the habit.

28. • DUNLOP’S BETA HYPOTHESIS: The best way to
break a habit is by purposeful repetition of a habit
• The child should be asked to sit in front of a mirror
and asked to suck his thumb, observing himself as
he indulges in the habit.

29. • Thumb sucking book ‘The Little Bear
who Sucked his Thumb’ is a book
directed at children, written and
illustrated by Dr.Dragan Antolos
• The book and chart are a noninvasive
and effective strategy for stopping
thumb sucking, and have received
positive support from psychiatrists,
speech pathologist and paedodontic
societies

30. • REMINDER THERAPY
• Extra oral Approach
a. Chemical agents:
– Distasteful or bitter agents are applied on to the digit to
terminate the practice. Eg: Quinine, Asafoetida.
– Commercial preparations like Femite, Thumb-up, Anti-
thumb are available.
b. Mechanical Restraints:
– Splints,
– Adhesive tapes,
– Thermoplastic Thumb guard.

32. Thumb-home concept
• A small bag is given to the
child to tie around his wrist
during sleep and it is
explained to the child that just
as the child sleeps in his
home, the thumb will also
sleep in its house and so the
child is restrained from thumb
sucking during night

33. RUR’S elbow guard
• Impression of elbow is made and cast is
obtained 2 layer modelling wax (spacer)
acrylization spacer replaced with a layer of
sponge acrylic elbow guard is covered with
velco strap

35. Norton and Gellin (1968): Proposed a 3-alarm system
often effective in children between 3-7 yrs
• Offending digit is taped and when the child feels the
tape in the mouth it serves as the first alarm.
• Bandage tied on the elbow of the arm with the
offending digit, a safety pin is placed lengthwise.
When child flexes the elbow, the closed pin mildly
jabs indicating a second alarm
• Bandage tightens if the child persists serving as a
third alarm.

36. Intra Oral Approach / MechanoTherapy
Removable appliances
• Tongue spikes
• Tongue guard
• Spurs/rake
Fixed appliances
• Quad helix
• Hay rakes
• Maxillary lingual arch with palatal crib

37. • Removable or Fixed Palatal Crib: It breaks the
suction force of the digit on the anterior segment,
reminds the patient of his habit, makes the habit a
non-pleasurable one.
• Hay Rakes: (Mack) It is a device with a series of
fence like lines that prevents sucking.

38. • Oral Screen: It is an appliance introduced by
Newell in 1912. It prevents the child from placing
the thumb into the oral cavity during sleeping
hours as well as redirects the muscular forces of
cheeks and lips to produce desirable effects.

39. • Blue grass appliance: Developed by
Haskell(1991) for children with continued thumb
sucking. Is a fixed appliance with teflon roller
where the child is asked to roll the bead instead of
sucking the thumb.

40. • A modification of this appliance incorporates two
rollers of different materials instead of one which
causes the thumb to slip and fails to create the
suction there by prevents the child to derive
pleasure out of the habit.

41. • Quad Helix: Is a fixed appliance which is used to
expand the arch and also serves to remind the
child not to place his thumb or finger.

42. TONGUE THRUSTING HABIT
• Proffit: Tongue-thrust is a forward
placement of the tongue between the
anterior teeth and against the lower lip
during swallowing.
• Tongue thrust swallow, visceral
swallow, infantile swallow, reverse
swallow, deviant swallow and tongue-
thrust syndrome

43. CLASSIFICATION OF TONGUE THRUST
MOYER’S CLASSIFICATION
• INFANTILE SWALLOW:
• Tongue lies between the gum pads
• Mandible is stabilized by contraction of facial
muscles
• This type of pattern disappears on eruption of
primary buccal teeth

44. • NORMAL MATURE SWALLOW
• No anterior protrusion of tongue noted
• Very little lip and cheek activity
• Mainly there is contraction of mandibular elevators

45. • SIMPLE TONGUE THRUST
• Teeth are in occlusion during swallow
• Tongue protrudes into well defined open bite
• Contraction of lips, mentalis muscle and mand. Elevators
• COMPLEX TONGUE THRUST
• Teeth apart swallow
• The open bite is diffuse and difficult to define
• There is marked contraction of lips, facial and mentalis
muscles but absence of temporalis muscle contraction
during swallow.

46. • JAMES & TOWNSEND CLASSIFICATION
• TYPE I – Non deforming tongue thrust
• TYPE 2 – Deforming anterior tongue thrust
Subgroup 1: Anterior open bite
Subgroup 2: Associated procumbency of
anterior teeth
Subgroup 3: Associated posterior cross bite
• TYPE 3 - Deforming lateral tongue thrust
Subgroup 1: Posterior open bite
Subgroup 2: Posterior cross bite
Subgroup 3: Deep over bite
• TYPE 4 – Deforming anterior and lateral tongue thrust
Subgroup 1: Anterior and posterior open bite
Subgroup 2: Associated procumbency of
anterior teeth
Subgroup 3: Associated posterior cross bite

47. • ETIOLOGY
A. RETAINED INFANTILE SWALLOW: It is suggested that
tongue thrust is merely retention of infantile sucking
mechanism.
• With the eruption of incisors at 6 months of age, the tongue
does not drop back as it should and continues to thrust
forward.
B. UPPER RESPIRATORY TRACT INFECTIONS: Allergies
affecting tonsils and adenoids promote a more forward
tongue posture due to pain or due to the physiologic need
to maintain an adequate airway.

48. C. FUNCTIONAL ADAPTABILITY TO TRANSIENT
CHANGE IN ANATOMY: Following the loss of primary
teeth and prior to the eruption of permanent teeth,
there exists a natural opening or gap into which the
tongue can show tendency to protrude and fill the gap.
D. DUE TO OTHER ORAL HABITS: When other habits
such as thumb and finger sucking creates a
malocclusion such as open bite, tongue is seen to be
protruding into that space.

49. • GENETIC INFLUENCE: The type of maxillary structure that
predisposes tongue thrust such as inherited hyperactivity
of orbicularis oris with specific anatomic configuration and
neuromuscular activity can be hereditary.
• TONGUE SIZE: Macroglossia and microglossia can affect
the dentition which in turn can lead to tongue thrust.

50. DIAGNOSIS OF TONGUE THRUST
• HISTORY: Information regarding upper
respiratory tract infections, sucking habits,
neuromuscular problems.
• Determine the swallow pattern of siblings and
parents to check for hereditary etiological factors.

51. • EXAMINATION: Careful examination and differentiation
must be made among a simple, complex and retained
infantile swallow.
• FUNCTIONAL EXAMINATION
a. Observe the tongue position while the mandible is in the
rest position.
b. Observe the tongue during swallows
• Conscious swallow
• Command swallow of saliva
• Command swallow of water
• Conscious swallow during mastication

52. • PALPATORY EXAMINATION
1. Place water beneath the patients tongue tip and ask him to
swallow
normal - mandible rises and teeth are brought together but
no contraction of lips and facial muscles
tongue thrusting – marked contraction of lips and facial
muscles
2. Place hand over temporalis muscle and ask to swallow
normal – Temporalis contracts and mandible is elevated
tongue thrust – no temporalis contraction

53. Hold the lower lip and ask the patient to swallow
normal – swallow can be completed
tongue thrust – patient cant complete swallow

54. CLINICAL FEATURES
• SIMPLE TONGUE THRUSTING
• Normal tooth contact in posterior region
• Anterior open bite
• Contraction of the lips, mentalis muscle and
mandibular elevators.
• COMPLEX TONGUE THRUSTING
• Generalized open bite
• The absence of contraction of temporalis muscles

56. • LATERAL TONGUE THRUST
• Posterior open bite with lateral tongue thrust
• OTHER FEATURES
• Proclination of anterior teeth
• Anterior open bite
• Midline diastema
• Posterior cross bite

57. TREATMENT OF TONGUE THRUST
1. If tongue thrust habit is associated with other habits, then
the habit has to be treated first
2. Training of correct swallows and posture of the tongue
using various exercises.
3. Mechano therapy
MYO FUNCTIONAL EXERCISES
• The child is asked to place the tip of the tongue in the
rugae area for 5 min and is asked to swallow

58. • Orthodontic elastics and sugarless fruit drop exercise:
These can be held by the tongue tip against the palate
on the rugae area during practice.
4S exercise includes identifying the spot by tongue,
salivating, squeezing the spot and swallowing. 4 steps:
• Spotting exercise (1S) - Spot should be the rest
position of the tongue
• Salivation exercise (2S) - The tongue is placed on the
spot, which results in salivation

59. • Squeezing exercise (3S) - The tongue is squeezed
vigorously with the teeth closed against the spot
followed by relaxing
• Swallowing exercise (4S) – After squeezing, the
next step is to swallow the spot. This new
swallowing pattern should be practiced at least 40
times a day.

60. • Several exercises such as whistling, reciting the
count from 60 to 69, gargling, yawning etc to tone
respective muscles.
• Once the patient is familiar with the new tongue
position, an appliance is given for training the
correct positioning of the tongue.

61. • APPLIANCE THERAPY
• Preorthodontic trainer: this appliance aids in correct
positioning of the tongue with the help of tongue tag.
• Nance palatal arch: in this acrylic button can be used
as a guide to place the tongue in the correct position
• Oral screen: shields the teeth around thereby
preventing tongue thrust.

63. MOUTH BREATHING HABIT
• DEFINITION:
SASSOUNI (1971)
Habitual respiration
through mouth instead
of the nose.
ORONASAL BREATHING

64. CLASSIFICATION
FINN has classified mouth breathing into:
a. Anatomic: Short upper lips leads to
incompetence of lips and hence mouth
breathing.
b. Habitual: As a matter of habit or persistence
of habit even after elimination of the
obstructive cause.
c. Obstructive: Increased resistance to or
complete obstruction of normal airflow
through nasal passage- breathe thru mouth

65. DIAGNOSIS
HISTORY - Must be questioned about
– Frequent occurrence of tonsillitis, allergic rhinitis
– If the child adopts frequent lip apart posture
EXAMINATION
A. Study the patient unobserved – nasal breathers show lips
touching lightly while mouth breathers keep lips apart
A. Ask the patient to take deep breath – nasal breathers
demonstrate good reflex control of the alar muscles which
control the size and shape of external nares. Mouth
breathers – no change in size or shape of external nares.

66. CLINICAL TESTS
• MIRROR TEST (Fog test). Two surfaced mirror is placed on
the patient’s upper lip. Fogging of the mirror facing
towards the mouth during breathing indicates the
presence of mouth breathing.
• MASSLER’S WATER HOLDING TEST: The patient is asked to
hold mouth full of water. Mouth breathers cannot retain
the water for a long time.

67. • ZWEMER’S BUTTERFLY TEST: A wisp of cotton is
placed in front nose or mouth of the patient and
any flutter in the cotton fibers flutter upwards-
nasal , flutter downwards- mouth breather.

68. • INDUCTIVE PLETHYSMOGRAPHY/RHINOMETRY: The
total air flow through the nose and mouth can be
quantified
• CEPHALOMETRICS: calculate amt of nasopharyngeal
space- help in diagnosing any obliteration of airway
space due to some obstruction. The presence and size
of adenoids and tonsils can be estimated on lateral
cephalogram.

69. CLINICAL FEATURES
• FACIAL FORM: Patients who breathe through the
mouth display a tendency towards a more vertical
growth pattern.
• Adenoid Facies - Long, narrow face with
accompanying narrow nose and nasal passages.
– Flaccid and short upper lips
– Dolicofacial skeletal pattern
– Nose is tipped superiorly
– Expressionless face

70. • LIPS: Children with mouth breathing habit have a short, thick,
incompetent lip.
Gummy smile.
• SPEECH: Abnormalities of the oral and nasal structures can
compromise on speech performances. Nasal tone in the voice is
seen.
• GINGIVA: Mouth breathers with short upper lip are known to be
susceptible for inflammation of gingiva which may be
contributed to the drying of the exposed gingiva

71. • DENTAL EFFECTS –
• Constricted maxillary arch
• High arched palate
• Posterior cross bite
• Protrusion of maxillary incisors
• Tendency toward open bite
• Increased incidence of dental caries

72. TREATMENT OF MOUTH BREATHING
• ELIMINATION OF CAUSE
• To initiate the treatment of the actual cause, the
type of mouth breathing, whether it is Habitual or
Obstructive should be determined.
• Identification and correction of nasal obstruction

73. • INTERCEPTION OF THE HABIT - If the habit continues even
after the removal of obstruction, then it should be corrected by
means of the following -
• Deep breathing exercises: are done with deep inhalation
through the nose with arms raised sideways followed by
exhalation of air though mouth while bringing the arms
downwards.
• Lip exersices: Hypotonicity and flaccidity of upperlip are the
obvious characteristics. The child is instructed to extend the
upper lip as far as possible to cover the vermillion border under
and behind the maxillary incisors.
• Playing the wind instrument

74. • Oral screen
• It is used to retrain the lips
• Should not be used if the child has nasorespiratory
distress or nasal obstruction
• Breathing holes can be bored initially allows
passage of some amount of air into the mouth
• Metallic ring (Holtz)- to hold
• Double oral screen

75. BRUXISM
DEFINITION – Ramfjord
1966
Defined Bruxism as the
habitual grinding of teeth
when an individual is not
chewing or swallowing.

76. CLASSIFICATION
1. DAYTIME/DIURNAL BRUXISM: Can be conscious or
subconscious grinding of teeth usually during the day and
may occur along with parafunctional habits such as
chewing pencils, nails, cheeks and lips.
1. NIGHT TIME/NOCTURNAL BRUXISM: Is the subconscious
grinding of teeth characterized by rhythmic patterns of
masseter activity.

77. ETIOLOGY
1. CNS: Bruxism can be manifestation of certain definite cortical lesions such as
cerebral palsy
2. Psychological Factors: A tendency to gnash and grind the teeth has been
associated with feeling of anger and aggression or be a manifestation of the
inability to express emotions such as anxiety and hate.
3. Occlusal Discrepancies: Improper interdigitation of teeth may lead to
bruxism.
4. Genetics: Children of bruxing parents shows more tendency towards
bruxism.
5. Systemic Factors: Magnesium deficiency, chronic abdominal distress,
intestinal parasites
6. Occupational Factors: An over enthusiastic student and compulsive
overachievers may also develop the habit.

78. CLINICAL MANIFESTATIONS
• Signs and symptoms of bruxism depend on
– Frequency of bruxism
– Intensity
– Age of the patient

79. • Occlusal Trauma: This include tooth ache, mobility
mainly in morning.
• Tooth structure: Extreme sensitivity due to loss of
enamel, atypical wear facets, pulp may be exposed.
• Muscular: Tenderness of the jaw muscles on palpation,
muscular fatigue on waking up in the morning,
hypertrophy of masseter.
• TMJ: Pain, crepitation, clicking in the joint, restriction
of mandibular movements and jaw deviatons can be
observed.
• Headache

81. TREATMENT
• Occlusal adjustments of any premature contacts
• Occlusal splints/night guards
• Restorative treatment
• Relaxation training
• Physiotherapy

82. • Drugs – Local anesthetics, tranquilizers, muscle
relaxants
• Electrical method: Electro galvanic stimulation
for muscle relaxation

83. • Bio feedback: This technique utilizes positive
feed back to enable patient to learn tension
reduction. It is accomplished by allowing the
patient to view an EMG monitor while the
mandible is postured with a minimum activity.

84. LIP HABIT
DEFINITION: Is defined as the habit that involves
manipulation of lips and perioral structures.
The lip habit may involve either of lips, with a higher
predominance towards the lower lip.

85. CLASSIFICATION
1. Wetting of the lips by the tongue / lip licking
2. Lip sucking – Pulling the lips into the mouth
between the teeth.

86. ETIOLOGY
1. Malocclusion – In children with class II div I malocclusion
2. In conjunction with other habits – the digit habit may
result in a large overbite and overjet and the child while
trying to achieve an oral seal can indulge in lip sucking
habit.
3. Emotional stress

87. CLNICAL MANIFESTATIONS
• Protrusion of upper incisors
• Spacing in anteriors
• Retrusion of mandibular incisors which collapse
lingually with crowding
• Lips show reddened, irritated and chapped area
below the vermillion border

88. CLNICAL MANIFESTATIONS
• Vermillion border may be relocated farther
outside the mouth due to constant wetting of the
lips
• Mentolabial sulcus becomes accentuated

89. TREATMENT
• Treatment of lip sucking habit should be directed
initially towards the etiology followed by
appliance therapy
• Correction of malocclusion
• Appliance therapy using oral screen, lip bumper

90. NAIL BITING HABIT
• Nail biting habit is one of the most common habits in
children and adolescents
• Nail biting is absent before 3 years of age.
• The incidence rises sharply from 4-6 years and remains at
fairly constant level between 7 to 10 years and rises again
to a peak during adolescence.

91. ETIOLOGY
• Insecurity
• Nervous tension
• Psychosomatic successor of thumb sucking
• EFFECTS
• Crowding, rotation, attrition of incisal edges
• Inflammation of nails and nail beds

92. • MANAGEMENT
• Mild cases require no treatment
• Avoid punitive methods such as scolding, nagging
• Treat the basic emotional factors causing the act
• Encourage outdoor activities which may help in easing
tension
• Application of nail polish, light cotton mittens as reminders

93. SELF INJURIOUS HABITS
• Self-injury or self-mutilation is defined as a behavioral
disturbance that consists of deliberate destruction of
or damage to body tissues that is not associated with a
conscious intent to commit suicide
• Masochistic habits, sadomasochistic habits, self
mutilating habit
• Mostly seen in mentally challenged children (10-20%)
and children with psychological abnormalities

94. ETIOLOGY AND SYMPTOMS
ORGANIC
FUNCTIONAL

95. a) ORGANIC: Associated with Lesch-Nyhan disease and De Lange’s
syndrome  repetitive lip, finger, tongue, knee and shoulder
biting common
b) FUNCTIONAL: This can be further divided into
TYPE A(superimposed injury)
– These are the injuries superimposed on a pre existing lesion.
Eg:- A child with skin disease shows no evidence of healing as it is
perpetuated by this injurious habit

96. • TYPE B – Injuries secondary to another established
habit.
eg: Rotation of thumb while thumb sucking can harm
the tissues
• TYPE C – Injuries of unknown and complex etiology.
There may be multiplicity of symptoms of greater
intensity.

97. CLINICAL FEATURES
• Biting of fingers, knees,
shoulders
• Frenum thrusting: Locking of
maxillary frenum in between
spaced maxillary centrals.
• Picking of gingiva
• Insertion of sharp objects into
the oral cavity

98. TREATMENT
• Treatment of self injurious habits generally requires multi
disciplinary approach.
• Care should be taken in dealing with this form of behavior
due to underlying emotional component.
• Continued concern for the habit may support or reinforce
the habit.
• Palliative therapy in the form of protective padding, mouth
guards can be useful.

99. Generally requires a multidisciplinary approach
• Role of pediatric dentist is to elicit a thorough
social and medical history and correctly diagnose
the condition so as to distinguish it from one of the
physiologic etiology solely
• Referral to primary care physician, usually a
pediatrician should be undertaken

100. Psychological treatment
• Treatment should be first initiated towards
psychotherapy because some children who
experience sense of neglect, abandonment,
loneliness can use this behavior in an attempt to
solicit attention and love

101. Physical restraint
• enables self injury to be prevented
directly and in an individualized
manner
• The possible options include
helmets, face masks, gloves, special
clothing such as straight jackets,
and, in the case of lesions owing to
biting, restrictive oral devices

102. • Acrylic splints held in place by orthodontic bands
have been designed to displace the lip in a
vestibular direction by means of a plate also
formed of acrylic material
• Acrylic splints with oral shields that are inserted
into the buccal or labial sulcus, soft buccal
protectors positioned over the teeth, oral splints
held in place by extraoral straps, and face masks
anchored around the neck

103. • Lip bumper consists of one long element and a
small acrylic shield, fixed by intermaxillary wires
or elastic bands to tubes or bands anchored to the
first molar teeth act by displacing the lip
downwards and forwards to prevent it being bitten

104. • Oral screen has the advantage that it does not
have to be fixed to the teeth, and it may therefore
be indicated in infants and children in whom tooth
eruption is not advanced

105. Surgical procedures
• Severe cases consider tooth extraction as a
therapeutic alternative
• Although this is a radical solution, it has been
shown to produce an enormous reduction in
damage to the soft tissues
• Young patients primary teeth are extracted
simultaneously or in sequence

106. CONCLUSION
• Old habits are hard to break and new habits are hard
to form
• In order to replace the adverse oral habits by good
habits, holistic approach is indicated, which includes
patient-parent counseling, behaviour modification
techniques, use of habit breaking appliances, physical
exercise, followed by recall visits and reinforcement

107. • Prevention and interception of these deleterious
oral habits at an early stage is utmost important
for the good oral health of the children