Oral habits part 4 bruxism nail biting

1. Oral Habits
By -
Sudeep Madhusudan Chaudhari
MDS 2nd Year
Dept of Paedodontics & Preventive Dentistry

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Contents
●Introduction
●Definitions
●Classification
●Prevalence of habit
1) Thumb sucking
2) Pacifier habit
3) Tongue thrusting
4) Mouth breathing
5) Bruxism

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Definitions :-
Bruxism is the habitual grinding of teeth when the individual is not
chewing or swallowing.
- Ramjford (1966)
Nonfunctional movement of the mandible with or without an audible
sound occurring during the day or night.
- Vanderas (1995)
5)Bruxism :-

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Classification
1) Daytime bruxism / Diurnal bruxism / Bruxomania.
2) Night time bruxism / Nocturnal bruxism / Bruxism.

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Etiology
● Local factors
– Mild occlusal trauma or minor anatomic defects, traumatic occlusion.
● Systemic factors
– Intestinal parasites, subclinical nutritional deficiencies, allergies and endocrine
disorders.
● Psychological factor
– Emotional stress, anger, anxiety or aggression.
● Occupational factor
– Athletes , watch makers, die-makers, diamond cleaners

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Clinical features
●Occlusal trauma.
●Tooth mobility.
●Atypical shiny wear facets with sharp edges.
●Pulpal sensitivity to cold.
●Pulp exposures.

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●Muscular tenderness, especially lateral pterygoid and masseter muscles.
●Muscular fatigue on waking.
●Muscular hypertrophy.
●TMJ disorders.
●Headache.
●Grinding and tapping sound.
● Soft tissue trauma.

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Treatment considerations
● Occlusal adjustments-
– Any occlusal interferences should be corrected.
● Occlusal spilnts-
– night guards to cover all the teeth.
● Restorative treatment-
– In severe cases leading to pulp exposures.
● Relaxation training.
● Drugs (ethyl chloride for pain, local anesthetics, tranquilizers, sedatives, muscle
relaxants.)
● Acupuncture therapy.

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Normal lip anatomy & function is important
for speaking, eating and maintaining the
balance occlusion. The lip habit may
involve either of the lips, higher
predominance towards the lower lip.
This is defined as a habits that involve
manipulation of the lips and peri oral
structures.
6)Lip biting :-

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Classification
1) Lip biting.
2) Lip sucking.
3) Lip wetting.

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Etiology-
● Malocclusion-
– Class II div 1 with large overbite and overjet.
– Child wants to produce a normal lip seal during swallowing by
placing the lower lip posterior to upper incisors.
● Habits-
– In conjunction with thumb sucking habit which may result in large
overjet and overbite.
● Emotional stress.

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Clinical manifestations-
● Protrusion of maxillary incisors and retrusion of mandibular incisors.
● Reddened, irritated, chapped lips with vermillion border relocated
farther outside the mouth, especially with lower lip.
● Mentolabial sulcus becomes accentuated.
● Malocclusion.

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Treatment-
● Correction of malocclusion.
● Treating the primary habit.
● Appliance therapy-
– Lip bumper.
– Oral screen.

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● It is one of the most common habits in children and
adults.
7)Nail biting :-

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Etiology-
● Insecurity.
● Nervous tension.
Effects-
● Crowding, rotation and alteration of incisal edges of incisors.
● Inflammation of nail beds.

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Management-
● Patient is made aware of the habit.
● Scolding, nagging and threats are avaoided.
● Encouraging outdoor activities.
● Application of nail polish, light cotton mittens as reminder.

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Masochistic habits/ sadomasochistic habits/ self-mutilating habits
Definition-
Repetitive acts that result in physical damage to the individual.
8)Self-injurious habits :-

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Etiology-
● Organic-
– Lesch-Nyhan disease, De Lange’s syndrome.
● Functional-
– Type A- these are injury superimposed on a preexisting lesion.
– Type B- injuries secondary to another established habit.
– Type C- injuries of unknown or complex etiology.

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Clinical features -
● Biting of fingers, knees, shoulders
● Frenum thrusting
● Picking of gingiva
● Insertion of sharp object into the oral cavity

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Treatment -
● First initiated towards psychotherapy because some children
experience a feeling of neglect, abandonment and loneliness and thus
use this behaviour in an attempt to solicit attention and love.
● Treatment of self-injurious behaviour generally requires a
multidisciplinary approval.
● Care should be taken in dealing with this form of behaviour of
underlying emotional component.
● Palatal therapy followed by mechanotherapy using protective padding
and mouth guards has also been advocated.

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Conclusion
● As the mouth is the primary and permanent location for expression of
emotions and even is a source of relief in passion and anxiety in both
children and adults, stimulation of this region with tongue, finger, nail
or other materials can be a palliative action.
● Though it is difficult to delineate it, but it is important to have
differentiation of abnormal from normal because, if normal
development get disturbed unknowingly and at the same time, if
abnormal growth or underlying psychological cause let continue
without interfering at proper time or age it will lead to long lasting
effect on growth & development and psychological development of
the child.

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●Oral habits can manifest themselves in a variety of ways. The
identification of an abnormal habit and assessment of a particular habit
and its immediate and long term effect on the craniofacial complex and
dentition should be made as early as possible.
●The assessment of these behavior must include a thorough evaluation of
the habit itself and the presence of, or the potential for oral health
repercussions.
● These judgements must be coupled with the sensitive assessment of
the physical and emotional status of the child and the relationship of
the parent or caregiver.

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References
● McDonald RE, Avery DR. Dentistry for the child and adolescent. Mosby Incorporated; 2004.
● Pinkham JR, Casamassimo PS, Fields HW, McTigue DJ, Nowak A. Pediatric dentistry. Infancy
through adolescence. 2005 Sep 20;4.
● Finn SB, Akin J. Clinical pedodontics. WB Saunders company; 1973.
● Wei SH. Pediatric dentistry: total patient care. Lea & Febiger; 1988.
● Proffit WR, Fields HW, Larson B, Sarver DM. Contemporary orthodontics. Elsevier Health
Sciences; 2018 Aug 6.
● Marwah N. Textbook of pediatric dentistry. Jaypee Brothers, Medical Publishers Pvt. Limited;
2018 Oct 31.
● Tandon S. Textbook of pedodontics. Paras Medical Publisher; 2009.