Oral habits p2

by
Dr.Avaneethram
Department of pediatric and preventive
dentistry

• Tongue thrusting
• Mouth breathing
• Bruxism
• Lip biting
• Nail biting
• Cheek biting
• Self injurious habits/ Masochistic habits
• Conclusion
• References
Part 2 Part 1

defined tongue thrust as the forward movement of the tongue tip between the
teeth to meet the lower lip during deglutition and in sounds of speech, so that the tongue lies
interdentally.
Tongue thrusting is an oral habbit
pattern related to the persistence of an infantine
swallown pattern during chidhood and adolescen and
thereby produces an openbite and protrusion of
anterior tooth segment.
Tongue thrusting
Brauer,(1965) - a tongue thrusting is said to be present if the tongues is observed thrusting in
between, and the teeth do not close in centric occlusion during diglutition.
Schneider (1982) Tongue thrust is a forward
placement of the tongue between the anterior teeth
and against the lower lip during swallowing
Textbook of pedodontics - Shobha tandon

Classification
Profitt (1990)
• Physiologic: This comprises of the normal tongue thrust swallow of infancy.
• Habitual: The tongue thrust swallow is present as a habit even after the
correction of the malocclusion.
• Functional: The tongue thrust mechanism is an adaptive behavior developed to
achieve oral seal.
• Anatomic: Persons having enlarged tongue can have an anterior tongue
posture.
Pediatric dentistry principles and practice - MS Muthu

Moyers (1955)
1. Simple tongue thrusting
2. Complex tongue thrusting
3. Retained infantile swallow
4. Abnormal tongue posture
Textbook of pediatric dentistry - S G Damle

James S Brauer and Townsend V Holt classification of
tongue thrusting

Moyers’ classification of swallowing pattern

• The comparative largeness of the tongue within a retrognathic mandible causing the tongue
to protrude out.
• Enlarged adenoid and palatine tonsils.
• As associated with thumb sucking habit, it may result in anterior open bite leading to
tongue protrusive swallowing pattern.
• Malocclusion—the incidence of tongue thrusting during swallowing has been reported to be
higher in children with malocclusion
Reasons for the prevalence of tongue thrusting habit in children

Illustratted pediatric dentistry- P R Chokkalingom
Features of differentiation between the infantile and adult swallowing pattern
Features of differentiation Infantile swallowing Adult swallowing
Muscle contraction Contraction of muscles of facial
expression
Contraction of muscles of
mastication
Tongue postion Between incisors Behind incisors
Maxillary and mandibular
dentition
Dentition separated during the act of
swallowing
Dentition momentarily occluded
during the act of swallowing
Nerve involved VII cranial nerve V cranial nerve
Anterior seal Seal by tongue Sealed by lips

Differences between resting tongue posture in a Non-Habit and tongue
thrusting individual
Posture of tongue Tongue thrusting
individual
Non-Habit individual
Tongue tip Placed between maxillary and
mandibular anterior teeth
Placed behind maxillary incisor
Dorsum of tongue In contact with anterior part of
the palatal contour
In the mid-palatal contour

Etiology
• Retained infantile swallow
• Upper respiratory tract infection
• Neurological disturbances
• Functional adaptability to transient
change in anatomy
• Feeding practices and tongue thrusting
• Induced due to other oral habits
• Hereditary
• Tongue size

Clinical manifestation
Extraoral
• Lip exposure
→ incompetent
• Mandibular movements
→ more erratic and no correltion with
tongue tip and mandible.
• Speech
→ sibilant disorder,lisping,problems in
articulation of S,N,T,D,L,TH,Z,V sounds
• Facial form
→ ↑anterior facial height
Intraoral
• Tongue movements
• Tongue posture
• Malocclusion
• Maxilla
→ Proclination - ↑ overjet
→ Generalized spacing
→ Maxillary constriction
• Mandible
→ Retroclination/proclination
• Inermaxillary relationship
→ Anterior/ posterior open bite
→ Posterior cross bite

Anterior region Posterior region
Tongue thrusted between maxillary
and mandiblar anterior teeth exerts a
constant outward pressure over
incisors
Disocclusion of posterior t initiates
occlusal movement of posterior
teeth until they meet the opposing
teeth
Proclined maxillary and mandibular
incisors and anterior open bite
Supraeruption of posterior teeth
complicating the correction of
anterior open bitelater on

Extraoral Features
• Usually dolichocephalic face
• Increased lower anterior facial height
• Incompetent lips
• Expresion less face as the mandible
is stabilized by facial muscles instead
of masticatory muscles during
deglutition
• Speech problems like sibilant
distortions and lisping, etc.
• Abnormal mentalis muscle activity is
seen.
Intraoral Features
• Proclined, spaced and sometimes flared upper
anteriors resulting in increased overjet.
• Retroclined or proclined lower anteriors depending
upon the type of tongue thrust.
• Presence of an anterior open bite.
• Presence of posterior crossbites.
• The simple tongue thrust is characterized by a normal
• tooth contact during the swallowing act. They exhibit
• good intercuspation of posterior teeth in contrast to
• complex tongue thrust.
• The tongue is thrust forward during swallowing to
help establish an anterior lip seal. At rest the tongue
tip lies at a lower level.
Anterior Tongue Thrust
Clinical features

Singaraju GS, Chetan K. Tongue thrust habit-a review. Ann essences dent. 2009;1:14-23.

Diagnosis of tongue thrusting
• Examination
Methods of examination of tongue
• Functional examination
• Palpatory examination
History
1. Determine the swallow pttern of sibling and
parents to chek foe hereditary etiologic factor.
2. Determine whether or not remedial speech
was ever provided.
3. Information regarding upper respiratory tract
infections, sucking habits and nuromuscular
problems.
4. Past and present information regarding the
overall abilities, interests and motivation of
the patient should be.

Functional examination
• Observe the tongue position while the mandible is in the rest position.
• Observe the tongue during various swallows
• Conscious swallow
• Command swallow

Place water beneath the patient’s tongue tip and ask him to swallow.
1. Normal: Mandible rises and teeth are brought together but there is no
contraction of lips or facial muscles.
2. In tongue thrusting: There will be marked contraction of lips and facial
muscles.
Place hand over temporalis muscle and ask to swallow.
1. Normal: Temporalis contracts and mandible is elevated.
2. In tongue thrusting: No temporalis contraction
Palpatory examination

Treatment considerations
1. Age
2. Presence/absence of associated manifestations
3. Malocclusion
4. Speech defects
5. Associated with other habits

• Traning of correct swallow and posture of the tongue
• Speech therapy
• Mechanotherapy
• Removable
• Fixed
• Correction of malocclusion
• Surgical treatment
Management

Traning of correct swallow and posture of the tongue
• Myofunctional exercise
• 4`s’ Exercise
• Proprioception training
• Re-education of tongue posture
• Training tongue posture at swallowing
• Lemon Candy Exercise
• Lip Exercises
• Using appliances as a guide in the correct position of tongue
• Preorthodontic trainer for myofunctional training
• Nance palatal arch appliance
Textbook of pedodontics - Shobha tandon and Illustratted pediatric dentistry- P R Chokkalingom

Mechanism of action of habit breaking appliance
Singaraju GS, Chetan K. Tongue thrust habit-a review. Ann essences dent. 2009;1:14-23.

• It is recommended to start with the least invasive methods like counseling before using
habit breaking appliances.
• Some children need additional support to stop the habit and thus habit-breaking appliances
are indicated.
• Habit-breaking appliances can be either fixed or removable.
• One of the fixed appliances used to break the habit is the palatal crib appliance.
• The standardized fabrication method presented in this article enables clinicians to produce
cribs that are optimally designed and will thus reduce the chair side time required for
adjustments.
• Long-term evaluation of the performance of standardized cribs and the stability of their
results is required for promising results in the future.

• This case represents the use of a modified blue grass appliance with a roller as a
positive reinforcing approach to correct the tongue thrusting habit.
• When the patient played with the roller it created a new habit, thus breaking the old
one and holding true for the adage “the proper way to eliminate bad habits is to
replace them with good ones.”

Mouth Breathing
Sassouni (1971) defined it is as habitual respiration through the mouth instead of nose.
Merely (1980) used the term oronasal breathing instead of mouth breathing.

Classification
FINN (1987)
: The anatomic mouth breathers are the one whose short upper lip does
not permit complete closure without undue effort.
: Children who have a complete obstruction of the normal flow of air
through the nasal passages. The child is forced by sheer necessity to breathe
through the mouth.
: Habitual breather is a child who continuously breathes through his
mouth by force of habit, although the abnormal obstruction has been removed

Pathogenesis
Deformed maxillary
alveolus
Neutral zone moves
palatal to original
arch form
unopposed external
force by buccal
musculature
Buccinator
mechanism
disrupted in maxilla
Tongue lowered
along with mandible
Mandible opened
for mouth breathing
Air intake by mouth
breathing
Normal breathing
inhibited
↓
↓
↓
↓
↑
↑
↑
↑
→

Etiology
1. Enlarged turbinates
2. Deviated septum and other nasopharyngeal abnormalities.
3. Allergic rhinitis, nasal polyps.
4. Enlarged adenoids, tonsils.
5. Abnormally short upper lip preventing proper lip seal.
6. Obstruction in the bronchiol tree or larynx.
7. Obstructive sleep apnea syndrome.
8. Genetically predisposed individual—Ectomorphic children having a genetic type of
tapering face and nasopharynx are prone for nasal obstruction.
9. Thumb sucking or similar oral habits can be the instigating agent.
Essentials of Pediatric dentistry - Kanchan Harikishan Asnani

CLINICAL FEATURES
General Effects
• Pulmonary development with oral respiration the resistance is lacking and poor pulmonary
compliance is seen. This gives the appearance of pigeon chest.
• Lubrication of oesophagus: In mouthbreathers the oropharynx is dry and mucous collected
in expectorated. This denies the oesophagus of essential lubrication and can produce a low
grade esophagitis.
• Blood gas constituents: Blood gas studies reveal the mouthbreathers have 20 percent more
CO2, 20 percent less O2 in the blood.

Effect on Dentofacial Structures
i. Facial form: Adenoid facies—Characterised by long narrow face, short nose, short upper lip, V
shaped maxilla, expression less face, nose in tipped superiorly.
ii. Dentitional changes:
• Anterior open bite
• Proclination of maxillary anteriors
• Constricted maxilla.
• High vault palate
• Patient is prone to oral infections
• Patient is more prone to dental caries.
iii. Gingival: Chronic keratinized marginal gingivitis in the maxillary anterior region.

iv. Lip: The patient has a lip apart posture, on smiling, many of these patient reveal large
amount of gingiva producing ‘gummy smile’.Incompetent upper lip and a voluminous curled
over lower lip.
v. Speech: Speech performance is compromised. Nasal tone in voice is seen.
vi. External nares: Long-standing nasal airway obstruction can lead to disuse atrophy of the
lateral cartilage. The result is a slit-like external nares with a narrow nose; sometimes after the
airway obstruction is removed and patent airway is established, the nose may collapse
oninspiration, making reconstructive surgery necessary.
vii. Other effects: Otitis media.

The different effects of oral breathing.
Denotti G, Ventura S, Arena O, Fortini A. Oral breathing: new early treatment protocol. J Pediatr Neonat Individual Med.
2014;3(1):e030108. doi: 10.7363/030108.

• History
• Examination
• A mouthbreather when asked to deep breath with his lips closed he will not change
appreciably shape and size of external nares rather contracts nasal origins while inspiring.
• A normal nose breather will dilate the nostril while deep breathing.
• Clinical Test
• Inductive plethysmography - (Rhinomanometry)
• Cephalometrics
DIAGNOSIS
• Butterfly test: A whisp of cotton is placed in front of the patient mouth if
patient is a mouth breather, the flattering of water is observed.
• Water holding test: Ask the patient to hold some water in the mouth. If patient
is a mouth breather, he can’t hold it for a longer time.
• Mirror test: Take a double ended mouth mirror keep one in front of nose and
one in front of mouth.If patient is a mouth breather fogging of the mouth
mirror in the front of mouth is seen.
• Paper test: Ask the patient to hold a piece of paper in between the lips. If he is
a mouth breather he can’t hold it for long

Management
Treatment consideration
• Age of child: Mouth breathing in many instances is self-correcting after puberty. This can
be attributed to the increase in nasal passages as the child grows, thereby relieving the
obstruction caused due to enlarged adenoids.
• ENT examination: An otorhinolaryngologist examination may be advised to determine
whether conditions requiring treatment are present in the tonsils, adenoids or nasal septum.
If habit continues after removal of cause then it is habitual.
• Prevention and interception: Mouth breathing can be intercepted by use of an oral screen
Singh S, Awasthi N, Gupta T. Mouth breathing-its consequences, diagnosis & treatment. ACTA Sci Dent Sci. 2020;4(5):32-41.

Treatment according to symptoms
Gingiva of the mouth breathers should be restored to normal health by coating the
gingiva with petroleum jelly.
It may be divided under three main factors:
1. Remove the cause: Etiological agents should be treated first. Removal of nasal or
pharyngeal obstruction by surgery orlocal medication should be sought. If a
respiratory allergy is present, it should be brought under control.
2. Rapid maxillary expansion has been reported to reduce the rapid maxillary
expansion.
3. Intercept the habit: If the habit continues even after the removal of the
obstruction then it should be corrected.
Singh S, Awasthi N, Gupta T. Mouth breathing-its consequences, diagnosis & treatment. ACTA Sci Dent Sci. 2020;4(5):32-41.

Methods of correction
Exercises
1. During day time-hold pencil between the lips.
2. During night time-tape the lips together with surgical tape in habitual mouth breathing
3. Hold a sheet of paper between the lips.
4. Piece of card 1 × 11⁄2” held between the lips.
5. Patients with short hypotonic upper lip: Stretch the upper lip to maintain lip seal or stretch
in downward direction toward the chin.
6. Button pull exercise: A button of 11⁄2” diameter is taken and a thread is passed through
the button hold. The patient is asked to place the button behind the lip and pull the thread,
while restricting it from being pulled out by using lip pressure.
7. Tug of war exercise: This involves two buttons, with one placed behind the lips while the
other button is held by another person to pull the thread. Blow under the upper lip and
hold under tension to a slow count of 4 repeat 25 times a day. Draw upper lip over the
upper incisors and hold under tension for a count of 10.

Oral screen
Oral screen: First introduced by
Newell in 1912.It is a
myofunctional appliance that is
easy to fabricate and easy to
wear.It works on the principle
of both force application and
force elimination
Singh S, Awasthi N, Gupta T. Mouth breathing-its consequences, diagnosis & treatment.
ACTA Sci Dent Sci. 2020;4(5):32-41.

• The protocol of intervention includes the use of the following devices and
procedures: a maxillary rapid expander (to correct the transverse discrepancy, to
increase the amplitude of the upper respiratory airway and to reduce nasal
resistances tract) in association with myo-functional devices (nasal stimulator and
oral obturator).
• They allow the reconstruction of a physiological balance between the perioral
musculature and tongue, the acquisition of nasal and lips competence and the
reduction of overjet. This protocol speeds up and stabilizes the results.
• The control of the muscles during the growth phase is important: muscular forces
influence the direction of facial growth.

Bruxism
Rubina (1986): Bruxism is the term used to indicate non final contact of
teeth which may include clenching, grinding, washing and tapping of teeth.
Ramfjord in 1966 defined bruxism as the habitual grinding of teeth
when an individual is not chewing or swallowing.
Vanderas 1995: Nonfunctional movement of the mandible with or without
an audible sound occurring during the day or night.
Textbook of pedodontics- Shobha tandon

Classification
• Diurnal bruxism/bruxomania: It is daytime bruxism; can be conscious or subconscious and
may occur along with para-functional habits.
• Nocturnal bruxism: It is night-time bruxism. Subconscious grinding of teeth characterized by
rhythmic patterns of masseter is observed.
According to presence:
a. Past bruxism
b. Present bruxism
Textbook of pedodontics- Shobha tandon
According to etiology:
a. Primary, essential or idiopathic bruxism: No
apparent cause is known.
b. Secondary bruxism: Secondary to disease (e.g.
coma, ictus, cerebral palsy), medicinal products (e.g.
antipsychotic medication, cardioactive medication),
drugs (e.g. amphetamines, cocaine, ecstasy).
According to occurrence
a. Awake bruxism
b. Sleep bruxism
c. Combined bruxism
Watted N, Zere E, Abu-Hussein M. Bruxism in Childhood-Etiology, Clinical Diagnosis
and the Therapeutic Approach.

Etiology
1. Local: Reaction to an occlusal interference, high restoration or some irritating dental
condition.
2. Systemic: Intestinal parasites, nutritional deficiencies (magnesium deficiency), allergies
and endocrine disorders
3. Psychological: Manifestation of a personality disorder, stress.
4. Occupational factors: An over enthusiastic student and compulsive overachievers may also
develop the habit.

Clinical Manifestations
• 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 and many fractured teeth can also occur.
• Muscular: Tenderness of the jaw muscles on palpation, muscular fatigue on waking up in the
morning, hypertrophy of masseter.
• Temporomandibular Joint: Pain, crepitation, clicking in joint, restriction of mandibular
movements.
• Associated features: Headache.

1. Elimination of local or general causes
2. Occlusal equilibrations/adjustments, traumatic high point elimination
3. Psychological counselling vation education and moti
4. Medications for symptomatic management:
(a) Analgesics
(b) Topical counter-irritants and massaging sore areas
(c) Muscle relaxants
(d) Topical medicaments, desensitising pastes or restorations to address hypersensitivity of teeth
(e) Anxiolytic drugs: calming effect on mind
(f) Anti-helminthic drugs (as nocturnal bruxism is observed in individuals with helminthic infections,
elimination of the habit should include ruling out such infections)
5. Stress-relieving disciplines such as yoga, meditations and autohypnosis, especially in adolescents
6. Appliances:
(a) Cap splints - help in relieving occlusal interference and prevent attrition of teeth
(b) Crowns for occlusally worn out teeth to restore lost occlusal height and prevent further attrition
(c) Prosthetic replacement of lost teeth
Management

• Bruxism is a common parafunctional habit, occurring both during sleep and wakefulness.
Usually it causes few serious effects, but can have serious effects in some patients affecting
their quality of life.
• As the etiology is multifactorial, there is no known treatment to stop bruxism, including
prosthetic treatment.
• Counselling and behavioral strategies, splint therapy, medications, and contingent electrical
stimulation can be used as different ways reducing the effects of bruxism.
• The management of bruxism should focus to prevent progression of dental wear, reduce
teeth grinding sounds, and improve muscle discomfort and mandibular dysfunction in the
most severe cases.

Lip Biting
Christensen et al have defined lip habits as “habits that involve manipulation of the lips and
perioral structures”.
Classification of lip habits
1. Lip licking—wetting of lips by the tongue
2. Schneider (1982)Lip sucking habit—pulling the lips into the mouth between the
teeth.
ETIOLOGY
i. Malocclusion
ii. Habits
iii. Emotional stress Essentials of Pediatric dentistry - Kanchan Harikishan Asnani

Clinical
Manifestations
• Protrusion of upper incisors
• Retrusion of lower incisors
• Lip trap
• Muscular imbalance
• Lower incisor collapse with lingual
crowding.
• Lip has reddened and chapped area below
the vermilion border.
• Mentolabial sulcus becomes accentuated.

MANAGEMENT
1. Correction of malocclusion treating the habit
2. Appliance therapy
• Oral screen
• Lip Bumper

This appliance is not only efficient but also esthetically pleasing and better accepted
by the patient.

Nail Biting
Nail biting is one of the most common habits in children. It is a sign of internal
tension.
Age of Occurrence
Nail biting is absent before 3 years of age. The incidence
rises sharply from 4-6 years and remains at a fairly
constant level between 7 to 10 years and rises again to a
peak during adolescence.
Etiology
• Insecurity
• Psychosomatic successor of thumb sucking
• Nervous tension

Effects
• Effects (Dental): Crowding, rotation and attrition of incisal
edges of incisors (mandibular)
• Effects on nails: Inflammation of nail beds and also of
nails.
Management
• Mild cases no treatment is indicated.
• Avoid punitive methods, such as scolding, nagging and threats
• 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 a reminder.
Textbook of pedodontics- Shobha tandon and Textbook of pediatric dentistry - S G Damle

• This paper describes a fixed oral appliance placed by the dentist, aiming to make nail biting
rather unpleasant and difficult for the affected patient. The case report discussed in this paper
shows an innovative successful treatment for nail biters providing efficient results within a 9-
month follow-up.
• Further studies and clinical follow-ups are still required in order to confirm the effectiveness
of this appliance.

Cheek Biting
This is an abnormal habit of keeping or biting the cheek muscles in between the upper and
lower posterior teeth. It may injure the soft tissues and may cause an openbite or an individual
tooth malposition in the buccal segment where a persistent cheek biting habit exists.
Clinical features
1. Ulcer at the level of occlusion
2. Open bite
3. Tooth malposition in the buccal segment.
Treatment
• A removable crib may be constructed to break
the habit;
• a vestibular screen may also be used.
Oral lubricant such as oral gel may temporarily
relief the surface.
Textbook of pedodontics- Shobha tandon and Textbook of pediatric dentistry - S G Damle

Both the casts were then articulated in occlusion
Wire bending was done by using 21 gauge wire on the mandibular
cast to incorporate a passive labial bow and modified pin head
clasps
acrylization
Two buccal shields extending from premolar to second
permanent molar on both sides were made using self-cure
acrylic resin which were supported by lingual plate with the aid
of modified pin head clasps
After acrylization, the appliance was trimmed, polished, and
checked for sharp extensions
Cheek plumper
↓
↓
↓
↓
Rana V, Srivastava N, Kaushik N, Panthri P. Cheek Plumper: An innovative anti-cheek biting appliance. International journal of clinical pediatric
dentistry. 2016 Apr;9(2):146.

SELF INJURIOUS HABITS
(Masochistic habits, sadomasochistic habits, self – mutilating habit).
• Repetitive act that result in physical damage to the individual. These habits show increased
incidence in mentally retarded population.
ETIOLOGY
1. Organic
Syndrome and syndrome like maladies – Lesch Nyhan disease and Cornelia
Lange’s syndrome in which symptoms such as repetitive lip, finger, tongue,
knee and shoulder biting are common. Winchel (1991) reported even seen in
conditions – Tourett’s syndrome Rett syndrome, xxxxxy syndrome, x4y
syndrome, and autism and sensory neuropathies

Functional :
This is further divided into
Type A
These are injuries superimposed on a pre existing lesion for eg. A child with a skin disease.
The lesion shows no evidence of healing as it is perpetuated by this injurious habit which
occurs mainly at the night.
Type B
Include injuries secondary to another established habit. The self injurious habit may
exacubate the features existing due to 1 percent habit for a rotation of the thumb while
thumb sucking can harm the soft tissues.
Type C
Habit may be injuries and of unknown or complex etiology. This type of behavior has a
greater psychogenic component. There may be a multiplicity of symptoms of greater
intensity. The child may report to various soft injurious habits as a form of release.

Treatment
• Treatment first initiated towards psychotherapy. Some children experience a feeling of
neglect and loneliness and through the use of self-injurious behaviour attempt to solicit
the attention and love.
• Pallative treatment—Bandages for oral ulceration which will help healing of wounds as
well as serve as habit reminder.
• Mechanotherapy—Oral shields.

FRENUM THRUSTING
This habit which is rarely seen is also a form of self injurious habit, if the maxillary incisors
are slightly spaced apart. The child may lock his labial frenum between these teeth and permit
it to remain in this position for several hours. On constant repetition, this may turn into a habit
which may displace the teeth.
Bobby pin opening
Usually seen in teenage girls where opening bobby pin with anterior incisors is done.
Clinically notched incisors and partially denuded labial enamel can be seen. At this age,
calling attention to the harmful habit is generally necessary to stop the habit.

• Oral habits may cause malocclusion with similar clinical figures as upper anterior teeth
protrusion, anterior open bite, big overjet or Angle Class II malocclusion and abnormalities in
the perioral structures.
• In oral habit management, there should be an agreement on the time target without criticizing
the child because it will stress the child.
• Parents or the dentist should emphasize that the therapy is not a punishment for the child.

• In order to replace the adverse oral habits by good habits, an holistic approach is indicated,
which includes patient-parent counselling, behaviour modification techniques, use of habit
breaking appliances, physical exercise, followed by recall visits and reinforcement.
• Prevention and interception of these deleterious oral habits at an early stage is utmost important
for the good oral health of the children.
• Techniques to eliminate the undesirable oral habit should be introduced when a program plan,
which will outline the replacement behaviors, is established and when family and caregiver
support is in place.

• Out of 909 children 497(54.7%) had oral habits. (48.2 %) Mouth breathing was the most
common occurrence followed by Thumb sucking habit (18.9%) and tongue thrust (12.7%). All
the habits were more frequent among 3 to 6 years of age. Anterior open bite was found to be
(27.0 %) and high significant value with nail biting (16.3%) was found .Therefore presence of
mouth breathing, thumb sucking and tongue thrusting habit were directly associated with
development of malocclusion in the permanent dentition.
• There was a high prevalence of malocclusion associated with oral habits harmful to deciduous
dentition.

• Prevalence of adverse oral habits was 72.7% in children reporting for dental treatment in
Central Kerala, India.
• Majority of the children had only one habit, of which mouth breathing was the most
commonly occurring habit, followed by tongue thrusting and nail biting.
• Nail biting was seen significantly more in female children and bruxism more in male children.
• Prevalence of thumb sucking was more in younger children (4–8 years) and tongue thrusting in
older children (9–13 years).
• As the prevalence of oral habits is very high in this population, compared to other Indian
populations, preventive and interceptive strategies to eradicate the oral habits should be
planned at the earliest.

• Prevalence of 8.9% of children with different types of malocclusion in the total sample size of
800, and the prevalence of oral habits observed was 47.2%.
• It is very important to advice children to refrain from tongue thrust, mouth-breathing and
thumb sucking. The correlation between prevalence of oral habits and malocclusions in
deciduous dentition does not seem to be strong, but we found tongue thrusting and mouth
breathing habit more in this age group constituting 29.5% and 26.2%, respectively contributing
to the malocclusions.
• Hence, early attention must be given to these malocclusions mainly posterior crossbites and
sagittal malrelationships and motivate the parents to eliminate these habits before damage is
done to the permanent dentition as ideal primary dentition is the indicator of future ideal
permanent dentition.

References
• Pediatric dentistry principles and practice - MS Muthu
• Illustratted pediatric dentistry- P R Chokkalingom
• Dentistry for the child and adolescent - McDonald
• Pediatric dentistry Infancy through adolescences - pinkham
• Textbook of pedodontics - Shobha tandon
• Textbook of pediatric dentistry - S G Damle
• Textbook of pediatric dentistry - Nikhil marwah
• Essentials of Pediatric dentistry - Kanchan Harikishan Asnani

• Singaraju GS, Chetan K. Tongue thrust habit-a review. Ann essences dent. 2009;1:14-
23.
• Denotti G, Ventura S, Arena O, Fortini A. Oral breathing: new early treatment protocol.
J Pediatr Neonat Individual Med. 2014;3(1):e030108. doi: 10.7363/030108.
• Singh S, Awasthi N, Gupta T. Mouth breathing-its consequences, diagnosis & treatment.
ACTA Sci Dent Sci. 2020;4(5):32-41.
• Watted N, Zere E, Abu-Hussein M. Bruxism in Childhood-Etiology, Clinical Diagnosis
and the Therapeutic Approach.
• Rana V, Srivastava N, Kaushik N, Panthri P. Cheek Plumper: An innovative anti-cheek
biting appliance. International journal of clinical pediatric dentistry. 2016 Apr;9(2):146.
• Sucking vs Suckling and Mouth Development by Brooke Andrews | Mar 18, 2017
• Anila S, Dhanya RS, Thomas AA, Rejeesh TI, Cherry KJ. Prevalence of oral habits
among 4–13-Year-Old children in Central Kerala, India. J Nat Sc Biol Med 2018;9:207-
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