This document defines and classifies common oral habits in children, including thumb sucking, tongue thrusting, mouth breathing, bruxism, lip biting, nail biting, and self-injurious habits. It discusses the development, etiology, effects, and clinical findings associated with each habit. Key points include that oral habits are learned patterns that develop from frequent repetition, can be caused by overprotection, isolation, or pain/discomfort, and result in unbalanced pressure on developing dental structures. The document classifies habits as obsessive or non-obsessive and provides diagnostic criteria for common habits significant to dental surgeons.
2. DEFINITIONS
Dorland:
Habit can be defined as a fixed or constant
practice established by frequent repetition.
Mathewson:
Oral habits are learned patterns of muscular
Contraction.
Buttersworth:
Defined a habit as a frequent or constant
practice or acquired tendency,which has
been fixed by frequent repetition.
4. BASIC ETIOLOGY OF HABIT
Overprotection
Loneliness
Isolation
Pain and discomfort
Abnormal physical size of parts
Imitation or imposition of others
5. BASIC EFFECT OF HABIT
Brings unbalanced pressure on immature,
highly malleable alveolar ridges.
All the clinical features are consequences
of this effect
10. SUCKING REFLEX
One of baby’s inherent reflex
Natural normal infant habit which gives the
baby a feeling of security, pleasure and
nutritional satisfaction.
Babies restricted from sucking,adapt to
sucking a available object,mostly thumb.
11. CLASSIFICATION
Normal:
During 1st and 2nd yrs
Disappears as child
matures
Abnormal:
Persist beyond
preschool age or 3yrs
Divided into:
Psychological:
Habitual
12. Sucking habits can also classified as
Nutritive sucking habit
Breast-feeding
Bottle-feeding
Non-nutritive sucking habit
Thumb sucking
13. Subtelny classification of thumb sucking
Type A: More common
Whole digit is placed inside the mouth with
the pad of the thumb pressing over the
palate and thumb contact with max. and
man. Anteriors is maintained.
Type B:
Thumb is placed into the oral cavity without
touching the vault of the palate and thumb
contact with max. and man. Anteriors is
maintained.
14. Type C:
Thumb is placed into the mouth just beyond
the first joint,contacting the hard palate and
thumb contact is maintained with only
max.anteriors.
Type D:
Little portion of the thumb is placed into the
mouth
15. Etiology of thumb suking
Parents from high socioeconomic status
Working mother
Increased number of siblings
Later order of birth of child
Social adjustment and stress-scolding
parents
Feeding practices
Age of child
16. Clinical findings
Maxillary anterior proclination and mandibular
retroclination.
The anterior open bite
Constriction of maxillary arches
Posterior cross bite
Increased maxillary arch length
Increased trauma to maxillary central incisors
Increased mandibular intermolar distance
Increased overjet
Decreased overbite
17.
18. TONGUE THRUSTING
Definition:
Brauer:
A tongue thrust is said to be present if the
tongue is observed thrusting between, and
the teeth do not close in centric occlusion
during deglutition.
19. Tulley:
States 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
becomes interdental.
20. Classification
Physiologic:
Due to retained infantile swallow
Habitual:
Present as a habit even after the
correction of malocclusion.
Functional:
Adaptive behaviour developed to
achieve an oral seal.
Anatomic:
Persons having enlarged tongue.
21. Etiology of tongue thrust
Retained infantile swallow
Upper respiratory tract infections
Neurological disturbances
Functional adaptability to transient change
in anatomy
Feeding practices
Other oral habits
Hereditary
Tongue size
22. Clinical manifestations
Extra oral findings:
Seperated lips
No corelation between the movements of
tongue tip and mandible.
Mandibular movement is upward and
backward with tongue moving forward
Problems in articulation of
/s/,/n/,/t/,/d/,/i/,/th/,/z/,/v/ sounds
Increase in anterior facial height
23. Intraoral findings
Tongue movements are irregular
Swallowing sequences are seen to be jerky and
inconsistent
Lowered tongue tip at rest
Malocclusion:
maxilla:Proclination of anteriors
Generalized spacing
Maxillary constriction
mandible:Retroclination or proclination
intermaxillary relationships:
Anterior or posterior open bite
Posterior cross bite
27. Classification(Finn)
Anatomic:
In persons whose short upper lip
does not permit complete closure.
Obstructive:
Children who have increased
resistance to or complete obstruction
of,normal flow of air through the nasal
passages.
Habitual:
Child who continually breathes
through his mouth by force of habit.
28. Etiology
Nasal insufficiency in most of the children
Allergies,physical obstructions and chronic
infections
Airway obstruction due to
-Enlarged turbinates
-Deviated septum
-Obstruction in bronchial tree or
larynx
-Obstructive sleep apnea
syndrome
-Ectomorphic children
29. Clinical features
General effects:
No purification of inspired air
Poor pulmonary compliance and pigeon chest
appearance
Esophagitis
Low % of oxygen in air inhaled through mouth
Effects on dentofacial structures:
Increased facial height,retrognathic maxilla
and mandible
Adenoid facies
30.
31. Retroclined upper and lower incisors and
posterior cross bite
Nasal tone in voice is seen
Lip apart posture,short thick incompetent
upper lip and a voluminous curled over
lower lip
Slit like external nares with a narrow nose
Hyperplastic gingiva and classic rolled
margin in gingiva
Enlarged interdental papilla
Otitis media
32. BRUXISM
Definition:
Ramfjord:
Habitual grinding of teeth when the
individual is not chewing or swallowing.
Vanderas:
Nonfunctional movement of the mandible
with or without an audible sound occuring
during the day or night.
33. Types of bruxism
Day time bruxism/Diurnal bruxism:
Night time bruxism/Nocturnal bruxism:
34. Etiology
CNS-cortical lesions,children with cerebral
palsy and mental retardation
Psychological factors-feelings of anger
and aggression
Improper interdigitation of teeth
Genetics
Mg++ deficiency and other systemic
factors
Allergies
Overenthusiastic student or compulsive
overachievers
35. Manifestations
Occlusal trauma-tooth mobility
Increased tooth sensitivity from an
excessive abrasion of the enamel
Fracture of the tooth crown or restorations
Muscular tenderness,muscular fatigue
TMJ disturbances and pain
Chronic headache
Soft tissue trauma
Small ulcerations on the buccal muosa
opposite the molar teeth
36. Lip habit
Definition:
Habits that involve manipulation of the lips
and perioral structures are termed as lip
Habits
Classification:
-Wetting the lips with the tongue
-Pulling the lips into the mouth between the
teeth
37.
38. Etiology
Angle’s class II division 1 malocclusion with
large overbite and overjet
Other habits-thumb sucking
Emotional stress
Manifestations:
Protrusion of max.incisors and retrusion of man.
Incisors
Interdental spacing in max.incisors
Crowding in man.incisors
Dislocated vermilion border
Malocclusion
39. Cheek biting
Definition:
Abnormal habit of keeping or biting the
cheek muscles in between the upper and
lower posterior teeth
Clinical features:
Ulcer at the level of occlusion
Open bite
Tooth malposition in the buccal segment
41. Self injurious habits
Definition:
In these habits, the patient enjoys inflicting
damage to himself.
Etiology:
Organic-Lesch nyhan disease
-De Lange’s syndrome
Functional-Superimposed on pre existing
lesion
-Secondary to an habit