Oral Habits _ Dr. Nabil Al-Zubair


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Oral Habits _ Dr. Nabil Al-Zubair

  1. 1. ORAL HABITS Dr. Nabil Al-Zubair
  2. 2. A tendency towards an ACT that has become - a repeated performance, - relatively fixed, - consistent and - easy by a person ‫متكرر‬ ‫أداء‬ ‫ثابت‬‫نسبيا‬
  3. 3. In initial stages habits are of conscious effort gradually they become less conscious and often become unconscious if performed repeatedly Frequently children acquire certain habits that may be either temporary or permanent Oral habits in children have a definite effect on developing teeth and its supporting structures
  4. 4. Aetiology of malocclusion Malocclusion
  5. 5. Aetiology of malocclusion ‫ع‬ ‫نظر‬ ‫وجهة‬ ‫من‬‫ملية‬ Skeletal factors Soft tissue factors Dento-alveolar or local factors Habits From a clinical perspective, it is useful to classify the aetiology of malocclusion under the following headings: Combinations
  6. 6. Malocclusion and Age Strongly established  During the first 3 yrs Damage can be DETRIMENTAL The worst amount of damage seen damage confined Anterior Segment Anterior Open Bite  Beyond the age of 3.5 yrs if the habit is continued  After 4 years of age the habit becomes  After the eruption of the permanent incisors ‫ضار‬
  7. 7. Malocclusion and Habits  Position of the digit/pacifier etc.  Associated orofacial muscle contraction force  Mandibular position during sucking  Facial skeletal genetic pattern  Amount, frequency, & duration of force applied The type of malocclusion produced by the habit is dependent on the following variables:
  8. 8. Finger Sucking Pacifier Nail Biting Lip Sucking Abnormal swallowing or Tongue Thrusting Abnormal Muscle habits Mouth Breathing
  9. 9. Pacifier/Binkie Habit
  10. 10.  Includes the physiologic pacifiers like the NUK.  Nearly identical to thumb sucking  Similar clinical findings, only not that pronounced!  Tx - throw away the pacifier!  Caution - child may substitute missing pacifier with a digit! Pacifier/Binkie Habit
  11. 11. Thumb sucking may be practiced even in intra-uterine life and is considered as normal till age of 3 1/2 to 4 years. Common habit seen in most of the children The placement of thumb or one or more fingers in varying depths into the mouth
  12. 12. 6. Improper or inadequate nursing. 7 . Attention getting mechanism. 8. Habit during eruption of teeth. 9. Feeling of hunger. 10. Feeling of personal in adequacy Thumb and Finger Sucking : * Causes: 1. Prolonged suckling 2. Rooting or placing reflex of mammalian infants 3. Feeling of insecurity 4. Child deprived of parental love and care 5. Learned pattern without any underlying cause
  13. 13. Thumb and Finger Sucking : Thumb sucking habit could be divided into 3 phases: Phases (a) Phase I: Normal Subclinically Significant Thumb-Sucking: From birth to 3 years. (b) Phase II: Clinically Significant Thumb-Sucking: From 3- 7 years (c) Phase III :Intractable Thumb- Sucking: after 7 years ‫عسير‬
  14. 14. Factors that Affecting the Degree of Damage to Teeth and Investing Tissue: Position of digit
  15. 15. Diagnosis Clinical Features of Prolonged Active Thumb-Sucking: Prolonged sucking Direct pressure on the teethAlteration in the cheek & lip pressure Spacing & proclination of upper incisors Narrowing of maxilla Retroclination of lower incisors Anterior open bite +
  16. 16. 1.Labial tipping of upper front teeth resulting in proclination of maxillary anteriors 2.Increased overjet 3.Anterior open bite 4.Contraction of cheek muscles results in narrow maxillary arch and posterior cross bites 5.May develop tongue thrust habit due to open bite 6.Hypotonic upper lip and hyperactive mentalis muscle EFFECTS
  17. 17. Prevention  Usually starts with proper nursing  on the part of the parent ⌧Time ⌧Patience ⌧Holding the baby while nursing, ⌧using a physiologically designed nursing nipple and pacifier to augment normal functional and deglutitional maturation
  18. 18. MANAGEMENT A)Psychological approach :- B)Mechanical aids :- C)Chemical approach :-
  19. 19. - Parents should be counseled to provide with adequate love and affection - Diverting the child's attention towards play and toys - Motivating the child for co-operation and willingness to discontinue the habit A)Psychological approach :- MANAGEMENT ‫المودة‬ ‫تحويل‬ ‫تحفيز‬
  20. 20. - Habit breaking appliances with a crib placed palatal to the maxillary central incisors - Removable or Fixed habit breakers can be used - Other aids like bandaging the thumb or elbow can be used B)Mechanical aids :- MANAGEMENT
  21. 21. - Habit breaking appliances with a crib placed palatal to the maxillary central incisors - Removable or Fixed habit breakers can be used - Other aids like bandaging the thumb or elbow can be used B)Mechanical aids :- MANAGEMENT
  22. 22. - Use of bitter tasting or foul smelling preparation placed on the thumb that is sucked makes the habit distasteful - Pepper, Quinine can be used C)Chemical approach :- MANAGEMENT
  24. 24. Placing the tongue between the teeth before, and during the act of swallowing The tongue should be placed on the roof of the mouth and not between the teeth Swallowing occurs 24 hours per day and about 2000 times per day Tongue thrusting During a normal swallow on the surrounding structures of the mouth During each swallow tongue can exert momentary pressures of 1 to 6 pounds Push the teeth and bone forward or apart Move teeth into abnormal positionsGrowth distortions of the face and teeth 453.592 g1 pounds
  25. 25. Modern scientific investigations have shown that tongue thrusting is merely an adaptive technique that is used to create an anterior seal when swallowing or speaking
  26. 26. 1. Specific anatomic or NEUROMUSCULAR VARIATIONS In orofacial region like hypertonic orbicularis oris 2. Improper bottle feeding 3. Prolonged thumb sucking or forced discontinuation of thumb sucking 4. Prolonged tonsillar and upper respiratory tract infections CAUSES
  27. 27. 5. Persistent infantile swallow and delayed maturation 6. Presence of conditions like: macroglossia, constricted dental arches and enlarged adenoids 7. Neurological disturbances like hyposensitive palate and moderate motor disability CAUSES
  28. 28. 1.Proclination of anterior teeth 2.Anterior open bite 3.Bimaxillary protrusion 4.Posterior open bite in case of lateral tongue thrust 5.Posterior cross bite EFFECTS
  29. 29. -Tongue thrust habit can be intercepted using HABIT BREAKERS both fixed and removable with cribs -Child is thought the correct method of swallowing MANAGEMENT
  30. 30. -Various MUSCLE EXERCISES of the tongue are carried to adapt the new swallowing pattern -After the habit is intercepted the malocclusion is treated using fixed or removable appliances MANAGEMENT
  31. 31. Mature swallowing 1. Cessation of lip activity 2. Placement of the tip of the tongue against the alveolar process behind the upper central incisor 3. Post. teeth come in contact during swallowing Infantile swallowing 1. Contraction of the perioral muscles during swallowing 2. Protrusion of the tongue. 3. No contact in the molar region Swallowing
  32. 32. Normal Swallow
  33. 33. Tongue Thrust Simple tongue thrust Complex tongue thrust History of digit sucking adaptive mechanism to maintain open bite created by thumb-sucking History of chronic nasorespiratory disease and allergies Teeth are in occlusion as tongue protrude into open bite Teeth apart during tongue thrust Diminishes with age Does not Diminishes with age Treatment is simple, good prognosis Poor prognosis
  34. 34. A major cause of anterior tongue posture is the rate of development of the tongue as compared to the mandible. By age 8 the tongue has reached 80-90% of its adult size. Compare this to the 50% size of the mandible at age 8.
  35. 35. EXERCISES FOR TONGUE THRUST AND OPEN BITE PATIENTS An open bite describes the lack of overlap of the upper and lower front teeth. This can have a significant consequences to chewing food, speech, and tooth wear. An anterior tongue thrust during swallowing is usually seen in these cases. These exercises will help retrain the tongue and help close the open bite. The goal is to repeat each exercise 10 times, and do these exercises 4 times per day. The exercises should take a few minutes to do. 1. Clicking 2. Slurp; Squeeze: & Swallow 3. Squeeze teeth together thorough the day 4. Drink fluids after meals 5. Chew gum 1hour per day (sugarless)with lips together ‫التهم‬
  36. 36. -Various muscle exercises of the tongue are carried to adapt the new swallowing pattern -After the habit is intercepted the malocclusion is treated using fixed or removable appliances. - The mode of respiration influences the posture of the jaw ,the tongue and to a lesser extent the head - Thus mouth breathing leads to altered jaw and tongue posture and malocclusion
  37. 37. -Various muscle exercises of the tongue are carried to adapt the new swallowing pattern -After the habit is intercepted the malocclusion is treated using fixed or removable appliances. 1.Normal people indulge in mouth breathing under physical exertion such as during strenuous exercise or Sports Activity 2.Complete or partial Obstruction of nasal passage like deviated septum, nasal polyps, tumors or adenoids can result in obstructive mouth breathing CAUSES
  38. 38. -Various muscle exercises of the tongue are carried to adapt the new swallowing pattern -After the habit is intercepted the malocclusion is treated using fixed or removable appliances. 3.Habitual mouth breathing can be seen as a unconscious deep rooted habit in few people even after the removal of nasal obstruction 4.Anatomic mouth breathing can be seen in people with Short upper lip or incomplete closure of mouth CAUSES
  39. 39. Mouth breathing Functional causes of malocclusion ! Large adenoids. ! Diseased tonsil e.g. tonsillitis. ! Hypertrophy of nasal turbinate. ! Nasal deformity e.g. deflected nasal septum. ! Hypertrophy of lymphoid tissue in the nasopharynx. ! High fever. Pathological mouth breathing * Types of Mouth Breathing: Habitual mouth breathing
  40. 40. -Various muscle exercises of the tongue are carried to adapt the new swallowing pattern -After the habit is intercepted the malocclusion is treated using fixed or removable appliances. 1.Long and narrow face. 2.Narrow nose and nasal passage. 3.Short and flaccid upper lip. 4.Contracted upper arch. 5.An expressionless or blank face. 6.Increased overjet. 7.Anterior marginal gingivitis. 8.Dryness of mouth predisposes to caries. 9.Anterior open bite. EFFECTS
  41. 41. Mouth breathing The effect of mouth breathing in producing malocclusion is explained as Mouth breathing Alters the posture of tongue, jaws & head Tongue occupies a low posture, mandible drops & head tips back This alters the equilibrium of pressure to jaw & teeth Forces from buccinator mechanism is not counteracted Cause adenoid faces or long face syndrome
  42. 42. Mouth breathing Features of ADENOID FACES or long face syndrome 1. Increased overjet 2. Increased facial height 3. Narrow maxillary arch 4. Supraeruption of posterior teeth 5. Mandible rotates downward & backward 6. Open bite 7. Gingival and periodontal disease 8. Posterior cross-bite
  43. 43. -Various muscle exercises of the tongue are carried to adapt the new swallowing pattern -After the habit is intercepted the malocclusion is treated using fixed or removable appliances. -Referring to ENT surgeon for the removal of nasal or pharyngeal obstruction. -Interception of the habit by using Vestibular screens. -Adhesive tapes can be used to establish lip seal -Rapid maxillary expansion procedures are used to widen the constricted palate. MANAGEMENT
  44. 44. - Bruxism is grinding of teeth for non functional purposes - Nocturnal grinding is called as Bruxism and day time grinding is called as Bruxomania ‫ليلى‬
  45. 45. 1.Psychological and emotional stress 2.Occlusal interference or discrepancy 3.Pericoronitis and periodontal pain CAUSES
  46. 46. 1. Occlusal wear facets on teeth. 2.Fractures of teeth and restorations. 3.Mobility of teeth. 4.Tendreness and hypertrophy of masticatory muscles. 5.Muscle pain when patient wake up in the morning. 6.TMJ pain and discomfort. EFFECTS
  47. 47. -Many cases of bruxism are involved with emotional and psychological disturbances ,thus Psychological Counselling is initiated. -Hypnosis, relaxing exercises and massage can help in relieving muscle tension. -Night guards or Occlusal splints are covered to prevent wear and occlusal prematurities. MANAGEMENT
  48. 48. Consideration for Oral Habit Therapy
  49. 49.  Age of the patient ⌧7 yrs  Maturity of the patient ⌧understands the problem, desires to correct it!  Parent cooperation ⌧Support and encouragement  Timely deliberation ⌧Alert to suggestive psychologic problems  Assessment of deformity ⌧Degree and the presence/absence of other complexities Consideration for Oral Habit Therapy
  50. 50. Treatment Options Accurate assessment in context of the child’s physiologic and psychologic state Proper and effective management  Dentist-Patient Discussion  Reminder Therapy  Reward System  Appliance Therapy
  51. 51. Dentist-Patient Discussion  Straight-forward discussion  Express concern and explain why the habit should be dropped.  Encourage them to call the office and speak to you if the habit urge returns.  Parents can help monitor only.
  52. 52. Reminder Therapy  Reminder and not a punishment! ⌧Adhesive bandage ⌧Cotton glove ⌧Fingernail polish ⌧Bitters ⌧Arm wraps ‫وليس‬ ‫تذكير‬‫عقاب‬!
  53. 53. Reward System  Consult parents to find out what are the child’s likes and what prizes are suitable and special to the child.  Above the age of 5 yrs, use self esteem rewards.  Formulate a contract between the child and parent for a short period of time (1-2 weeks).  Greater the involvement of the parent and child, the more successful the outcome.  Highly recommended as it is effective.
  54. 54. Appliance Therapy  Intra-oral appliance  Child must welcome continued assistance  Permanent reminder
  55. 55.  Finger Sucking Appliances  Palatal Crib Habit Correcting Appliances Orthodontists commonly use a “crib” to break the chronic tongue thrust. This appliance serves only as a reminder to keep the tongue back. This in combination with “tongue exercises” has shown to help reduce an anterior open bite.
  56. 56. Habit Correcting Appliances  Tongue/Thumb Retainer  Fixed Tongue Crib
  57. 57. Habit Correcting Appliances Lip Habit Correction Appliance Lip Bumper
  58. 58. Habit Correcting Appliances
  59. 59. Myofunctional Trainer
  60. 60. Summary  Abnormal habits typically interfere with regular facial development.  The longer a habit is practiced, the harder it is to break.  Duration, frequency and intensity play important roles in the permanency of the damage seen.  When considering treatment, make sure the child wants to break the habit.  Placing fixed appliances should be the last resort for habit cessation.
  61. 61. Dr. Nabil Al-Zubair