Prepared by Mohammed Shalik Final year BDS, Al-Azhar Dental College Thodupuzha, Kerala

1. Submitted by
Mohammed Shalik
2014 batch

2. ORAL HABITS
Oral habits may be a part of normal
development, a symptom with a deep rooted
psychological basis or may be the result of abnormal
facial growth.
Eg:
 Digit sucking
 Lip and nail biting
 Tongue thrusting
 Mouth breathing

4. DEFINITION
• Habit can be defined as a fixed or constant
practice established by frequent repetition.
DORLAND 1957
• It is defined as frequent or constant practice or
acquired tendency, which has been fixed by
frequent repetition. BUTTERSWORTH 1961
• Oral habits are learned patterns of muscular
contractions. MATHEWSON 1982

5. CLASSIFICATION
By James
(1923)
USEFUL
HABITS
Habits that are
considered essential
for normal function
HARMFUL
HABITS
Habits that have a
deleterious effect
on the teeth and
supporting
structures

6. By Klein
(1971)
Empty
habits
Habits that are not
associated with any
deep rooted
psychological
problems
Meaningful
habits
Habits that have a
psychological
bearing

7. Morris and
Bohanna
(1969)
PRESSURE
HABITS
Sucking
habits
NON-
PRESSURE
HABITS
Do not apply
direct
pressure
eg ; mouth
breathing
BITING
HABITS
Nail biting lip
biting etc

8. By Finn
(1987)
COMPULSIVE
HABITS
NON-
COMPULSIVE
HABITS
Deep rooted habits
that have acquired
a fixation in the
child
Habits that are
easily learned
and dropped as
the child matures

9.  Oral habits in infancy and early child hood can be
considered normal.
 Habits beyond 3-4 years may become a symptom
and may produce harmful effects on the
development of maxillofacial complex.

10. THUMB SUCKING

11.  It can be defined as the placement of thumb at
various depth in to the mouth.
 Many children suck their thumb or fingers for short
periods during infancy or early childhood with the
habit considered normal during the first two years of
life.
 Persistence of the habit beyond 3-4 years can leads
to various malocclusions.

12. 1. Freudian theory:
 proposed by ‘sigmond freud’.
 He suggested that a child passes through
various distinct phases of psychological
development of which the oral and anal phases
are seen in the first 3 years of life
 In the oral phase the mouth is believed to be an
oro-erotic zone
 The child has the tendency to place his/her
fingers or any other object into the oral cavity

13. 2. Oral drive theory of SEARS AND WISE
By sears and wise in 1950
Proposed that prolonged suckling could lead to
thumb sucking

14. 3. Benjamin’s Theory
 Benjamin suggested that thumb sucking arises
from the rooting or placing reflex seen in all
mammalian infants
 Rooting reflex is the movement of the infant’s head
and tongue towards an object touching his cheek
 This rooting reflex disappears in normal infants
around 7-8 months of age

15. 1.Psychological Aspects
 Children deprived of parental love, care and
affection are believed to resort to this habit due to a
feeling of insecurity
2.Learned Pattern
 According to some authors thumb sucking is merely
a learned pattern with no underlying cause or
psychological bearing

16. Phase 1:
 Seen during first 3 yrs of life
 Thumb sucking during this phase is considered
to be quite normal
 Usually terminate at the end of phase 1
PHASES OF DEVOLOPMENT

17. Phase 2- clinically significant sucking
 Extends between 3-6 1/2 yrs of age
 Presence of sucking during this age is an
indication that the child is under great anxiety
 Treatment should be initiated to correct dental
problems

18. Phase 3- Intractable sucking
 Any thumb sucking persisting beyond the 4-5th yr
of life
 A psychologist might have to be consulted
during this phase

19. CAUSATIVE FACTORS
• Parent’s occupation
• Working mother
• Number of siblings
• Order of birth of child
• Social adjustment and stress
• Feeding practices
• Age of the child

20. NUTRITIVE SUCKING HABIT
• Eg: breast feeding, bottle feeding
NON-NUTRITIVE SUCKING HABIT
• eg: thumb or finger sucking, pacifier sucking
CLASSIFICATION

21. • STANLEY 1973- has graded thumb sucking in to 4
types.
TYPE A: seen in 50% of children
• The whole digit is placed inside the mouth, with
the pad of the thumb pressing over the palate at
the same time maxillary and mandibular contact
is present.
TYPE B: 13-24%
• Thumb is placed in the oral cavity without
touching the vault of the palate, and maxillary and
mandibular contact is maintained.

22. TYPE C: 18% of children.
• Thumb is placed in the mouth just beyond the
first joint contacting the hard palate and only the
maxillary incisors but there is no contact with the
mandibular incisors.
TYPE D: 6% children.
• Very little portion of the thumb is placed in the
mouth.

23. Effects of thumb sucking
• The severity of the malocclusion caused
depends on trident of factors.
1. Duration
2. Frequency and
3. Intensity

24. Effects includes
 Labial tipping of maxillary anterior teeth resulting
in proclination.
 Overjet increases
 Anterior open bite as a result of restricted incisor
eruption and supra eruption of the buccal teeth
 cheek muscles contract resulting in a narrow
maxillary arch and posterior crossbites
 May develop tongue thrust habit as a result of
open bite
 Upper lip is generally hypotonic , while the lower
part of face exhibit hyperactive mentalis activity

25. DIAGNOSIS
 History
 Questioned on the frequency and duration of
the habit
 Feeding habits
 Parental care of the child
 Whether the parents are working etc
 Intra-oral clinical examination
 Proclination, open bite etc
 Extra- oral examination
 Digits, facial form etc

26. MANAGEMENT
 PSYCHOLOGICAL APPROACH
Parent’s involvement in prevention
Divert the child’s attention to other things
 DUNLOP suggests that the child should be asked to
sit in front of large mirror and asked to suck his
thumb observing himself as he indulges the habit.
This is very effective if the child is asked to do the
same when he is involved in an enjoyable activity.

27.  Appliances usually consist of a crib placed palatal to
the maxillary incisors.
 Palatal crib to be used if no posterior cross bite exits.
 Post cross bite-Maxillary expansion appliance to be
added along with palatal crib.
MECHANICAL AIDS

28. Habit breakers can be of 2 types;
1. Removable habit breakers
Passive removable appliances that
consist of a crib and is anchored to the oral cavity
through clasps

29. 2. Fixed habit breakers
 Heavy gauge stainless steal wire designed to
form a frame that is soldered to bands on the
molars

31.  Other aids include bandaging the thumb and
bandaging the elbow

32. 3. Chemical approach.
 Use of bitter tasting and foul smelling preparation
placed on the thumb.
 The medicaments used includes;
Pepper dissolved in a volatile medium
Quinine
Asafoetida

33. TONGUE THRUSTING
It is defined as a condition in which the
tongue makes contact with any teeth anterior to the
molars during swallowing.

34. ETIOLOGY
Genetic factor
 specific neuromuscular or anatomic variations in
the orofacial region.
Eg; hypertonic orbicularis oris activity.
Learned behaviour
 Predisposing factors includes
a) Improper bottle feeding
b) Prolonged thumb sucking
c) Prolonged tonsilar and upper respiratory tract
infections
d) Prolonged duration of tenderness on gums or
teeth

35. • Maturational
 If the infantile swallow persists for a longer duration
of time
• Mechanical restrictions
 Presence of certain conditions like macroglossia,
constricted dental arches, enlarged adenoids etc.
• Neurological disturbance
 Like hyposensitive palate and moderate motor
disability
• Psychogenic factors
 As a result of forced discontinuation of other habits
like thumb sucking

36. Simple
classification
of tongue
thrust
Simple
tongue
thrust
1.Normal tooth contact during
swallowing act
2.Anterior open bite
3.exhibit good intercuspation of teeth
4. Tongue is thrusting forward during
swallowing help in anterior lip seal
5.Abnormal mentalis muscle activity
Complex
tongue
thrust
1.Teeth apart swallow
2.Anterior open bite is diffuse or absent
3.Absence of temporal muscle
constriction and contraction of
circumoral muscles during swallowing
4.Occlusion of tooth may be poor

37. CLINICAL FEATURES
 Proclination of anterior
teeth.
 Anterior open bite.
 Bimaxillary protrusion.
 Posterior open bite in case
of lateral tongue thrust.
 Posterior crossbite.
crossbite

38. MANAGEMENT
 Involves interception of the habit followed by
treatment to correct the malocclusion.
HABIT INTERCEPTION
1. Use of habit breakers
2. child is taught the correct method of swallowing
3. Various muscle exercises of tongue
 The child is asked to place the tip of the tongue
in the rugae area for 5 min and is asked to
swallow
.

39. 4s exercise :-
 This includes identifying the spot, salivating,
squeezing the spot and swallowing.
 Spot is on the incisive papillae and is
should be against the tip of the tongue at
rest. Place the tongue on the spot,
salivate, squeeze against the spot and
swallow.

40. TREATMENT OF MALOCCLUSION
 Using removable or fixed orthodontic appliances

41. MOUTH BREATHING
Habitual respiration through the mouth
instead of the nose.

42. MOUTH BREATHING can be classified into 3 types.
a) OBSTRUCTIVE-
 Complete or partial obstruction of nasal passage
result in mouth breathing.
Causes of obstruction
includes
1. Deviated nasal
septum
2. Nasal polyps and
benign tumors
3. Chronic
inflammation of
nasal mucosa etc.

43. b) HABITUAL
 Continues to breaths
through mouth even after
the removal of nasal
obstruction.
c) ANATOMIC
Lip morphology does not
permit complete closure of
the mouth such as a patient
having short upper lip.

44. CLINICAL FEATURES
Long face syndrome or classic adenoid facies:-
 Malocclusion most often associated with mouth
breathing.
1. long narrow face
2. Narrow nose and nasal passage
3. Short and flaccid upper lip
4. Contracted upper arch

45. 5. Expressionless face
6. Increased overjet due to flaring of incisors
7. Anterior marginal gingivitis
8. Caries and anterior open bite

46. DIAGNOSIS
 History
 Clinical examination: mirror test, water test etc are
used
 Cephalometrics: helps in establishing the amount
of nasopharyngeal space, size of adenoids, and
shape of face
 Rhinomanometry: helps in estimation of airflow
through the nasal passage and nasal resistance

47. MANAGEMENT
 Removal of nasal or pharyngeal obstruction.
 Interception of habit.
Use of vestibular screen
Adhesive tapes to establish lip seal

48. Rapid maxillary expansion.
In patients with narrow constricted maxillary
arches
Expansion increase the nasal airflow and
decrease nasal air resistance

49. BRUXISM
Bruxism can be defined as the grinding of the
teeth for non-functional purposes

50. ETIOLOGY
1. Psychological and emotional stresses
2. Occlusal interference between centric relation
and centric occlusion
3. Pericoronitis and periodontal pain
CLINICAL FEATURES
 Occlusal wear facets on
the teeth
 Fractures of teeth and
restorations
 Mobility of teeth

51.  Tenderness and
hypertrophy of
masticatory muscles
 Muscle pain on
waking up in the
morning
 TMJ pain and
discomfort

52. DIAGNOSIS
 History and clinical examination.
 Articulating papers for occlusal prematurities.
 Electro-myographic examination to check for
hyperactivity of muscles of mastication.

53. TREATMENT
 Psychological counselling.
 Hypnosis, relaxing exercises, and massage in
relieving muscle tension.
 Occlusal adjustments to eliminate maturities.
 Night guards or occlusal splints that cover the
occlusal surfaces of teeth.

54. LIP BITING

55.  Lip biting most often involves the lower lip. Turned
inwards and pressure is exerted on the lingual
surface of maxillary incisors
CLINICAL FEATURES
 Proclined upper anteriors and retroclined lower
inscisors
 Hypertrophic and rebundant lower lip
 Cracking of lips

56. MANAGEMENT
 Lip bumpers
 Keep the lips away.
 Improve the axial
inclination of
anterior teeth due to
unrestrained action
of the tongue.

57. NAIL BITING

58.  Nail biting produces minor local tooth irregularities
such as rotation, wear of incisal edge, and minor
crowding
 Nut notch - wear of teeth in the form of notch, is a
result of cracking open and eating hard nuts using
incisal edge of anteriors.

59. POSTURE
Frequently suggested that poor posture can lead
to malocclusion.
Stooping with chin on the chest causes
mandibular retrusion.
Child resting head on hand or sleeping on arm or
fist can develop malocclusion.

61. TRAUMA
Undiscovered traumatic experiences- significant in
malocclusion.
Eruptive abnormalities.
Abnormal resorption.
Loss of vitality.
Both prenatal trauma & postnatal injuries -
Dentofacial deformity.

62. REFERENCES
 CONTEMPORARY ORTHODONTICS - W.R.PROFFIT
 TEXTBOOK OF ORTHODONTICS - GURKEERAT SINGH
 ORTHODONTIC THE ART AND SCIENCE-THIRD EDITION - BHALAJI

63. THANK YOU