knowledge of bad habit

1. Bad habit

2. •Is a constant or fixed practice established by
frequent repetition. Aformed reaction that’s
resistance to change it depends on the degree to
which its interfere with the child physical , emotional
and social function .
What is a habit ?

3. Mathewson (1982)
"Oral habits are learned
patterns of muscular
contractions."
Authors
William James
"A new pathway of discharge
formed in the brain by
which certain incoming currents
lead to escape."
Finn (1972)
"A habit is an act, which is
socially unacceptable."
Moyer
"Habits are learned patterns of
muscular contractions,
which are complex in nature."

4. Classification of oral habit
1. By william james :
a) useful habits: habits that consider essential
for normal function such us proper tongue
position , deglutition ,nasal breathing ……etc .
b) Harmful habits: habits that have harmful
effect on teeth and supporting structure such
us thumb sucking , tongue thrust …...etc.

5. 2. By fin :
A) compulsive :
they are deep rooted habits that have acquired a . fixation in a child
the child tend to suffer when try to correct .
b) Non compulsive :
Habits that easily learned and dropped as child mature .

6. 3. By morris and bohana :
A) pressure : that apply force on teeth and supporting structures such
as lip sucking , tongue thrusting .
B) non pressure : Doesn’t apply force on the teeth and supporting
structure such as mouth breathing .
C) biting habits : such as lip biting , nail biting

7. Morris and bohanaFinWilliam jamesAuthor
a) Pressure
b) Non
pressure
c) Biting
habit
a)Compulsive
b) Non
compulsive
A) Useful
habit.
B) Harmful
habit .
Claasifications

8. Etiological agents in the development of oral habits
Pathological
Anatomical
Mechanical
interferenceImitation
Emotional

9. Bruxism
Lip
biting
Mouth
breathi
ngTongue
thrusti
ng
Thumb
sucking

10. Thumb sucking
(digit sucking habit / finger sucking):
it’s the placement of finger or
thumb in a varying depth into
the mouth. It obseve in most
children beyond 3 years old
.practically all children take up
this habit and discontinue with
age and maturation if the habit
persist beyond this time the
permanent teeth erupt in
malocclusion and habit breaker
is required .

11. Effect of thumb suking on the teeth:
1. Flaring of maxillary incisors.
2.lingual posion of lower incisors .
3.Anterior openbite .

12. 4. Narrow maxillary arch (posterior
crossbite).

13. Proclination of upper incisors
and retroclination of lower
incisors .

14. anterior open bite and posterior
crossbite

15. The severity of malocclusion caused by
digit sucking depend on several factors :
Frequency :
Number of
times per day
habit is
practiced .
Duaration :
Amount of
time spend
on habit .
Intensity :
Amount of force
applied to the
teeth during
sucking .

16. Treatment of digit sucking
1.Consuling : its simplest approach mean discussion
between the child and dentist that express concern and
include explantation by dentist . This approach which is
cold “adult approach” its enough to terminate the habit
in most older children .

17. 2. Reminder therapy :
best for the patient who are desire to stop the habit and need assistant
to do . Its include adhesive taps , bandages to offending digits ,
disastered liquid or ointment like hot flavored ,foul smelling ,bitter
testing placed on finger or thumb that are sucked.

18. 3. Reward system :
If the reminder approach fails , arewared system can be
applied that provide small tangible reward (gift) daily for not
engaging in the habit , in some cases a large reward must be
given for complete cession of habit .

19. 4. Appliance therapy :
This include either removable appliance with tongue guard
crib or fixed appliance like quadhelix or maxillary lingual arch
with palatal crib .
Removable
appliance with
tongue crib

20. Fixed orthodontic appliance use for
treatment of thumb sucking
Quad helix appliance : its an
orthodontic appliance consist of
four helix spring and its attached to
the molars by 2 bands .

21. In general child beyond 3 years there is no active intervention regardless of type
and severity of malocclusion because of general emotional immaturity .
Most children outgrow of habit by 5 years of age and the malocclusion self-
corrected .
The patient should be at least 7 years old to receive appliance therapy always
parents support and encourgment is necessary to help the child throw treatment
period .

22. Lip sucking and lip biting
Lip sucking may appear
by itself or it may be
seen with thumb
sucking . Always the
mandibular lip involved
in sucking and biting
although biting of
maxillary lip are
observed as well .

23. when the mandibular lip
repeatedly held beneath the
maxillary anterior teeth the
result is labioversion
(proclination) of these teeth
lead to openbite and
sometimes may cause
linguoversion ( retroclination)
of mandibular incisors .

24. 1. lip over lip excercises .
2. lip bumper .
Management

25. Nail biting habit
Its amost common habit in children and adult which is a sign of
internal tention and may be indicative of emotional problems . The
clinical features that teeth may be rotating ,alteration of incisal edge,
attrition of lower teeth and inflammation of nail bed .

26. 1. Mild cases no treatment.
2. Treat basic emotional factors causing the habit.
3.Encourage outdoor activities that may decrease
tention .
4.As a reminder nail polish ,tight cotton ,mitten
can applied on nail .
Mangment

27. Inflamation of nail beds

28. Nail polish can be apply to remind the patient

29. Tongue thrust
• Also called reverse swallow or immature swallow.
• It’s common name of orofacial imbalance , a human behavior pattern
in which the tongue protrudes through the anterior incisor during
swallowing , speech , and while the tongue is at rest

30. Etiology of
tongue thrust
Upper respirotary
truct infection
Feeding practice
Hereditary or tongue
size
Neurological
disturbances
Retained infantile
swallow

31. 1. Retained infantile swallow:
Retention infantile swallow mechanism .with the eruption of lower
incisors the tongue doesn’t drop back as it should and continue to
thrust forward .
2. Upper respiratory tract infection:
Such as mouth breathing and allergies that promote
forward movement of tongue due to pain .
3.neurological disturbance:
Such as hyposensitive palate ,disruption of sensory
control and co-ordination of swallowing .

32. Etiology :
Bottle feeding
Hypersensetive palate
Macroglossia tongue

33. 4. Feeding practice :
•Bottle feeding is more contributory to tongue thrust than breast
feeding.
•5. hereditary and tongue size :
•Macroglossia have effect on dentition lead to tongue thrust .

34. Clincal features:
 Short flaccid upper lip.
 Mandibular movement no correlation. between tongue tip and
mandible
 Speech : s , n , d , I , z, v , th.
 Increase the anterior facial hight .

35. Classifiction of tongue
thrusting
Moyer:
-Simple tongue thrust
-Retained tongue thrust
-Complex tongue thrust
Back lund :
Anterior tongue thrust-
- Posterior tongue
thrust.

36. 1. Backlund classification :
A) anterior tongue thrust :forceful anterior thrust lead to anterior
openbite .
B) posterior tongue thrust : lateral thrusting in case of missing
posterior teeth leading to posterior openbite .

37. 2. Moyers classification :
 Simple : normal tooth contact during the swallowing act .
1. Anterioer openbite .
2. Good intercuspation of teeth .
3. The tongue thrust forward to established anterior seal .
4. Abnormal mentalis muscle activity .

38. b) Complex tongue thrust (teeth are apart) :
 Complex : teeth apart during swallow .
1. Diffuse or absent anterior openbite (bimaxillary protrustion ) .
2. Absence of temporal muscles contraction during swallowing .
3. Contraction of the circum oral muscles during swallowing .
4. Poor occlusion of teeth .

39. c) Retained infantile thrust : (endogenous
tongue thrust )
•Persistance of infantile swallowing refex even after perminant teeth
appear. The swallowing activity is accompanied by an anterior
thrust of the tongue which appear to be abasic neuromuscular
mechanism . This endogenous tongue thrust is sometimes
associated with anterior lisp during speech . Its affecting the teeth
to the extent of prenventing full vertical development of anterior
dento alveolar segment . The endogenous tongue thrust lead to
develop incomplete overbite ,anterior openbite ,proclination of
upper and lower incisors , sometimes lower incisors may be
retroclined, occasionally this type of swallong activity may have no
adverse effect on developing occlusion .

41. Treatment :
Treatment consideration :
• Self correcting by age 8 – 9 yrs
Treatment modalities :
• 1. training of correct swallow and posture of tongue .
• 2. speech therapy .
• 3. Mechanotherapy .
• Correction of malocclusion .

42. Training of correct swallow and tongue
posture:
1. Ask the patient to put tongue tip in the rugae area for 5 mints
then ask him to swallow .
2. Tongue tip hold against the palate using the orthodontic elastics
or sugarless friut drops .
3. 4S ecercise .
4. Whistling .
5. Count from 60 – 69 .

43.  Using appliance as guide in the coorect postioning of tongue
preorthodontic trainer :
 It’s aids in correct the positioning of the tongue with help on
tongue tags .
 The tongue guards prevent tongue thrusting when in place .
Nace palatal
arch
applience

44. Speech therapy

45. Mechanical therapy :
A. Fixed appliance :
Tongue thrust device Fixed palatal crib Myofunctional bead

46. Removable appliance :
 Restriction of the tongue thrusting habit .
 Alignment of maxillary anterior teeth .
 Correction of open bite .
 Lip muscles exercises performed with ring attach in anterior part
of appliance .
Oral screen Hawely retainer

47. Bruxism
 Is the term that indicate nonfunctional contact of the teeth which
may include clenching , grinding and tapping of the teeth .
habitual grinding of the teeth when the individual is not
chewing or swallowing .

48. Classification
•1. day time bruxism: it may be conscious or subconscious and may
along with another habit suck us nail biting , chewing pencil ….etc .
•2. night time bruxism :its sub conscious grinding of the teeth at
night .

49. Clinical features
• 1. occlusal trauma .
• 2. tooth structure loss .
• 3. muscular tenderness .
• 4. T.M.J disorder .
• 5. headache .

51. Management
1. determine the underlying cause and eleminate it .
2. occlusal adjustment including restoration and
occlusal splint – biteguard
3. psychotherapy like relaxtion exercises.
4. drugs like local anesthetic injection into T.M.J for
muscle , sedative , and muscle relaxant .

53. Mouth breathing
 It’s habitual respiration through the mouth instead of the nose .
 The main causes of the mouth breathing habit are realted to nasal
obtruction which may due to hypertrophy of pharyngeal lymphoid
tissues adenoid) , defect in nasal septum , allergic rhinitis .

54. Classification
1.anatomical: mouth breather whose upper lip is short that
doesn’t communicate with lower lip .
2.habitual: persistence of habit after elimination of obstructive
cause .
3. obstructive : increase resistance to complete obstruction of
normal air flow to nasal passage.

55. Effects of mouth breathing habit
1. increase facial height .
2. posterior teeth will supra-erupt.
3.mandible will rotate down and back .
4.openbite develop anteriorly , increase overjet .
5.narrowing of the maxillary arch –increase pressure from the
stretched cheeks .
6. adenoid fade appearance .

57. Management
•ENT referral for management of nasopharyngeal obstruction is
necessary before any orthodontic treatment .

58. Thank you