This document discusses various oral habits including thumb and digit sucking, tongue thrusting, mouth breathing, bruxism, lip biting, and nail biting. It describes the definitions, typical ages, common effects on dental alignment, diagnostic methods, and treatment approaches for managing each habit. The goal of treatment is typically to discontinue the habit and correct any resulting malocclusion through counseling, appliances, arch expansion, or occlusal adjustment.

1. HABITS
Prepared by:
Dr. Md. Rezaul Karim
Lecturer, Children dentistry
Dental unit
Shaheed Suhrawardy Medical College

2. THUMB AND DIGIT
SUCKING

3. Digit sucking is defind as placementof the thumb or
more fingers in varying depths into the mouth.
It's normal upto the age of 3.5 -4 years.Persistence
of this habit beyond this age can lead to various
malocclusions.

4. Effects:

6. Common effects are..
• Labial tipping of the maxillary anterior teeth resulting in
proclination of maxillary anteriors.
• Retroclination of the mandibular incisors.
• Increases of overjet.
• Anterior open bite.
• Deep palatal vault.
• Narrow maxillary arch.
• Posterior crossbite.
• That child may develop trust habit as a result of the open
bite

8. Diagnosis
History
1. Ask the parents about the frequency and duration of the
habit.
2. Assessment of the emotional status of child.
3. Assessment of the, feeding habits, parent and care of
the child, whether the parents are working.

9. Intraoral examination
Record all the features such as proclination open
bite etc.
Child's fingers examination
Presence of clean nails and kelos on the finger is is
commonly associated with thumb sucking.

10. Management
Psychological approach
• Counselling the parents to provide the child with
adequate love and affection. These will help to divert the
child's attention to other things such as play and toys.
• Dunlop theory: according to this theory the best way to
break a habit is by its purposeful repetition. Dunlop
suggests that the child should be asked to sit in front of a
large mirror and asked to suck his thumb observing
himself as he indulges in the habit.

11. Mechanical aids

14. Chemical approach
Placement of beta testing for fall smelling
preparations on the harm that is sucked can make the
habit distasteful. E.g. Quinine.

15. Others
• Bandaging the thumb.
• Bandaging the elbow.

17. Tongue thurst habit
Tongue thurst may be defined as a condition in which the
tongue makes contact with any teeth anterior to the
molars.

18. Etiology
1. Genetic factor: genetically orofacial and neuromuscular variations in the
orofacial region. E.g: hypertonic orbicularis oris activity.
2. Learn behaviour for habits: such as improper bottle feeding ,thumbsucking
etc.
3. Maturational: when infantile swallow converts to mature swallow.
4. Mechanical restrictions: such as, narrow palatal arch, enlarged adenoids,
macroglossia etc.
5. Psychological factors: such as ,forced discontinuation of thumb sucking
habit

19. Clinical features
• Proclination of maxillary anteriors.
• Bimaxillary proclination.
• Anterior open bite.
• Posterior open bite in case of lateral tank cast.
• Posterior crossbite.

22. Management

23. 2.Taught the child the correct method of swallowing.
3. Various muscle exercise of the tongue can help in
training to adapt to the new swallowing pattern .
4.Correction of malocclusion:once the habit is
intercepted the malocclusion can be corrected by
removable or fixed appliances.

24. Mouth breathing habit
The mode of respiration influences the posture of
the jaw, the tongue and to a lesser extent the
head.Thus it seems quite logical that mouth
breathing can result in altered jaw and tongue
posture which could alter the oro-facial
equilibrium thereby leading to malocclusion.

26. Classification
Mouth breathing can be of three types.
1. Obstructive: Due to complete or partial obstruction
of the nasal passage. Common causes are...
Septum deviation.
Nasal polyps.
Chronic inflammation of nasal mucosa.
Localized banign tumors.
Allergic reaction of the nasal mucosa.
Obstructive adenoids.

28. Nasal polyp

30. 2. Habitual: Unconscious continuation of
oral breathing though the nasal
obstruction is removed.
3. Anatomic: Patient having short upper
lip.This type of lip morphology doesn't
permit complete lip closure.

31. Short upper lip

32. Pathophysiology
During oral respiration, the following three changes in
the posture occur:
• Lowering of the mandible.
• Positioning the tongue downwards and forwards.
• Tipping back of the head.
• As a result unrestricted buccinator activity will
occur that influences the position of the teeth and
also the growth of the Jaws.

33. Clinical features

34. 6. Increased overjet as a result of flaring of the
incisors.
7. Anterior marginal gingivitis can occur due to
drying of the gingiva.
8. The dryness of the mouth predisposes to
caries.
9. Anterior open bite can occur.

36. • Marginal gingivitis.
• Anterior open bite.

38. Diagnosis
• History : Proper history should be taken from the patient
as well as parents.
• Clinical examination: Examination to find out the clinical
features .e.g,
Breathing test such as mirror test, water test.
• Cephalometrics: To establish the amount of nasophrangeal
space. Size of adenoids, also helps in diagnosing the long
face.
• Rhinomanometry: These devices help in estimation of
airflow through the nasal passage and nasal resistance.

39. Management
1. Removal of nasal or pharyngeal obstruction: Any nasal
or pharyngeal obstruction should be removed by
referring the patient to the ENT surgeon.
2. Interception of the habit: By using of appliance such as
vestibular screen.
3. Rapid maxillary expansion: Patient with narrow
constricted maxillary arches need rapid palatal
expansion procedures to widen the arch. Rapid
maxillary expansion has been found to increase the
nasal air flow and decreased the nasal air resistance.

42. Bruxism
Bruxism can be defined as the grinding of teeth for
non functional purposes.
It also refers to nocturnal grinding and grinding
during the day time.

43. Etiology
• Psychological and mental stresses.
• Occlusal interfaces. Discrepancy between centric
occlusion and centric relationship can predisposes
to grinding.
• Pericoronitis and periodontal pain can trigger
bruxism in some individuals.

44. Clinical features
• Occlusal wear facets can be seen.
• Tooth and restoration fractures.
• Mobility of teeth.
• Tenderness and hypertrophy of masticatory muscles.
• Muscles pain when the patient wakes up in the morning.
• TMJ pain and tenderness and discomfort.

46. Diagnosis
• History.
• Clinical examination. It may reveals... Occlusal wear facets.
• Muscle tenderness.
• TMJ tenderness.
• Occlusal prematurities can be diagnosed by use of
articulating paper.
• Electromyographic examination to evaluate the muscle power
and tone.

47. Management
• If the case is associated with psychological
disturbance, psychological counselling may
needed. Referred this type of patients to
psychiatrist.
• Hypnosis, relaxing exercise and massage can
help in relieving the muscle tension.

48. • Occlusal adjustment have to be carried out to
correct the prematurities.
• Night guards and other occlusal splints that covers
the occlusal surfaces of the teeth help in
eliminating occlusal interference, prevent occlusal
wear and break the neuromuscular adaptation.

49. Occlusal splint

50. Lip biting
Lip biting and lip sucking sometimes appear after the
forced discontinuation of thumb or finger sucking.
This habit most commonly involves the lower lip,that is
turned inwards abd pressure is exerted on the lingual
surface of maxillary anteriors.

51. Clinical features
• Proclination of maxillary anteriors.
• Retroclination of mandibular anteriors.
• Hypertrophic and redundent lower lip.
• Cracking of lips.

52. Management
• Habit breaking appliance, lip bumper.This
appliance helps to keep the lip away from the
teeth and also improve the axial inclination of
teeth by preventing unrestrained activity of
tongue.

55. Nail biting
Common clinical effects...
Usually this habit exhibit no major malocclusion.
• Minor irregularities.
• Rotation.
• Wear of incisal edge in the form of a notch.