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Habits O.ppt
1. Oral habits
PART 1
DR CHANDRIKA KATTI
Reader, Dept Of Orthodontics.
Navodaya Dental College, Raichur.
2. Contents
Introduction
Maturation of oral functions
Normal oral habits
Abnormal oral habits and its role in malocclusion
- Thumb sucking
- Tongue thrusting
- Mouth breathing
- Bruxism
- lip, cheek biting and others
Conclusion
3. Introduction:
Oral habits may be a part of normal development;
a symptom with a deep rooted psychological basis
or may be a result of abnormal facial growth.
These habits bring about harmful unbalanced
pressures to bear on the immature, highly
malleable dental arches, the potential changes in
the position of the teeth, and occlusion, which may
become decidedly abnormal if these habits are
continued for a long time.
4. Definition:
Boucher – a tendency towards an act or
an act that has become a repeated
performance, relatively fixed, consistent,
easy to perform and almost automatic.
5. ETIOLOGY OF ORAL HABITS:
Once the biological and psychological functions of the child
undergo maturation, heshe can separate from mother without
experiencing significant anxiety, spontaneously doing away
with many oral habits.
Some of the etiological factors consider responsible are conflict,
jealousy, school pressure, lack of satisfaction through
nourishment, irritations associated with tooth eruption, occlusal
interferences, breathing obstructions etc.
12. Theories:
Classical Freudian theory (1905):
The psychoanalytical theory holds that this orginal response
arises from inherent psychosexual drive suggesting that digit
sucking is a pleasurable erotic stimulation of the lips and
mouth. One of the concepts of thumb sucking brought about
by this theory is that humans possess a biological suckling
drive. An infant associates sucking with pleasurable feelings
such as hunger, satiety and being held. These events will be
replaced in later life by transferring the sucking action to the
most suitable object available, namely the thumb or finger
13. The learning theory :(Davidson 1967)
This theory advocates that non-nutritive sucking
stems from an adaptive response. The infant
associates sucking with such pleasurable feelings
as hunger. These events are recalled by sucking a
suitable object available mainly thumb or finger.
14. Oral drive theory :( Sears and wise 1982)
They suggested that the strength of the oral drive
is in part a function of how long the child continues
to feed by suckling. Thus, thumb sucking is the
result of prolonged nursing; and not the frustration
of weaning. This theory agrees with Freud’s theory
that sucking increases the erotogenesis of the
mouth.
15. Benjamin`s theory: suggests that sucking
arises from rooting or placing reflex .
Rooting reflex is movement of infants head
and tongue towards an object touching his
cheek.
Object is mothers breast or pacifier .
This reflex disappears in around 7-8
months of age.
17. level Description
Classification of NNS habits by Johnson 1993
Level I (+/-)
Level II (+/-)
Level III (+/-)
Level IV (+/-)
Level V (+/-)
Level VI (+/-)
Boys and girls of any chronological age with a habit that occurs
during sleep.
Boys below the age of 8 with a habit that occurs at one setting
during waking hours.
Boys under the age of 8 with the habit that occurs at multiple
settings during the waking hours
Girls below the age of 8 or boys above the age of 8 with a habit
that occurs at one setting during waking hours.
Girls below age of 8 or boys above the age of 8 with a habit that
occurs across multiple settings during waking hours.
Girls over the age 8 with a habit during the waking hours.
18. Phases of development:
Phase 1: Age: its during first 3 years of life
Normal thumb sucking is seen during this
phase.
Phase 2: Age: 3-6 years of age.
Indicates child is under anxiety.
Rx should be done during this phase.
Phase 3: Age: Beyond 4-5 year of age.
It might be due to underlying psychological
aspect of the habit.
Psychologist consultation is necessary.
20. Effects
on
maxilla
- proclination of maxillary incisors
- increased maxillary arch length
- anterior placement of apical base
- increased SNA
- increase in clinical crown length of anteriors
- counter clock wise rotation of occl.plane
- decreased SN to ANS-PNS angle
- decreased palatal arch width
- atypical root resorption in primary central
incisors
- trauma to maxillary central incisors
Effects
on
mandible
- proclination or reteroclination of the mandibular
incisors
- increased intermolar distance
- distal position of point B
21. Effects on
interarch
relationship
-↓ maxillary and mandibular incisal angle
- increased over jet
- decreased over bite
- posterior cross bite
- uni-bilateral class-II occlusion
Effect on lip
placement and
function
- incompetence lips
- lower lip function under the maxillary
incisors
Effect on
tongue
placement and
function
- tongue thrust
- lip to tongue resting position
- lowered tongue position
Other effects - thumb deformity
- speech defects, lisping
26. Psychological therapy: children lacking parental
love ,care, and affection .So parents counseling is
important for treatment. Doctor should advice
parents to divert child`s attention.
Beta hypothesis theory: Dunlop suggested that
habit is by its conscious ,purposeful repetition.
27. Chemical method : bitter tasting or foul
smelling preparation is placed on thumb .It
can be pepper ,quinine , or asafetida.
29. An aid to stop thumb sucking: the Bluegrass
appliance
The appliance indicated for those children who
have continued a thumb sucking habit which is
affecting the mixed or permanent dentition.
Children also should indicate that they want to
stop the habit and are willing to try for the
appliance
The patients believed that they had acquired a
new toy with which to play with their tongues, as
instructions were given to turn the roller instead
of sucking digit.
33. Transition from infantile to mature
swallow
Infantile or visceral swallow : active contraction of the
musculature of the lip, tongue tip brought forward in
contact with the lower lip, and little activity of the
posterior tongue or pharyngeal musculature. mandible is
stabilized by the tongue interposed between the gum
pads and the peri oral musculature with the involvement
of 7th cranial nerve
Adult or Mature swallow: this type of swallow is
characterized by cessation of lip activity the placement of
tongue tip against the alveolar process behind the upper
incisors, more complex movements of the posterior part
of the tongue. Posterior teeth come in contact for the
stabilization of the mandible which is achived by the fifth
cranial nerve
34. Normal swallow:
Stage 1: the anterior third of
the superior surface of
the tongue is flat or
retracted, the food bolus
is collected on the flat
anterior part of the tongue
or in the sublingual area
in front of the retracted
tongue. The posterior
arched part of the tongue
is in contact with the soft
palate. posterior seal is
established. teeth and
lips are not in contact.
35. Stage 2: the soft palate moves
cranially and posterior
direction. The platoglossal
and Plato pharyngeal seal
are now open. The tip of the
tongue moves up and the
dorsum drops down creating
a groove or depression in the
middle third and permitting
posterior transportation of
the bolus. Simultaneously a
slight contraction of the lips
and the lips are brought to
contact. The anterior teeth
approximate at the end of
this stage . Symptoms of the
tongue thrust swallow are
seen at this stage
36. Stage 3 : the superior
constrictor muscle ring in the
epipharyngeal wall starts to
constrict . The soft palate
assumes a triangular form;
both tissues together form
the platopharengeal seal.
with the closing of the
nasopharynx the posterior
part of the dorsum drops
further and allows the bolus
to go further back.
simultaneously the anterior
part of the tongue is pressed
against the hard palate,
which helps to manipulate
the bolus in posterior
direction. The teeth are in
contact and the lips are
together
37. Stage 4: the dorsum of
the tongue moves
posteriorly and
superiorly as the
platopharyngeal move
down ward and forward
. The tongue presses
aganst the tensed soft
palate , squeezing the
residual food bolus out
of the oropharyngeal
area
40. Embryonic life
Disproportionably large
Fills the nasal cavity
Infants
In between the gum pads
In contact with lower lip
Stabilizes the mandible
Childhood
Starts retracting with incisor eruption
7th to 5th cranial nerve
Volume of oral cavity increases
41. Fletcher (1971) listed the patterns
characteristic of tongue thrust.
- A thrusting movement of the tongue against or between
the anterior teeth
- Slight or no contraction of the muscles of mastication
- Strong contraction of the lip musculature
- Movement of the hyoid bone in the oblique or forward
direction
- Distortion of speech sounds.
42. TONGUE THRUSTING AND MALOCCLUSION
The differential growth changes that usually resolve the largeness of
the tongue size relative to skeletal jaw size is the reason why
orthodontists watch some open bite malocclusions close down with
no therapy.
Favourable growth of the craniofacial complex could substantially
increase space within the oral and pharyngeal cavities to reduce the
need for a tongue to be fronted and protrusive and permit a self-
correction of some open bite malocclusions.
Worms et al 1971-80% spontaneous correction of anterior open bite.
Obviously, tongue thrust is more common than the malocclusion it is
supposed to cause. Also, the decreased prevalence of open bite
with increasing age,should indicate that if myofunctional training
techniques are to be employed to retrain tongue position it would be
best to defer treatment.
The best time to determine the need for therapy would be after
prepubertal growth spurt rather than during the period from 6-12 yrs
of age. Even then look out for fronted tongue posture( eg.,
unfavourable skeletal environment, specific respiratory problems or
thumb and finger sucking).
44. Diagnosis
History >hereditary etiologic factor, speech problems , upper respiratory
infections, sucking habits and neuromuscular problems
Examination
1. Simple tongue thrust
- Normal tooth contact in posterior region
- Anterior open bite (defined)
- Contraction of the lips, mentalis muscle and mandibular elevators.
2. Complex tongue thrust
- Generalized open bite with the absence of contraction of lip and muscle and
teeth contact in occlusion. (undefined)
- Cusp to cusp occlusion
- Absence of gag reflex and streognosis
- Dysdiadokokinesis
3. Lateral tongue thrust -posterior open bite with tongue thrusting laterally.
Functional methods
45. Maxilla
- Tipping of the palatal plane
-Proclination of maxillary anteriors resulting
in increase in over jet
- Generalized spacing between the teeth
- Teeth may be mesially inclined
- or all parameters may be norm
Mandible
-Retroclination or Proclination of mandibular
teeth depending on the type of growth
-Generalized spacing between the teeth
-Teeth may be mesially tilted
- or all parameters may be normal
Inter arch - Anterior or posterior open bite depending on
the posture of the tongue
- Posterior cross bite
- lack of interdigitation of the posterior teeth
- Or all the parameters may be normal
46. Facial form
- Convex profile
- Increased LAFH
lips
- Short upper lip/normal upper lip
- Hyperactive mentalis/ normal
Tongue
- Enlarged
- Forwardly placed
- Normal position
Speech
-Tongue thrust children are more likely to have
various speech disorders, such as sibilant distortions,
lisping problems in articulation of s, n, i, d, l, th, z, v
sounds
52. Treatment
Traning of correct swallow and posture of the tongue
a) myofunctional exercises
b) using appliances as a giude in correct positioning of
the tongue
Speech therapy
Mechanotherapy
Removable appliance therapy
Fixed habit breaking appliance
Oral screen
Correction of malocclusion
Surgical treatment
