This document discusses the management of pernicious oral habits. It begins by defining oral habits and classifying them. Common oral habits discussed include non-nutritive sucking, tongue thrusting, mouth breathing, nail biting, lip habits, and bruxism. The etiology and effects of each habit are described. Management approaches aim to identify and address the underlying causes, use reminders or appliances to break the habit, and may involve counseling or orthodontic treatment to correct dental malocclusions resulting from prolonged habits. A multidisciplinary approach is often needed to successfully manage pernicious oral habits.

1. MANAGEMENT OF PERNICIOUS ORAL
HABITS
Mohammad alkeshan , Pediatric
Dentistry

2.  Introduction
 Classification of pernicious oral habits
 Etiology of pernicious oral habits
 Nonnutritive Sucking habit (NNSH)
 Tongue Thrusting
 Mouth breathing habit
 Nail biting (onychophagia )
 Lip habits
 Bruxism
 Management of pernicious oral habits
 Conclusion

3. INTRODUCTION
 Habit Definition:
 Habit can be defined as a fixed or constant practice
established by frequent repetition(Dorland1957).
 A routine of behavior that is repeated regularly and
tend to occur unconsciously.
 An acquired pattern of behavior that has become
almost involuntary as a result of frequent repetition.
 Oral habits are learned patterns of muscular
contraction and have a very complex nature
(Mathewson1982).

4. INTRODUCTION
 Bad oral habits are common in infantile
period and most of them are started and
finished spontaneously.
 Bad Oral habits are a clear example of
environmental etiology of malocclusion.
 Oral habits usually associated with anger,
hunger, sleep, tooth eruption and fear.
 Some children display oral habits for
release of mental tension.
 These habits can result in damage to
dento-alveolar structure.

5. CLASSIFICATION OF PERNICIOUS ORAL HABIT
Oral habits classification:
Earnest Klien
Intentional habits (meaningful)
Unintentional habits (empty)
Morris & Bohana
Pressure habits
Nonpressure habits
Biting habits
Sydney Finn
Noncompulsive
Compulsive
William James
Useful habits
Nonuseful habits/harmful
habits

6. CLASSIFICATION OF PERNICIOUS ORAL HABITS
Morris & Bohana divided the oral habits to :
 Pressure oral habits
Habit that apply direct pressure on tooth and its supporting structure(sucking
habits and tongue thrust )
 Non_pressure oral habits
Habit that does not apply direct pressure on tooth and its supporting structure
e.g. mouth breathing
 Biting habits
e.g. lip, pencil and nail biting

7. EARNEST KLIEN
Oral habit
Meaningful
Psychological
approach
Diagnosis and
resolve the
problem
Empty
Dental
approach
Habit
remainder

8. ETIOLOGICAL FACTORS OF PERNICIOUS ORAL
HABITS
stress
Level of
parent’s
education
negligence of
the parents
parental
awareness
emotional
disturbance
disharmonious
relationship
between parents
and children

9. NON-NUTRITIVE SUCKING HABIT
 Sucking behaviors in infants & young children
are mainly derived from the physiologic need for
nutrients.
 Current understanding of child development suggests
that sucking behaviors also arise because of
psychological needs.
 Sucking behaviors are very common in babies and
young children as they give a feeling of security
 Multiple studies had been reported the prevalence
and relationships between NNSH and occlusal
abnormalities. These studies found that NNSH were
associated with certain Malocclusions.

10. NON-NUTRITIVE SUCKING HABIT (NNSH)
 78% of 4-year-old children had histories of NNSH with
about equal proportions of pacifier- and finger-sucking
habits.
( Kohler and Holst 1973)
 Early studies on the prevalence of nonnutritive sucking
found that 70% to 90% of Danish children had some
history of nonnutritive sucking habits. ( Ravn JJ 1974)

 62% of 3- to 5-year-old Swedish children had a pacifier
habit.
(Svedmyr B. 1979)

11. NON-NUTRITIVE SUCKING HABIT (NNSH)
 88% of 4-year-old children had histories of nonnutritive
sucking, with 48% having continuing habits at the age of
4 years.
(Modeer T 1982)
 The incidence of NNSH was 73% for children between
two and five years of age.
(Adair 1992)

12. NONNUTRITIVE SUCKING HABIT (NNSH)
 Pacifier
 Sucking has a nutritive significance in infants.
 infants have a natural sucking instinct or urge. Sucking is
considered the first feeding reflex established
 It is also a source of pleasure, comfort, and relaxation.
 The use of pacifiers is considered socially normal and this has
led to a significant increase in its use.
 Many parents introduce the use of pacifiers to babies to help
them settle.
 If it is not stopped until 2 or 3 years of age , it will cause
permanent changes in dentition
 and if it is used more than 5 years old , these effects would be
more sever

13. NONNUTRITIVE SUCKING HABIT (NNSH)
2) Thumb sucking
 Thumb sucking which is the most common oral habit. It
has been described as a common childhood behavior,
manifestation, or habit that is considered normal up to the
age of 3 to 4 years.
 Hand sucking is naturally developed in 89% of infants at
the second month and in 100% of them at the first year of
age. (Maguire, 2000; Rani, 1998)
 The risks associated with thumb sucking are dependent
upon its frequency, intensity, and duration.

14. NONNUTRITIVE SUCKING HABIT (NNSH)
 The incidence of thumb sucking had been reported from 13%
to 45% in some countries as shown in table(1).
 The prevalence of thumb sucking is decreased as age
increases, and mostly it is stopped up to age of 4 years.

15. NON-NUTRITIVE SUCKING HABIT
 Children with pacifier habit were significantly more likely to develop anterior
open bite, excessive overjet, and posterior crossbite in comparison with children
with no such history.
(Kohler and Holst, 1973)
 Anterior open bite was associated with persistent sucking habits, and that Class II
canine relationship was associated with continued pacifier use.
(Ravn, 1974)
 The side effects of finger sucking are: anterior open bite, increase overjet, lingual
inclination lower incisor and labial inclination of upper incisor, posterior cross bite,
compensatory tongue thrust and deep palate.
 60% of children with a history of a sucking habit exhibited malocclusion
(maxillary protrusion of 4 mm or more, anterior open bite and/or
unilateral/bilateral crossbites), whereas only 16% of those with no habit had
malocclusion.
(Svedmyr, 1979)

17. 3)TONGUE THRUST
Also called reverse swallow or immature swallow

18. TONGUE THRUST
 It is forward positioning of the tongue at rest so that the lip is against
or between the anterior teeth.
 Tongue plays an important role in many oral functions including
respiration, mastication, deglutition, and speech.
 Tongue thrust is seen in 50% of normal 8 years old children.
 The tongue thrust represents not a habit in the sense of learned
extraneous behavior, but a normal developmental stage and many
normal children do not complete the transition to adult swallowing
until they approach puberty. (1975, proffit)
 Child who sucks his thumb apparently delays his transition toward
adult swallowing, and then is more likely to be labeled as a tongue
thruster in his early mixed dentition years. A change in the swallow
pattern will not occur until the sucking habit ceases.

19. TONGUE THRUST
 Intra oral finding:
1. Tongue movements- irregular
2. Malocclusion
3. Mandibular proclination
4. Maxilla proclination with increase in overjet
5. Anterior open bite
 During swallowing:
Forward positioning of the tongue between the
anterior teeth so that the tongue tip contacts the lower
lip.
 During speech:
Fronting of the tongue between or against the anterior
dentition with the mandible hinged open.
 At rest:
Movement of the tongue forward in the oral cavity with
the mandible hinged slightly open and the tongue tip
against or between the anterior teeth.
(1975, proffit)

20. TONGUE THRUST AND OPEN BITE
 The resting tongue thrusting causes continuous pressure
in comparison to the pressure during swallowing or
speaking.
 Light forces produced by an anteriorly positioned tongue
tip can impede eruption of incisors. (1975, proffit)

21. 4-MOUTH BREATHING HABIT.
 Etiology of mouth breathing is
obstructed airway in the nose, these
maybe caused by allergy, atrophy
rhinitis, hot and dry weather or
polluted air.
 The presence of anatomic disorders
such as bent nasal septum can also
obstruct the air way leading to
difficulty in breathing to the nose.

22. 4)MOUTH BREATHING HABIT .
 Some people develop a habit of
breathing through their mouth instead
of their nose even after the nasal
obstruction clears. For some people
with sleep apnea it may become a
habit to sleep with their mouth open
to accommodate their need for
oxygen
 Intra oral features in person with
mouth breathing habit that include
angle class 2 division1 occlusion
,narrow upper dental arch , crowded
teeth in the upper and lower arches ,
vertical growth disturbance,
inadequate lip seal , and low
positioned tongue that disturb
functions

23. (5) NAIL BITING. (ONYCHOPHAGIA )
 Nail biting is defined as a chronic habit of biting nails,
commonly observed in both children and young adults.
 These habit start after 3 to 4 years of age and is in its peak in
10 years of age.
 The rates of NB in seven to 10-year-old children and during
adolescent are suggested being 20-33% and 45%.
 Onychophagia is transference of thumb-sucking habit,
because this tends to be abandoned during the third year of
life, when onychophagia starts. Then onychophagia usually
replaced by the habit of lip “pinching” or other objects.
thumb-
sucking
habit
NAIL
BITING
lip chewing
OR LIP
BITING

24. NAIL BITING (ONYCHOPHAGIA)
 The exact etiology of onychophagia remains as
yet unclear. No relevant relationship was found
between nail biting and anxiety. Usually occurs
as a result of boredom or working on difficult
problems rather than anxiety.
 A study on 5554 children (5-13 years old) in
Delhi indicated that the rate of finger and NB in
patients suffering TMJ pain and dysfunction
was about 24%. Therefore, it is recommended
to inquire about oral habit such as NB in all TMJ
pain and dysfunction.
 it can cause TMJ dysfunction, small fractured at
the edge of incisors due to the biting pressure,
apical root resorption particularly for upper
central incisor, alveolar destruction,

25. (6) LIP SUCKING OR LIP CHEWING
 lip-chewing is a common occurrence among
developmentaly disabled patients such as
 Lesch- Nyhan syndrome,
 x-linked genetic disorder of purine metabolism
 cerebral palsy
 autism
 Epilepsy
 These habit happens almost in all cases in inferior
lip and can cause the upper incisors to tip labially
and lower incisor to collapsed lingually
 The prevalence of some form of Self Injures
Behavior approaches up to 40% in some society.

26. (7) BRUXISM
 It is a common para function habit, occurring both
during sleep and wakefulness.
 Bruxism with some individuals showing clenching
and others predominantly exhibiting teeth grinding.
 The etiology not well known but it is agreed that it is
multifactorial (local/mechanical, psychological
,systemic /neurophysiological).
 A number of problems can develop if bruxism
behavior is intense and continuous like tooth
mobility may lead to the spread of gingivitis, uneven
occlusal wear , abrasion, pulp exposure and TMJ
disturbances

27. PACIFIER HABIT MANAGEMENT
 Most children stop their pacifier habit
at 2 to 3 years of age. if not, Pacifier
can be discontinued gradually or
completely withdrawn with
discussion and explanation to the
child.

28. MANAGEMENT OF THUMB SUCKING
 Management should starts from 5to 6 years
4 different approached :
1. Counseling
2. Reminder therapy
3. Reward system
4. Appliance therapy
The final stage of treatment is use of orthodontic
treatment (fixed or removable).
(2012,Shahraki N)

29. MANAGEMENT OF THUMP SUCKING
 Intra oral appliance:
1) Quad Helix
 Patient with posterior cross bite as a reminder
 (Cozza et al 2006)described the effectiveness
of the use the Quad-Helix and crip (Q-H/C) IN
growing subjects with thumb-sucking habits
and dento-skeletal open bites showed clinical
effectiveness in correcting the dental open bite
in 90% of patients and clinically significant
improvement in vertical skeletal relationships
because of downward rotation of the palatal
plane.

30. MANAGEMENT OF THUMB SUCKING
 2) Palatal crip
 digit-inhibiting appliance
 significant closure of the dento-alveolar anterior open
bite after palatal crip therapy (Villa and Cisneros)
 (Haryett et all) found that crips were effectives in
stopping thump-sucking habits when they were effective
worn for 1 year.
 The crip act as :
1. Break the suction and force
of the digit on the anterior segement.
1. To remained the pt of his habit.
2. To make the habit non-pleasure.

31. MANAGEMENT OF THUMB SUCKING
3) Bluegrass Appliance
 the appliance is indicated for those
children who have continued a thumb-
sucking habit which is affecting the
mixed and the permanent dentition
 It is the least intrusive and easiest
appliance to wear and tolerate , the
initial reaction of the children's to the
appliance was positive and
enthusiastic, the child believed ha/she
had acquired a new toy with which to
play their tongues

32. MANAGEMENT OF THUMP SUCKING
 4) Hybrid Habit Correcting Appliance
(HHCA)
 It is remainder appliance.
 This single appliance can be used to treat
both tongue thrusting as well as digit
sucking.
 This appliance gives the flexibility to be
used along with the fixed appliance which
increases its efficiency as well as reduces
the appliance wear time. It can also be
used to correct posterior cross-bites.

33. MANAGEMANT OF THUMP SUCKING HABIT
 The alternative treatment for anterior
skeletal open bite associated with thump
sucking during the mixed dentition with
removable mandibular acrylic occlusal
splint and spring-loaded block , these
modified appliance guides the vertical
force against the posterior teeth and the
alveolar process, the effective of the
appliance as a habit-breaking therapy is
highlighted. (Iscan et all) and Akkaya and
Hayder , suggested the use of a spring-
loaded bite-block for early correction of
skeletal open bite associates with thump
sucking

34. MANAGEMENT OF TONGUE THRUST
 Tongue thrust alone
 No treatment is needed.
 Tongue thrust with speech problems
 referred the child to speech therapist.
 Tongue thrust with malocclusion
 the dentist begin to treat either malocclusion OR tongue
thrust.
 Tongue thrust with malocclusion and a speech problem
 Modify the resting posture of the tongue.
 Speech therapy certainly should not be delayed. hybrid habit
correction appliance (HHCA) , nance palatal arch appliance
and hawley appliance can be used to correction of open bite
and alignment of anterior teeth

35. MOUTH BREATHING MANAGEMENT
 The best managed by using a multidisciplinary approach
involving pediatricians, physicians, dentists, and ear-nose-
throat (ENT) specialists. pediatricians, physicians, and
dentists
 Dentists are the primary care providers who can diagnose
mouth breathing and sleep disorder problems; these patients
then should be referred to an ENT specialist for further
evaluation and treatment.
 surgical removal of swollen tonsils and adenoids should be
the first line of treatment for individuals with upper airway
obstruction
 then treatment should be provided by dentists, who can
correct facial and dental abnormalities with functional
appliances. Various functional appliances, such as Frankel II
and Herbst, have been used to open retrognathic mandibles,

36. NAIL BITING TREATMENT
 Nail biting cannot be managed without
considering its co-morbidities,
antecedents and consequences.
 Punishment and threat may not lead to
the decrease of NB frequency.
 NB. Coating nails with unpleasant
materials or covering them is tried by
many parents, but it is usually ineffective.
There are some methods suggested for
controlling of NB such as chewing gum or
wearing a rubber piece on the wrist
 For treatment NB,an appliance utilizing
stainle sssteel twisted round wire was
made to help the patient break this habit.
(o.marouane et all )

37. LIP HABIT MANAGMENT
 Treatment objectives included the elimination of
lower lip sucking habit and reduction of the
increased overjet to improve function and facial
esthetics.
 phase I orthodontic treatment with a lip bumper
appliance THEN phase II fixed orthodontic
therapy was indicated to align and level the dental
arches.

38. BRUXISM MANAEGMENT
 1) ADJUCTIVE THERAPY:
 Aimed at lowering emotional
 2) elimination of oral pain and discomfort :
 Pain associated with periodontal disease, lip and check
should be eliminated
 3) Occlusal therapy :
 Occlusal adjustments
 Bite guard

39. CONCLUSION
 The line of treatment for these habits includes removal
of the etiology, retraining exercises and use of
mechanical restraining appliances
 The management by using the appliance is performed
when the child is already 6 years or more or when the
permanent teeth start to erupt
 Differentiation between normal and abnormal pressure
oral habit is very important before intervention
 Main key for success of intervention is the child
cooperation
 For best result to the child, time of intervention must
be correct.