This document discusses various oral habits. It defines oral habits as learned patterns of muscular contractions that are complex in nature. Oral habits are classified in different ways, including useful vs harmful habits, compulsive vs non-compulsive habits, and primary vs secondary habits. Specific oral habits discussed include thumb sucking, tongue thrusting, mouth breathing, lip biting, and bruxism. The document examines various theories regarding the causes of oral habits, such as the functional matrix theory and psychodynamic theory. Treatment approaches are also summarized, including psychological therapy, habit reversal training, reminder therapy using appliances, and consideration of the patient's age in selecting a treatment approach.

1. ORAL HABITS
KOMAL GHIYA
MDS PEDODONTICS AND PREVENTIVE DENTISTRY

2. CONTENTS
• Definition
• Classification of habits
• Thumb sucking
• Tongue thrusting
• Mouth breathing
• Lip biting
• Bruxism
• Masochistic

3. DEFINITION
• BOUCHER OC: habit as a tendency towards an act or an act that
has become a repeated performance ,relatively fixed, constant,
easy to perform and almost automatic
• FINN 1987 : an act, which is socially unacceptable

4. DEFINITION
• BUTTERSWORTH (1961): frequent or constant practice or
acquired tendency, which has been fixed by frequent
repetition
• MOYERS (1982): oral habits are learned patterns of
muscular contractions, which are complex in nature
• DORLAND(1957):fixed or constant practice established
by frequent repition

5. THEORIES
• FUNCTIONAL MATRIX THEORY BY MELVIN MOSS
• PSYCHOANALYTICAL THEORY BY SIGMUND FREUD

6. MELVIN MOSS
ORAL
HABITS
ABNORMAL SOFT TISSUE
PRESSURE,ALTERED MUSCULAR
CONTRACTION
NORMAL DENTOFACIAL AND
SKELETAL GROWTH
ALTERED DENTOFACIAL AND SKELETAL
GROWTH
BUCCINATOR,SUPERIOR,
PTERYGOMANDIBULAR
RAPHAE
TONGUE
LIPS
HARMONIOUS PRESSURE
BALANCE

7. FREUD
• PERSONALITY DEVELOPS THROUGH A SERIES OF CHILDHOOD
STAGES DURING WHICH THE PLEASURE SEEKING ENERGIES OF
THE id BECOME FOCUSED ON CERTAIN EROGENOUS AREAS
• THIS PSYCHOSEXUAL ENERGY ,OR LIBIDO, WAS DESCRIBED AS
THE DRIVING FORCE BEHIND BEHAVIOUR

8. EFFECT DEPENDS UPON
►Frequency; how often the habit is performed i.e. no. of times
per day
►Intensity ; how vigorously it is done
►Duration ; total no. days, weeks, months & year habit is
performed

9. PREVALENCE OF HABITS

10. CLASSIFICATION OF HABITS
• Useful and harmful habit james 1923
• Useful habit:
• Should include all those habits of normal function such as correct
tongue position proper respiration and deglutition
• Harmful habit
• All those exert prevented stress against the teeth and dental arches
e.g:mouth breathing, tongue thrusting

11. COMPULSIVE AND NONCOMPULSIVE
HABITS(FINN-1987)
• COMPULSIVE HABIT
• Acquired as a fixation in the child to the extent that he retreats to the
practice whenever his security is threatened
• NONCOMPULSIVE HABIT
• Children appear to undergo continuing behavior modification, which
permit them to release certain undesirable habit patterns and form
new ones which are socially accepted

12. • SECONDARY HABITS
Secondary habit is a habit that is due to a supplemental
problem ;e.g: large tongue and tongue thrusting habit
MEANINGFUL AND EMPTY HABIT(KLEIN-1971)
Meaningful habit: Habit with a deep rooted psychological
problem
Empty habit: Meaningless habit that can be treated easily
by a dentist using reminder therapy

13. NORMAL AND ABNORMAL HABIT
• NORMAL HABIT: those habits that are deemed normal by
children of a particular age group
• ABNORMAL HABIT: those habits are pursued after their
physiological period of cessation

14. PHYSIOLOGIC AND PATHOLOGIC HABIT
• PHYSIOLOGIC HABIT
• Physiologic habits are those that are required for normal
physiologic fractioning e.g: nasal respiration, sucking during
infancy
• PATHOLOGIC HABITS
• Habits that are pursued due to pathological reasons such as
adenoids and nasal septal defects that may lead to mouth
breathing

15. RETAINED AND CULTIVATED HABITS
• Retained habit
• Those that are carried over from childhood into adulthood
• Cultivated habit
• Those cultivated during the socio –active life of an individual

16. MORRIS AND BOHANNA-1969
• Non pressure habits: mouth breathing
• Pressure habits: sucking habit: lip sucking, thumbsucking
• Biting habit:nail biting/needle holding
• Pillow rest
• Postural habit: chin rest
• Miscellaneous:bruxism

17. THUMBSUCKING
• Defined as the placement of thumb in varying
depths into the mouth :GERLIN 1978
• Repeated and forceful sucking of thumb with
associated strong buccal and lip contractions:
MOYERS

18. CLASSIFICATION:
• Normal thumb sucking:
• The thumbsucking habit is considered normal during the first one
and half years of life.such a habit is usually seen to disappear as
child matures
• Abnormal thumbsucking:
• When thumbsucking habit persists beyond the pre school period then
it could be considered as an abnormal habit.

19. PSYCHOLOGICAL
• Habitual
• Nutritive
• Non nutritive

20. • According to subtenly(1973)
• Type A:50%
• WHOLE DIGIT INSIDE THE MOUTH
WITH THE PAD OF THUMB PRESSING
OVER THE PALATE
• TYPE B:
• 13-24%
• THUMB AT THE SAME MAXLLARY
AND MANDIBULAR CONTACT IN
MAINTAINED

21. • TYPE C:
• 18%’THUMB JUST BEYOND THE FIRST
JOINT AND CONTACTS THE HARD
PALATE AND MAXILLARY INCISORS BUT
NO CONTACT WITH MANDIBULAR
ANTERIOR INCISORS
• TYPE D:
• 6%’LITTLE PORTION OF THUMB IS
PLACED INTO THE MOUTH

22. PHASES OF HABIT:MOYERS
• PHASE 1:NORMAL AND SUBCLINICALLY SIGNIFICNT:1-3 YEARS
• PHASE 2:CLINICALLY SIGNIFICANT:3-5 YEARS
• PHASE 3:INTRACTABLE HABIT:MORE THAN 4-5 YEARS

23. JHONSON AND LARSON 1993-JDC
LEVEL DESCRIPTION
LEVEL1(+/-) BOY OR GIRLS OF ANY CHRONOLOGICAL AGE WITH A
HABIT THAT OCCURS DURING SLEEP
LEVEL 11(+/-
)
BOYS BELOW AGE 8 yr WITH A HABIT THAT OCCURS AT
ONE SETTING DURING WAKING HOURS
LEVEL111(+/
-)
BOYS BELOW AGE 8 YEAR WITH A HABIT THAT OCCURS
AT MULTIPLE SITTINGS DURINGWAKING HOURS
LEVEL1V(+/-) GIRLS BELOW AGE 8 YEAR OR A BOY OVER 8 YEARS
WITH A HABIT THAT OCCURS AT ONE SETTING DURING
WAKING HOURS
LEVEL V(+/-) GIRLS UNDER AGE 8 YEAR OR ABOY OVER AGE 8 YEARS
WITH A HABIT THAT OCCURS AT MULTIPLE SITTINGS
DURING WAKING HOURS
LEVEL V1(+/-
)
GIRLS OVER AGE 8 YEARS WITH A HABIT DURING
WAKINGHOURS

24. THEORIES OF THUMB SUCKING
• CLASSICAL FREUDIAN THEORY(SIGMUND FREUD-1919)
• ORAL DRIVE THEORY(SEARS AND WISE-1982)
• ROOTING REFLEX(BENJAMIN-1962):FIRST 3 MONTHS
• SUCKING REFLEX(ERGEL-1962):29 WEEKS I.U-1.5 TO 3 YEARS
• LEARNING THEORY(DAVIDSON-1967)

25. ETIOLOGICAL FACTORS ASSOSCIATED WITH
THUMB SUCKING
variables
age Levin and keyes,1964
Singhal and Bhatia,1988
Garathini,1990
Traisman and traisman
Robert,Brazelton 1956-158
Race Brenchley,1992
Pacifier Ravn,1976
Feeding
methods
Levyy,1928
Robert,1944
Yarrow,1956
Tandon,2006
Siblings Larsson,1971
Tandon,2006
Parental status Popovich and Thompson,1973
Moghall,1969
Tandon,2006

26. DENTOFACIAL CHANGES ASSOCIATED
WITH THUMB SUCKING
• INCREASED MAXILLARY ARCH LENGTH
• ANTERIOR PLACEMENT OF THE APICAL
BASE OF THE MAXILLA
• INCREASED CLINICAL CROWN LENGTH
OF MAXILLARY INCISORS
• HIGH PALATAL ARCH
• ATYPICAL ROOT RESORPTION IN
CENTRAL INCISOR
• INCREASED TRAUMA TO MAXILLARY
INCISORS

27. • RETROCLINATION OF MANDIBULAR INCISORS
• RETRUSION OF MANDIBLE
• INCREASED OVERJET
• DECREASED OVERBITE
• DEVELOPMENT OF TONGUE THRUST
• LOWER TONGUE POSITION
• HYPOTONIC UPPER LIP
• HYPERACTIVE LOWER LIP

28. PROCLINATION OF MAXILLARY INCISORS
ANTERIOR OPEN BITE
POSTERIOR CROSS BITE

29. HISTORY:MATHEWSON,FORRESTER,1981
• PARENTS
• FEEDING PATTERNS
• EMOTIONAL STATUS
• THREE MAJOR QUESTIONS
• FREQUENCY
• DURATION
• INTENSITY
• DIRECTION,TYPE

30. DIGITS
 REDDENED
 EXCEPTIONALLY CLEAN AND CHAPPED
 SHORT CLEAN FINGER/THUMB NAIL(DISH PAN
THUMB)
 FIBROUS ROUGHENED CALLUS ON SUPERIOR
ASPECT OF FINGER NAIL
 GROOVES ON THUMB

31. CEPHALOMETRIC
CHANGES
Effects of maxilla Increased proclination of maxillary incisor
Increased maxillary arch legth
Increased anterior placement of apical base of maxilla
Increased SNA
Decreased palatal arch width
Effects on the mandible Increased proclination of mandibular incisors
Increased mandibular intermolar distance
Increased distal position of B point
Effects on the interarch relationship Decreased maxillary and mandibular incisal angle
Increased overjet
Decreased overbite
Increased posterior crossbite
Effect on lip placement and function Increased lip competence
Increased lower lip function under maxillary incisors
Effect on tongue placements and
function
Increase tongue thrust
Increase lip to tongue resting position
Increase lower tongue position
Other effects Risk to psychologic health
Increased risk of poisoning
Increased deformation of digits
Increased risk of speech defects,especially lisping

32. MANAGEMENT
• PREVENTIVE TREATMENT
• HUGHES 1941:FEED THE CHILD WHENEVER HUNGRY,LET HIM
EAT AS MUCH AS HE WANTS
• BREASTFEEDING
• HABIT SHOULD BE DISCONTINUED AT ITS INCEPTION
• USE OF A DUMMY/PACIFIER:

33. PSYCHOLOGICAL THERAPY
• BETA HYPOTHESIS /DUNLOP’S HYPOTHESIS
• IF A SUBJECT IS FORCED TO CONCENTRATE ON THE PERFORMANCE
OF THE ACT AND THE TIME HE PRACTICES IT,HE COULD LEARN TO
STOP PERFORMING THE ACT
• FORCED PURPOSEFUL REPITIION OF HABIT EVENTUALLY ASSOCIATES
WITH UNPLEASANT REACTIONS AND THE HABIT IS ABAONDEED
• THE CHILD SHOULD BE ASKED TO SIT IN FRONT OF THE MIRROR AND
ASKED TO OBSERVE HIMSELF AS HE INDULGES IN THE HABIT

34. LARSON AND JHONSON 1993
• STEP 1:SCREENING FOR PSYCHOLOGICAL COMPONENT
• STEP 2:HABIT AWARENESS
• STEP 3:HABIT REVERSAL WITH A COMPETING RESPONSE
• STEP 4:RESPONSE ATTENTION
• STEP 5:ESCALATED DRO
• STEP 6:ESCALATED DRO+REPRIMAND

35. DIFFERENTIAL REINFORCEMENT OF OTHER
BEHAVIOURS
• DRO behaviors are reinforcing the lack of the target response, in this
case the lack of thumb sucking.
• The reward can also be applied to a different but related behavior,
such as compliance to habit cessation therapy.
• If reinforcement schedule is lengthened as treatment progresses, it is
called escalated DRO. In some studies, DRO plus reprimands were
used.
• The reprimands consisted of holding the child, establishing the eye
contact, and firmly admonishing the child to stop the targeted
behavior.

36. THREE ALARM SYSTEM(NORTON AND
GERLIN-1968)
• FIRST:DIGIT IS WRAPPED AND CHILD FEELS THAT IN MOUTH
• SECOND:IT IS WRAPPED ON THE ELBOW AND SECURED WITH
SAFETY PINS
• THIRD:THIGHTENED

37. RAGHVENDER SHETTY ET AL,2015,IJCPD

38. CHEMICAL TREATMENT
• QUININE,AESEFETIDA,PEPER,CASTOR OIL,
• ANTITHUMB SUCKING
SOLUTIONS:FEMITE,THUMBUP,ANTITHUMB
MECHANICAL THERAPY
EXTRAORAL APPROACH:MECHANICAL
RESTRAINTS:SPLINTS,ADHESIVE TAPES

39. INTRAORAL APPROACH:3-4.5 YEARS
• REMOVABLE OR FIXED PALATAL CRIB
ORAL SCREEN
HAYRAKES: MORE THAN 3.5 YEARS

40. • BLUE GRASS APPLIANCE:7-13 YEARS
• MINK AND HASKELL 1991:
• PEDIATRIC CLINICS OF UNIVERSITY OF KENTUCKY AND UNIVERSITY OF
LOUSVILLE
• SIX SIDED ROLLER MADE OF TEFLON ATTACHED WITH 0.045 STAINLESS
STEEL WIRE SOLDERED TO MOLAR ORTHODONTIC BANDS

41. • PATIENT IS ASKED TO TURN THE ROLLER INSTEAD OF
SUCKING
• PATIENT GETS A NEW TOY TO PLAY
• TIME:3-6 MONTHS
• LOCATION OF ROLLER:MOST SUPERIOR ASPECT OF
PALATE
• NOT IN CONTACT WITH PALATE

42. QUAD HELIX
• MAXILLARY EXPANSION
• POSTERIOR CROSSBITE
CORRECTION
• ALIGNMENT OF MAXILLARY
AND MANDIBULAR INCISORS

43. MODIFIED BLUE GRASS APPLIANCE:CHRIS BAKER
2000
• 4 MM ACRYLIC BEADS
• ADV:REDUCED BULK
• LESS OBSTRUCTION,ATTRACTIVE FOR
CHILDREN
• USED IN AGE GROUP 1.5 TO 12 YEARS
• MODIFICATION
• ATTACHMENT WITH QUAD HELIX
• REMOVAL TIME:6 MONTHS AFTER
CESSATION OF HABIT

44. CURRENT
• INCREASING THE ARM LENGTH OF THE SUIT
• THUMB HOME CONCE

45. HAND PUPPETS

46. THUMB SUCKING BOOK

47. AGE FACTOR. JACOBSON A. 1979 (YOUNGER
THAN 3 YEARS)
• NO ACTIVE INTERVENTIONAL:GENERAL EMOTIONAL
IMMATURITY
• MOST CHILDREN WILL OUTGROW THE HABITBY 5
• MOST CLASS 1 OPEN BITE MALOCCUSION WILLL BE SELF
CORRECTING WHEN THE PERMANENT INCISORS ERUPT IF THE
HABIT DOESN’T’ CEASE PRIOR TO ERUPTION

48. • THE PARENTS SHOULD BE ADVISED GENERALLY TO IGNORE THE
ACTIVE HABIT,AND GIVE THE CHILD AS MUCH ATTENTION AS
POSSIBLE WHEN HE IS NOT THUMBSUCKING
• THEY SHOULD ALSO BE ADVISED
• FOR CLASS 2 CHILDREN:FURTHER ORTHODONTIC TREATMENT
WILL BE NECESSARY WHEN THE CHILD IS OLDER

49. 3 TO 7 YEARS
• DEPENDING ON THE HABIT AND WHETHER HE IS ACTIVELY PULLING
THIS MAXILLA ANTERIORLY OR JUST SUCKING WHIS DIGIT WITH
BUCCAL CONSTRICTION
• FINGER SUCKERS:CONCERN THEN THUMB SUCKERS BECAUSE
ANTERIOR ORTHOPEDIC FORCE VECTORS ASSOCIATED WITH FIGER
SUCKING LEVERAGE
• IT IS ADVISED COUNSELLING THE CHILD WITH GOOD MOTOR
INTERCUSPATION WITH LITTLE ANTERIOR PULL i.e PASSIVE SUCKING
CHILD

50. OLDER THAN 7 YEARS
• ANTERIOR OPEN BITE THAT IS USUALLY NOT CLOSED BY ITSELF
BECAUSE OF FUNCTIONAL PATTERNS THAT HAVE BEEN
ESTABLISHED
• THEY WILL REQUIRE ACTIVE ORTHODONTIC TREATMENT
• THE APPLIANCES DELIVERED SHOULD NOT BE PUNITIVE
• SHOULD BE MULTIPURPOSE
• SHOULD HELP THE CHLD TO CONTROL HIS HABITS BY GIVING
HIM A REMINDER
50

51. TREATMENT CONSIDERATIONS-FINN
• PSYCHOLOGICAL SATUS OF CHILD
• AGE FACTOR
• MOTIVATION OF CHILD
• PARENTAL COOPERATION
• FRIENDLY RAPPORT
• OTHER FACTORS

52. TREATMENT CONSIDERATIONS:PINKHAM
• COUNSELLING
• REWARD SYSTEM
• REMINDER THERAPY
• ADJUNCTIVE THERAPY

53. TONGUE THRUSTING
• TULLEY :FORWARD MOVEMENT OF THE TONGUE TIP BETWEEN THE
TEETH TO MEET THE LOWER LIP DURING DEGLUTITION AND IN
SOUNDS OF SPEECH ,SO THAT THE TONGUE LIES INTERDENTALLY
• A TONGUE THRUST IS SAID TO BR PRESENT IF THE TONGUE IS
OBSERVED THRUSTING BETWEEN AND THE TEETH DO NOT CLOSE IN
CENTRIC OCCLUSION DURING DEGLUTITION:BRAUER,1965
• TONGUE THRUST IS A FORWARD PLACEMENT OF THE TONGUE
BETWEEN THE ANTERIOR TEETH AND AGAINST THE LOWER LIP
DURING SWALLOWING:SCHNEIDER(1982)

54. • CLASSIFICATION
• PHYSIOLOGICAL
• HABITUAL
• FUNCTIONAL
• ANATOMIC

55. MOYERS CLASSIFICATION OF SWALLOWING
PATTERNS
Normal infantile swallow During this swallow the tongue lies
between the gum pads and mandible is
tabilized by contraction of facial muscles
especially buccinators.This type of pattern
disappears on eruption of the buccal teeth
of primary dentition
Transitional swallow Intermixing of normal infantile swallow and
mature swallow during the primary
dentition and early mixed dentition period
Normal mature swallow During this swallow there is very little lip
and cheek activity. Mainly there is
contraction of mandibular

56. BRAUER AND TOWNSEND CLASSIFICATION
• TYPE 1:NON DEFORMING TONGUE THRUST
• TYPE 2:DEFORMING ANTERIOR TONGUE THRUST
• SUBGROUP 1:ANTERIOR OPEN BITE
• SUBGROUP 2:ASSOCIATED PRECUMBENCY
• SUBGROUP 3:ASSOCIATED POSTERIOR CROSSBITE
• TYPE 3:DEFORMING LATERAL TONGUE THRUST
• SUBGROUP 1:POSTERIOR OPEN BITE
• SUBGROUP 2:POSTERIOR CROSS BITE
• SUBGROUP 3:DEEP OVERBITE

57. • TYPE 4:DEFORMING ANTERIOR AND LATERAL TONGUE THRUST
• SUBGROUP 1:ANTERIOR AND POSTERIOR OPEN BITE
• SUBGROUP 2:ASSOCIATED PROCUMBENCY OF ANTERIOR TEETH
• SUNBGROUP 3:ASSOCIATED POSTERIOR CROSS BITE

58. ETIOLOGY OF TONGUE THRUSTING
• GENETIC INFLUENCE
• THUMB SUCKING
• MIXED DENTITION
• GAP FILLING TENDENCY
• ALLERGIES
• SOFT DIET
• ORAL TRAUMA
• SLEEPING HABITS

59. ANTERIOR TONGUE THRUST
• EXTRAORAL FEATURES:
• DOLICOCEPHALIC FACE
• INCREASED LOWER ANTERIOR FACIAL HEIGHT
• INCOMPETENT LIPS
• EXPRESSIONLESS FACE
• SPEECH PROBLEMS
• ABNORMAL MENTALIS MUSCLE ACTIVITY

60. INTRAORAL FEATURES
• PROCLINED ,SPACED
,SOMETIMES FLARED UPPER
ANTERIORS RESULTING IN
INCREASED OVERJET
• RETROCLINED OR PROCLINED
LOWER ANTERIORS DEPENDING
UPON THE TYPE OF TONGUE
THRUST
• PRESENCE OF ANTERIOR OPEN
BITE
• POSTERIOR CROSSBITES

61. COMPLEX TONGUE THRUST
• PROCLINATION OF ANTERIOR TEETH
• BIMAXILLARY PROTRUSION
• ANTERIOR OPEN BITE
• ABSENCE OF TEMPORAL MUSCLE CONSTRICTION DURING
SWALLOWING
• OCCLUSION OF TEETH MAY BE POOR
• POSTERIOR OPEN BITE
• POSTERIOR CROSS BITE

62. CLINICAL FEATURES
• SIMPLE:
• NORMAL TOOTH CONTACT IN POSTERIOR REGION
• ANTERIOR OPEN BITE
• CONTRACTION OF THE LIPS AND MENTALIS MUSCLE AND
MANDIBULAR ELEVATORS
• COMPLEX:
• GENERALIZED OPEN BITE
• ABSENCE OF CONTRACTION OF LIP AND ORAL MUSCLES

63. • LATERAL TONGUE THRUST
• POSTERIOR OPEN BITE WITH
LATERAL TONGUE THRUST
• OTHER:
• PROCLINATION OF ANTERIOR
TEETH
• ANTERIOR OPEN BITE
• MIDLINE DIASTEMA
• POSTERIOR CROSSBITE

64. DIAGNOSIS
• EXAMINATION OF TONGUE THRUSTING
• CHECK FOR SIZE,SHAPE AND MOVEMENT
• FUNCTIONAL EXAMINATIONS
• OBSERVE THE TONGUE POSITIONWHILE MANDIBLE IS IN THE REST POSITION
• OBSERVE THE TONGUE DURING VARIOUS SWALLOW
• -CONCIOUS SWALLOW
• -COMMAND SWALLOW OF WATER AND SALIVA
• -CONCIOUS SWALLOW DUEING MASTICATION

65. • PALPATORY EXAMINATION:
• PLACE WATER BENEATH THE PATIENTS TONGUE TIP AND ASK HIM TO SWALLOW
• NORMAL:MANDIBLE RISES AND TEETH ARE BROUGHT TOGETHER BUT NO CONTRACTION OF LIPS OR
FACIAL MUSCLES
• TONGUE THRUSTING:MARKED CONTRACTION OF LIPS AND FACIAL MUSCLES
• PLACE HAND OVER TEMPORALIS MUSCLE AND ASK TO SWALLOW
• TONGUE THRUSTING:NO TEMPORALIS CONTRACTION
• HOLD THE LOWER LIP AND AKS THE PATIENT TO SWALLOW
• NORMAL:SWALLOW CAN BE COMPLETED
• TONGUE THRUSTING:PATIENT CANNOT COMPLETE SWALLOW

66. CEPHALOMETRIC CHANGES
• NORMAL UPPER INCISOR TO SN AND UPPER INCISOR TO NA AS
WELL AS IMPA
• AND LOWER INCISOR TO NB ANGLES INDICATIVE OF A
BIMAXILLARY DENTO-ALVEOLAR PROTRUSION
• LIP INCOMPETENCY

67. TREATMENT CONSIDERATIONS
• MYOFUNCTIONAL THERAPY:
• GARDLIADER:ASKING THE CHILD TO PLACE THE TONGUE IN THE RUGAE AREA FOR 5 MINUTES AND
THEN ASKING HIM TO SWALLOW
• ORTHODONTIC ELASTICS
• ORTHODONTIC ELASTIC5/16” AND SUGARLESS FRUIT DROP
• LEMON CANDY EXERCISE
• 4S EXERCISE:SPOT
• SALIVATING
• SQEEZING THE SPOT
• SWALLOWING

68. • OTHER EXERCISE:WHISTLING,RECITING THE COUNT FROM 60-
90,GARGLING,YAWNING,etc
• LIP EXERCISE:
• TUG OF WAR AND BUTTON PULL EXERCISE
• SUBCONCIOUS THERAPY
• MECHANOTHERAPY
• PREORTHODONTIC TRAINER

69. • MODIFICATION OF HAWLEY’S APPLIANCE
• TONGUE CRIB
• ORAL SCREEN

70. REFERENCES
• P CASAMASSIMO,H FIELDS,D MCTIGUE,A NOWAK,PEDIATRIC
DENTISTRY,INFANCY THROUGH ADOLESCENCE,5 th edition
• J DEAN,D AVERY,RMC DONALDS,DENTISTRY FOR CHILD AND
ADOLESCENT,9 TH ED
• TEXTBOOK OF PEDIATRIC DENTISTRY, R STEWART
• FINN,CLINICAL PEDODONTICS,4 TH EDITION
• WELBURY,MONTY S ,DUGGAL,4 th ed,PEDIATRIC DENTISTRY
• GRABER,NEUMANN,ORTHODONTICS,CURRENT PRINCIPLES AND
TECHNIQUES