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Onychophagia (Nail biting), anxiety, and malocclusion

Article  in  Indian journal of dental research: official publication of Indian Society for Dental Research · September 2012
DOI: 10.4103/0970-9290.107399 · Source: PubMed

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Short Communication

Onychophagia (Nail biting), anxiety, and malocclusion

Avesh Sachan, TP Chaturvedi

Department of Orthodontics,
Faculty of Dental Sciences,
ABSTRACT
Institute of Medical Sciences, Nail biting is a stress removing habit adopted by many children and adults. People usually
Banaras Hindu University,
Varanasi, India
do it when they are nervous, stressed, hungry, or bored. All of these situations are having a
common phenomenon between them is anxiety. Onychophagia is also a sign of other emotional
or mental disorders. It is a habit that is not easy to quit and reflection of extreme nervousness or
inability to handle stressful conditions. This abnormal habit may cause various malocclusions
associated with dentoalveolar segment of the oral cavity. Crowding and rotations of incisors
Received : 26-07-10 are common with this habit.
Review completed : 01-12-11
Accepted : 05-04-12 Key words: Anxiety, malocclusion, nail biting

Nail biting or onychophagia is a common stress-relieving
oral habit. Onychophagia, the habit of biting one’s nails is
commonly observed in both children and young adults. Nail
biting includes biting the cuticle and soft tissue surrounding
the nail as well as biting the nail itself. Onychophagy is a
nail disease caused by repeated injuries of nails. Nail biting
as auto destruction and onychophagy are its most aggressive
forms. The need to bite or eat fingernails is related to a
psycho emotional state of anxiety. A nail biting child is
exhibiting an evolutionary disturbance related to the oral
stage of psychological development.[1]
The problem is usually not observed before the age of 3 or
4 years. Most cases of nail biting or onychophagia are seen
between the ages of 4 and 6 years; it stabilizes from 7 to 10 and
increases considerably during adolescence, because this period
is a time of crisis. To most adolescents, this is a difficult and
even traumatic passage. Up to 10 years of age, the incidence
of nail biting is relatively equal but thereafter it is observed
that boys are significantly higher than girls as nail biters. [2]
Dentofacial or dentoalveolar functional abnormalities like
nail biting can associated with other dentofacial conditions
Address for correspondence:
Dr. Avesh Sachan
E-mail: dr.aveshsachan@gmail.com
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DOI:
10.4103/0970-9290.107399
Indian Journal of Dental Research, 23(5), 2012
and should be diagnosed and managed according to
requirements of clinical situation. Correction or control of
this functional problem might involve alteration of behavior
patterns and multidisciplinary treatment. Nail biting should
be evaluated to identify specific concerns regarding stability
and to suggest methods of retention to improve stability.
ETIOLOGY
Nail biting, demonstrating anxiety made worse by tense
moments, is seen as a reflex of emotional unbalances.[3] Nail
biting has a sequence of four distinct postures.
• The hands are placed close to the mouth and keep there
for a few seconds to half a minute.
• The fingers are quickly tapped against the front teeth.
• A series of quick spasmodic biting follows, with the
fingernails pressed tightly against the biting edge of the
teeth.
• The finger is withdrawn from the mouth.
The basic cause of onychophagia is difficult to determine.
Although it has been observed that nail biters have more
anxiety than those who do not have the habit. People
bite their nails during moments of stress. Children do it
in moments of anguish, when they do not know a lesson,
read sad stories, listen to horror stories, watching television,
or talking on the phone. It can also be a learned behavior
from family members. Nail biting is the most common of
the typical “nervous habits,” which include thumb-sucking,
nose-picking, hair-twisting or pulling, tooth-grinding, and
picking at skin.
COMPLICATIONS
When nail biting associated with other problems, it gets
more complex, and requires specialized help. When a child
680
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Onychophagia (Nail biting), anxiety and malocclusion Sachan and Chaturvedi
swallows the bitten-off nails, stomach problems like stomach
infection can develop, in addition to the hygienic aspect of
nails, which are seldom clean, and various diseases can be
transmitted. After adolescence, onychophagia is usually
replaced by the habit of lip “pinching,” chewing of pencils
or other objects, nose scratching, or hair twirling. In adults,
smoking or gum chewing seems to be a common substitute.
Nail biting children are at risk of developing malocclusion
of the anterior teeth. Non-physiological forces acting on the
teeth, such as those from nail biting, can speed up resorption
or cause apical root resorption.[4] Dental examinations of
these patients can show crowding, rotation, and attrition on
the incisal edges of the mandibular incisors and protrusion
of the maxillary incisors.[5] These malocclusions are created
by pressures from the onychophagia habit. The forceful and
continuous habit of nail biting causes alveolar destruction
in the area of the involved teeth.[6] Chronic nail biting can
produce small fractures at the edges of the incisors, and
gingivitis might result from continued nail biting.[7]
Bacterial infection can occur from diseases of the nail such as
onychomycosis and paronychia and nail biting might spread
the infection to the mouth. A nail biter with oral herpes can
develop herpetic whitlow of the bitten finger.[8] A positive
aspect of nail biting is that fingernail growth is not retarded
but it increases nail growth by approximately 20%, perhaps
because frequent manipulation of the nail stimulates the
circulation to the germinal area in the nail root.[9] Rarely, nail
biting may be a symptom of obsessive-compulsive disorder
(OCD). OCD symptoms are usually treated with medicines.
MANAGEMENT
Several treatment measures may help to stop nail biting,
some focus on behavior changes and some focus on
physical barriers to nail-biting. To control or correct the
nail biting habit, the patient must be motivated. Patient
must be aware of the need to abandon the habit, and
here the professional role acquires relevance, offering
helpful suggestions in overcoming the addiction. Sudden
suppression might introduce personality alterations. Some
people spontaneously quit onychophagia because of fear of
developing infections; others quit to imitate friends who
have attractive nails.[10] No treatment is needed for mild cases
of onychophagia. For more serious situations, treatment
should involve removal of the emotional factors inducing the
habit, in most cases; a little more attention, love, affection,
and comprehension are enough to break the habit.
Outdoor activities requiring great physical effort might be
indicated. Outdoor play and opportunities to use the mind,
hands, and emotions in arts and crafts are recommended,
since they function as tensions releasers. When the habit
is corrected early, especially in mild cases before the
permanent damage to incisal edge of incisors and sever
681
rotations, the malocclusion will usually revert without
treatment.[11] Application of a bitter-tasting commercial
preparation to the nail, in the hope of stopping the habit,
is ineffective; these procedures cause greater tension in
young people. Techniques such as application of olive oil
to the nails, make them soft and pliable, and removes the
temptation to chew off nails with the teeth.
Keeping the nails well trimmed is another useful measure,
so that poorly trimmed corners and cuticles are not
temptations. For girls, having the nails manicured could
have a positive and surprising result. Boys might apply
bandages to their fingers, letting their friends believe they
are treating injuries, rather than fighting onychophagy.
An effective alternative is to ask the patient to use the rubber
bite piece when he or she feels the urge for nail biting or
has anxiety. Chewing sugar-free gum, if not compulsively
done, could also be a way to keep the mouth occupied and
render the habit difficult or impossible. Occupying the
hands with another activity, such as handicrafts or a musical
instrument, might also be effective in keeping the hands
away from the mouth.[12]
The best way to treat a nail biter is to educate them,
stimulate good habits, develop conscious awareness, and
thus guarantee effective results, because no other way to
stop the habit is more efficient, intelligent, and satisfactory.
During treatment, the child should be given emotional
support and encouragement. A multidisciplinary approach
should focus on efforts to build up the child’s self-confidence
and self-esteem.[13]
CONCLUSION
Nail biters have crowding, rotation, and attrition on the
incisal edges of the mandibular incisors and protrusion
of the maxillary incisors. Mild cases of onychophagia do
not cause severe malocclusion. Severity of malocclusion
associated with nail biting depends upon intensity, duration,
and frequency of habit. Behavioral modification techniques,
positive reinforcements, and regular follow-ups are
important for the treatment of nail biting or onychophagia
with a multidisciplinary approach, if necessary.
REFERENCES
1. Pearson GHJ. The psychology of finger sucking, tongue sucking, and
other oral habits. Am J Orthod 1948;34:589-98.
2. Pennington LA. Incidence of nail biting among adults. Am J Psychiatry
1945;102:241-4.
3. Deardoff PA, Finch AJ, Royall LR. Manifest anxiety and nail-biting. J Clin
Psychol 1974;30:378.
4. Odenrick L, Brasttstrom V. Nailbiting: Frequency and association with root
resorption during orthodontic treatment. Br J Orthod 1985;12:78-81.
5. Klein ET. Pressure habit, etiological factors in malocclusion. Am J Orthod
1952;38:569-87.
6. Hideharu Y, Kenji S. Malocclusion associated with abnormal posture.
Indian Journal of Dental Research, 23(5), 2012
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Onychophagia (Nail biting), anxiety and malocclusion Sachan and Chaturvedi

Bull Tokyo Dent Coll 2003;44:43-54.
7. Shetty SR, Munshi AK. Oral habits in children. J Indian Soc Pedod Prev
Dent 1998;16:61-6.
8. Leung AK, Robson LM. Nailbiting. Clin Pediatr 1990;29:690-2.
9. Bean WB. Nail growth: Thirty-five years of observation. Arch Intern
Med 1980;140:73-6.
10. Coleman JC, McCalley JE. Nail-biting among college students. J Abnorm
Soc Psychol 1948;43:517-25.
11. Sassouni V, Forrest EJ. Orthodontics in dental practice. St Louis:
C. V. Mosby; 1971.
12. Schneider PE, Peterson J. Oral habits: Considerations in management.
Pediatr Clin North Am 1982;29:523-46.
13. Tanaka OM, Vitral RW, Tanaka GY, Guerrero AP, Camargo ES. Nailbiting,
or onychophagia: A special habit. Am J Orthod Dentofacial Orthop
2008;134:305-8.
How to cite this article: Sachan A, Chaturvedi TP. Onychophagia (Nail biting),
anxiety, and malocclusion. Indian J Dent Res 2012;23:680-2.
Source of Support: Nil, Conflict of Interest: None declared.

RETRACTION NOTICES

Rekha Rani Koduganti, N Sandeep, Srikanth Guduguntla, VSS Chandana Gorthi. Probiotics and prebiotics in
periodontal therapy. IJDR 2011, Volume 22, Issue 2, Pages 324-330
It has been brought to the notice of the IJDR editorial team, that the substantial portion of the above mentioned
article has been plagiarized (copied) from the article titled “Prospects for the development of probiotics and
prebiotics for oral applications”, J Oral Microbiol.v.1; 2009 and after due inquiry and unconvincing reply from the
authors the Indian J Dent Res has decided to retract the same from the issue.
• •
Devi Charan Shetty, Aadithya B Urs, Puneet Ahuja, Anshuta Sahu, Adesh Manchanda, Yuthicka Sirohi.
Mineralized components and their interpretation in the histogenesis of peripheral ossifying fibroma. Indian J Dent
Res 2011,Vol 22. Issue 1, Pages 56-61
It has been brought to the notice of the IJDR editorial team, that the substantial portion of the above mentioned
article has been plagiarized(duplicated)from the article published in Pathology and Laboratory Medicine
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and

Devi Charan Shetty, Aadithya B Urs, Adesh Manchanda, Yuthicka Sirohi. A color contrast aided density imaging
technique to differentiate between dental hard tissues and its relevance. Indian J Dent Res 2011, Volume 22,
Issue 2 , Pages 266-269 has also been plagiarized (multiple publication of articles) in The Internet Journal of
Radiology. 2010 Volume 12 Issue 1 and Journal of Indian Academy of Oral Medicine and Radiology, April-June
2010;22(2):102-104.

After due inquiry and unconvincing reply from the authors the Indian J Dent Res has decided to retract the above
mentioned articles from the issue as well as to ban the Authors from submission of manuscripts in Indian J Dent
Res for the next three years.
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