Oral Habits

• PRESENTED BY
• AHMED ALZAYAT
• MAHMOUD ELOKDA

Oral Habits
A habit can be defined as the tendency towards an act
that has become a repeated performance, relatively fixed,
consistent and easy to perform by an individual.
• Habits are thus acquired as a result of repetition. In the initial stages there is a
conscious effort to perform the act. Later the act becomes less conscious and if repeated
often enough may enter the realms of unconsciousness

Classification of habits

• Useful and harmful habits

• Empty and Meaningful habits
• Pressure, non pressure and biting habits
• Compulsive and Non compulsive habits
 Useful and harmful habits

Empty and Meaningful habits

• They are habits dose not • They are habits that have
associated with any deep a psychological bearing
rooted psychological
problems.
Pressure, non pressure and biting habits

Compulsive and Non compulsive habits

 OBSESSIVE
(DEEP ROOTED)

INTENTIONAL MASOCHISTIC
(MEANINGFUL
(SELF
)
INFLICTING)
NAIL BITING
GINGIVAL STRIPPING
LIP BITING
DIGIT
NON SUCKING
OBSESSIVE (EASILY
LEARNED & DROPPED)

UNINTENTIONA FUNCTIONAL
L
ABNORMAL PILLOWING TONGUE THRUSTING
CHIN PROPPING BRUXISM

Oral habits
• Thumb and Digid sucking
• TONGUE THRUST HABIT
• MOUTH BREATHING HABIT
• BRUXISM
• OTHER MINOR HABITS
Thumb and Digid sucking

• Definition
• Etiology
• Phases of development
• Effect of thumb sucking
• Diagnosis
• Management

Definition

• it is one of the commonly

seen habits that most children
indulge in. Recent studies
have shown that thumb
sucking may be practiced
even during intrauterine life.
The presence of this habit is
considered quite normal till
the age of 3.5-4 years.
Persistence of the habit
beyond this age can lead to
various malocclusions.
Etiology

• Sigmond Freudian theory> developmental phases

• Oral drive theory of Sears and Wise> prolonged
suckling
• Benjamin's theory >rooting or reflex
• Psychological aspects>deprived love
• Learned pattern

Phases of development

• Phase I: (Normal and sub-clinically significant)

• Phase 11: (Clinically significant sucking): The second
phase extends between 3 - 6 1/2 years of age > anxity
>treatement intiated
• Phase Ill : (Intractable sucking)
Photographs of a patient who indulged in thumb
sucking till the age of 9 years(A and
(B)Intraoral photographs (C) Lateral
cephalogram of the same patient

Photographs of
a 8 year old
patient with
thumb sucking
habit.
 Effect of thumb sucking

• Factors
• Duration
• Frequency
• Intensity

Effect of thumb sucking

• INTRA ORAL
• Labial tipping of the maxillary anterior
• The overjet increases due to proclination
• Anterior open bite
• Posterior crossbite
• The upper lip is generally hypotonic
• child may develop tongue thrust habit
 EXTRA ORAL

➢ Fungal infection on thumb

➢ Thumb nail exhibit dish pa appearance.
➢ Upper Lip: short, hypotonic
➢ Jaw: maxillary protrusion, mandibular retrusion
➢ Nasal floor : narrow
➢ Profile: straight
Diagnosis

• The parents should be questioned on the frequency and duration of the

habit
• An intra-oral clinical examination should record all the features seen
such as proclination , clean nail,…..etc

Management
• Psychological approach :Dunlop put forward a theory
called Beta hypothesis
Mechanical aids: reminding appliances fixed
or removable and finger guard

Chemical approach :
Pepper dissolved in a volatile medium
Quinine
Asafoetida
TONGUE THRUST HABIT

• Etiology of tongue thrust

• Classification of tongue thrust
• Clinical features
• Management of tongue thrust

Etiology of tongue thrust

• Genetic factors>specific anatomic or neuromuscular variations

• Learned behavior (habit)
• Maturational >The infantile swallow changes to a mature swallow
• Mechanical restrictions >macroglossia, constricted dental arches
and enlarged adenoids
• Neurological disturbance> hyposensitive palate and moderate
motor disability can cause tongue thrust habit.
• Psychogenic factors
Classification of tongue thrust
• Classification of tongue thrust by James Braner and holt
• Type I ,II,III,IV
SIMPLE CLASSIFICATION
SIMPLE
• The simple tongue
thrust is
characterized by a
normal tooth contact
during the
swallowing act.
• Presence of an
anterior open bite
• They exhibit good
COMPLEX
• This kind oftongue
thrust is characterized
by a teeth apart
swallow.
• The anterior open bite
can be diffuse
orAbsent
• Absence of temporal
muscle constriction
during swallowing.
 Clinical features

• Proclination of anterior teeth and Anterior open

bite
• Bimaxillary protrusion
• Posterior open bite in case of lateral tongue
• Posterior crossbite

(A) to (C)Patient with anterior tongue thrust. Note the resultant

spacing and proclination of the anteriors. There is also a anterior
open bite and a mild bimaxillary protrusion. (D) Lateral
cephalogram
 Management of tongue thrust

• Both fixed and removable cribs or rakes are valuable

aids in breaking the habit
• child is taught the correct method of swallowing.
• Various muscle exercise of the tongue can help in
training it to adapt to the new Habits
• Treatment of malocclusion
• Once the habit is intercepted the malocclusion associated
with the tongue thrust is treated using removable or fixed
orthodontic appliances.
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.
Most normal people indulge in mouth breathing when
they are under physical exertion such as during
strenuous exercise or sports

MOUTH BREATHING HABIT

• Classification of mouth breathers

• Pathophysiology
• Clinical features of mouth breathing
• Diagnosis of mouth breathing
• Management of mouth breathing
Classification of mouth breathers
• Mouth breathers can be classified into 3 types:
• Obstructive: .
• Deviated nasal septum
• Nasal polyps
• Chronic inflammation of nasal mucosa
• Localized benign tumors
• Congenital enlargement of nasal turbinates
• Allergic reaction of the nasal mucosa
• Obstructive adenoids

Classification of mouth breathers

• Habitual :continues to breathe through his mouth even

though the nasal obstruction is removed thus mouth
breathing becomes a deep-rooted habit that is performed
unconsciously
Classification of mouth breathers

• Anatomic An anatomic mouth breathers one whose lip

morphology does not permit complete closure of the mouth, such
as a patient having short upper lip.

Pathophysiology

• In wering of the mandible.

• Positioning the tongue downwards and forwards.
• Tipping back of the head.
Clinical features of mouth breathing

• Extra oral
• long face syndrome or classic adenoid facies
• Long and narrow face
• Narrow nose and nasal passage
• Short and flaccid upper lip
• An expressionless or blank face

• Intra oral
• Increased overjet as a result of flaring of the incisors
• Anterior marginal gingivitis can occur due to drying of the gingiva
• The dryness of the mouth predisposes to caries
• Anterior open bite can occur
Diagnosis of mouth breathing

• History:.
• Clinical examination: Look out for its various clinical features
• A number of simple tests such as the mirror test, water test
inductive plethysmography ,Cephalometrics and
Rhinomanometry

Management of mouth breathing

• Removal of nasal or pharyngeal obstruction

• Interception of the habit
• Rapid maxillary expansion
 BRUXISM

• CLASSIFICATION
• OCCURRENCE
• ETIOLOGY
• CLINICAL FEATURES
• MANAGEMENT

CLASSIFICATION

• Day Time Bruxism/Diurnal Bruxism

• Night Time Bruxism/Nocturnal Bruxism

OCCURRENCE

May commence in infancy with the eruption of the first primary

tooth Common occurrence is during sleep.
Incidence of bruxism in children varies widely from 7% to 88%.
ETIOLOGY

CNS This CNS phenomena was found in children with cerebral

palsy & mental retardation.

Psychological: A tendency of grind teeth associated with feeling

of hunger and aggression, hate, anxiety etc.
Occlusal discrepancy : Improper interdigitation of teeth lead to
bruxism.
systemic factor : Mg++ deficiency may lead to bruxism
Genetic.

CLINICAL FEATURES
Occlusal trauma
Pain in TMJ
Trauma to periodontium.
Masticatory muscle soreness.
Headache.
MANAGEMENT

ADJUNCTIVE THERAPY:-
Psychotherapy- Aim to lower the emotional disturbances.

Relining exercise - Serve to decrease muscle function Elimination

of oral pain & discomfort by giving ethyl chloride within the
tempromandibular joint area

Auto suggestion and Hypnosis: Where the patient becomes

conscious of his habit and understands the possible consequence

MANAGEMENT

OCCLUSAL THERAPY:

Occlusal adjustments: Bite raising crowns , splint sand

elimination of occlusal interference

Bite plates and splints

Occlusal reconstruction and prosthesis

Bite guard: Prevent abrasion of teeth

OTHER MINOR HABITS

Lip biting
• Lip biting and lip sucking sometimes appear after forced
discontinuation of thumb or finger sucking
following features
Proclined upper anteriors and retroclined lower anterior
Hypertrophic and redundant lower lip
Cracking of lips

Management

• This habit can be intercepted using lip bumpers that not only keep
the lips away but also improve the axial inclination of the anterior
teeth due to unrestrained action of the tongue.
References
• Bresolin, Shapiro, Shapiro, Chapko, and Dassel: Mouth breathing
in allergic children. Am J Orthod 1983;334-340
• Ellingsen, Vandevanter, Shapiro, and Shapiro : Tem poral
variation in breathing. Am J Orthod 1995;411.
• Fields, Warren, Black, and Phillips : Vertical mor
phology and respiration in adolescents. Am J Orthod
1991
• Hannuksela and VdånOnen : Predisposing factors
197-206for malocclusion as related to atopic
diseases. Am J 28. Weber, Preston, and Wright :
Resistance to nasal Orthod 1987 ; 299-303
airflow related to changes in head posture. Am J

CASE PRESENTATION

• CASE HISTORY
• Personal Data
• Name: Yasmin mohammed
• Started TTT at age :9
• Address: cairo
• Gender: Female
 CASE HISTORY

• Chief Complain: teeth spacing

• Medical History: Medically Free
• Dental History: restorations and
extraction
• Familial History: Free
• Growth status: CHILD
• Social behavior: Cooperative
• Expectations: Adjustment of teeth
• TMJ: No history of clicking &
tenderness, normal mouth opening

CLINICAL EXAMINATION
EXTRAORAL EXAMINATION

• Soft Tissue
• Profile: straight
• Facial type :mesiocephalic
• Lower facial height: normal
• Lips: competent
• Upper normal
• Lower normal
• Nose:
• Nasolabial angle : 98
• chin
• Mentolabial sulcus: (obtuse)
• Chin button: orthognathic
CLINICAL EXAMINATION
EXTRAORAL EXAMINATION

• Frontal View
• Symmetry: Symmetric
• Teeth show at rest: 0mm
• Teeth show at smile: 9.5mm
• Midlines: 1mm
• Upper on on facial
• Lower: on facial

CLINICAL EXAMINATION
INTRA ORAL EXAMINATION

• Frontal View with smile

• Teeth show at smile: 9.5mm
• Smile Arc: Normal
• Lip line: normal lip line
• Buccal Corridors: normal
• Golden Proportion: Absent
CLINICAL EXAMINATION
INTRA ORAL EXAMINATION
• Oral hygiene: fair
• Soft Tissues thin attached gingiva
• Eruption Problems: missing upper laterals
• Erupted Teeth Present:
• Spacing upper 4mm

CLINICAL EXAMINATION
INTRA ORAL EXAMINATION
STATIC & FUNCTIONAL OCCLUSAL EXAMINATION
• Incisor Relation: overlap • Midline Discrepancies:
• Overjet: reverse diastma_ 1.5mm
• Overbite: 1 mm • Upper: on facial
• Lower: on facial
CLINICAL EXAMINATION
INTRA ORAL EXAMINATION
STATIC & FUNCTIONAL OCCLUSAL EXAMINATION
Dental class I Posterior cross bite

DIAGNOSTIC RECORDS
PANORAMIC VIEW
DIAGNOSTIC RECORDS
LATERAL CEPHALOMETRIC RADIOGRAPH
 DIAGNOSTIC RECORDS
LATERAL CEPHALOMETRIC
RADIOGRAPH

• SNA: 74
• SNB: 74
• ANB: -0.2
• Interincisal angle: 132

FINAL • Maxillary retrusion

DIAGNOSIS AND • Posterior cross bite

Reverse overjet
PROBLEM LIST •

• Dental midline shift

Objective's
list

Treatment PLAN and SEQUENCE

• 3D expander with spring and a

posterior bite block