DEPARTMENT OF ORTHODONTICS

AND DENTOFACIAL ORTHOPEDICS

ORAL HABITS
Guided By: Dr. Varunjeet Choudhary
Submitted By: Ananya Saxena
BDS III Year
 ORAL HABITS

 Correcting bad habits cannot be done

by forbidding or by punishment.
 -Robert Baden-Powel
 INDEX
 1.Introduction
 2. Definition
 3. Classification
 4.General consideration
 5. Various habits
 6. Thumb/digit sucking
 7.Etiology
 8. Subtenly’s Classification of thumb sucking
 9. Phases of development
 10.Effects of thumb sucking
 11. Diagnosis
 12. Management
 13. Tongue thrusting
 14. Definition
 15.Etiology
 16.Facror’s affecting
 17.classification of tongue thrusting
 18.Clinical features
 19. Diagnosis
 20.Management
 INTRODUCTION
 Oral habits are habits that frequently
children acquire that may either
temporarily or permanently be harmful to
dental occlusion and to the supporting
structures.
 When habit causes defect in orofacial
structure it is termed as pernicious oral
habits.
 DEFINITION
 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 .
 CLASSIFICATION
(James. William 1923)

 Useful habits
 These include habits that are considered essential
for normal function such as proper positioning of
the tongue , respiration and normal deglutition.
 Harmful habits
 These include habits that have a deleterious effect
on the teeth and their supporting structures such
as thumb sucking , tongue thrusting , etc.., .
(EARNEST KLEIN -1971)
 Empty habits
 They are habits that are not associated
with any deep rooted psychological
problems.
 Meaningful habits
 They are habits that have a
psychological bearing.
(MORRIS AND BOHANA -1969)
 Pressure habits
 These include sucking habits such as thumb sucking ,
lip sucking ,finger sucking ,and also tongue thrusting.
 Non- Pressure habits
 Habits that do not apply a direct force on the teeth or
its supporting structures are termed as non pressure
habits .
 Ex- Mouth breathing
 Biting habits
 These include habits such as nail biting , pencil biting
and lip biting.
(FINN - 1958 )
 Compulsive habits
 These are deep rooted habits that have
acquired fixation in the child to the child that
it retreats to the habit whenever his security
is threatened by events around him. The
child tends to suffer increased anxiety
when attempts are made to correct it .
 Non-compulsive habits
 These are the habits that are easily learned
and dropped as the child matures.
(KINGSLEY -1956)
 Functional habits
 This includes Mouth breathing.
 Muscular Habits
 Cheek and lip biting and tongue thrusting .
 Combined muscular habits
 This include thumb and finger sucking.
 Postural habits
 Habits like abnormal pillowing and chin
propping .
( GRABER - 1972)
 He included all habits under extrinsic factors of
general causes of malocclusion .They are
 Thumb/Digit sucking
 Tongue thrusting
 Lip/Nail biting /bobby pin opening
 Mouth breathing
 Abnormal swallowing
 Speech Defects
 Postural defects
 Bruxism
 Defective occlusal habits
GENERAL CONSIDERATION
 Factors influencing the dento – alveolar
skeletal deformation :
 1.Frequency – more the child indulges his
habit each day, more the deformation .
 2.Duration – longer the child performs the
habit , greater the deformation .
 3. Intensity – more the force applied , more
the deformity.
 4.Direction and type – deformity results due
to the force vector applied to the bone.
 Various Habits
 Thumb Sucking
 Tongue Thrusting
 Mouth Breathing
 Bruxism
 Nail Biting
 Lip Biting
THUMB / Digit sucking
 Digit sucking is defined as the
placement of the thumb or one or more
finger in varying depths into the mouth .
 Thumb and digit sucking is one of the
most commonly seen habits that most
children indulge in .
 Recent studies have shown that thumb
sucking may be practiced even in
intrauterine life.
 ETIOLOGY
 A number of theories have been put
forward to explain why thumb sucking
occurs .
 5 Theories were put forward from time to
time they are :
 FREUDIAN THEORY
 This theory was proposed by Sigmund Freud.
He suggested that a child passes through
various distinct phases of psychological
development of which the oral and anal
phases are seen in the first three years of life.
In the oral phase, the mouth is believed to be
an oro – erotic zone. The child has tendency to
place his finger or any other object into oral
cavity. Prevention of such an act is believed to
result in emotional insecurity and poses the
risk of the child diversifying into the habits .
 ORAL DRIVE THEORY OF SEARS AND
WISE - in 1950 proposed that prolonged suckling
could lead to thumb sucking.
 BENJAMIN THEORY – has suggested that thumb
sucking arises from the rooting or placing reflex seen in
all mammalian infants. This rooting reflex disappear in
normal infants around 7-8 months of age.
 PSYCHOLOGICAL THEORY – children
deprived of parental love, care and affection are
believed to resort to this habit due to a feeling of
insecurity.
 LEARNED PATTERN – thumb sucking is merely a
learned pattern with no underlying cause or
psychological bearing.
 Classification
BASED ON OUR CLINCAL
OBSERVATION
1. Normal thumb sucking
 Normal during the first and second year of
life
 Disappears as the child matures.
 Habit at this age does not produce any
malocclusion .
 2. Abnormal thumb sucking

 When thumb sucking habit persists

beyond the preschool period then it is
consider to be an abnormal habit .
 If not treated may result in deleterious
effects to the dento –facial structures.
 This can be again:
 Psychological
 Habitual
SUBTENLY’S CLASSIFICATION OF
THUMB SUCKING
 He classified them into 4 types:
 TYPE A
 Seen in 50% of children .
 This type is characterized by the major part of
the thumb placed inside the mouth (beyond the
first knuckle or joint) with the pad of the thumb
pressing against the tissue or alveolar mucosa.
The lower anterior contacted the thumb beyond
the first knuckle or joint.
 TYPE B
 Seen in 13 -24% of children.
 Major portion of thumb ( up to the first joint ) is
placed inside the mouth without touching the
palate maintaining the maxillary and mandibular
anterior contact .
 TYPE C
 Seen in 18% of children .
 Major portion of thumb is inserted into the
mouth just beyond the first joint, contacting
the hard palate and only thr maxillary
incisors

 TYPE D
 Seen in 6% of children .
 only little portion of thumb is inserted into
the mouth.
 The lower incisor makes the contact at the
approximate level of the thumbnail
PHASES OF
DEVELOPMENT
 Phase 1
 Presence of thumb sucking at this phase is
considered quite normal and usually
terminates at the end of phase one .
 Phase 2
 Presence of thumb sucking at this stage
indicates great anxiety in the child. Treatment
to resolve the dental problem should be
initiated at this stage.
 Phase 3
 Might indicate the underlying psychological
aspect of the habit . A psychologist might have
to be consulted at this phase.
EFFECTS OF THUMB SUCKING
 1.Labial tipping of the maxillary anterior
teeth resulting in proclination of maxillary
anterior .
 2. The overjet increase due to proclination
of the maxillary anteriors. Some children
rest their hand on the mandibular
anteriors during the sucking act. In such
children lingual tipping of the mandibular
incisors cab be expected which further
increases the overjet.
 3.Anterior open bite can occur as a result of
restriction of incisor eruption and supraeruption
and of the buccal teeth.
 4. The cheek muscles contract during the thumb
sucking resulting in a narrow maxillary arch,
which predisposes to posterior cross bite.
 5.The child may develop tongue thrust as a
result of open bite.
 6. The upper lip generally hypotonic while the
lower part of the face exhibits hyperactive
mentalis activity.
 DIAGNOSIS
 The parents should be questioned on the
frequency and duration of the habit.
 The child’s emotional status should be
assessed by enquiring into such things as:
 A. Feeding habits
 B. Parental care of the child.
 C. Whether the parents are working.
 Presence of clean nails and callus on the
fingers .
 An Intraoral examination.
EXAMINATION
MANAGEMENT OF THUMB
SUCKING
 PSYCHOLOGICAL APPROACH
 Parents should be counseled to provide
the child with adequate love and
affection.
 Parents and Dentist should seek to
motivate the child.
 DUNLOP’S BETA HYOPTHESIS
 The best way to break the habit is by its
conscious , purposeful repetition.
Thermoplastic thumb sheilds can be used
to break thumb sucking habit

Guard can also used to

restrict the movement of
the hand
MECHANICAL AIDS
FIXED HABIT BREAKERS
 1. FLAT CRIB

 2. VERTICAL CRIB
3.VERTICAL RAKE APPLIANCE


 4. BLUE GRASS APPLIANCE

 This thumb sucking appliance is designed

with a Teflon roller. It prevents thumb
sucking action and comfort the child.
CHEMICAL AAPROACH
 Use of bitter tasting or Foul
smelling preparation placed on
the thumb that is sucked can
make the habit distasteful. The
medicaments can be used are
TONGUE THRUSTING
Definition
 Tongue thrusting is defined as a
condition in which the tongue
makes contact with any teeth
anterior to the molars.
ETIOLOGY
 Factor’s affecting
 Fletcher has proposed the following
factors as being the cause for tongue
thrusting.

 A. Genetic causes – specific anatomic

or neuromuscular variation in the oro-
facial region that can precipitate tongue
thrust .
 Ex- hypertonic orbicularis oris activity.
 B. Learned behavior habit - tongue thrusting can be acquired as
a habit .
 Factors leading to it are :
 1. Improper bottle feeding
 2. Prolonged thumb sucking
 3. Prolonged tonsillar and upper respiratory tract infections.
 4. Prolonged duration of tenderness of gum or teeth.

C. Maturational – tongue thrust can be a part of normal

childhood behavior .The infantile swallows swallow
changes to mature swallow once the posterior
deciduous teeth starts to erupt , but sometimes the
maturation is delayed and thus infantile swallow persists.
D. Mechanical restriction

 Presence of certain condition such as

macroglossia , constructed dental arches and
enlarged adenoids can be the cause .
 E. Neurological disturbances – hypo –sensitive
palate and moderate motor disability can cause
tongue thrusting

 . F. Psychogenic factors – sometimes it occurs as

a result of forced discontinuation of thumb sucking
CLASSIFICATION OF TONGUE THRUSTING

 According to James S. Braner and Holt

 Type 1 – Non deforming tongue thrust.
 Type 2 – Deforming anterior tongue
thrust.
 Type 3- Deforming lateral tongue thrust.
 Type 4- Deforming anterior, and lateral
tongue thrust.
Tongue thrust can also be classified as :
 Simple tongue thrust
○Comple
x tongue
trust

( fig- complex tongue thrust is

characterized by teeth apart
swallow)
 ( anterior open bite )
SIMPLE TONGUE THRUST
 The simple tongue thrust is
characterized by normal tooth contact
during swallowing.
 Presence of an anterior open bite.
 They exhibit good intercuspation of
teeth.
 The tongue is thrust forward during
swallowing to help establish an anterior
lip seal.
 COMPLEX TONGUE THRUST
 This is defined as tongue thrust with teeth apart
swallow. The malocclusion associated with it has two
distinct characteristics.
 Poor occlusal fit resulting in a slide into occlusion.
 There is generalized anterior open bite .
 Absence of temporal muscle contracting during
swallowing.
 There is dropping of mandible and strong contraction
during swallowing.
 Prognosis is for correction of a complex tongue thrust is
fair at best, as there are two neuromuscular problems.
 An abnormal occlusal reflex.
 An abnormal swallow reflex.
CLINICAL FEATURES -EXTRA ORAL

 1. Lip posture –lip separation is more both

at rest and in function.
 2.Mandibular movement – path of
mandible movement is upward and
backward with tongue movement forward.
 3.Speech –lip sync problem in articulation
of s/n/t/d/1/th/z/v.
 (a) Facial forms –increase anterior facial
height.
 INTRA ORAL
 1. Tongue posture – tongue tip at rest is lower because of
anterior open bite present .
 2.Tongue movement – movement is irregular from one
swallow to another.
 3.Malocclusion
 In maxilla
 -proclination of maxillary anterior
 An increased overjet
 Maxillary constriction
 Generalized spacing between teeth.
 In mandible
 - retro inclination of mandible
 DIAGNOSIS
 History –
 Determine the swallowing pattern of the
sibling and parents to check for the
hereditary etiologic factor.
 Information regarding upper respiratory
infections, sucking habits.
 Examination-
 Patient seated upright - with a little water
placed in patients mouth and is asked to
swallow it
 During normal swallowing pattern:
 Lip touch each other.
 Mandible rise as the teeth are brought
together.
 Check for any contraction in the facial
muscles.
 During abnormal swallowing :
 Check for –
 Teeth are apart
MANAGEMENT OF TONGUE
THRUSTING
 It involves interception of the habit
followed by treatment to correct the
malocclusion.
 HABIT INTERCEPTION
 The tongue thrust can be intercepted by the use
of habit breaker .
 Both fixed and removable cribs are used.
 The child is taught the correct method
of swallowing.
 Various muscle exercise of tongue can
help in training and in adapting the new
swallowing pattern
Neuromuscular exercises are used to
retrain the lips, tongue and facial
muscles , teaching them to rest in the
proper place.
REFERENCE:
 Sky Dental
 Dental Hub
THANK YOU