2. 1. Habit may be defined as ‘a constant settled practice or
custom, established by the repetition of the same act.’
2. 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.’
3. William James has written - ‘an acquired habit from a
psychological point of view, is nothing but a new pathway
of discharge formed in the brain, by which certain in -
coming currents, then tend to escape.’
4. A repeated static or functional exercise or ritual is defined
as a habit.
DEFINITIONS
4. BARRETTE CLASSIFICATION
INTRA – ORAL EXTRA – ORAL
1. DIGIT SUCKING
2. TONGUE THRUSTING
3. MOUTH BREATHING
4. BRUXISM
5. NAIL BITING
6. LIP – CHEEK BITING
1. CHIN PROPPING
2. FACE LEANING ON
HEAD
3. ABNORMAL PILLOW
POSITIONING
4. HABITUAL SLEEPING
ON ONE SIDE OF
FACE
5. THUMB SUCKING
DEFINITION – DIGIT SUCKING IS DEFINED AS ‘THE PLACEMENT OF
THE THUMB OR ONE OR MORE FINGERS IN VARYING DEPTHS INTO
THE MOUTH.’
• THE HABIT IS CONSIDERED NORMAL TILL THE AGE OF 3 – 4
YEARS
• IF THE HABIT PERSISTS BEYOND THIS AGE, IT CAN LEAD TO
VARIOUS MALOCCLUSIONS.
6. THE CLINICAL ASPECT OF THE PROBLEM MAY BE
DIVIDED INTO 3 DISTINCT PHASES OF DEVELOPMENT
1. PHASE I = NORMAL AND SUB – CLINICAL SIGNIFICANT SUCKING
(FROM A CHILDS BIRTH TO 3 YEARS OF AGE)
2. PHASE II = CLINICAL SIGNIFICANT SUCKING
(FROM 3 – 7 YEARS) – TIME TO SOLVE DENTAL PROBLEMS
RELATED TO DIGIT SUCKING
3. PHASE III = INTRACTIBLE SUCKING
(THUMB SUCKING WHICH PERSISTS AFTER 7 YEARS OF AGE) – AN
INTEGRATED APPROACH BY DENTIST, PSYCHOLOGIST AND
PHYSICIAN IS REQUIRED
7. ETIOLOGY – COMMON THEORIES
FREUDIAN THEORY – ‘SIGMOND FREUD’ PROPOSED THAT A CHILD GOES
THROUGH VARIOUS DISTINCT PHASES OF PSYCHOLOGICAL
DEVELOPMENT OF WHICH ORAL AND ANAL PHASES ARE IN THE FIRST 3
YEARS OF AGE. IN THE ORAL PHASE, IT IS BELIEVED THAT THE MOUTH IS
THE CENTRE OF ATTRACTION. DURING THIS PHASE, THE CHILD TAKES
ANYTHING AND EVERYTHING TO THE ORAL CAVITY.
ORAL DRIVE THEORY OF ‘SEARS’AND ‘WISE’ – IN 1950, THEY PROPOSED THAT
PROLONGED SUCKLING CAN LEAD TO THUMB SUCKING.
BENJAMIN’S THEORY – IN KEEPING WITH FREUDIAN HYPOTHESIS, SUGGESTED
THAT, SUCKING INCREASES THE ERATOGENESIS TO ALL MAMMALIAN INFANTS.
BEHAVIOURAL THEORY –
ENGEL’S THEORY –
8. EFFECT OF THUMB SUCKING ON DENTITION AND FACIAL
SKELETON -
THE TRIDENT FACTORS
1. DURATION
3. INTENSITY
2. FREQUENCY
OTHER FACTORS -
1. POSITION OF THUMB OR FINGERS IN MOUTH
2. ASSOCIATED MUSCLE CONTRACTION OF THE LIPS
AND CHEEKS
9. EFFECTS OF THUMB SUCKING
• PROCLINED MAX. ANT. TEETH
• INCREASED OVERJET
• ANTERIOR OPEN BITE
• NARROW MAX. ARCH DUE TO
CONTRACTION OF CHEEK MUSCULATURE AND POST. CROSSBITE
• DEVELOPMENT OF TONGUE THRUST HABIT DUE TO
ANT. OPEN BITE
• HYPOTONIC UPPER LIP AND HYPERACTIVE MENTALIS MUSCLE
ACTIVITY.
10. DIAGNOSIS -
THE PARENTS SHOULD BE QUESTIONED ON THE FREQUENCY AND
DURATION OF THE HABIT. THE CHILD’S EMOTIONAL STATUS SHOULD
BE ASSESSED BY ENQUIRING ABOUT – FEEDING HABITS, PARENTAL
CARE OF THE CHILD, WHETHER THE PARENTS ARE WORKING?
AN INTRA – ORAL CLINICAL EXAMINATION WILL REVEAL THE
PRESENCE OF THUMB SUCKING HABIT. CLEAN NAILS AND CALLUS
ON FINGER IS GENERALLY ASSOCIATED WITH THIS HABIT.
11. MANAGEMENT OF THUMB SUCKING
1. PSYCHOLOGICALAPPROACH –
• PARENTAL COUNSELLING
• DUNLOP’S ‘BETA HYPOTHESIS’
2. MECHANICAL AIDS –
• THESE ARE REMINDER APPLIANCES THAT ASSIST THE CHILD IN LEAVING
HIS HABIT, WHICH HAS ENTERED A SUB-CONSCIOUS LEVEL.
I REMOVABLE - REM. TONGUE CRIB (CAGE,FENCE,CURTAIN,HAYRAKE)
II FIXED - SOLDERED CRIBS
3. CHEMICAL APPROACH –
• USE OF BITTER TASTING OR FOUL SMELLING PREPARATION IS PLACED
ON THE THUMB.
• MEDICAMENTS – 1 PEPPER DISSOLVED IN A VOLATILE MEDIUM
2 QUININE 3 ASAFETIDA
12. TONGUE THRUST HABIT
DEFINITION –
TONGUE THRUST IS DEFINED AS ‘A CONDITION IN WHICH
THE TONGUE MAKES CONTACT WITH ANY TEETH ANTERIOR
TO THE MOLARS, DURING SWALLOWING’.
13. ETIOLOGY
‘FLETCHER’ HAS CLASSIFIED THE ETIOLOGICAL FACTORS
1. GENETIC
2. LEARNED BEHAVIOUR (HABITS)
3. MATURATIONAL
4. MECHANICAL RESTRICTIONS
5. NEUROLOGICAL DISTURBANCE
6. PSYCHOGENIC FACTORS
• INHERITED VARIATIONS IN OROFACIAL FORM PRECIPITATES A
TONGUE THRUST PATTERN
• INHERITED ORBICULARIS ORIS HYPERTROPHY
• GENETICALLY PREDETERMINED PATTERN OF MOUTH BEHAVIOUR
1. GENETIC
14. 2. LEARNED BEHAVIOUR (HABITS)
• IMPROPER BOTTLE FEEDING
• PROLONGED THUMB SUCKING
• PROLONGED TONSILLAR AND UPPER RTI
• PROLONGED GUM OR TEETH TENDERNESS, RESULTING IN A
CHANGE OF SWALLOWING PATTERN
3. MATURATION
• TONGUE THRUST CAN PRESENT AS PART OF A NORMAL
CHILDHOOD BEHAVIOUR, THAT IS GRADUALLY
MODIFIED AS THE AGE ADVANCES
• THE INFANTILE SWALLOW CHANGES TO A MATURE SWALLOW
ONCE THE POSTERIOR DEC. TEETH START ERUPTING
• SOMETIMES, THE MATURATION IS DELAYED AND THE
INFANTILE SWALLOW PERSISTS FOR A LONGER TIME
15. 4. MECHANICAL RESTRICTION
• MACROGLOSSIA
• CONSTRICTED DENTAL ARCHES
• ENLARGED ADENOIDS
5. NEUROLOGICAL DISTURBANCES
• ‘HYPOSENSITIVE PALATE’ PRECIPITATES, CRUDE PATTENS OF
FOOD MANIPULATION AND SWALLOWING
• THERE IS DISRUPTION IN THE TACTILE SENSORY CONTROL AND
CO- ORDINATION OF SWALLOWING, BECAUSE OF INADEQUATE
UNDERLYING SKELETODENTAL CONFIGURATION
• MODERATE MOTOR DISABILITYAND LOSS OF PRECISION IN ORAL
FUNCTION
16. 6. PSYCHOGENIC FACTORS
• SUBSTITUTION OF TONGUE THRUST FOR FORCIBLY
DISCONTINUATION OF FINGER SUCKING
• EXAGGERATED MOTOR IMAGE OF TONGUE
LEWIS (1965) – 97% OF NEW BORN INFANTS HAVE TONGUE
THRUST
FLETCHER (1961) – 25 - 30% CHILDREN WITHIN 9 YEARS OF AGE,
HAVE A TONGUE THRUST HABIT OF SOME
TYPE
17. CLASSIFICATION OF TONGUE THRUST
TYPE I
TYPE II
TYPE III
TYPE IV
NONDEFORMING TONGUE THRUST
DEFORMING ANT. TONGUE THRUST
SUB GROUP 1 : ANT. OPEN BITE
SUB GROUP 2 : ANT. PROCLINATION
SUB GROUP 3 : POSTERIOR CROSS BITE
DEFORMING LAT. TONGUE THRUST
SUB GROUP 1 : POST. OPEN BITE
SUB GROUP 2 : POST. CROSS BITE
SUB GROUP 3 : DEEP OVERBITE
DEFORMING ANT. & LAT. TONGUE THRUST
SUB GROUP 1 : ANT. & POST. OPEN BITE
SUB GROUP 2 : PROCLINATION OF ANT.
SUB GROUP 3 : POST. CROSS BITE
BY –
‘BRANER’AND ‘HOLT’
18. NORMAL INFANTILE SWALLOW
• TONGUE LIES BENEATH THE GUM PADS
• MANDIBLE IS STABILIZED BY CONTRACTION OF FACIAL MUSCLES
• BUCCINATOR ACTIVITY IS STRONG DURING INFANTILE SWALLOW
• IT IS SEEN IN NEONATE AND GRADUALLY DISAPPEARS WITH THE
ERUPTION OF THE BUCCAL TEETH IN PRIMARY DENTITION
• IT IS ALSO CALLED AS ‘TRANSITIONAL SWALLOW’
NORMAL MATURE SWALLOW
• THERE IS VERY LITTLE LIP AND CHEEK ACTIVITY
• CONTRACTION OF MANDIBULAR ELEVATOR MUSCLES BRING
TEETH INTO OCCLUSION
19. SIMPLE TONGUE THRUST SWALLOW
• CONTRACTION OF THE LIPS, MENTALIS MUSCLE AND MANDIBULAR
ELEVATOR MUSCLES
• TEETH ARE IN OCCLUSION, AS THE TONGUE PROTRUDES INTO AN
OPEN BITE
• THERE IS GOOD INTERCUSPATION OF POSTERIOR TEETH AND GOOD
OCCLUSAL FIT
COMPLEX TONGUE THRUST SWALLOW
• IT IS ALSO CALLED AS TEETH APART SWALLOW
• THERE IS CONTRACTION OF LIP, FACIAL AND MENTALIS MUSCLE
• NO CONTRACTION OF MANDIBULAR ELEVATOR MUSCLES
• THERE IS POOR OCCLUSAL FIT AND STABILITY OF INTERCUSPATION
20. CLINICAL FEATURES - 1
1. PROCLINATION OF ANTERIOR TEETH
2. ANTERIOR OPEN BITE
3. BIMAXILLARY PROTRUSION
21. 3. POSTERIOR OPEN BITE IN CASES OF
LATERAL TONGUE THRUST
4. POSTERIOR CROSS BITE
CLINICAL FEATURES - 2
22. PALATOGRAPHIC EXAMINATION OF THE TONGUE
‘GUM ARABICAAND FLOUR’ WERE MIXED AND PAINTED ON THE
TONGUE. AFTER SOME TONGUE EXERCISES, THE CONTACTS ON THE
PALATE AND TEETH WERE THEN TRANSFERRED TO THE CAST
INDIRECT METHOD – GIVEN BY KINGSLEY
KINGSLEY USED THE UPPER PLATE MADE OF ‘BLACK INDIA RUBBER’
AND COVERED THE TONGUE USING A MIXTURE OF CHALK PASTE AND
LATER TRANSFERRED IT TO THE CAST
‘CURRENT DIRECT METHOD’
A VERY THIN LAYER OF PRECISION IMPRESSION MATERIAL IS COATED
ON THE TONGUE AND THE FUNCTIONAL MOVEMENTS OF THE TONGUE
IS PERFORMED
DIRECT METHOD – GIVEN BY OAKLEY COLES (1873)
23. CINE FLUROGRAPHIC ANALYSIS OF THE TONGUE
IN THIS METHOD, THE TIP OF THE TONGUE IS COATED WITH A BARIUM
SOLUTION. WHEN THE PATIENT IS ASKED TO SWALLOW, A
CINEFLUROGRAPHIC CAMERA IS STARTED WHICH SHOOTS AROUND 240
FRAMES/SEC. THE WHOLE SWALLOWING CYCLE TAKES A SECOND. THE
TOTAL PROCESS IS MONITORED ON A TV SCREEN
ELECTROMYOGRAPHY
IT PROVIDES A MORE OBJECTIVE AND DEFINITE MEAN OF APPRAISING
MUSCLE ACTIVITY BEFORE, DURING AND AFTER ORTHODONTIC
THERAPY
ELECTROMYOGRAPH IS AN APPRAISAL OF THE ELECTRICAL ACTIVITY OF
THE MUSCLES. THE ABILITY TO PICKUP, AMPLIFY AND RECORD
ELECTRICAL DISCHARGES FROM MUSCLE ACTIVITY WITH MINIMAL
DISTORTION
PARTS – CRYSTOGRAPHIC INK WRITING RECORDER, CATHODE RAY
OSCILLOSCOPE, MAGNETIC TAPE RECORDER, SURFACE HOOK AND
NEEDLE TYPE ELECTRODES
24. MANAGEMENT OF TONGUE THRUST
• HABIT BREAKING FIXED/REMOVAL
APPLIANCES (CRIBS OR RAKES) ARE GIVEN. IN SOME CASES
MYOFUNCTIONAL APPLIANCES MAY ALSO BE USED
• IN RARE CASES, A TRIANGULAR WEDGE SHAPED PART OF THE
TONGUE MAY BE SURGICALLY REMOVED OR DETACHMENT OF
GENIOGLOSSUS MUSCLE MAY BE PERFORMED
• THE CHILD IS TAUGHT THE CORRECT METHOD OF SWALLOWING
• VARIOUS MUSCLE EXERCISES ARE PRESCRIBED
1. HABIT INTERCEPTION
2. TREATMENT OF MALOCCLUSION
• ONCE THE HABIT IS INTERCEPTED, THE MALOCCLUSION ASSOCIATED
WITH THE TONGUE THRUST MAY BE TREATED, WITH A
REMOVABLE/FIXED ORTHODONTIC APPLIANCE
25. MOUTH BREATHING
• MOUTH BREATHING MAY 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 STRENOUS
EXERCISE OR SPORTS ACTIVITY.
26. ETIOLOGY/CLASSIFICATION OF MOUTH BREATHERS
OBSTRUCTIVE
HABITUAL
ANATOMIC
NASAL OBSTRUCTION
• DEVIATED NASAL SEPTUM
• NASAL POLYPS
• CHRONIC INFLAM. OF NASAL MUCOSA
• LOCALIZED BENIGN TUMOURS
• CONGENITAL ENLARGEMENT OF
NASAL TURBINATES
• ALLERGIC REACTION OF THE NASAL
MUCOSA
• OBSTRUCTIVE ADENOIDS
A PERSON WHO CONTINUES TO BREATHE
THROUGH HIS MOUTH, EVEN THOUGH
THE NASAL OBSTRUCTION IS REMOVED
A PERSON WHOSE LIP MORPHOLOGY
DOES NOT PERMIT COMPLETE CLOSURE
OF THE MOUTH, SUCH AS A PATIENT
HAVING SHORT UPPER LIP
27. PATHOPHYSIOLOGY
1. LOWERING OF THE MANDIBLE
2. POSITIONING OF THE TONGUE DOWNWARDS
3. TIPPING BACK OF THE HEAD
DURING ORAL RESPIRATION, THE FOLLOWING THREE CHANGES IN
THE POSTURE OCCUR -
CLINICAL FEATURES OF MOUTH BREATHERS
1. LONG AND NARROW, ‘PIGEON LIKE’ LEPTOPROSOPIC FACE
2. NARROW NOSE AND NASAL PASSAGE
3. SHORT AND FLACCID UPPER LIP
4. CONTRACTED UPPER ARCH WITH POSSIBILITY OF POST. CROSS BITE
5. AN EXPRESSIONLESS FACE
6. INCREASED OVERJET
7. ANT. MARGINAL GINGIVITIS CAN OCCUR DUE TO DRYING OF GINGIVA
8. DRYNESS OF MOUTH, PREDISPOSES TO CARIES
9. ANT. OPEN BITE CAN OCCUR
28. DIAGNOSIS OF MOUTH BREATHERS
1. HISTORY – PATIENTS AND PARENTS
2. CLINICAL EXAMINATION – MIRROR TEST AND WATER TEST
3. CEPHALOMETRICS – SIZE OF ADENOIDS,
NASOPHARYNGEAL SPACE ,AND
LONG FACE, CAN BE TRACED
4. RHINOMANOMETRY – IT IS THE STUDY OF NASAL AIR
FLOW.
FLOW METERS AND
PRESSURE GAUGES HELP IN
ESTIMATION OF AIR FLOW
THROUGH THE NASAL PASSAGE
AND NASAL RESISTANCE
29. MANAGEMENT OF MOUTH BREATHING
1. REMOVAL OF NASAL OBSTRUCTION (ENT)
2. INTERCEPTION OF THE HABIT (ORAL SCREEN)
3. RAPID MAXILLARY EXPANSION (RME) OR
MAXILLARY PROTRACTION APPLIANCE CAN BE
GIVEN, IF THE MAXILLARY ARCH IS CONSTRICTED
31. BRUXISM
DEFINITION -
BRUXISM HAS GENERALLY BEEN DEFINED AS CLENCHING OR
GRINDING OF THE DENTITION DURING NON – FUNCTIONAL
MOVEMENTS OF THE MASTICATORY SYSTEM
PREVALENCE -
‘ROLAND ATTANASIO’ =
7 – 88% IN CHILDREN
15 – 90% IN THE ADULT POPULATION
‘FROHMAN’ (1931) WAS PROBABLY THE FIRST TO USE THE WORD BRUXISM
32. ETIOLOGY
1. PSYCHOLOGICAL AND EMOTIONAL STRESS
2. OCCLUSAL INTERFERENCE
3. PERICORONITIS AND DENTAL PAIN MAY TRIGGER BRUXISM
CLINICAL FEATURES
1. OCCLUSAL WEAR FACETS
2. FRACTURE OF TEETH AND RESTORATIONS
3. TEETH MOBILITY
4. TENDERNESS AND HYPERTROPHY OF MASTICATORY MUSCLES
5. MUSCLE PAIN
6. TMJ PAIN
DIAGNOSIS
1. HISTORY AND CLINICAL EXAMINATION
2. OCCLUSAL PREMATURATIES CAN BE DIAGNOSED BY
ARTICULATING PAPER
3. EMG – TO CHECK FOR HYPERTROPHY WITH MUSCLES OF
MASTICATION
33. MANAGEMENT OF BRUXISM
1. EMOTIONALAND PSYCHOLOGICAL DISTURBANCE HAVE TO BE
ADDRESSED
2. HYPNOSIS, RELAXING EXERCISES A ND MASSAGE CAN RELIEVE
MUSCLE TENSION
3. OCCLUSAL ADJUSTMENTS MIGHT BE REQUIRED TO ELIMINATE
PREMATURATIES
4. NIGHT GUARDS OR OCCLUSAL SPLINTS MAY BE REQUIRED
34. NAIL BITING
IN A STUDY OF ‘WECHSLER’ –
43% OF ADOLESCENTS
25% OF COLLEGE STUDENTS
FOLD (1964) –
• NAILBITING DOES NOT PRODUCE ANY GROSS MALOCCLUSION
• NAILBITING CAUSES CROWDING, WEAR OF INCISAL EDGE
AND ROTATION OFANT. TEETH
35. LIP-CHEEK BITING
• LIP BITING AND LIP SUCKING MAY APPEAR AFTER FORCED
DISCONTINUATION OF THUMB OR FINGER SUCKING
• IT USUALLY INVOLVES LOWER LIP, WHICH IS TURNED INWARDS
36. CLINICAL FEATURES
1. PROCLINED UPPER ANTERIORS
2. RETROCLINED LOWER INCISORS
3. HYPERTROPHIC LOWER LIP
4. CRACKING OF LIPS
MANAGEMENT
1. LIP BUMPER
2. ORAL SCREEN, ETC.
37. EXTRA ORAL HABITS
1. DAVIDIAN (1957) –
BILATERAL PRESSURE AGAINST THE MANDIBLE PRODUCED BY
LEANING ON BOTH HANDS, RESTRICTS THE FORWARD MANDIBULAR
GROWTH AND RESULTS IN A BILATERAL CROSS - BITE
2. FLUHRER (1957) –
CHIN LEANING CAUSES THE BITE TO BE CLOSED, IF THE PRESSURE IS
EXERTED ON THE UNDERLYING CHIN
3. GINGFOLD (1964) –
HABITUAL NECK AND HEAD POSTURE MAY CAUSE LOWER INCISOR
CROWDING AND LINGUAL INCLINATION OF TEETH. WHEREAS, SLEEPING ON
ONE SIDE OF THE FACE CAN RESULT IN ASYMMETRIES
38. 4. BARRETT AND HANSEN –
SOME PATIENTS SLEEPING ON A LOW PILLOW MAY DEVELOP AN OPEN
MOUTH POSITION, AS THE TONGUE RESTS IN THE MANDIBULAR
ARCH AND MOVES FORWARD AGAINST THE TEETH DURING
SWALLOW. WHEREAS, WITH A HIGH PILLOW, CLOSED MOUTH
POSTURE IS MORE LIKELY
5. DEWEL (1960) –
A LATERAL TONGUE THRUST MAY DEVELOP FROM HABITUALLY SLEEPING
ON ONE SIDE
39. INTRA – ORAL EXTRA – ORAL
1. DIGIT SUCKING
2. TONGUE THRUSTING
3. MOUTH BREATHING
4. BRUXISM
5. NAIL BITING
6. LIP – CHEEK BITING
1. CHIN PROPPING
2. FACE LEANING ON
HEAD
3. ABNORMAL PILLOW
POSITIONING
4. HABITUAL SLEEPING
ON ONE SIDE OF
FACE
BRIEF REVIEW
