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1. ORAL HABIT
“ Correcting bad habits cannot be
done by forbidding or
punishment”
-Robert Baden-Powell
Chinthamani Laser Dental Clinic

2. DEFINITION
Oral habit is defined as a
frequent or constant
practice or acquired
tendency, which has been
fixed by frequent
repetition. – Buttersworth
(1961)

3. CONTENTS
Thumb
sucking
Tongue Thrusting
Mouth Breathing
Bruxism
Lip Habit
Cheek Biting
Nail Biting

4. THUMB SUCKING

5. Definition
Classification
Etiology
Diagnosis
Clinical
feature
Prevention
Treatment

6. DEFINITION
Thumb sucking is define as placement of
the thumb at various depths into the
mouth.

7. CLASSIFICATION
Based on our clinical observation,
1.NORMAL THUMB SUCKING:
•
Normal during the first and second year of life.
•
Disappear as the child matures.
•
Habit at this age does not generate any malocclusion.
2.ABNORMAL THUMB SUCKING :
•
When thumb sucking habit persist beyond the preschool
period then it is consider to be an abnormal habit .
•
If not controlled or treated may cause deleterious effects to
the dento facial structures .

8. This can be again :
Psychological.
Habitual.
Can also be classified by Subtenly as :
o Type A : seen in 50% children. Whole
digit is placed inside the mouth with pad
of thumb pressing over the palate, at the
same time maxillary and mandibular
anteriors contact is present.

9. o
o
o
Type B : seen in 13-24% children.thumb placed
in the mouth without touching the palate
maintaining the maxillary and mandibular
anterior cantact.
Type C : seen in 18% children. Thumb is placed
into the mouth just beyond the first joint,
contacting the hard palate and only the maxillry
incisors.
Type D : seen in 6% children where little
portion of thumb is placed into the mouth.

10. CLINICAL FEATURES
PROCLINATION
OF MAXILLARY
INCISIORS
ANTERIOR OPEN BITE
POSTERIOR CROSS
BITE
CONSTRICTION OF
MAXILLARY ARCH
Maxillary Anterior
Proclination and
Mandibular
Retroclination.

11. TREATMENT
BLUE GRASS
HABIT
APPLIANCE BREACKING
APPLIANCES
QURD HELIX
THUMB GUARD

12. TONGUE THRUSTING

13. DEFINITION
Brauer , 1965- A tongue thrust is said to be
present if the tongue is observed thrusting
between, and the teeth do not close in centric
occlusion during deglutition.
• Tulley , 1969- States tongue thrust as the
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 becomes interdental.
•

14. Barber , 1975- Tongue thrusting is an oral
habit pattern related to the persistence of an
infantile swallow pattern during childhood and
adolescence and thereby produces an open
bite and protrusion of the anterior tooth
segments.
• Schneider , 1982- tongue thrust is a forward
placement of the tongue between the anterior
teeth and against the lower lip during
swallowing,
•

15. 1.
CLASSIFICATIO
N
Physiologic: normal tongue thrust of the
infancy.
2. Habitual : the tongue thrust swallow is
present as a habit even after the correction
of the malocclusion.
3. Functional : when the tongue thrust
mechanism is an adaptive behavior
developed to achieve an oral seal, it can be
grouped as functional .
4. Anatomic : persons having enlarged tongue
can have an anterior tongue posture.

16. •
•
•
•
•
•
•
•
ETIOLOGY
Retained infantile swallow
Upper respiratory tract infections such as
mouth breathing, chronic tonsillitis , allergies,
etc…
Neurological disturbances- hyposensitive
palate , moderate motor disability, disruption
of sensory control and coordination of
swallowing can lead to tongue thrust.
Functional adaptability to transient change in
anatomy.
Feeding practices and tongue thrusting
Induced due to other oral habits
Hereditary

17. CLINICL FEATURE
EXTRAORAL FINDING:
•
•
•
•
•
Lip is incompetent
Mandibular movements during swallowing are
erratic, and no correlation can be found between
movement of tongue tip and of mandible.
Average mandibular movement is upward and
backward with tongue moving forward.
Speech disorder like sibilant distortions ,lisping,
problems in articulation of s, n, t, d ,l , th ,z , v
sound.
Increase in anterior facial height.

18. INTRA ORAL FINDINGS
•
•
•
Swallowing sequences are jerky and inconsistent .
Tongue movement are also irregular.
Malocclusion
a) Features pertaining to the maxilla:
- Proclination of maxilla anteriors resulting in an
increase in over jet.
-Generalized spacing between the teeth.
- Maxillary constriction.
b) Features pertaining to the mandible:
-Retroclination or proclination of mandibular teeth.
c) Inter maxillary relationships:
- Anterior or posterior open bite
- Posterior teeth cross bite.

19. DIAGNOSIS

20. TREATMENT
ORTHODONTIC
ELASTICS
PRE ORTHODONTIC TRAINER
HABIT BREACKING APPLIANCE

21. MOUTH BREATHING
•Definition
•Classification
•Etiology
•Clinical feature
•Diagnosis
•Treatment

22. DEFINITION
Sassouni 1971: defined
mouth breathing as habitual
respiration though the
mouth instead of the nose.
Merle 1980 : suggested the
term oro nasal breathing
instead of mouth breathing.

23. CLASSIFICATION
Finn (1987) has classified
mouth breathing into:
A. Anatomic
B. Obstructive
C. Habitual

24. ETIOLOGY








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.
Short upper lip.

25. CLINICAL FEATURES
•
Long and narrow face.
Narrow nose and nasal passage.
• Short and flaccid upper lip.
• Posterior cross bite.
•

26. Expressionless
or blank face.
Anterior marginal gingivitis.
Dryness of the mouth
predisposing to caries.
Proclination of anterior teeth.

27. DIAGNOSIS
History
: good history should be
recorded from parent and patients.
Clinical examination:
a) Mirror test.
b) Butterfly test.
c) Water holding test.
d) Rhinomanometry.
e) Cephalometrics.

28. TREATMENT
SYMPTOMATIC
TREATMENT:
The gingiva of mouth breathers
should be restored to normal health
by coatin the gingiva with petroleum
jelly, by applying preventive dentistry
methods and by clinically correcting
periodontal defects thet have
occurred during habit.

29. THE TREATMENT SHOULD BE
AIMED AT….
1. ELIMINATION OF THE CAUSE.
2.INTERCEPTION OF THE
HABIT .
If there is no physiological cause the
patient should be instructed for:
a) Lip exercises.
b) Physical exercises.
c) Maxillothorax myotherapy.

30. 3.CORRECTION OF THE
MALOCCLUSION.
a) Children with class l skeletal and
dental occlusion and anterior
spacing- oral shield appliance.

31. b) Class ll division l without crowding
age 5-9 years- monobloc activator.
c) Class lll malocclusion : chin cap.

32. BRUXISM
•Definition.
•Type.
•Etiology.
•Manifestation.
•Treatment.

33. DEFINITION
Ramfjord
(1966): Bruxism is the habitual
grinding of teeth when the individual is not
chewing or swallowing.
Rubina (1986): Bruxism is the team used
to indicate nonfuntional contact of teeth
which may include clenching, grinding,
gnashing, and tapping of teeth.
Vanderas(1995): Non funtional movement
of the mandible with or without an audible
sound occurring during the day or night.

34. CLASSIFICATION
1. Day
time bruxism /
Diurnal bruxism.
2. Night time bruxism /
Nocturnal bruxism.

35. ETIOLOGY
1.
2.
3.
4.
5.
6.
7.
Psychological and emotional stresses.
Occlusal interference.
Cortical lesion.
Systemic factor: magnessium deficiency,
chronic abdominal distress.
Genetics: children of bruxism parents have
an increased incidence of bruxism.
Allergies: related to nocturnal bruxism.
Occupational factors: compulsive
overahievers and competitive sports lead
to clenching.

36. CLINICAL FEATURES
1. OCCLUSAL TRAUMA:
• Tooth mobility, more in mornings.
• Spread of gingivitis into deeper periodontal
structures and alveolar bone loss.

37. 2. Tooth structure:
• Non functional pattern of
occlusal wear is seen as signs.
•It can also lead to increased tooth
sensitivity from excessive abrasion of
the enamel.
•Pulp is exposed to attrition leading to
dental abscess.
•Fracture of tooth crown and
restorations can also cause bruxism.

38. 3. HEADACHE:
• mostly of muscular contraction
•type.
4.
OTHER SIGNS AND SYMPTOMS:
• grinding and tapping sounds.
• soft tissue trauma.
• small ulcerations or ridging on the
buccal mucosa opposite molar teeth.

39. TREATMENT:
1.





Occlusal adjustments:
Results in immediate disappearance of habitual
grinding.
Any prematurities or occlusal interferences
should be corrected.
Coronoplasty plays an important role.
Extensive adjustments are contraindicated.
Muscles should be brought back to a relaxed
position before adjustments.

40. 2. OCCLUSAL SPLINTS:
Vulcanite
splints to cover occlusal surfaces of
teeth. A reduction in increased muscle tone is
observed.
In children, splint is made on the mandibilar
models using Scher Dental Bioplast material.

41. 3. RESTORATIVE TREATMENT:
Severe
abrasion where penetration into
pulp chamber is imminent, pulpal therapy
with full coverage crown is indicated.

42. 4. Psychotherapy :
Counseling
the patient and behavioral modality
through explanation and arousal and patient’s
awareness of the habit.
5. Relaxation training:
To
relax the muscle group voluntarily
Hypnosis, conditioning also indicated.
6. Physical therapy
7. Electrical method:
Electrogalvanic stimulation for muscle relaxation.

43. 8. Drugs :
Vapocoolants
such as ethyl chloride for
pain
LA injections, tranquilizers, sedatives and
muscle relaxants.
Placebos to rule out psychological
etiology.
Low doses of tricyclic antidepressants to
inhibit amount of REM sleep.

44. 9. Biofeedback.
10. Acupunture techniques for muscle
relaxation.
11. Orthodontic correction.

45. LIP HABIT

46. Definition
Classification
Etiology
Manifestation
Treatment

47. DEFINITION:
Habits
that involve manipulation of lips and
perioral structures.
CLASSIFICATION:
Wetting the lips with the tongue.
Pulling the lips into the mouth between
the teeth.

48. ETIOLOGY:
Malocclusion : in angle’s class 2 div.1.
2. Habits : occur in conjunction with other
habits such as thumb or digit sucking.
3. Emotional stress : children in stressful
situations have an increased salivary
output, thus increasing the number of
swallows and lip seals required. May
become a compulsive and gratificational
activity during sleeping hours.
1.

49. CLINICAL FEATURES:
Protrusion
of maxillary incisors and retrusion of
mandibular incisors: Action is to
wedge the lip between upper
and lower incisors. This creates a
muscular imbalance and cause
maxillary incisors to move labially and upward
with interdental spacing.
Ulcers :

50. Lip
: reddened, irritated and chapped
area below the vermillion border.
the vermillion border may be farther
outside the mouth, mostly in lower lips.
in some cases, chronic herpes infection
with areas of irritation and cracking of
lips.
Malocclusion :
Mentolabial
sulcus becomes accentuated.

51. TREATMENT:
1.Correction of malocclusion:
Class 1 with increased overjet : fixed or
removable appliance to tip the teeth back.
Class 2 : growth modification procedures.
activator if the child has an uncrowded early
mixed dentition.
2. Treating the primary habit : digit sucking with
hawley’s retainer.

52. 3. Appliance therapy:
Oral
shield : useful in class
1 malocclusion. Addition of
small loop to the labial oral
shield improves the lip tonus
by helping in lip exercises-10 minutes, 3
times a day.

53. Lip
bumper : positioned in the
vestibule of the mandibular
arch and serves to prohibit the
lip from exerting excessive
force on the mandibular incisors and
reposition the lip away from the lingual
aspect of the maxillary incisors.
can be combined, fixed and removable
appliance.

54. CHEEK BITING
DEFINITION:
This is an abnormal
habit of keeping or
biting the cheek
muscles in between the
upper and lower
posterior teeth.

55. CLINICAL FEATURES
1. ULCER
2.OPEN BITE
3. TOOTH MALPOSITION IN THE BUCCAL SEGMENT.

56. TREATMENT :
Removable
Vestibular
crib.
screen.

57. NAIL BITING

58. One
of the most common habits in
children.
It is a sign of internal tension.
AGE OF OCCURENCE : rises sharply
from 4-6 years, constant level between
7&10 years and rises to peak during
adolescence.
ETIOLOGY : indicative of an emotional
problem.

59. CLINICAL FEATURES
 INFLAMATION
 DENTAL
OF THE NAIL AND NAIL BEDS
EFFECTS : crowding, rotation and
attrition of incisal edges of mandibular incisors.

60. TREATMENT :
Mild
cases : no treatment.
Avoid scolding, nagging and threats.
Treat the emotional factor
Encourage outdoor activities.
Application of nail polishes, light cotton mittens
as reminder.

61. SELF INJURIOUS HABITS
 DEFINITION
 ETIOLOGY

62. DEFINITION :
Repetitive acts that result in physical
damage to the individual.
these habits show an increased incidence
in mentally retarded population.
ETIOLOGY :
Organic
: syndromes and syndrome-like
maladies such as Lesch-Nyhan disease and De
Lange’s syndrome.

63. Functional
:
o Type A : injuries superimposed on a preexisting lesion. E.g; child with nail biting
habit is ubder treatment for skin lesion.
o Type B : injuries secondary to another
established habit. E.g; rotation of thumb
while thumb sucking can harm the soft
tissues.
o Type C : injuries of unknown or complex
etiology. Has a greater psychogenic
component.

64. FRENUM THRUSTING :
If the maxillary incisors are slightly
spaced apart, the child may lock his labial
frenum between these teeth and permit it
to remain in thus position for several
hours.
It may displace the tooth.
TREATMENT :
o Psychogenic therapy.
o Palliative treatment.
o Mechanotherapy : oral shields, restraints
and protective padding.

65. BOBBY PIN OPENING :
Seen
in teen age girls where in opening bobby
pin with anterior incisors is done.
Clinically, notched incisors and partially
denuded labial enamel are seen.
Calling attention is all that is necessary to stop
the habit.

66. CONCLUSION
“ Oral habits can manifest themselves in a
variety of ways, and these activities may or
may not be a concern for parents. Likewise ,
the presence of an oral habit may or may
not have a marked effect on the child’s
developing facial structures and dentition.
Hence assessment of these behaviors must
include a thorough evaluation of the habit
itself and the presence of the potential for
oral health repercussions. These judgments
must be coupled with a sensitive assessment
of the physical and emotional status of the
child and the relationship of the parent or
caregiver.”

67. Email.id: chinthamanidental@gmail.com
044-43800059 , 92 83 786 776
www.chinthamanilaserdentalclinic.com