ORAL HABITS

By Dr Bomatuyibapre Ogoli

Outline

INTRODUCTIONDEFINITIONAETIOLOGYTYPESMANAGEMENTCONCLUSIONREFERENCES

Introduction

The process of oral habit in the 3 to 6 year old is an important finding in the clinical examination

A habit that has resulted in the movement of the primary teeth requires some form of intervention prior to the eruption of the permanent teeth

Changes in the dentition brought about by oral habit vary and these may depend on the intensity duration and frequency of the habit

Intensity ndash This is the amount of force applied to the teeth while performing the habit

Duration ndash Defined as the amount of time spent practicing a habit Duration plays the most critical role in tooth movements

Frequency ndash It is the number of times the habit is performed throughout the day

Definition

Habit is a tendency towards an act or an act that has become repeated performances relatively fixed consistent easy to perform and almost automatic (Boucher OC)

A relationship exists between the physiologic development of the oral cavity and -The nature -The onset and -The duration of the oral habit Arise from -Reflex and instinct - seen in infancy -Complex and Controlled behavior - seen

later in life Generally the longer the habit is practiced -The harder it will be to break -The more the pathology seen in the oral

cavity

Aetiology

Anatomical Factor Abnormal Physical size of an organ can result in

development of habits For example infantile swallow occurs due to a

large tongue in a small oral cavity

Emotional Instability of the child This can result in parafunctional

habit for example digit sucking may give a feeling of security Family

conflicts peer group pressure lack of satisfaction through

nourishment stress all have a direct bearing on oral habits

Mechanical Interferences These lead to undesirable oral habits For

example ectopic eruption of permanent incisors can make achieving

a proper anterior oral seal difficult during swallowing This can result

in mouth breathing

Pathological factor Disease conditions of oral and

perioral structures can result in oral habits Eg

Deviated nasal septum and hypertrophy of inferior

nasal turbinate can cause nasal blockage Also

enlarged adenoids can cause obstruction of the

upper air way These factors result in mouth

breathing

Imitation The child may imitate jaw position or

speech disorders of parents siblings friends

Types

Compulsive Non compulsive Fixated in a childrsquos behavior

pattern Malocclusion frequently results

due to persistent and intense habit

Generally reflects a psychologic dependency on certain behavior

Compelling reason for the behavior to continue

-Insecurities

-Fears

-Lack of ego-defense mechanism development

Naturally modified or eliminated through the maturation process

Not so entrenched in the childrsquos behavior that they cannot be not changed in response to the childrsquos changing physiologic psychologic profile

Resolve on their own and child ldquogrowsrdquo out of

No detrimental effects seen

The oral habits of dental significance include

ndash Digit Sucking (thumb or finger sucking)

- Tongue Thrusting- Mouth breathing- Bruxism

- Lip sucking - Lip biting

Digit Sucking (Thumb Finger Sucking)

These make up majority of the

oral habits

Sucking is the first coordinated

muscular activity of the infant

which enables bottles feeding

- Two forms of sucking are

- Nutritive sucking (bottle)

- Non nutritive sucking

(thumb digit pacifier etc)

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Outline

INTRODUCTIONDEFINITIONAETIOLOGYTYPESMANAGEMENTCONCLUSIONREFERENCES

Introduction

The process of oral habit in the 3 to 6 year old is an important finding in the clinical examination

A habit that has resulted in the movement of the primary teeth requires some form of intervention prior to the eruption of the permanent teeth

Changes in the dentition brought about by oral habit vary and these may depend on the intensity duration and frequency of the habit

Intensity ndash This is the amount of force applied to the teeth while performing the habit

Duration ndash Defined as the amount of time spent practicing a habit Duration plays the most critical role in tooth movements

Frequency ndash It is the number of times the habit is performed throughout the day

Definition

Habit is a tendency towards an act or an act that has become repeated performances relatively fixed consistent easy to perform and almost automatic (Boucher OC)

A relationship exists between the physiologic development of the oral cavity and -The nature -The onset and -The duration of the oral habit Arise from -Reflex and instinct - seen in infancy -Complex and Controlled behavior - seen

later in life Generally the longer the habit is practiced -The harder it will be to break -The more the pathology seen in the oral

cavity

Aetiology

Anatomical Factor Abnormal Physical size of an organ can result in

development of habits For example infantile swallow occurs due to a

large tongue in a small oral cavity

Emotional Instability of the child This can result in parafunctional

habit for example digit sucking may give a feeling of security Family

conflicts peer group pressure lack of satisfaction through

nourishment stress all have a direct bearing on oral habits

Mechanical Interferences These lead to undesirable oral habits For

example ectopic eruption of permanent incisors can make achieving

a proper anterior oral seal difficult during swallowing This can result

in mouth breathing

Pathological factor Disease conditions of oral and

perioral structures can result in oral habits Eg

Deviated nasal septum and hypertrophy of inferior

nasal turbinate can cause nasal blockage Also

enlarged adenoids can cause obstruction of the

upper air way These factors result in mouth

breathing

Imitation The child may imitate jaw position or

speech disorders of parents siblings friends

Types

Compulsive Non compulsive Fixated in a childrsquos behavior

pattern Malocclusion frequently results

due to persistent and intense habit

Generally reflects a psychologic dependency on certain behavior

Compelling reason for the behavior to continue

-Insecurities

-Fears

-Lack of ego-defense mechanism development

Naturally modified or eliminated through the maturation process

Not so entrenched in the childrsquos behavior that they cannot be not changed in response to the childrsquos changing physiologic psychologic profile

Resolve on their own and child ldquogrowsrdquo out of

No detrimental effects seen

The oral habits of dental significance include

ndash Digit Sucking (thumb or finger sucking)

- Tongue Thrusting- Mouth breathing- Bruxism

- Lip sucking - Lip biting

Digit Sucking (Thumb Finger Sucking)

These make up majority of the

oral habits

Sucking is the first coordinated

muscular activity of the infant

which enables bottles feeding

- Two forms of sucking are

- Nutritive sucking (bottle)

- Non nutritive sucking

(thumb digit pacifier etc)

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Introduction

The process of oral habit in the 3 to 6 year old is an important finding in the clinical examination

A habit that has resulted in the movement of the primary teeth requires some form of intervention prior to the eruption of the permanent teeth

Changes in the dentition brought about by oral habit vary and these may depend on the intensity duration and frequency of the habit

Intensity ndash This is the amount of force applied to the teeth while performing the habit

Duration ndash Defined as the amount of time spent practicing a habit Duration plays the most critical role in tooth movements

Frequency ndash It is the number of times the habit is performed throughout the day

Definition

Habit is a tendency towards an act or an act that has become repeated performances relatively fixed consistent easy to perform and almost automatic (Boucher OC)

A relationship exists between the physiologic development of the oral cavity and -The nature -The onset and -The duration of the oral habit Arise from -Reflex and instinct - seen in infancy -Complex and Controlled behavior - seen

later in life Generally the longer the habit is practiced -The harder it will be to break -The more the pathology seen in the oral

cavity

Aetiology

Anatomical Factor Abnormal Physical size of an organ can result in

development of habits For example infantile swallow occurs due to a

large tongue in a small oral cavity

Emotional Instability of the child This can result in parafunctional

habit for example digit sucking may give a feeling of security Family

conflicts peer group pressure lack of satisfaction through

nourishment stress all have a direct bearing on oral habits

Mechanical Interferences These lead to undesirable oral habits For

example ectopic eruption of permanent incisors can make achieving

a proper anterior oral seal difficult during swallowing This can result

in mouth breathing

Pathological factor Disease conditions of oral and

perioral structures can result in oral habits Eg

Deviated nasal septum and hypertrophy of inferior

nasal turbinate can cause nasal blockage Also

enlarged adenoids can cause obstruction of the

upper air way These factors result in mouth

breathing

Imitation The child may imitate jaw position or

speech disorders of parents siblings friends

Types

Compulsive Non compulsive Fixated in a childrsquos behavior

pattern Malocclusion frequently results

due to persistent and intense habit

Generally reflects a psychologic dependency on certain behavior

Compelling reason for the behavior to continue

-Insecurities

-Fears

-Lack of ego-defense mechanism development

Naturally modified or eliminated through the maturation process

Not so entrenched in the childrsquos behavior that they cannot be not changed in response to the childrsquos changing physiologic psychologic profile

Resolve on their own and child ldquogrowsrdquo out of

No detrimental effects seen

The oral habits of dental significance include

ndash Digit Sucking (thumb or finger sucking)

- Tongue Thrusting- Mouth breathing- Bruxism

- Lip sucking - Lip biting

Digit Sucking (Thumb Finger Sucking)

These make up majority of the

oral habits

Sucking is the first coordinated

muscular activity of the infant

which enables bottles feeding

- Two forms of sucking are

- Nutritive sucking (bottle)

- Non nutritive sucking

(thumb digit pacifier etc)

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Intensity ndash This is the amount of force applied to the teeth while performing the habit

Duration ndash Defined as the amount of time spent practicing a habit Duration plays the most critical role in tooth movements

Frequency ndash It is the number of times the habit is performed throughout the day

Definition

Habit is a tendency towards an act or an act that has become repeated performances relatively fixed consistent easy to perform and almost automatic (Boucher OC)

A relationship exists between the physiologic development of the oral cavity and -The nature -The onset and -The duration of the oral habit Arise from -Reflex and instinct - seen in infancy -Complex and Controlled behavior - seen

later in life Generally the longer the habit is practiced -The harder it will be to break -The more the pathology seen in the oral

cavity

Aetiology

Anatomical Factor Abnormal Physical size of an organ can result in

development of habits For example infantile swallow occurs due to a

large tongue in a small oral cavity

Emotional Instability of the child This can result in parafunctional

habit for example digit sucking may give a feeling of security Family

conflicts peer group pressure lack of satisfaction through

nourishment stress all have a direct bearing on oral habits

Mechanical Interferences These lead to undesirable oral habits For

example ectopic eruption of permanent incisors can make achieving

a proper anterior oral seal difficult during swallowing This can result

in mouth breathing

Pathological factor Disease conditions of oral and

perioral structures can result in oral habits Eg

Deviated nasal septum and hypertrophy of inferior

nasal turbinate can cause nasal blockage Also

enlarged adenoids can cause obstruction of the

upper air way These factors result in mouth

breathing

Imitation The child may imitate jaw position or

speech disorders of parents siblings friends

Types

Compulsive Non compulsive Fixated in a childrsquos behavior

pattern Malocclusion frequently results

due to persistent and intense habit

Generally reflects a psychologic dependency on certain behavior

Compelling reason for the behavior to continue

-Insecurities

-Fears

-Lack of ego-defense mechanism development

Naturally modified or eliminated through the maturation process

Not so entrenched in the childrsquos behavior that they cannot be not changed in response to the childrsquos changing physiologic psychologic profile

Resolve on their own and child ldquogrowsrdquo out of

No detrimental effects seen

The oral habits of dental significance include

ndash Digit Sucking (thumb or finger sucking)

- Tongue Thrusting- Mouth breathing- Bruxism

- Lip sucking - Lip biting

Digit Sucking (Thumb Finger Sucking)

These make up majority of the

oral habits

Sucking is the first coordinated

muscular activity of the infant

which enables bottles feeding

- Two forms of sucking are

- Nutritive sucking (bottle)

- Non nutritive sucking

(thumb digit pacifier etc)

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Definition

Habit is a tendency towards an act or an act that has become repeated performances relatively fixed consistent easy to perform and almost automatic (Boucher OC)

A relationship exists between the physiologic development of the oral cavity and -The nature -The onset and -The duration of the oral habit Arise from -Reflex and instinct - seen in infancy -Complex and Controlled behavior - seen

later in life Generally the longer the habit is practiced -The harder it will be to break -The more the pathology seen in the oral

cavity

Aetiology

Anatomical Factor Abnormal Physical size of an organ can result in

development of habits For example infantile swallow occurs due to a

large tongue in a small oral cavity

Emotional Instability of the child This can result in parafunctional

habit for example digit sucking may give a feeling of security Family

conflicts peer group pressure lack of satisfaction through

nourishment stress all have a direct bearing on oral habits

Mechanical Interferences These lead to undesirable oral habits For

example ectopic eruption of permanent incisors can make achieving

a proper anterior oral seal difficult during swallowing This can result

in mouth breathing

Pathological factor Disease conditions of oral and

perioral structures can result in oral habits Eg

Deviated nasal septum and hypertrophy of inferior

nasal turbinate can cause nasal blockage Also

enlarged adenoids can cause obstruction of the

upper air way These factors result in mouth

breathing

Imitation The child may imitate jaw position or

speech disorders of parents siblings friends

Types

Compulsive Non compulsive Fixated in a childrsquos behavior

pattern Malocclusion frequently results

due to persistent and intense habit

Generally reflects a psychologic dependency on certain behavior

Compelling reason for the behavior to continue

-Insecurities

-Fears

-Lack of ego-defense mechanism development

Naturally modified or eliminated through the maturation process

Not so entrenched in the childrsquos behavior that they cannot be not changed in response to the childrsquos changing physiologic psychologic profile

Resolve on their own and child ldquogrowsrdquo out of

No detrimental effects seen

The oral habits of dental significance include

ndash Digit Sucking (thumb or finger sucking)

- Tongue Thrusting- Mouth breathing- Bruxism

- Lip sucking - Lip biting

Digit Sucking (Thumb Finger Sucking)

These make up majority of the

oral habits

Sucking is the first coordinated

muscular activity of the infant

which enables bottles feeding

- Two forms of sucking are

- Nutritive sucking (bottle)

- Non nutritive sucking

(thumb digit pacifier etc)

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

A relationship exists between the physiologic development of the oral cavity and -The nature -The onset and -The duration of the oral habit Arise from -Reflex and instinct - seen in infancy -Complex and Controlled behavior - seen

later in life Generally the longer the habit is practiced -The harder it will be to break -The more the pathology seen in the oral

cavity

Aetiology

Anatomical Factor Abnormal Physical size of an organ can result in

development of habits For example infantile swallow occurs due to a

large tongue in a small oral cavity

Emotional Instability of the child This can result in parafunctional

habit for example digit sucking may give a feeling of security Family

conflicts peer group pressure lack of satisfaction through

nourishment stress all have a direct bearing on oral habits

Mechanical Interferences These lead to undesirable oral habits For

example ectopic eruption of permanent incisors can make achieving

a proper anterior oral seal difficult during swallowing This can result

in mouth breathing

Pathological factor Disease conditions of oral and

perioral structures can result in oral habits Eg

Deviated nasal septum and hypertrophy of inferior

nasal turbinate can cause nasal blockage Also

enlarged adenoids can cause obstruction of the

upper air way These factors result in mouth

breathing

Imitation The child may imitate jaw position or

speech disorders of parents siblings friends

Types

Compulsive Non compulsive Fixated in a childrsquos behavior

pattern Malocclusion frequently results

due to persistent and intense habit

Generally reflects a psychologic dependency on certain behavior

Compelling reason for the behavior to continue

-Insecurities

-Fears

-Lack of ego-defense mechanism development

Naturally modified or eliminated through the maturation process

Not so entrenched in the childrsquos behavior that they cannot be not changed in response to the childrsquos changing physiologic psychologic profile

Resolve on their own and child ldquogrowsrdquo out of

No detrimental effects seen

The oral habits of dental significance include

ndash Digit Sucking (thumb or finger sucking)

- Tongue Thrusting- Mouth breathing- Bruxism

- Lip sucking - Lip biting

Digit Sucking (Thumb Finger Sucking)

These make up majority of the

oral habits

Sucking is the first coordinated

muscular activity of the infant

which enables bottles feeding

- Two forms of sucking are

- Nutritive sucking (bottle)

- Non nutritive sucking

(thumb digit pacifier etc)

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Aetiology

Anatomical Factor Abnormal Physical size of an organ can result in

development of habits For example infantile swallow occurs due to a

large tongue in a small oral cavity

Emotional Instability of the child This can result in parafunctional

habit for example digit sucking may give a feeling of security Family

conflicts peer group pressure lack of satisfaction through

nourishment stress all have a direct bearing on oral habits

Mechanical Interferences These lead to undesirable oral habits For

example ectopic eruption of permanent incisors can make achieving

a proper anterior oral seal difficult during swallowing This can result

in mouth breathing

Pathological factor Disease conditions of oral and

perioral structures can result in oral habits Eg

Deviated nasal septum and hypertrophy of inferior

nasal turbinate can cause nasal blockage Also

enlarged adenoids can cause obstruction of the

upper air way These factors result in mouth

breathing

Imitation The child may imitate jaw position or

speech disorders of parents siblings friends

Types

Compulsive Non compulsive Fixated in a childrsquos behavior

pattern Malocclusion frequently results

due to persistent and intense habit

Generally reflects a psychologic dependency on certain behavior

Compelling reason for the behavior to continue

-Insecurities

-Fears

-Lack of ego-defense mechanism development

Naturally modified or eliminated through the maturation process

Not so entrenched in the childrsquos behavior that they cannot be not changed in response to the childrsquos changing physiologic psychologic profile

Resolve on their own and child ldquogrowsrdquo out of

No detrimental effects seen

The oral habits of dental significance include

ndash Digit Sucking (thumb or finger sucking)

- Tongue Thrusting- Mouth breathing- Bruxism

- Lip sucking - Lip biting

Digit Sucking (Thumb Finger Sucking)

These make up majority of the

oral habits

Sucking is the first coordinated

muscular activity of the infant

which enables bottles feeding

- Two forms of sucking are

- Nutritive sucking (bottle)

- Non nutritive sucking

(thumb digit pacifier etc)

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Pathological factor Disease conditions of oral and

perioral structures can result in oral habits Eg

Deviated nasal septum and hypertrophy of inferior

nasal turbinate can cause nasal blockage Also

enlarged adenoids can cause obstruction of the

upper air way These factors result in mouth

breathing

Imitation The child may imitate jaw position or

speech disorders of parents siblings friends

Types

Compulsive Non compulsive Fixated in a childrsquos behavior

pattern Malocclusion frequently results

due to persistent and intense habit

Generally reflects a psychologic dependency on certain behavior

Compelling reason for the behavior to continue

-Insecurities

-Fears

-Lack of ego-defense mechanism development

Naturally modified or eliminated through the maturation process

Not so entrenched in the childrsquos behavior that they cannot be not changed in response to the childrsquos changing physiologic psychologic profile

Resolve on their own and child ldquogrowsrdquo out of

No detrimental effects seen

The oral habits of dental significance include

ndash Digit Sucking (thumb or finger sucking)

- Tongue Thrusting- Mouth breathing- Bruxism

- Lip sucking - Lip biting

Digit Sucking (Thumb Finger Sucking)

These make up majority of the

oral habits

Sucking is the first coordinated

muscular activity of the infant

which enables bottles feeding

- Two forms of sucking are

- Nutritive sucking (bottle)

- Non nutritive sucking

(thumb digit pacifier etc)

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Types

Compulsive Non compulsive Fixated in a childrsquos behavior

pattern Malocclusion frequently results

due to persistent and intense habit

Generally reflects a psychologic dependency on certain behavior

Compelling reason for the behavior to continue

-Insecurities

-Fears

-Lack of ego-defense mechanism development

Naturally modified or eliminated through the maturation process

Not so entrenched in the childrsquos behavior that they cannot be not changed in response to the childrsquos changing physiologic psychologic profile

Resolve on their own and child ldquogrowsrdquo out of

No detrimental effects seen

The oral habits of dental significance include

ndash Digit Sucking (thumb or finger sucking)

- Tongue Thrusting- Mouth breathing- Bruxism

- Lip sucking - Lip biting

Digit Sucking (Thumb Finger Sucking)

These make up majority of the

oral habits

Sucking is the first coordinated

muscular activity of the infant

which enables bottles feeding

- Two forms of sucking are

- Nutritive sucking (bottle)

- Non nutritive sucking

(thumb digit pacifier etc)

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

The oral habits of dental significance include

ndash Digit Sucking (thumb or finger sucking)

- Tongue Thrusting- Mouth breathing- Bruxism

- Lip sucking - Lip biting

Digit Sucking (Thumb Finger Sucking)

These make up majority of the

oral habits

Sucking is the first coordinated

muscular activity of the infant

which enables bottles feeding

- Two forms of sucking are

- Nutritive sucking (bottle)

- Non nutritive sucking

(thumb digit pacifier etc)

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Digit Sucking (Thumb Finger Sucking)

These make up majority of the

oral habits

Sucking is the first coordinated

muscular activity of the infant

which enables bottles feeding

- Two forms of sucking are

- Nutritive sucking (bottle)

- Non nutritive sucking

(thumb digit pacifier etc)

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Most commonly seen non-nutritive

habit in children Normal for newborns to

engage in digit sucking Commonly develop in the

first year of life Psychological factors

contribute to the continuation of this habit past 6-7 months of age

Most habits abandoned prior to the eruption of the permanent incisors

No Tx needed if habit stopped by 6-7 years of age

Earlier Tx instituted if maxillary arch constricted or parentchild is concerned

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Sucking mechanism

During infancy it is the most well-developed sensation

-Helps with sustenance as well as deriving sensory pleasures

-Gives a feeling of security warmth and euphoria

An impatiently nursed baby loses the warmth and feeling of well being and is therefore deprived of the suckling pleasures

This deprivation may motivate the infant to suck on the thumb or finger for additional gratification

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Malocclusion and digit sucking The type of malocclusion

produced by the habit is dependant on the following

variables1 Position of the

digitpacifier etc2 Associated orofacial

muscle contraction force3 Mandibular position during

sucking4 Facial skeletal genetic

pattern5 Amount frequency amp

duration of force applied

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Digit sucking and age

During the first 3 yrs the damage from the habit is mainly confined to the anterior segment producing an anterior open bite

Damage can be detrimental if the habit is continued beyond the age of 35 yrs

After 4 years of age the habit becomes strongly established The damage seen is more significant

After the eruption of the permanent incisors the worst amount of damage seen

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Effects of digit sucking

AOB Posterior Crossbite Increased Overjet Decreased Overbite Narrow Nasal floor and high palatal vault Decrease palatal width Leftright side is usually

affected The deformation depends on whether the right or left thumb is sucked

Lip incompetence Hypotonic upper lip Tongue thrust Deformation of digits Speech defects (lisping

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Management

Diagnosing Digit SuckingHx taking which is obtained from the parents Frequency of Sucking Duration Intensity (Amount of force applied)

Extra oral Examination Cleaner digit Redness Wrinkling of digits due to regular sucking Dishpan Thumb ndash clean thumb with short finger nails Short Upper lip higher incidence of middle ear infections enlarged tonsils and mouth breathing

Intra oral examination Malocclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Treatment

3 categories of treatment

- Behavioral modifications - Counseling- Reinforcement either positive or negative

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Appliance therapy

Removable appliance -Goal post -Tongue spikes -Tongue guard Fixed appliance -Fixed rake -Quad helix - hay rakes

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Tongue spike

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Tongue guard

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Fixed rake appliance

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Quad helix

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Goal post appliance

Goal post appliance is an upper removable appliance used to dissuade the sucking habit It is composed of the functional component which consists of a palatal bar which is shaped like a goal post made of 09mm HSSW

It functions by preventing the patient from attaining a comfortable position for the digit

The goal post appliance is applicable to patients who are aware that the habit is bad and are ready to stop

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Fixed rake appliance

Fixed rake appliance is for a patient with both a tongue thrusting habit and a digit sucking habit

It consists of molar bands banded to the 1st or 2nd molars The wire is made of 09mm HSSW which extends across the palate forming vertical spurs or loops in the anterior region

This prevents the digit from gaining a comfortable position and in addition deters associated tongue thrust habit It is usually worn for a period of 6-10 months to prevent recurrence of the habit

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Tongue thrusting habit

Defined as the placement of the tongue tip forward between

the incisors during swallowing

2 types of swallow patterns are the infantile and the adult

swallow patterns

Infantile type In the new born the tip of the tongue rests

between the gum pads anteriorly to form the anterior lip seal

Mature Adult Swallow pattern placement of the tip of the

tongue against the palate and behind the upper incisors This

usually happens when the incisors begins to erupt by age 6 ndash

9 months

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Delayed transition between the infantile and adult swallowing pattern

Transition usually begins to happen around the age of 2 years

By the age of 6 years 50 have completed the transition

10-15 estimated never to fully complete the transition

Commonly associated with mouth breathing and anterior open bite

Functional adaptation of malocclusion and not the etiology

Can cause speech problems - lisping Most cases (80) will self correct by 12 years

of age

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Abnormally large tongue causing a tongue thrust

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Effects of tongue thrusting habit1) Open bite ndash Anterior posterior

(lateral)2) Proclined upper anterior teeth 3) Bimaxillary proclination with spaced

arches between incisors and canines

4) High arched Vndash Shaped palate resulting in posterior cross bite

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Abnormal placement of the tongue

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Management

Hx taking which is obtained from the parents child Frequency of tongue thrust Duration Intensity (Amount of force applied)

Extra oral Examination ndash This is done to examine the facial profile in order to assess growth pattern (favorable or unfavorable) anterior facial height

Intra oral Examination of the tongue to assess the tongue posture and its function At rest the dorsum of the tongue touches the palate while the tip rests against the Cingular or fossa of mandibular incisors loss of posterior teeth can result in lateral open bite

Tongue protraction due to retained infantile swallow pattern or enlarged tonsils or adenoids or pharyngitis or macroglossia

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Treatment

Treatment involves interception of the habit first before treating malocclusion

Treatment is based on age because tongue thrust decreases with age

Myofunctional Therapy The patient is trained to develop a new swallow

pattern There are different ways to achieve this These include

1) Patient is advised to swallow 20 times before each meal The child takes a sip of water close the teeth into occlusion place the tip of the tongue against incisive papilla and swallow

2) Using a sugar less mint the tip of the tongue is used to hold it in the roof of the mouth until saliva floors which makes it necessary for the child to swallow

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Appliances Therapy Tongue muscles function properly

during swallowing once the child has been trained

Mandibular lingual arch with a crib or rake can be worn by the patient

Appliance serves as a reminder in positioning the tongue properly during swallowing

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Mouth breathing habit

Defined as habitual respiration through the mouth instead of the nose

Mouth Breathing - can be caused by physiologic or anatomic conditions such as enlarged adenoids enlarged tonsils deviated nasal septum etc it can be transitional when exercise induced or due to a nasal obstruction

True mouth breathing when the habit continues after the obstruction is removed

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Effect of mouth breathing Adenoid Facies

-Long narrow face

-Narrow nose and nasal airway

-Flaccid lips with short upper lip

-Upturned nose exposing nares frontally

Skeletal Open Bite or ldquoLong Face Syndromerdquo

-Excessive eruption of posteriors

-Constricted maxillary arch

-Excessive overjet

-Anterior openbite

-Mandibular downforward growth is poor

Hypertrophic gingivitis Drying of the gingiva causes irritation as a result of increased plaque accumulation

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Constricted arches of mouth breathers

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Effect of mouth breathing on the gingiva and occlusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Diagnosing mouth breathing habit

A good history from parents and patients History of nasal

stiffness sore throats repeated cold attacks night thirst

Hoarseness of voice

Examination Study patientrsquos breathing unobserved Mouth

breathers are likely to keep the lips parted during relaxed

breathing

Ask patient to take a deep breathe

The nose does not change in size or shape

in mouth breathers

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Investigation Cephalometry assessment of naso-pharyngeal space

size of adenoids and long face syndrome

Water Test patients is asked to hold water in the mouth for 4 minutes A mouth breather will be unable to do so and will spit out the water as soon hersquos unable to breath

Cotton Test A butterfly shaped piece of cotton is placed over the upper lip below the nostrils If the cotton flutters down it indicates nasal breathing

Mirror Test Use of a double sided mirror which is held between the nose and mouth Fogging on the nasal size indicates nasal breathing Fogging on the oral side indicates mouth breathing

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Management

Rule out airway impairment ENT referral in case of nasopharyngeal obstruction

Myofunctional Therapy A child is taught certain exercise which will gradually train him to breath through the nose

reg During the day Hold a pencil or a piece of paper between the lips

reg Night Time Tape the lips together with surgical tape

reg Draw upper lip over the upper incisors and hold under tension for a count of 10

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Appliance therapy

reg Oral Screen it fits into the vestibule and shuts off air ingress through the mouth and retrain the lips

reg It is contraindicated in a case of nasopharyngeal obstruction

Breathing holes can be bored initially to allow passage of some air in the mouth As the child learns to breath through the nose fill some holes with acrylic so that less air enters through the mouth and finally close all the holes

reg Rapid maxillary expansion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Oral screen

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Bruxism

Defined as non functional contact of the teeth which may include clenching grinding and tapping of the teeth

Bruxism is usually seen in nervous children patients with psychogenic disturbances and restlessness

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Generalized attrition following Bruxism

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Effects of Bruxism Occlusal trauma resulting tooth mobility Occlusal wear which may result in dentine

sensitivity and Pulpal exposures Can be seen in both primary and permanent teeth TMJ Pan

Diagnosing Detailed Hx and clinical examination The two most reliable signs of active Bruxism are

- Scalloping of the lateral border of the tongue- Ridging of the buccal mucosa along the occlusal line

Both signs disappear when the parafunctional habit stops

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Management

Determine the underlying cause and eliminate it Eg Occlusal adjustment is done to correct occlusal interferences Stressful patients are counseled and reassured Ant anxiety

drugs valium 5mg nocte can also be prescribed Restoration of lost vertical dimension (onlays or an overlay

denture help in achieving this) thus overcoming the problem of over closure

Bite planes occlusal splints bite guards are used to cover the occlusal surface They raise the bite therefore resulting in passive stretching of painful muscle fibers They also minimize tooth wear and reduce tooth contact that act as trigger factors eliciting bruxism

Muscle relaxation Ethylchoride is sprayed over the TMJ area

Local anesthesia for TMJ muscles

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Occlusal guard

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Lip sucking

May be a compensatory mechanism for an excessive overjet and difficulty in closing the lips properly during swallowing

Effects - proclined upper

incisors - retroclined lower

incisors -crowding of lower

anterior segment

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Lip biting

Either of the lips may be involved

Cuts abrasions marks of incisors are the major features seen in this habit

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Management

Lip over lip exercise

Lip bumper Oral screen

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Prevention of oral habits Usually starts with proper nursing -on the part of the parent Time Patience Holding the baby while nursing using a physiologically designed

nursing nipple and pacifier to augment normal functional and deglutitional maturation

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Consideration for oral habit therapy

Age of the patient -7 yrs Maturity of the patient -understands the problem desires to correct it Parent cooperation -Support and encouragement Timely deliberation -Alert to suggestive psychologic problems Assessment of deformity -Degree and the presenceabsence of other

complexities

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Treatment options

Accurate assessment in context of the childrsquos physiologic and psychologic state of development for proper and effective management

-Dentist-Patient Discussion -Reminder Therapy -Reward System -Appliance Therapy

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Dentist patient discussion Straight-forward discussion Express concern and explain why the

habit should be dropped Encourage them to call the office and

speak to you if the habit urge returns

Parents can help monitor only

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Reminder therapy

Tx principles of Aversive conditioning -Association of unpleasant stimuli with a

particular behavior Unpleasant and more difficult method Reminder and not a punishment -Adhesive bandage -Cotton glove -Fingernail polish -Bitters -Arm wraps

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Reward system

Highly recommended as it is effective Consult parents to find out what are the

childrsquos likes and what prizes are suitable and special to the child

Above the age of 5 yrs use self esteem rewards

Formulate a contract between the child and parent for a short period of time (1-2 weeks)

Greater the involvement of the parent and child the more successful the outcome

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Appliance therapy

Intra-oral appliance 1048673Child must welcome continued

assistance 1048673Permanent reminder

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Summary

Abnormal habits typically interfere with regular facial development

The longer a habit is practiced the harder it is to break

Duration frequency and intensity play important roles in the permanency of the damage seen

When considering treatment make sure the child wants to break the habit

Placing fixed appliances should be the last resort for habit cessation

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion

Conclusion

Oral habits have been known to have serious long term effects on dentofacial structures Hence early diagnosis of these habits and prompt management are extremely important in order to avoid unpleasant effects on the dentofacial complex

• Oral habits
• Outline
• Introduction
• Slide 4
• Definition
• Slide 6
• Aetiology
• Slide 8
• Types
• Slide 10
• Digit Sucking (Thumb Finger Sucking)
• Slide 12
• Sucking mechanism
• Malocclusion and digit sucking
• Digit sucking and age
• Effects of digit sucking
• Management
• Treatment
• Appliance therapy
• Tongue spike
• Tongue guard
• Fixed rake appliance
• Quad helix
• Goal post appliance
• Fixed rake appliance
• Tongue thrusting habit
• Slide 27
• Abnormally large tongue causing a tongue thrust
• Effects of tongue thrusting habit
• Abnormal placement of the tongue
• Management
• Treatment (2)
• Slide 33
• Mouth breathing habit
• Effect of mouth breathing
• Constricted arches of mouth breathers
• Effect of mouth breathing on the gingiva and occlusion
• Diagnosing mouth breathing habit
• Investigation
• Management (2)
• Appliance therapy
• Oral screen
• Bruxism
• Generalized attrition following Bruxism
• Slide 45
• Management (3)
• Occlusal guard
• Lip sucking
• Lip biting
• Management (4)
• Prevention of oral habits
• Consideration for oral habit therapy
• Treatment options
• Dentist patient discussion
• Reminder therapy
• Reward system
• Appliance therapy (2)
• Summary
• Conclusion