1. ORAL HABITS
Dr. Nabil Al-Zubair

2. A tendency
towards an ACT
that has become
- a repeated
performance,
- relatively fixed,
- consistent and
- easy by a
person
‫متكرر‬ ‫أداء‬
‫ثابت‬‫نسبيا‬

3. In initial stages habits are of conscious effort
gradually they become less conscious and
often become unconscious if performed
repeatedly
Frequently children acquire certain habits that
may be either temporary or permanent
Oral habits in children have a definite effect on
developing teeth and its supporting structures

4. Aetiology of malocclusion
Malocclusion

5. Aetiology of malocclusion
‫ع‬ ‫نظر‬ ‫وجهة‬ ‫من‬‫ملية‬
Skeletal factors Soft tissue factors Dento-alveolar or
local factors
Habits
From a clinical perspective, it is useful to classify the aetiology of malocclusion under
the following headings:
Combinations

6. Malocclusion and Age
Strongly established
 During the first 3 yrs
Damage can be DETRIMENTAL
The worst amount of damage seen
damage confined
Anterior Segment
Anterior Open Bite
 Beyond the age of 3.5 yrs
if the habit is continued
 After 4 years of age
the habit becomes
 After the eruption of the permanent incisors
‫ضار‬

7. Malocclusion and Habits
 Position of the digit/pacifier etc.
 Associated orofacial muscle contraction force
 Mandibular position during sucking
 Facial skeletal genetic pattern
 Amount, frequency, & duration of force applied
The type of malocclusion produced by the habit is dependent on the following variables:

9. Finger Sucking
Pacifier
Nail Biting
Lip Sucking
Abnormal swallowing
or Tongue Thrusting
Abnormal Muscle habits
Mouth Breathing

10. Pacifier/Binkie Habit

11.  Includes the physiologic pacifiers like the NUK.
 Nearly identical to thumb sucking
 Similar clinical findings,
only not that pronounced!
 Tx - throw away the pacifier!
 Caution - child may
substitute missing
pacifier with a digit!
Pacifier/Binkie Habit

13. Thumb sucking may be practiced even in
intra-uterine life and is considered as
normal till age of 3 1/2 to 4 years.
Common habit seen in most of the children
The placement of thumb or
one or more fingers in
varying depths into the
mouth

15. 6. Improper or inadequate nursing.
7 . Attention getting mechanism.
8. Habit during eruption of teeth.
9. Feeling of hunger.
10. Feeling of personal in adequacy
Thumb and Finger Sucking :
* Causes:
1. Prolonged suckling
2. Rooting or placing reflex of mammalian
infants
3. Feeling of insecurity
4. Child deprived of parental love and care
5. Learned pattern without any underlying
cause

16. Thumb and Finger Sucking :
Thumb sucking habit could be divided into 3 phases:
Phases
(a) Phase I: Normal Subclinically
Significant Thumb-Sucking: From birth to 3 years.
(b) Phase II: Clinically Significant Thumb-Sucking:
From 3- 7 years
(c) Phase III :Intractable Thumb- Sucking:
after 7 years
‫عسير‬

17. Factors that Affecting the Degree of
Damage to Teeth and Investing Tissue:
Position of digit

20. Diagnosis
Clinical Features of Prolonged Active Thumb-Sucking:
Prolonged sucking
Direct pressure on the teethAlteration in the
cheek & lip pressure
Spacing & proclination of upper incisors
Narrowing of maxilla Retroclination of lower incisors
Anterior open bite
+

21. 1.Labial tipping of upper front teeth resulting
in proclination of maxillary anteriors
2.Increased overjet
3.Anterior open bite
4.Contraction of cheek muscles results in
narrow maxillary arch and posterior cross bites
5.May develop tongue thrust habit due to
open bite
6.Hypotonic upper lip and hyperactive
mentalis muscle
EFFECTS

22. Prevention
 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

24. MANAGEMENT
A)Psychological approach :-
B)Mechanical aids :-
C)Chemical approach :-

25. - Parents should be counseled to provide
with adequate love and affection
- Diverting the child's attention towards
play and toys
- Motivating the child for co-operation
and willingness to discontinue the habit
A)Psychological approach :-
MANAGEMENT
‫المودة‬
‫تحويل‬
‫تحفيز‬

26. - Habit breaking appliances with a crib
placed palatal to the maxillary central
incisors
- Removable or Fixed habit breakers can be
used
- Other aids like bandaging the thumb or
elbow can be used
B)Mechanical aids :-
MANAGEMENT

27. - Habit breaking appliances with a crib
placed palatal to the maxillary central
incisors
- Removable or Fixed habit breakers can be
used
- Other aids like bandaging the thumb or
elbow can be used
B)Mechanical aids :-
MANAGEMENT

28. - Use of bitter tasting or foul smelling
preparation placed on the thumb that is
sucked makes the habit distasteful
- Pepper, Quinine can be used
C)Chemical approach :-
MANAGEMENT

33. TONGUE THRUSTING

34. Placing the tongue between the teeth before,
and during the act of swallowing
The tongue should be placed on the roof of
the mouth and not between the teeth
Swallowing
occurs 24
hours per day
and about
2000 times
per day
Tongue
thrusting
During
a normal
swallow
on the surrounding
structures of the mouth
During each swallow
tongue can exert momentary
pressures of 1 to 6 pounds
Push the teeth and bone forward or apart
Move teeth into abnormal positionsGrowth distortions of the face and teeth
453.592 g1 pounds

35. Modern scientific investigations have shown that tongue thrusting is
merely an adaptive technique that is used to create an anterior seal when
swallowing or speaking

36. 1. Specific anatomic or NEUROMUSCULAR
VARIATIONS In orofacial region like
hypertonic orbicularis oris
2. Improper bottle feeding
3. Prolonged thumb sucking or forced
discontinuation of thumb sucking
4. Prolonged tonsillar and upper respiratory
tract infections
CAUSES

37. 5. Persistent infantile swallow and delayed
maturation
6. Presence of conditions like: macroglossia,
constricted dental arches and enlarged adenoids
7. Neurological disturbances like hyposensitive
palate and moderate motor disability
CAUSES

38. 1.Proclination of anterior teeth
2.Anterior open bite
3.Bimaxillary protrusion
4.Posterior open bite in case of lateral tongue
thrust
5.Posterior cross bite
EFFECTS

39. -Tongue thrust habit can be intercepted using
HABIT BREAKERS both fixed and removable
with cribs
-Child is thought the correct method of
swallowing
MANAGEMENT

40. -Various MUSCLE EXERCISES of the tongue are
carried to adapt the new swallowing pattern
-After the habit is intercepted the malocclusion
is treated using fixed or removable appliances
MANAGEMENT

41. Mature swallowing
1. Cessation of lip activity
2. Placement of the tip of the tongue
against the alveolar process behind
the upper central incisor
3. Post. teeth come in contact during
swallowing
Infantile swallowing
1. Contraction of the perioral
muscles during swallowing
2. Protrusion of the tongue.
3. No contact in the molar region
Swallowing

43. Normal Swallow

44. Tongue Thrust
Simple tongue thrust Complex tongue thrust
History of digit sucking adaptive mechanism to
maintain open bite created by thumb-sucking
History of chronic nasorespiratory
disease and allergies
Teeth are in occlusion as tongue protrude into open
bite
Teeth apart during tongue thrust
Diminishes with age Does not Diminishes with age
Treatment is simple, good prognosis Poor prognosis

47. A major cause of anterior tongue posture is the rate of development of the tongue as
compared to the mandible.
By age 8 the tongue has reached 80-90% of its adult size. Compare this to the 50% size
of the mandible at age 8.

50. EXERCISES FOR TONGUE THRUST AND OPEN BITE
PATIENTS
An open bite describes the lack of overlap of the upper and lower front teeth.
This can have a significant consequences to chewing food, speech, and tooth
wear. An anterior tongue thrust during swallowing is usually seen in these
cases. These exercises will help retrain the tongue and help close the open
bite.
The goal is to repeat each exercise 10 times, and do these exercises 4 times
per day. The exercises should take a few minutes to do.
1. Clicking
2. Slurp; Squeeze: & Swallow
3. Squeeze teeth together thorough the day
4. Drink fluids after meals
5. Chew gum 1hour per day (sugarless)with lips together
‫التهم‬

52. -Various muscle exercises of the tongue are
carried to adapt the new swallowing pattern
-After the habit is intercepted the malocclusion
is treated using fixed or removable appliances.
- The mode of respiration
influences the posture of the jaw ,the tongue
and to a lesser extent the head
- Thus mouth breathing leads to altered jaw
and tongue posture and malocclusion

53. -Various muscle exercises of the tongue are
carried to adapt the new swallowing pattern
-After the habit is intercepted the malocclusion
is treated using fixed or removable appliances.
1.Normal people indulge in mouth
breathing under physical exertion such as
during strenuous exercise or Sports Activity
2.Complete or partial Obstruction of nasal
passage like deviated septum, nasal polyps,
tumors or adenoids can result in obstructive
mouth breathing
CAUSES

54. -Various muscle exercises of the tongue are
carried to adapt the new swallowing pattern
-After the habit is intercepted the malocclusion
is treated using fixed or removable appliances.
3.Habitual mouth breathing can be seen
as a unconscious deep rooted habit in
few people even after the removal of
nasal obstruction
4.Anatomic mouth breathing can be
seen in people with Short upper lip or
incomplete closure of mouth
CAUSES

55. Mouth breathing
Functional causes of malocclusion
! Large adenoids.
! Diseased tonsil e.g. tonsillitis.
! Hypertrophy of nasal turbinate.
! Nasal deformity e.g. deflected nasal septum.
! Hypertrophy of lymphoid tissue in
the nasopharynx.
! High fever.
Pathological mouth breathing
* Types of Mouth Breathing:
Habitual mouth breathing

57. -Various muscle exercises of the tongue are
carried to adapt the new swallowing pattern
-After the habit is intercepted the malocclusion
is treated using fixed or removable appliances.
1.Long and narrow face.
2.Narrow nose and nasal passage.
3.Short and flaccid upper lip.
4.Contracted upper arch.
5.An expressionless or blank face.
6.Increased overjet.
7.Anterior marginal gingivitis.
8.Dryness of mouth predisposes to
caries.
9.Anterior open bite.
EFFECTS

58. Mouth breathing
The effect of mouth breathing in producing malocclusion is explained as
Mouth breathing
Alters the posture of tongue, jaws & head
Tongue occupies a low posture, mandible drops & head tips back
This alters the equilibrium of pressure to jaw & teeth
Forces from buccinator mechanism is not counteracted
Cause adenoid faces or long face syndrome

59. Mouth breathing
Features of ADENOID FACES or long face syndrome
1. Increased overjet
2. Increased facial height
3. Narrow maxillary arch
4. Supraeruption of posterior teeth
5. Mandible rotates downward & backward
6. Open bite
7. Gingival and periodontal disease
8. Posterior cross-bite

61. -Various muscle exercises of the tongue are
carried to adapt the new swallowing pattern
-After the habit is intercepted the malocclusion
is treated using fixed or removable appliances.
-Referring to ENT surgeon for the
removal of nasal or pharyngeal
obstruction.
-Interception of the habit by using
Vestibular screens.
-Adhesive tapes can be used to establish
lip seal
-Rapid maxillary expansion procedures
are used to widen the constricted palate.
MANAGEMENT

64. - Bruxism is grinding of teeth for
non functional purposes
- Nocturnal grinding is called as
Bruxism and day time grinding is
called as Bruxomania
‫ليلى‬

65. 1.Psychological and emotional stress
2.Occlusal interference or discrepancy
3.Pericoronitis and periodontal pain
CAUSES

66. 1. Occlusal wear facets on teeth.
2.Fractures of teeth and restorations.
3.Mobility of teeth.
4.Tendreness and hypertrophy of masticatory
muscles.
5.Muscle pain when patient wake up in the
morning.
6.TMJ pain and discomfort.
EFFECTS

67. -Many cases of bruxism are involved with
emotional and psychological disturbances
,thus Psychological Counselling is
initiated.
-Hypnosis, relaxing exercises and massage
can help in relieving muscle tension.
-Night guards or Occlusal splints are
covered to prevent wear and occlusal
prematurities.
MANAGEMENT

68. Consideration for Oral Habit Therapy

69.  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 presence/absence
of other complexities
Consideration for Oral Habit Therapy

70. Treatment Options
Accurate assessment in context of the child’s physiologic and psychologic state
Proper and effective management
 Dentist-Patient Discussion
 Reminder Therapy
 Reward System
 Appliance Therapy

71. 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.

72. Reminder Therapy
 Reminder and not a punishment!
⌧Adhesive bandage
⌧Cotton glove
⌧Fingernail polish
⌧Bitters
⌧Arm wraps
‫وليس‬ ‫تذكير‬‫عقاب‬!

73. Reward System
 Consult parents to find out what
are the child’s 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.
 Highly recommended as it is effective.

74. Appliance Therapy
 Intra-oral appliance
 Child must welcome continued assistance
 Permanent reminder

75.  Finger Sucking Appliances
 Palatal Crib
Habit Correcting Appliances
Orthodontists commonly use a
“crib” to break the chronic tongue
thrust. This appliance serves only as
a reminder to keep the tongue back.
This in combination with “tongue
exercises” has shown to help reduce
an anterior open bite.

76. Habit Correcting Appliances
 Tongue/Thumb Retainer
 Fixed Tongue Crib

77. Habit Correcting Appliances
Lip Habit Correction Appliance
Lip Bumper

78. Habit Correcting Appliances

79. Myofunctional Trainer

80. 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.

82. Dr. Nabil Al-Zubair