Dental Public Health 5th-year lecture

1. Prevention
of Oral
Habits
ASS. PROF. RANDA YOUSSEF

2. Any repetitive behaviour that
utilizes the oral cavity.

3. COMMON ORAL HABITS
LIP BITING
TONGUE THRUSTING
BRUXISM
NAIL BITING
• Pencil chewing
• Bobby pin opening
• Bottle opening
• Needle biting
• Improper brushing
• Wire Chewing ( Electricians)
MOUTH BREATHING
THUMB SUCKING

4. • The presence of an oral habit in the 3 to 6 year old is an
important finding.
• An oral habit is no longer considered “normal” for
children near the end of this age group.
• If the habit has resulted in movement of the primary
teeth, some form of intervention is warranted prior to
the eruption of the permanent teeth.

5. The types of changes in the dentition that an oral habit may
cause vary, depending on the intensity, duration, and
frequency of the habit.
• Intensity
– Intensity is the amount of force that is applied to the
teeth while performing the habit (i.e. Sucking).
• Duration
– Duration is defined as the amount of time spent sucking a
digit.
• Frequency
– Frequency is the number of times the habit is practiced
throughout the day.

6. DURATION PLAYS THE MOST CRITICAL
ROLE IN TOOTH MOVEMENT!!!
Clinical and experimental evidence suggests that
4 to 6 hours of force per day are necessary to
cause tooth movement.

7. •Badgering the child
about the habit
tends to negatively
reinforce the habit.

8. • Depending on the willingness of the child to stop the habit,
three different approaches to treatment have been
advocated.
They are:
1. Reminder Therapy
2. Reward Therapy
3. Appliance Therapy

9. CLASSIFICATION
• Sucking:
Nutritive / Non-nutritive
• Non-sucking:

10. Sucking Habits
• Nutritive Sucking Habits
Prolonged bottle feeding…………………..ECC

11. Non-nutritive Sucking
•Sucking is a normal baby reflex, beginning
around the 29th week of gestation.
•Almost 100% of normal babies engage in
non-nutritive sucking.
•Babies may suck their thumb, fingers,
hand, a pacifier, or other inanimate object
such as a blanket or toy.
•

12. •Sucking tends to occur more often
when the child is tired, bored,
anxious, or upset.
•Although most children discontinue
non-nutritive sucking between 2 and
4 years of age, more than 20% still
engage in the habit at age 3.
•Older children are often motivated to
quit by peer pressure at school.

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THUMB SUCKING
Thumb and finger habits are seen
in children from very small ages.
Develops as a habit or due to sense of insecurity.
It is defined as the placement of thumb or one or
more fingers in varying depth into the mouth

14. • Thumb and finger habits make up to
majority of oral habits.
• The classic symptoms of an active habit are
reported to be the following:
1. Anterior open bite.
2. Facial movement of the upper incisors.
3. lingual movement of the lower incisors.
4. Maxillary constriction.

15. • Maxillary arch constriction is due to the
change in equilibrium balance between the
oral musculature and the tongue.
• When the thumb is placed in the mouth, the
tongue is forced down and away from the
palate.
• The obicularis oris and buccinator muscles
continue to exert a force on the buccal
surfaces of the maxillary dentition.
• Without the tongue’s counterbalancing force
on the lingual surfaces, the posterior
maxillary arch collapses into crossbite.

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WHAT HAPPENS TO YOUR CHILD’S
TEETH & THUMB???

17. • Timing of treatment is critical.
• The child should be given every opportunity to
stop the habit spontaneously before the eruption
of the permanent teeth.
• Treatment is usually undertaken by age 6 years.

18. HOW DO I STOP THUMB SUCKING???
• Reminder Therapy
– Reminder therapy is appropriate for those who want to stop the
habit but need some help to stop completely.
– An adhesive bandage taped to the offending finger can serve as a
constant reminder not to place the finger/digit in the mouth.
The “reminder” must be neutral and not perceived as any form of
punishment

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REMINDER THERAPY
 Extraoral approaches:
It employs hot tasting, bitter flavoured preparation or distasteful agents that are
applied to finger and thumbs.
For example, cayenne, pepper,
Thermoplastic thumb post.
 Intraoral approaches:
Various orthodontic appliances are employed to attenuate and eventually break
the habit
THUMB
CAP

20. • Reward Therapy
– A contract is agreed upon between the child and parent or
between the child and dentist.
– The contract simply states that the child will discontinue
the habit for a specified period of time and in return
he/she will receive a reward if the requirements of the
contract are met.
The more involvement the child can take in the project, the
more likely the project will succeed.

21. • Appliance Therapy
– Appliance therapy should only be used when reminder and reward
therapy have failed.
– The dentist should explain to the patient and parent that the appliance
is not a punishment but rather a permanent reminder.
– The parent and the child should be informed that certain side effects
may temporarily appear after the delivery of an appliance.
– These include:
• Eating difficulties.
• Speaking/speech problems.
• Disturbed sleeping patterns.
– Habit discouragement appliances should be left in the mouth for six
months.

22. • There are two major categories of commonly used appliances:
1. Removable
2. Fixed
• Removable
– Easily misplaced or lost
– Patient compliance is a major factor
• Fixed
– “Cemented” in-place using a dental cement/adhesive
– Does not rely on patient compliance

23. Oral Habits
--Appliance Therapy--
• Removable Appliance
– Example: Modified Hawley

24. • Fixed Appliance
Examples: Palatal Crib
Blue grass appliance

25. --Pacifier Habits--
• Dental changes created by pacifier habits are similar to changes
created by thumb habits.
• Anterior open bite and maxillary constriction are seen
consistently in pacifier suckers.
• Labio-lingual movement of incisors may not be as pronounced as
with a digit habit.
• Manufacturers have developed orthodontic pacifiers that claim
to be more like a mother’s nipple and not as deleterious to the
dentition as a thumb or conventional pacifier.

27. • Pacifier habits are theoretically
easier to stop than digit habits.
• The pacifier can be discontinued
gradually or at one point in time
under the control of the parent.
• In a few cases, the child may
subsequently start sucking a
finger or thumb.

28. MOUTH BREATHING
Usually seen in people
with nasal obstruction.
May also occur as a habit.

29.  Habitual respiration through the mouth instead of the nose
CLASSIFICATION
FINN(1987)
Anatomic-short upper lip permits incomplete closure
Obstructive-complete obstruction of the normal flow of air through nasal passages
Habitual-continual breathing from mouth by force of habit although abnormal obstruction has been removed

30. WHAT CAN HAPPEN DUE TO THIS??? DENTAL EFFECTS
Forward placement of
upper front teeth
Gap between upper & lower
front teeth
Improperly placed teeth

31. Effects on the facial structures
Facial form
 Large face height
 Large mandibular plane angle
 Retrognathic mandible &maxilla
Adenoid facies
 Long narrow face with long narrow
nose, nasal passage & flaccid lips
 Nose tipped superiorly Infront so an
observer can look directly into the nares
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32. Gingiva
 Inflamed &irritated gingival tissue in the anterior
maxillary arch
 Gingiva is hyperplastic due to continuous exposure of
the tissues to air
 Gingiva exhibits classic rolled margin with an enlarged
interdental papilla
Lip
 Short thick incompetent upper lip and a voluminous
curled over lower lip
 On smiling, patients reveal large amounts of gingiva
producing a ‘gummy smile’

33. TREATMENT
Treatment of mouth breathing
includes:
 Elimination of the cause
 Interruption of the habit
 Correction of malocclusion
 Symptomatic treatment

34. ORAL SCREEN
 This is the most effective way to reestablish
nasal breathing, by preventing air from
entering oral cavity.
 It is curved corresponding to the curvature of
the arch and is made of acrylic.
 It works on the principle of both force
application and force elimination
 The appliance has to be worn for 2-3 hrs
during the day and during the sleep at night.
 If patient feels difficult to breathe, then multiple holes can be made that are closed one
by one over a period of time.

35. TONGUE THRUSTING
Tongue thrust is the forward movement of the
tongue tip between the teeth to meet the lower
lip during deglutition & in sounds of speech, so
that the tongue lies inter-dental (Tulley1969)

36. CLASSIFICATION
 Physiologic
Normal tongue thrust swallow of infancy
 Habitual
Tongue thrust present as a habit even after correction
of the malocclusion
 Functional
When tongue thrust is an adaptive behavior
Developed to achieve an oral seal
 Anatomic
Person having an enlarged tongue

37. TONGUE THRUST
 Simple tongue thrust
Anterior open bite
Normal tooth contact posteriorly
Contraction of lips, mentalis
 Complex tongue thrust
Generalised open bite
Absence of contraction of lips, mentalis
 Lateral tongue thrust
Posterior open bite with tongue thrusting laterally
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38. CLINICAL MANIFESTATIONS
Extra oral findings
 Lip posture- lip separation is greator in tongue thrust, both at rest and in
function.
 Mandibular movements- More erratic, no correlation between the movement
of tongue and mandible.
 Speech- speech disorders such as lisping, problems in articulation of s, n, t,
d, l, z, and v sounds.
Intra oral findings-
 Tongue movements- swallowing movements are seen to be jerky and
inconsistent.
 Chin point is posterior as compare to normal position.
 Tongue posture- tongue tip at rest is lower in tongue thrust group.

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Malocclusion-
Features pertaining to maxilla-
 Proclination of maxillary anteriors resulting in an increase
overjet
 Generalized spacing
 Maxillary constriction
Features pertaining to mandible-
 Retroclination or proclination of mandibular teeth
depending on type of tongue thrust present
Intermaxillary relationship-
 Anterior or posterior open bite
 Posterior teeth crossbite

40. TREATMENT
Tongue thrust often self corrects by 8 or 9years of age by the time the
permanent anteriors completely erupts
TRAINING OF CORRECT SWALLOW & POSTURE OF THE TONGUE:-
 Myofunctional exercises
2S EXERCISES –
Using the pressure point on the papilla the SPOT is shown .the tip is
against this spot at rest position
SQUEEZE is done by squeezing the tongue vigorously against this spot
with the teeth closed , followed by relaxing.
4S EXERCISES
SPOT ,SALIVATE,SQUEEZE & SWALLOW

41. MECHANOTHERAPY:-
Tongue crib
Oral Screen
Tongue guard

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BRUXISM
Bruxism is the grinding or gnashing of teeth, usually occuring at night
Causes ‘ ’

43. ETIOLOGY
1. PSYCHIC TENSION ASSOCIATED WITH ANY KIND OF STRESS.
2. OCCLUSAL INTERFERENCE SUCH AS DUE TO MALOCCLUSION.
3. INTESTINAL PARASITES.
4. SUBCLINICAL NUTRITIONAL DEFICIENCY
5. ALLERGY
6. ENDOCRINE DISTURBANCE.

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TREATMENT
Counseling
Occlusal Splint
Tranquillizers

46. HABITS THAT INVOLVE MANIPULATION OF
THE LIPS AND PERIORAL STRUCTURES ARE
TEERMED AS LIP HABITS
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LIP HABIT

47. Mouth ulcers
Spacing & flaring of
upper front teeth
 Protrusion of maxillary incisors & retrusion of
mandibular incisors.
 Reddened irritated & chapped area below the
vermillion border
 Mentolabial sulcus becomes accentuated

48. HOW DO I STOP???
 Correction of malocclusion
 Treating the primary habit
Lip habit along with digit sucking can be corrected by hawley’s retainer with
labial bow
 Appliance therapy
Oral screen
Lip bumper
It is positioned in the vestibule of the mandibular arch &serve to prohibit
the lip from exerting excessive force on the mandibular incisors
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Use of LIP BUMPER

49. NAIL BITING
BELOW 3 YEARS – ABSENT
4 TO 6 YEARS – INCIDENCE RISES SHARPLY
7 TO 10 YEARS – REMAINS CONSTANT
REACHS ITS PEAK AT ADOLSCENCE
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EFFECTS
Chapping of finger nails
Fungal Infection of fingers
Prevention
Application of bitter
substances onto finger
nails

51. O
THER
O
RAL
H
ABITS
Bobby pin opening
Needle biting by
tailors
Pencil Chewing
Wire chewing by electricians
Bottle
Opening

52. EFFECTS
Chipping of tooth
edge
Notching of tooth
edge
Loss of tooth
vitality

53. IMPROPER BRUSHING HABIT
Effects

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•QUESTIONSSSS