Oral Habits in Children

Habit is a tendency towards an act that has become a repeated performance,relatively fixed,consistent and easy by a person.Frequently children acquire certain habits,that may be either temporary or permanent.In initial stages habits are of conscious effort gradually they become less conscious and often become unconscious if performed repeatedly.Oral habits in children have a definite effect on developing teeth and its supporting structures.

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

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

EFFECTS

Persistence of habit beyond the age cen lead to various malocclusions and the severity depends on intensity ,duration and frequency of the habit.

1.Labial tipping of upper front teeth resulting in proclination of maxillary anterirs.

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.

MANAGEMENT

A)Psychological approach :- 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.

B)Mechanical aids :- 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.

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

Tongue thrust is a condition in which the tongue makes contact with any teeth anteroir to the molars during swallowing.

CAUSES

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.

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.

EFFECTS

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.

MANAGEMENT

-Tongue thrust habit can be intercepted using habit breakers both fixed and removable with cribs and rakes.

-Child is thought the correct method of swallowing

-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.

CAUSES

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.

3.Habitual mouth breathing can be seen as an 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.

EFFECTS

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.

MANAGEMENT

-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.

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

CAUSES

1.Psychological and emotional stress.

2.Occlusal interference or discrepancy.

3.Pericoronitis and periodontal pain.

EFFECTS

1. Occlusal wear facets on teeth.

2.Fractures of teeth and restorations.

3.Mobility of teeth.

4.Tendreness aand hypertrophy of masticatory muscles.

5.Muscle pain when patient wake up in the morning.

6.TMJ pain and discomfort.

MANAGEMENT

-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.

Lip biting involves the lower lip which is turned inwards and pressure is exerted on the lingual surfaces of the maxillary anteriors.

CAUSE

Lip biting and lip sucking appear after forced discontinuation of thumb or finger sucking.

EFFECTS

1.Proclined upper anteriors and retroclined lower anteriors.

2.Hypertrophic and redundant lower lip.

3.Cracking lips.

MANAGEMENT

Lip bumpers are used to intercept this habit.They not only keep lips away but also improve axial inclination of anterior teeth.

Nail biting does not produce gross malocclusion.Minor local tooth irregularities like rotation,wear of incisal edge and minor crowding may occur.