Bad Oral Habits Flashcards
Bad oral habits
Creates malocclusion
1.- Thumb sucking
2.- Tongue thrusting
3.- Lip sucking
4.- Nail biting (Onicofagia)
5.- Mouth breather
6.- Bruxism
BOH depends on:
- intensity
- duration
- frequency
amount of force that is applied to the teeth while the habit is performed
Intensity
means the age at which the child get the habit, and the time spent by the child to do the habit per day (hours/day)
Duration
Who produces more changes?
A) a child who sucks intermittently with high intensity
B) a child who sucks continuously (for more than 6 hrs)
B) a child who sucks continuously (for more than 6 hrs) can cause more significant dental changes
Hours of force per day enough to cause tooth movement.
4-6 hrs
The most important thing to remember before any kind of treatment is that the child must
the child must want to discontinue the habit so that the treatment can be successful.
how many times the child do the habit per day
Frequency
Each one of bad oral habits would show one or more occlusal problems
- change in the inclination of upper and lower incisors
- anterior open bite
- constriction of maxillary arch (with posterior cross bite and/or crowding)
is the placement of the thump or more fingers in the oral cavity with repeated and forceful sucking movements associated with strong buccal and lip contraction
Thumb or finger sucking
2 types of thumb sucking
Active
Passive
There is a heavy force by the muscles during sucking and if this habit continues for a long period the position of permanent teeth and the shape of mandible will be affected.
95%
thumb sucking ACTIVE
The child puts his/her finger in the mouth but there is no force on teeth and mandible so this habit is NOT associated with skeletal changes.
Como común
Thumb sucking PASSIVE
Diagnosis
determine the psychological or the causative factor involve
Which are: (6)
working mother
feeling lost
rebel
attention seeking
imitation
fear
Thumb sucking extra oral features
Digits (fingers): show redness, exceptionally clean, wrinkling, roughened wart, blister or ulceration and rarely deformity
lips: hypotonic upper lip and incompetent lips
facial form: mandible retursion and maxillary protrusion
Thumb sucking intra oral features
- anterior open bite
- posterior cross bite
- increased overjet
upper arch: pro lined maxillary incisors with or without diastema, constricted V-shaped arch with more constriction across the canines
lower arch: returned mandibular incisors
inter-arch: reduced overbite, increased over jet (open bite) and posterior cross bite
Treatment thumb sucking must be
During the eruption of the permanent incisors
Treatment approaches of sucking habit
- direct interview
- reward system
- reminder therapy appliance
- non appliance reminders
- appliance reminder therapy
- removable palatal crib
- fixed palatal crib
Consists is a simple discussion between the child and the dentist in which they express the concerns and include an explanation by the dentist
Direct interview
Appliance reminder therapy for sucking habit
These are passive appliances which are retained in the oral cavity by clasps and an acrylic baseplate with a palatal crib.
Removable palatal crib
Appliance reminder therapy for sucking habit
The design consists in bilateral bands placed in the first molars connected to a lingual arch with anterior crib device.
Fixed palatal crib
This are for those patients who want to stop the habit but they need the assistance to do it. Usually 6 to 8 weeks of treatment should be enough.
They include:
An adhesive bandage with waterproof tape on the finger that is sucked.
An elastic bandage that is wrapped around the elbow to prevent the arm flex and the fingers from being sucked.
Chemicals with hot flavoring placed on the sucked digits.
non-appliance reminder therapy
Time of therapy for sucking
6-8 months
- if the habit reappears, the appliance should be retained for 3 more months to make sure the habit has truly stopped
abnormal tongue function and posture that cause many malocclusions. The effects and management at early stages may be helpful to prevent future severe skeletal malocclusions
Tongue thrusting
Is related to the persistence of a wrong childish swallow pattern during childhood and adolescence which produces an open bite and protrusion of the anterior tooth segment
Tongue thrusting
removing the etiology is the primary and the most important step in the correction of the tongue thrusting habit
Tt habit
has proposed the following factors that cause the tongue thrusting habit
Who and what factors
Fletcher
- genetic
- feeding practices
- infections
these are specific anatomic and neuromuscular variations in the orofacial area that can precipitate tongue thrust
Genetic
long feeding bottle and wrong swallowing pattern can be attributed as one of the etiological factors of tongue thrusting
Feeding practices
breathing tract infections such as: chronic tonsillitis and allergies can cause a decrease in the amount of in the mouth which brings the tongue thrusting swallow
Infections
Types of tongue thrusting (5)
anterior tongue thrusting
posterior tongue thrusting
both: anterior and posterior tt
lateral tt
unilateral tt
Intra oral features of tt
anterior open bite
posterior cross bite
simple tt, abnormal tooth contact during the swallowing
Extra orals features of tt habit
usually have a dolichocephalic face
incompetent lips
speech problems
Different treatments for tt
Myofunctional therapy
Simple habit control
Habit-breaking app
MYOFUNCTIONAL THERAPY FOR TT
the px can be guided to have the correct posture of the tongue during swallowing, by different exercises:
- swallow with the tip of the tongue in the palatal
- molar tap
- ABC trace
- tongue trace
Habit breaking appliance for tt
- removable app
- nance palatal arch app
- fixed appliances with fixed tongue cribs
in about 85% of cases represents an involuntary subconscious adaptation to reduce potency of the nasal airway and mouth breathing is a simply requirement in order to get enough air
Mouth breathing
3 etiology of MB
Obstructive
Habitual
Anatomic
complete obstruction of the normal flow of air through the nasal passages
Obstructive
continuous breathing through the mouth by the habit force
Habitual
a short upper lip does not allow the correct closure of the lips
Anatomic
If the patient has an altered breathing pattern; it could change the … and …
it could change the posture ol this structures.
And
the balance between the jaw growth and teeth position.
Other two consequence of MB
Face height would increase leading to adenoid facial appearance.
The posterior teeth would over-erupt and the mandible would rotate down and back leading in an anterior open bile and an increased overjet.
Intra oral features MB
5
anterior dental protrusion
distal relationship between the mandible and the maxillary
V-shaped maxillary arch and deep palatal vault
anterior open bite
gingivoplastia y enf periodontal
Extra oral features
3
adenoid long face with increased facial height
incompetent lip posture with short upper lips
narrow external nares
With what can we diagnostic MB
HC
Allergic rhinitis
Chronic Nasopharyngeal obstruction
Treatment for MB
Otorhinolaryngology referral
Oral screen
almost all px should be referred to the specialist
to check and management nasal airway
otorhinolaryngology referral
it should be used after the removal of the nasal obstruction.
One of the most effective ways to reestablish nasal breathing Is preventing the access of air through the oral cavity.
It consists of a thin sheet of acrylic extending deep into the vestibular sulcus and the labial & buccal breathing holes can be punch out so that they can allow the entrance of some amount of air Into the mouth.
after 3-6 months of this tx, reduction in the anterior open bite could be seen
Oral screen
Involves manipulation of the lips and perioral structures there will be a big overjet with the protrusion of the upper anterior teeth and a lingual inclination of the lower anterior teeth followed by a skeletal discrepancy
Lip biting
Etiology of LB
malocclusion ANGLE II div1
habits — transference of the other bad habits such as thumb sucking
emotional stress
Children in stressful situations have an increased salivary output this increases the number of swallows and lip seals required and it may become a compulsive activity.
Emotional stress
Clinical features of LB
Maxillary protrusion and lingual inclination of the mandibular incisors
ulcers
lip: redded, irritated and a chapped area below the vermilion border, in some cases it could be chronic herpes infection
Treatment of LB
- appliances fixed therapy
LIP BUMPER
is made of stainless steel wire. It is placed on the jaw from the right molar to the left molar. The curve is located more to the gingival margin direction, 3 mm from the labial teeth surface.
The anterior area can be covered by plastic or acrylic which functions are to help the adaptation of lip and cheeks muscles, so the pressure of lip muscle on teeth will decrease.
LIP BUMPER
Time use for lip bumper
It is better used 24 hours within 6 to 18 months period, depending on teeth movement and the treatment.
Effect of using lip bumper
Is the forward movement of lower incisors and distal movement of molars.
Etiology of onychof
anxiety, stress, loneliness, imitation of other family member, inactivity, transference from a thumb-sucking habit.
Management treatment for NB onico
The key to success is the nailbiter’s consent and cooperation.
Nail biting is a habit that cannot be managed without considering some related factors such as co-morbidities precedent and consequences of the behavior.
Therapy for NB
Variety of reminders and application of chemicals with hot flavored on the nail area.
