- intensity - duration - frequency

Bad Oral Habits Flashcards by Regina Sánchez

Bad oral habits
Creates malocclusion

1.- Thumb sucking
2.- Tongue thrusting
3.- Lip sucking
4.- Nail biting (Onicofagia)
5.- Mouth breather
6.- Bruxism

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BOH depends on:

intensity
duration
frequency

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amount of force that is applied to the teeth while the habit is performed

Intensity

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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

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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

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Hours of force per day enough to cause tooth movement.

4-6 hrs

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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.

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how many times the child do the habit per day

Frequency

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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)

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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

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2 types of thumb sucking

Active
Passive

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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

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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

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Diagnosis
determine the psychological or the causative factor involve

Which are: (6)

working mother
feeling lost
rebel
attention seeking
imitation
fear

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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

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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

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Treatment thumb sucking must be

During the eruption of the permanent incisors

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Treatment approaches of sucking habit

direct interview
reward system
reminder therapy appliance
non appliance reminders
appliance reminder therapy
- removable palatal crib
- fixed palatal crib

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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

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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

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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

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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

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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

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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

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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.