Transcript Common oral habits in children

Contents:
 definition.
Types.
Etiology.
Effect on occlusion.
Management.
 Definition :
A habit is a fixed practice produced by constant
repetition of an act.
 Type of oral habits:
1- thumb sucking.
2-digit sucking.
3-Bruxism.
4-mouth breathing.
5- lip biting and sucking.
6-Tongue thrusting.
1-Digit sucking :
-Non nutritive sucking behaviour.(thumb+finger sucking)
-Mean repeated forceful sucking of thumb with associated
strong buccal &lip contraction.
Etiology :
1- physiological : the infant sucks on any object brought into
contact with his lips as a reflex last for several months of
postnatal life.
2- Imitation of other children.
3-Feeding problem as rapid feeding or transition from liquid into
solid feeding.
4-Emitional or social problem.
Types of thumb sucking:
- passive : place thumb in mouth with no pressure or
bone change.
-active : heavy , vigorous prolong time affecting
incoming permanent teeth & shape of the jaw.
 Some children used for
- comfort + compensation.
- To attract attention especially in presence new baby.
- As a means of revenge against parents.
Classification of digit sucking:
- Phase 1: infancy (from birth up 2 years) considered
normal activity.
- Phase 2 : preschool child (2-5 yr) which could result
in temporary malformation of the jaws or
displacement of the teeth. Could resolve
spontaneously with habit withdrawal.
-Phase 3: School child (6-12yr) . Habit breaking appliance is
required in addition to correction of malocclusion.
Effect on occlusion:
Classical symptoms:
- Ant . Open bite.
- Proclination of upper incisor & retroclination of the lower
incisor
overjet.
- Ant. Open bite and tongue thrusting into the opened space.
speech defect ( lisping ).
- Post. Cross bite due to over activity of buccinator muscle
compressing the maxilla.
High palatal vault + narrow
nasal floor
mouth breath.
- Cheek muscles become hyperactive.
- Hyperactive lower lip ( hyperactive mentalis muscle).
- Hypotonic upper lip lead to lip habit.
management :
1- Role of parent ( physiological ):
-direct conversation with child.
-Avoid using –ve reinforcement or punishment.
2- Reminder therapy: - using tape to secure child
finger.
- thumb bag and cotton gloves most effective for
nocturnal habit.
3- chemical therapy :
Unpleasant stimuli such as ill-tasting solution painted onto
finger.
4- mechanical therapy: (appliance ).
Only when child really wants to discontinue and just needs only
reminder to accomplish this task.
a) Removable
Hawley appliance with palatal bar.
b) Fixed
1- Quad helix
used to expand constricted
maxilla & helices of appliance serve to remind child not to
put his finger in his mouth.
2- Palatal crib stop habit immediately, but should kept for
6month as retainer.
3- active oral screen eliminate habit +correct protruded upper
incisors.
 The best time to eliminate this habit by age of 3 years or
younger.
 Critical time by eruption of permanent incisor 6 yrs.
 As long as the habit stops before eruption of permanent
incisors , dental changes resolve spontaneously.
2- Bruxism :
Is habitual non functional grinding on teeth during sleep and
result in traumatic occlusion and TMJ problem.
- Etiology : may arise due to: emotional disturbance , cuspal
interference , GIT, Parasite and handcapped problem as
epilepsy or cerebral pulsy.
 Effect of bruxism :
Soreness of masticatory muscles , TMJ dysfunction, traumatic
occlusion ,dental attrition(wear) , hypersensitivity and
vertical dimension.
 Management :
1- in case of stress have little talk with child to find out what
bother him school or home , try to solve it .
2-occlusal adjustment in case of occlusal interference .
3- medications ( tranquilizers, tetrazepam ).
4-appliance : night guard
prefabricated or custom made.
Use of vinyl plastic bit guard cover occl. Surface to prevent
continuing abrasion.
5- Oral rehabilitation:
In case of great loss of vertical dimension. Eg : SSC to
prevent pulp exposure and hypersensitivity.
6- Referral physician with resistant condition.
3- Mouth breathing : it may result from :
a) anatomical
upper lip incompetent.
b) respiratory obstruction adenoid , deviated nasal septum.
Or c) Habitual mouth breathing .
 harmful effect : -protrusion of upper anterior teeth.
-high arched palate.
-ch. Gingivitis.
- dental caries ( xerostomia).
 Management :
1- removal of the cause.
2-passive oral screen in case of habitual type.
3-active oral screen in case of protruded incisors.
4-evaluated by ENT physician + orthodontic.
5- mouth breathing may be self-correcting as child grows older
How we know such pt.
- keep patient unaware of evaluation:
 By placement thin piece of tissue paper in front of nose ,
mouth when child is a sleep.
 A cold mirror also can be used to evaluate mouth breathing.
(fogging).
4-lip biting and sucking:
 Etiology : - Stress
-Psychological disturbance.
-Excessive overjet.
-Class 2 division 1.
 Harmful effect:
1- ant. Open bite.
2-proclination of upper incisors and retroclination of the lower
incisors.
Correction of the condition by elimination of the cause and habit
breaking appliance (lip bumper and oral screen ).
5- tongue thrusting :
Pattern where tongue tip become placed in forward position
between incisors during swallowing.
Etiology :
-persistence of the infantile type of swallowing.
-respiratory obstruction.
- macroglssia.
-muscular imbalance.
Harmful effect:
- Open bite.
- Increased overjet.
- Protrusion of the upper incisors.
- Speech problem.( lisping).
Type of tongue thrusting:
1-Simple
ant. Leads ant. Open bite.
post. Leads lat. Open bite. Caused by early loss of
primary molar.
2-complex associated with naso-respiratory distress , mouth
breathing and tonsillitis.
3-retained infantile swallowing
sever open bite.
-Infantile swallow: - during sucking infant place tongue
beneath nipple in contact with lip.
- Swallow with jaw a part , lips together.
-Adult swallow : swallow with tongue tip against palate.
-swallow with teeth together, lips relaxed.
Dental management:
1- insertion of tongue guard as remainder appliance.
2-correction of malocclusion.
3- myofunctional therapy:
- Child instruct to practice swallowing correctly 20 time before
each meal.
- Mand. Ligual arch with crib or acrylic palatal retainer with
fence maybe constructed as reminder to properly position
tongue during swallowing .
Thank you for your
attention.