Oral habits and treatment orthodontics

Abd ul karim Mohammad noor alchino

Introduction

•Oral habits are very common among children and they cause a concern to the parents as they result in many dental manifestations as improper alignment of teeth and etc .. Oral habits are considered to be abnormal among children of 3 – 6 years old

the type of changes resulting from Oral habits depends on :

1 . Intensity 2. Duration 3. Frequency

All those factors together should be considered , but duration plays the most important role in tooth movement

Many experimental evidences suggests that 4 to 6 hours of force is needed daily to cause tooth movement

THE oral habits

•Thumb / finger sucking •Pacifier Habits•Lip Habits•Tongue Thrust/and Mouthbreathing

Habits•Nail Biting•Bruxism

Thumb sucking

Thumb / finger sucking

Sucking is a normal baby reflex , beginning around the 29th week of gestation

the classic symptoms of this habit are :

1. Anterior open bite 2. Labial movement of the upper incisors

and lingual movement of the lower incisors

3. Maxillary constriction

Anterior open bite

•Anterior open bite is lack of vertical overlap of the upper and lower incisors when the teeth are in occlusion , this results because the digits rest directly on the incisors

•The digits impedes the eruption of the incisors while the posterior teeth are free to erupt … to a lesser degree the anterior open bite might be a result of intrusion of the incisors

Anterior open bite

Facio – lingual movement of the incisors

this depends on how the thumb or finger is placed into the mouth

Usually the finger is placed into the mouth as it exerts pressure on the palatal aspect of the upper incisors and labial aspect of the lower incisors , this results in increased over jet .

Orientation of the finger into the mouth which results in pressure on the palatal aspects of the upper incisors and the lingual aspect of the lower incisors resulting in increased overjet

Maxillary constriction

Maxillary ach constriction results due to change in the equilibrium balance between the oral musculature and the tongue , when the thumb is introduced into the mouth the tongue is forced down and away from the palate , and the orbicularis oris and the buccinator muscles exert pressure on the buccal ascpect of the upper teeth , with out the tongue counterbalancing the force on the lingual aspect of the maxillary teeth , this results in posterior crossbite .

The direction of force exerted from the oral musculature

Posterior cross bite resulting from the maxillary constriction due to change in the equilibrium balance between the tongue and the oral musculature

Treatment

•Treatment time is critical

•The child should be given the opportunity to stop the habit spontaneously before the eruption of the permanent teeth

•The treatment is undertaken usually by the age of 6 years old

Non dental intervention •Reminder therapy is used in child who

wants to quit and needs help , the use of any reminders as a adhesive badage on the finger bieng sucked

•Reward system therapy

•An elastic bandage wrapped around the elbow loosely preventing the arm from flexing

Dental devices used to correct damage from finger sucking habit

• The Palatal Crib is designed to reduce the comfort of thumb sucking by placing a metal crib over the most anterior portion of the palate, preventing the thumb from resting along or contacting the palate.

• The Hayrake is a fixed appliance designed to discourage thumb sucking by adding spurs to a metal crib placed in the anterior portion of the palate.

• The Blue Grass appliance is designed to prevent the patient from sucking their thumb or tongue thrusting. This fixed appliance uses a spinning roller to help break the patient's habit and allow the anterior teeth to return to their normal position

• The Quad Helix appliance is designed to achieve arch development by providing a light, continuous force to both anterior and posterior segments. Fabricated as either fixed or removable (MIA), this appliance can also be used for molar rotation

Pacifier habits

•Pacifier habits are similar to thumb / finger habits as the mechanism is the same and the change is the same but the facio – lingual movement us less pronounced in here

•Some manufacturers have developed pacifiers that claim to be more similar to the mother’s nipples as to be less harmful to the dentition than the conventional pacifier or the thumb

Pacifier habits

• Pacifier habits theoretically are more easier to stop than thumb habits , they can be stopped gradually or at one point of time under the control of the parents

• In few cases the child starts to suck his thumb or finger

Lip Biting

Lip habits

• habits the involve manipulation of the lip and perioral structures

• Most lip habits do not cause dental problems but they may maintain an existing malocclusion

• The most common presentation of lip habit is the lower lip tucked back to the maxillary incisors

• lingually directed force is placed on the mandibular teeth and a palatal force on the maxillary teeth resulting in proclination of the maxillary incisors, a retroclination of the mandibular incisors, and an increased overjet

treatment1 . correction of malocclusion Class 1 with increased over jet :Fixed or removable to tip the teeth back Class 2 : growth modification procedures 2. appliance therapy

Oral shield

•Lip pumper is used to prohibit lip from exerting excessive force on the mandibular incisors and reposition the lip away from the lingual aspect of the maxillary incisors

Nail biting

Nail bitting

•Nail biting is a habit rarely seen before 3 to six years of age.

•The number of people who bite their nails is reported to increase until adolescence.

•There is no evidence that nail biting can cause malocclusion or dental change.

•There is no recommended treatment.

Tongue thrusthing

Tongue thrusting

•a human behavioral pattern in which the tongue protrudes through the anterior incisors during swallowing , speech , and while the tongue is at rest

• Factors that can contribute to tongue thrusting include :•  macroglossia •  thumb sucking• large tonsils•  ankyloglossia • and certain types of artificial nipples used in feeding infants. In

addition, allergies or nasal congestion can cause the tongue to lie low in the mouth because of breathing obstruction, contributing to tongue thrusting

Effects

•Anterior open bite or posterior open bite depends on the posture of the tongue

•Proclination of maxillary anterior •Generalized spacing between teeth •Retroclination or proclination of the

mandibular incisors•Posterior crossbite•Speech defect

treatment

• There are two methods for treating tongue thrusting. The patient may place an appliance similar to a night guard in the mouth at night, or may wear a more permanent device that can be removed and adjusted by a dentist. The other method requires oral habit training, an exercise technique that re-educates the muscles associated with swallowing by changing the swallowing pattern. This method must be taught by a trained therapist. Therapy has proven to give the highest percentage of favorable results; however, the appliance is still used and is successful in some cases

Bruxism

Bruxism

• Bruxism is a grinding or gnashing of the teeth and is usually reported to be nocturnal ( at night ) .

• Most children engage in some bruxism that results in moderate wear of the primary canines and molars.

Treatment

• Treatment should begin with simple measures, including the elimination of occlusal interferences and occlusal equilibration if necessary.

• If occlusal interferences are not located or equilibration is not successful, referral to appropriate medical personnel should be considered to rule out any systemic problems (intestinal parasites, allergies, endocrine disorders, etc.).

• If neither of these two steps is successful, a mouth guard-like appliance can be constructed to protect the teeth and try to eliminate the grinding habit.

Mouth guard