Oral habits l Pediatric dentistry & dentistry for children MCQs for dental students 

 

ORAL HABITS in Pediatric dentistry

• Habit is defined as a frequent fixed tendency to perform an act or action.

 

Classification of habits

1. Compulsive habit-Habit which become fixated in a child’s behavior pattern.
2. Non compulsive habit-Habit which can be naturally modified or eliminated through the maturation process.
3. Physiological habit-Habit associated with normal physiological functioning. E.g. breathing, infantile swallow.
4. Pathological habit—Habit which develops due to some pathologies such as enlarged adenoids.
5. Intentional or meaning full habit are due to underlying psychological disturbances.
6. Unintentional or empty habits are without any underlying cause and can be easily intercepted.
7. Useful habits—Habit which are important to normal functioning of the body. E. g. Respiration, swallowing.
8. Harmful habit—Which are deleterious to the developing dentofacial complex due to harmful pressure or forces exerted.
9. The common Para functional oral habit in children—Thumb sucking, tongue thrusting, mouth breathing, lip sucking and bruxism.

Thumb sucking :

• Refers to placement of the thumb into the mouth in varying depth.
• Normal thumb sucking— Thumb sucking is considered normal till second year of life.
• Abnormal thumb sucking-The thumb sucking persisting beyond preschool period is abnormal as it may leads to deleterious effect on the developing orofacial structure.

 

Etiology of thumb sucking  : Etiological theories

Psychoanalytical theory (Sigmund freud):

• According to this theory, non-nutritive sucking habit is due to an inherent psychosexual drive. The oral cavity is an erogenous zone of sexual gratification during the oral period of psychosexual development.

Learning theory :

• According to this theory, habit of thumb sucking originates from the adaptive response. There is no psychological cause , This habit is acquired as the result of learning. The child relates the habit with some feeling, e.g. when he is hungry he starts sucking thumb or when he is bored he starts thumb sucking.

Oral drive theory of sear and wise :

• According to this theory, the thumb sucking is because of prolongation of nursing. strengthens the oral drive and to satisfy that, child starts with thumb sucking.

Benjamin :

• Habit of thumb sucking arises from rooting and placing reflexes.

Johnson and Larson:

• Every child has the inherent sucking reflex. Environmental factors may contribute in making this a non-nutritive habit like thumb sucking or digit sucking.

 

Predisposing etiological factor.

1. Prolonged bottle feeding.
2. Deprivation of necessary love, affection and care.
3. Stress, anxiety and fear.

 

Subtleny et al classification of thumb sucking

• Group 1 :  Thumb occupies large area of palatal vault. Lower incisors press out the thumb and contact it beyond the first joint. (50%).
• Group 2 :  Thumb placed into mouth around the first joint or just anterior to it. There is no palatal contact. The contact is only with Maxillary or mandibular anterior. (24%).
• Group 3 : Thumb fully contact with palatal vault without any contact with mandibular incisors (18%).
• Group 4 : (8%)Thumb did not progress appreciably into the mouth. The lower incisors made contact at the level of thumb nail.

Phases of thumb sucking as given by Moyers :

Phase I(Normal and sub clinically significant sucking)—From birth to 3 yrs of age.

• Persistence thumb sucking at the end of phase I need interceptive measure to prevent harm to developing dentition.

Phase II (Clinically significant sucking)- 3 yrs to 6/ 7 yrs.

• Interceptive and definitive corrective measure are indicated during this phase. 
• More serious attention required for purposeful digit sucking.
• Best time to solve dental problem related to digit sucking.
• Firm and definitive treatment program is indicated.

Phase III (Intractable Sucking) :

• Sign and symptom of malocclusion may be associated with sucking.

 

Clinical feature of thumb sucking

1. Proclination of maxillary incisors.
2. Retroclination of mandibular incisors.
3. Increased anterior placement of apical base of maxilla.
4. Increased over-jet.
5. Increased maxillary arch length.
6. Increased mandibular inter molar width.
7. Posterior cross bite.
8. Anterior open Bite.
9. High palatal vault.
10. Unilateral / Bilateral Class II occlusion.
11. Increased lip incompetence.
12. Hypotonic upper lip.
13. Hyper activity of lower lip.
14. Deformation of digit.

Tongue thrust

Clinical feature :

1. Proclination of upper anterior teeth.
2. protrusion of anterior segment of both arches with spaces between incisors and canines.
3. anterior and posterior open bite. posterior cross bite.
4. narrow and constricted maxillary arch.
5. usually dolichocephalic face.
6. Increased lower anterior facial height Incompetent lips.
7. expressionless face.
8. lisping.
9. The ”5” sound is the most affected

Management

• Tongue exercise
• Removable or fixed palatal crib
• My functional trainer.
• Oral screen

 

Mouth breathing :

• is a habit of breathing through mouth.

Types:

• Habitual, obstructive and anatomical:

Etiology

• Nasal pathologies—Enlarged turbinates, deviated nasal septum, allergic rhinitis, nasal polyps, chronic inflammation of nasal mucosa.
• Enlarged tonsils and adenoids.
• Constricted upper air way.
• Obstructive sleep apnoea syndrome.
• Persistive thumb sucking, excessive pacifier use or insufficient suckling as an infant.
• Hereditary factor. 

Clinical features

Adenoid fades—characterized by:

1.  Long narrow face
2. Narrow nasal passage
3. Flaccid lips with upper lip being short
4. Dolicocephalic skeletal pattern
5. Expressionless face
6.  Narrow V shaped maxillary arch.
7. Increased mandibular plane angle
8. Proclination of anterior
9. Anterior open bite
10. Posterior cross bite
11. Other feature include—Altered head and neck posture, pigeon chest, inflamed and irritated gingival tissue in the anterior maxillary arch, dry lips, dark circles under eyes, allergies and otitis media. Diagnostic tests—mirror test, butterfly test, water test, rhinomanometry (inductive plethysmography), cephalometrics.

 

Management:

1. Consultation with ENT specialist.
2. Removal of any pathologies.
3. oral screen.
4. pre orthodontic trainer. lip exercise.
5. Correction of the malocclusion