1. Common oral habits in children

2. Contents:
definition.
Types.
Etiology.
Effect on occlusion.
Management.

3. 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.

4. 1-Digit sucking : Etiology :
-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.

5. 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.

6. 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.

7. -Phase 3: School child (6-12yr)
-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.

8. 1- Role of parent ( physiological ): -direct conversation with child.
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.

9. 4- mechanical therapy: (appliance ).
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.
Removable Hawley appliance with palatal bar.
Fixed 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.

10. 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.

11. 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.

12. 3- Mouth breathing : it may result from :
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).

13. 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).

14. 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 ).

15. 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).

16. 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.

17. 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 .

18. Thank you for your attention.