Oral Habits 1233

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TONGUE THRUSTINGTONGUE THRUSTING

HABIT HABIT



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Tongue thrusting is defined as a condition in which thetongue makes contact with any teeth anterior to the molarsduring swallowing.

A tongue thrust is said to be present if the tongue isobserved thrusting between & the teeth do not close in centric

occlusion during deglutition.- Brauer (1965)

tongue makes contact with any teeth anterior to the molars duringswallowing.

A tongue thrust is said to be present if the tongue is observed

thrusting between & the teeth do not close in centric occlusionduring deglutition.- Brauer (1965)



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CLASSIFICATION OF

TONGUE THRUSTING

HABITS





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Type IV: Def orming anterior & lateral tonguethrust

Sub Group 1 : Anterior & Posterior open bite

Sub Group 2 : Proclination of anterior teeth

Sub Group 3 : Posterior cross bite



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2. Classification II:A. Simple tongue thrust

Features :

j Normal tooth contact in

posterior regionj Anterior open bite

j Contraction of lips, mentalis

muscle & mandibular elevators



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B. Lateral Tongue thrustFeatures :

Posterior open bite with tonguethrusting laterally



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C. Complex tongue thrust

Features : a) Generalized open bite

b) Absence of contraction of lip & muscle

c) Teeth contact in occlusion



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3. Classification III

1. Physiologic Tongue Thrust :During infantile swallow the tongue is placed

between the gum pads. After six months of life,

several maturational events occur that alter the

functioning of the orofacial musculature.

With the arrival of incisors the tongue assumes

a retracted posture.

If the transition of infantile to mature swallow

does not take place with the eruption of teeth, then

it leads to tongue thrust swallow.



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2. Habitual Tongue Thrust :It is present as a habit after the correction of the

malocclusion.

3. Functional Tongue Thrust :It develops to achieve an oral seal.

4. Anatomic Tongue Thrust :It occurs due to macroglossia.



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Anatomic or neuromuscular variations in orofacialregionHyper tonic orbicularis oris

Leaned behaviour

-impr oper bottle feeding

-thumb sucking

-respirator y tract infections

-pr olonged tender ness of gum

Maturational factors

retained infantile swallow

Mechanical restrictions

-macr oglossia

-constricted dental arches-enlar ged adenoids



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Neur ological disturbances * Hyposensitive palate

* Moderate motor disability

* Disruption of sensor y contr ol

* Coor dination of swallowing

Psychogenic factors-replacement of thumb sucking by tongue thrust



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10. Macr oglossia



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Clinical Manifestations of

tongue thrust :

Clinical manifestations depend on

y Intensity

y Duration

y Frequency &

y Type of tongue thrust





Anterior Open Bite

Spacing Between Incisors and Canine



MANAGEMENT OF TONGUETHRUSTING

Age consideration

3-11 Yrs:-

No need to concer n

Reassure patient

11 yrs or older :-

Interpretation of habit T reatment of Malocclusion



M AN AGEMENT

Habit interceptionFixed and removable cribs or rakesTaught correct method of swallowing

Muscle exercisesOral screen



Treatment of malocclusionBy removable or fixed appliances



MOUTH BREATHING HABIT



Habitual respiration through the Habitual respiration through the

mouth intead of mouth intead of nosenose--CHOPRA (1951)CHOPRA (1951)

Prolonged or continued exposure of Prolonged or continued exposure of the tissues of anterior areas of mouth the tissues of anterior areas of mouth to the drying effect of inspired airto the drying effect of inspired air--

CHACKER (1961)CHACKER (1961)

Habitual respiration through the Habitual respiration through the mouth instead of nosemouth instead of nose--SASSOUUNISASSOUUNI(1971)(1971)



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` Obstructive ± Due to complete or partial obstruction of nasal passage.

Deviated nasal septum

Nasal polyps

Chronic inflammation of nasal mucosa Localized benign tumors

Congenital enlargement of nasal turbinates

Allergic reaction of nasal mucosa

Obstructive adenoids

Deviated nasal septumNasal polypsChronic inflammation of nasal mucosaLocalized benign tumorsCongenital enlargement of nasal turbinates Allergic reaction of nasal mucosaObstructive adenoids



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` Habitual ± Deep rooted habit ± One continues to breathethrough mouth even though nasal obstruction is removed.

` Anatomic ± Short upper lip do not permit complete closureof mouth



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ETIOLOGY

1.Nasal Obstruction due to ±

-Enlarged turbinates

-Deviated nasal septum.

-Allergic rhinitis

-Nasal polyps

-Enlarged adenoids

-Chronic inflammation of

nasal mucosa



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2.Abnormally short upper lip preventing proper lip seal

3.Obstruction in the bronchial tree or larynx

4.Obstructive sleep apnoea syndrome

5. Genetically predisposed individuals

-Ectomorphic children having a genetic type of tapering face &nasopharynx are prone for nasal obstruction

6. Thumb sucking or other oral habits can be the instigating agent



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CLINICAL FEATURES

Effects on dentofacial structures-

Facial form ±

- A large face height- Increased mandibular plane angle

- Retrognathic mandible & maxilla



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Adenoid facies ±Characterized By

-Long narrow face

-Narrow nose & nasal passage-Flaccid lips with upper lip being short

-Dolicocephalic skeletal pattern

-Nose is tipped superiorly in front

-Expressionless face

-V shaped maxillary arch & high palatal vault.



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#anterior open bite

#anterior marginal gingivitis

#increased overjet of incisors

#posterior crossbite



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` History of patient` Clinical examination

` Mirror test ± Double-sided mirror is held between nose andmouth.

Cotton test ± A butterfly shaped piece of cotton is placed

over upper lip below nostrils.` If cotton flutters down,it indicates nasal breathing

` Water test ± Patient is asked to fill his mouth with water and retain it for a period of time.

While nasal breathers accomplish with ease, mouth

breathers find task difficult.

o on es ± u er y s ape p ece o co on s p ace

over upper lip below nostrils.

If cotton flutters down,it indicates nasal breathing

Water test ± Patient is asked to fill his mouth with water

and retain it for a period of time.While nasal breathers accomplish with ease, mouth

breathers find task difficult.



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CephalometricsNasopharyngeal space,space of adenoid

RhinomanometryStudy of nasal air flow characteristics



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MANAGEMENT

` Elimination of the cause

phar yngeal or nasal obstruction (ENT)

` Interception of the habit :-

Oral screen

Adhesive tapes for lip seal during night` Rapid maxillar y expansion

increase nasal air flow and decrease nasal air resistance



BRUXISM



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` Defined as the clenching or grinding of teeth when notmasticating or swallowing (Poselt and Wolff)

` Habitual grinding of teeth when the individual is not chewing or swallowing(Ramfjord 1966)

` Non-functional contact of teeth which may includeclenching,gnashing,grinding and tapping of teeth(Rubina 1986)

masticating or swallowing (Poselt and Wolff)

Habitual grinding of teeth when the individual is not chewing or

swallowing(Ramfjord 1966)

Non-functional contact of teeth which may includeclenching,gnashing,grinding and tapping of teeth(Rubina 1986)



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` Psychological and emotional stresses

` occlusal interference or discrepancy between centric relationand centric occlusion

` Genetics

` Mg++ deficiency` Allergies

` Occupational factors

occlusal interference or discrepancy between centric relation

and centric occlusion

Genetics

Mg++ deficiency

AllergiesOccupational factors



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` Occlusal wear facets

` Fractures of teeth and restorations

` Mobility of teeth

` Tenderness and hypertrophy of masticatory muscles

` TMJ pain and discomfort

` Occlusal wear facets

Fractures of teeth and restorations

Mobility of teeth

Tenderness and hypertrophy of masticatory muscles

TMJ pain and discomfort



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` History and clinical examination are sufficient to diagnose

` Occlusal prematurities can be diagnosed by use of articulatingpapers

` Electro myographic examination ± to check for hypertrophy of

masticatory muscles

` History and clinical examination are sufficient to diagnose

Occlusal prematurities can be diagnosed by use of articulating

papers

Electro myographic examination ± to check for hypertrophy of

masticatory muscles



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` Appropriate psychological counselling

` Hypnosis, relaxing exercises and massage can help relievemuscle tension.

` Occlusal adjustments need to be carried out to eliminateprematurities

` Night guards can be given which cover the occlusal surfaces of teeth and prevent interferences and wear

` Biofeedback-utilizes positive feedback to enable the patient tolearn tension reduction

,muscle tension.Occlusal adjustments need to be carried out to eliminateprematuritiesNight guards can be given which cover the occlusal surfaces of

teeth and prevent interferences and wear Biofeedback-utilizes positive feedback to enable the patient tolearn tension reduction



OTHER MINOR HABITS



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` Lip biting most often involves the lower lip which is turnedinwards and pressure is exerted on the lingual surfaces of maxillary anteriors.

` Lip biting most often involves the lower lip which is turned

inwards and pressure is exerted on the lingual surfaces of

maxillary anteriors.



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` Proclined upper anteriors and retroclined lower anteriors.

` Hypertrophic and redundant lower lip

` Cracking of lips

` Proclined upper anteriors and retroclined lower anteriors.

Hypertrophic and redundant lower lip

Cracking of lips



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` Lip bumpers can be used that not only keep the lips away butalso improve the axial inclination of anterior teeth due tounrestrained action of tongue

` Lip bumpers can be used that not only keep the lips away but

also improve the axial inclination of anterior teeth due to

unrestrained action of tongue

It does not produce any gross malocclusion



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` It does not produce any gross malocclusion

` Minor local tooth irregularities such as rotation, wear of incisaledge and minor crowding can occur

` Nut notch is seen which is wear of teeth in the form of notch. Itis seen due to cracking open of hard nuts using incisal edge of

anteriors

` It does not produce any gross malocclusionMinor local tooth irregularities such as rotation, wear of incisaledge and minor crowding can occur Nut notch is seen which is wear of teeth in the form of notch. Itis seen due to cracking open of hard nuts using incisal edge of

anteriors



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Oral Habits 1233