GUIDED BY: Dr. Mehamood Muthedath Dr. Azeela AHAMED

SUBMITTED BY: Honey Mol Thomas Jesty James

CHILDHOOD ORAL HABITSAND

PREVENTION OF MALOCCLUSION

CONTENTS INTRODUCTION DEFINITION-ORAL HABITS CLASSIFICATION OF ORAL HABITS VARIOUS HABITS 1)THUMB SUCKING 2)TONGUE THRUSTING 3)MOUTH BREATHING 4)BRUXISM 5)LIP BITING HABIT 6)CHEEK BITING 7)NAIL BITING 8)SELF INJURIOUS HABITS PREVENTION OF MALOCCLUSION CONCLUSION REFERENCE

• Oral habits may be a part of normal development; a symptom with deep rooted psycological basis or may be the result of abnormal facial growth.

• These habits bring about harmful unbalanced pressure to bear upon the immature ,highly malleable alveolar ridges , the potential changes in position of teeth and occlusion, which may become decidedly abnormal if this habits are continued for a long time.

INTRODUCTION

DEFINITION-ORAL HABITS

• According to Dorland(1957): Habit can be defined as a fixed or constant

practice established by frequent repetition.

• According to Buttersworth(1961) Habit is a frequent or constant practice or

acquired tendency which has been fixed by frequent repetitions.

• According to Carl O Boucher: Habit is a tendency towards an act or an

act that has become a repeated performance relatively fixed, consistent, easy to perform and almost automatic.

• According to Mathewson (1982) Oral habits are learned patterns of muscular contractions.

G

AuthorJames(1923)

Morris& Bohanna (1969)

Kingsley (1958)

Klein(1971)

Finn(1987)

Classification

a) Useful habits

a) Pressure habits

b)Harmful habits

b)Non pressure habits

c)Biting habits

a)Functional oral habits

b)Muscular habits

c)Combined ones

a) Empty habits

b)Meaningful habits

1.a)Compulsive habits

b)Non compulsive habits

2.a)Primary habits

b)Secondary habits

VARIOUS HABITS….

• Definition : Thumb Sucking can be defined as placement of the thumb at various depths into the mouth.

THUMB SUCKING

CLASSIFICATION

Based on clinical observation

THUMB SUCKING

NORMAL THUMB SUCKING ABNORMAL THUMB SUCKING

•Normal during 1st & 2nd year of life•Disappears as the child matures•Does not generate any malocclusion

•Persist beyond preschool period•Cause deleterious effects to the dento facial structures

Psychological

• Deep rooted emotional factor involved•Associated with insecurities, neglect or loneliness experienced by the child

Habitual

•No psychological bearing•The child performs the act out of habit•Has the potential to cause malocclusion

Sucking habits can also be classified as:

SUCKING HABITS

NUTRITIVE SUCKING HABITSEg: Breast feeding, bottle feeding

NON NUTRITIVE SUCKING HABITSEg: Thumb/ finger sucking, Pacifier sucking

Subtelny in (1973) has graded thumb sucking into 4 typesType A: Seen in almost 50% of children : Whole digit placed inside the mouth, thumb pressing over the palateType B: Seen in 13-24%of children : Thumb placed into the oral cavity without touching the palateType C: Seen in 18% of children : Thumb placed into the mouth just beyond the first joint : No contact between maxillary and mandibular incisorsType D: Seen in 6% of children : Very little portion of thumb placed into mouth

• Parents Occupation > In children of parents with a high

socioeconomic status, within a short time baby’s hunger is satisfied.

> Mother’s of low socioeconomic group is unable to provide the infant with sufficient breast milk.

ETIOLOGY

• Working mother Children brought up by the care takers may have feelings of insecurity and hence they use their thumb to obtain a secure feeling.

• Number of siblings

• Order of birth of the child

• Age of the child

SUCKING BREAST SURPLUS BOTTLE FEEDING SUCKING URGE CUP URGE

FRUSTRATION

Non nutritive suckingUnrestricted breast feedingThumbDummy

ETIOLOGY OF DIFFERENT SUCKING HABITS

SATISFACTION

DIAGNOSIS OF DIGITAL HABITS

EXTRA ORAL EXAMINATION Various key areas has to be noted:1.The digits• Reddened, clean, chapped, short finger nail• Fibrous roughened callus on superior aspect

of the finger• May cause deformation of the finger

2.The lips•Short hypotonic upper lip•Incompetent upper lip during swallowing•Proclination of upper anteriors3.Facial form analysisCheck for:•Mandibular retrusion•Maxillary protrusion•High mandibular plane angle and profile4.Other features•Habitual mouth breathing•Tongue thrust swallow•Middle ear infections•Enlarged tonsils

INTRA ORAL EXAMINATION

•1.Tongue•Examine for correct size and position of tongue at rest and during swallowing2.Dentoalveolar structures•Proclined maxillary anteriors with diastemas•Retroclined mandibular anteriors•Buccal crossbite and narrow palate•Measure diamensions of overjet and overbite•Observe symmetry of incisal position of upper central& lateral incisors3.Gingiva•Gumline itching•Decay or stain on the labial surface of the upper central and lateral incisors.

SEQUELAE OF THUMB SUCKING

• Hypotonic upper lip• Hyperactive lower lip• Maxillary anterior proclination & spacing• Mandibular retroclination• Anterior open bite • Posterior cross bite• Constriction of maxillary arch• Increased overjet

PREVENTON

1.MOTIVE BASED APPROACH • Prevention should be directed towards the

motive behind the habit2.CHILD’S ENGAGEMENT IN VARIOUS ACTIVITES• Child may practice the habit when bored or

left alone or before sleep• In such cases ,child should be kept engaged in

various activities

3.PARENTS INVOLVEMENT IN PREVENTION•When parents are at home ,they should spend ample time with child

•At night by playing soothing music or by telling good bedtime stories , the child should be made asleep

4.USE OF A PHYSIOLOGICAL NIPPLE

5.DURATION OF BREAST FEEDING•Duration of breast feeding should be adequate to exhaust the suckling urge and feel completely satisfied

6.USE OF DUMMY OR PACIFIER•Encourage the child to suck a dummy to prevent thumb sucking.

TREATMENT CONSIDERATIONS

• Psychological status of the child• Age factor• Motivation of the child to stop the habit• Parental concern regarding the habit• Other factors like severity of malocclusion anatomic variation in the perioral soft tissue presence of other oral habits

TREATMENT

Consists of three categories 1.PSYCOLOGICAL THERAPY• Screen the patient and if psychological

dependence suspected refer to professionals for councelling

• Thumb sucking between the age of 3-4 years of age needs reassurance, positive reinforcement & friendly reminders

•Awareness of the habit can be accomplished through various study models, mirrors to bring the habit under the notice of the child

•Children and parents should be informed about the existing dento facial deformities and long term risks of sustained habit

•Destructive approaches like nagging , shamming etc should be strictly avoided

•When the habit is discontinued ,the child can be rewarded with a favorite new toy or special outing.

2.REMINDER THERAPY

This includes >Extra oral approaches Employs hot tasting ,bitter flavored preparations or distasteful agents applied to the finger or thumb >Intra oral approaches Includes the use of a)Removable appliances like palatal crib , rakes, palatal arch, lingual spurs

b)Fixed appliances like upper lingual tongue screens

3.MECHANOTHRAPY

a)Fixed intra oral anti thumb sucking appliance It works by preventing the patient from putting the palmer surface of the thumb in contact with the palatal gingiva ,thereby robbing the pleasure of sucking

b)Blue grass appliance>Haskell in 1991 introduced this appliance>It consists of a modified six sided roller machine from Teflon >Its placed for 3-6 months

c)Quad helix This appliance prevents the thumb from being inserted and also corrects the malocclusion by expanding the arch

TONGUE THRUSTING

DEFINITIONS

>According to Barber(1975), Tongue thrust is an oral habit pattern, related to

the persistence of an infantile swallow pattern during childhood and adolescence and thereby produces an open bite and protrusion of the anterior tooth segments.

>According to Tulley(1969), States tongue thrust as the forward movement of the tongue tip between the teeth to meet the lower lip during deglutition and in sounds of speech ,so that the tongue becomes inter dental.

>According to Schneider(1982), Tongue thrust is a forward placement of the tongue between the anterior teeth and against the lower lip during swallowing.

CLASSIFICATION

1.Physiologic This comprises of the normal tongue thrust

swallow of infancy.

2.Habitual The tongue thrust swallow is present as a habit

even after the correction of malocclusion

3.Functional When the tongue thrust mechanism is an adaptive behavior developed to achieve an oral seal ,it can be grouped as functional.

4.Anatomic Persons having enlarged tongue can have an anterior tongue posture.

ETIOLOGY

A)Retained infantile swallow>With the eruption of the incisors at 6 months

of age, the tongue does not drop back as it should and continues to thrust forward.

B)Upper respiratory tract infections>Upper respiratory tract infections like tonsillitis,

allergies etc promote a more forward tongue posture due to pain and decrease in the amount of space.

C)Neurological disturbances>Hyposensitive palate, moderate motor disability, disruption of sensory control and coordination of swallowing can lead to tongue thrust

D)Functional adaptability to transient change in anatomy>The tongue can protrude when the incisors are missing . The tip of the tongue may protrude into the open area during swallowing.

E)Feeding practices and tongue thrusting

>Bottle feeding is more contributary than breast feeding to tongue thrust development.

F)Induced due to other oral habits

G)Hereditary

H)Tongue size>Conditions like aglossia and macroglossia can have an effect on the dentition.

CLINICAL MANIFESTATIONS

EXTRA ORAL FINDINGS• Lip posture >Lip separation greater both at rest and in

function• Mandibular movements >Its upward and backward with tongue

moving forward

•Speech >Speech disorders like sibilant distortions, lisping ,problems in articulation of sounds

•Facial form >Increase in anterior face height

INTRA ORAL FINDINGS•Tongue movements >Swallowing sequences jerky and inconsistent.

•Malocclusion >Features pertaining to the maxilla Proclination of maxillary anteriors resulting in increase in overjet Generalised spacing Maxillary constriction >Features pertaining to the mandible Retroclination or proclination of mandibular teeth >Intermaxillary relationship Anterior or posterior open bite Posterior teeth crossbite

DIAGNOSISThe following clinical features should be

checked during swallowing• Simple tongue thrust >normal tooth contact in posterior region >anterior open bite >contraction of lips ,mentalis muscle ,and

mandibular elevators

Complex tongue thrust>Generalised open bite

Lateral tongue thrust>Posterior open bite>Observe the role of the tongue during mastication and speech

CLINICAL FEATURES• Open bite• Tongue is held between the upper and lower

teeth• Dropping of mandible and contraction of

circum oral muscles• Angles Class 1 and Class 2 with open bite• Teeth may occlude only in molar region in

case of retained infantile swallow

TREATMENTIncludes the following steps

A)Training of correct swallow and posture of tongue• Myofunctional exercises >Ask the child to place the tip of the tongue in the rugae

area for 5 minutes and is asked to swallow >Orthodontic elastic and sugarless fruit drop exercise >4S exercise- Place the tongue on the spot ,salivate,

squeeze against the spot and swallow• Using appliances as a guide in the correct positioning of the

tongue

B)Nance palatal arch appliance

a)Speech therapyIndication :Children after the age of 8 years>Child is asked to repeat multiplication table of six and to pronounce words beginning with ‘s’ sounds

b)Mechanotherapy>Removable appliance therapy A variety of modifications of Hawley’s appliance can be used1. The anchorage value is gained from the acrylic covering2. Hawley’s appliance allows the closure of anterior open

bite through the use of the labial bow3. The crib can serve as a reminder

C)Oral screen >It’s a modified acrylic plate>The combined oral and vestibular screen is fabricated to control muscle forces both inside and outside the dental arch

D)Surgical treatment>Consists of orthognathic surgical procedure to correct the skeltal malformation as well as myofunctional therapy.

>Fixed habit breaking appliance Depending on the severity of the open bite , 4-9 months may

be required for the autonomous correction of the malocclusion…..

A modified habit crib is used to eliminate posterior open bite

MOUTH BREATHING

DEFINITION

Sassouni(1971) :Defined mouth breathing as habitual respiration through the mouth instead of the nose

Merle (1980) Suggested the term oro-nasal breathing instead of mouth breathing

CLASSIFICATIONFinn in 1987 has classified mouth breathing into:

A) Anatomic The anatomic mouth breather is the one whose short upper

lip does not permit complete closure without undue effort

B) Obstructive Children who have an increased resistance to, or a

complete obstruction of the normal flow of air through the nasal passages.

C) Habitual Habitual mouth breather in a child who continually

breathes through his mouth by force of habit, although the abnormal obstruction has been removed.

ETIOLOGY

Most of the children suffer from some degree of nasal insufficiencyAllergies, physical obstructions and chronic infections cause many children to breathe through the mouthThe airway obstruction may be due to

• Enlarged tonsils• Deviated septum and other nasopharyngeal deformities• Allergic rhinitis, nasal polyps• Enlarged adenoids or tonsils• Abnormally short upper lip preventing proper lip seal• Obstruction in the bronchial tree or larynx• Obstruction sleep apnea syndrome• Thumb sucking or similar oral habits can be the instigating agent

CLINICAL FEATURES

o Long faceo Contracted upper dental archo Receded lower jawo Vacant facial expressiono Short upper lipo Habits like tongue thrust, thumb suckingo Increase in gingival inflammation

DIAGNOSIS

1)History The parents should be questioned about the

child’s habit of frequent lip apart posture, occurrence of tonsillits, allergic rhinitis, otitis media etc

2)Examination Ask the patient to take a deep breath Most respond by inspiring through the mouth

CLINICAL TESTS MIRROR TEST When a clear mirror is kept near mouth, Mouth mirror gets fogged.

BUTTERFLY TEST Cotton fibers are kept near the nose and the mouth. If he is a nasal breather fibers near the nose moves whereas for mouth breathers fibers near the mouth will move.

WATER HOLDING TEST The patient is asked to fill his mouth with water and to retain it for a period of time . A nasal breather do this

with ease, while mouth breather finds it difficult.

INDUCTIVE PLETHYSMOGRAPHY

Allows the calculation of percentage of nasal or oral respiration by measuring the total airflow through the nose and the mouth using inductive plethysmography.

CEPHALOMETRICS

To establish the amount of nasopharyngeal space, size of adenoids and to know the skeletal patterns of the patient by taking various cephalometric angles

CORRECTION OF MOUTH BREATINGIt is corrected during the mixed dentition period to prevent or correct its ill effects on occlusion.

SYMPTOMATIC TREATMENTo The gingiva of mouth breathers should be restored to normal health by coating gingiva with petroleum jellyo Treatment should be aimed at 1) Examination of the cause 2) Interception of the habit

EXERCISESo Physical exercises > Deep breathing exercises are done with deep inhalation through the nose with arms raised sideways > After short period the arms are dropped to the sides and the air is exhaled through the mouth

o Lip exercise > The child is instructed to extend the upper lip or lower lip (protrusion of maxillary incisors )as far as possible to cover the vermilion border > Playing a wind instruments

o Maxillofacial myotherapy

o Oral screen > To re establish nasal breathing either the lips or the oral cavity must be closed to prevent air from entering the oral cavity > For this purpose oral screen can be used >Oral screen should be constructed with a material compatible with oral tissues

CORRECTION OF MALOCCLUSION

Mechanical appliancesa) Children with class1 skeletal and dental

occlusion and anterior spacing- oral shield appliance

b)Class2 div 1 dentition without crowding – Monoblock activator

c)Class3 malocclusion – Chin cap

DEFINITION

Ramfjoid 1966:Bruxism is the habitual grinding of teeth when the individual is not chewing or swallowing.

Rubina 1986:It is the term used to indicate nonfunctional contact of teeth which may include clenching, gnashing, grinding and tapping of teeth.

Vanderas 1995:Defines bruxism as the non functional movement of the mandible with or without an audible sound occurring during day or night.

BRUXISM

TYPES…

1) Day time bruxism / diurnal bruxism Conscious or unconscious grinding of teeth usually

during the day.

2)Night time bruxism / Nocturnal bruxism Subconscious grinding of teeth.

• In infants with the eruption of the first primary tooth.

• Infants with no teeth to oppose the newly erupted teeth have been seen to lacerate the opposing gum pad

• It may occur throughout life; however, it is seen to increase through the mixed dentition period and then decrease later with age

OCCURRENCE

• One common occurrence is during sleep• Rapid eye movement stage-most damaging• Incidence of bruxism in children 7%-88%

• Psychological factors• The tendency to grind teeth is associated with feelings of

anger and aggresion• Teeth grinding could be a manifestation of the inability to

express emotions such as anxiety, aggression, hate, rage etc• Olkinuora 1972 divide bruxers into: a) Bruxism associated with stressful events

b) No such association• Non stress related group had more of hereditary influence

ETIOLOGY1) CNS• Etiology of bruxomania could be from certain definite

cortical lesions• In children with cerebral palsy and mental retardation

3) Occlusal discrepancies• Improper interdigitation of teeth• Various occlusal abnormalities that prevent a stable occlusion of the mandible

4)GeneticsGenetically determined behavior related to the sharpening of teeth for defense

5) Systemic factors• Magnesium deficiency• Gastro intestinal disturbance from food allergies, enzymatic imbalances in digestion leading to chronic abdominal distress 6)Allergies7)Occupational factors• Over enthusiastic student/ compulsive overachievers

MANIFESTATION

1)Occlusal trauma

2)Tooth structureNonfunctional pattern of occlusal wear can be observed as signs of bruxism

The signs and symptoms of bruxism depend on:i. Frequency of bruxingii. Intensity with which the patient is bruxingiii. The age of the patient which may be associated with

the duration of the habit

The following clinical features may be seen in children with bruxism :

6)Other signs and symptoms•Sounds-grinding and tapping sounds•Soft tissue trauma•Small ulceration or ridging on the buccal mucosa opposite the molar teeth

4)TMJ Disorders•TMJ disturbances and pain

5)Headache

3)Muscular tenderness•Muscular fatigue on walking up•Hypertrophy of the masseter muscle unilaterally/bilaterally

TREATMENT

1)Occlusal adjustments

•Any pre maturities or occlusal interferences in restorations should be corrected

•Coronoplasty plays an important role in occlusal treatment

2)Occlusal splints

•Vulcanite splints have been recommended to cover the occlusal surfaces of all the teeth.

•In children soft splint is advisable

•The splint is made on the mandibular models using Scher Dental Bioplast material

3)Restorative treatment•If abrasion is so severe that penetration into the pulp chamber is imminent , pulpal therapy with full coverage stainless steel crown is indicated

4)Psychotherapy•Counseling the patient can lead to a decrease in tension and also create a habit awareness

•TMJ appliance – prefabricated intra oral appliance for TMJ disorder•It is prevented by the patented aerofoil shaped base & a double mouth guard device.

5) Relaxation training•Training the patient to relax muscle group •Hypnosis, conditioning are indicated for whom bruxism is due to a central cause

6)Physical therapy•If musculoskeletal pain and stiffness are associated with bruxism, a brief course of physical therapy is appropriate

7) Drugs•Vapo coolants such as ethyl chloride for pain within the TMJ area, local anesthetic injections directly into the TMJ or into the muscles, tranquilizers sedatives and muscle relaxants are used•Medication may be described to alter the sleep arousal and anxiety level eg: diazepam•Low doses of tri cyclic antidepressants may be used to inhibit the amount of REM sleep

8)Biofeedback•This is a technique that utilizes positive feed back to enable the patient to learn tension reduction

9)Electrical methodElectrogalvanic stimulation for muscle relaxation is used

10) Acupuncture techniques for muscle relaxation

11)Orthodontic correction•Malocclusion such as class2 and class3 occlusions, frontal open bite and cross bites when associated with functional and malocclusion may create a predisposition to bruxism

LIP BITING HABIT

DEFINITION

Habits that involve manipulation of the lips and perioral structures are termed as lip habits

CLASSIFICATION

1)Wetting the lips with the tongue

2)Pulling the lips into the mouth between the teeth

ETIOLOGY

1)Malocclusion•A lip habit may occur in a class 2 division 1 with large overjet and overbite

2)Habits•The habit can occur in conjunction with other habits such as thumb or digit habit•The digit habit may result in large overbite and overjet situation•The digit habit also create an oral seal by placing the mandibular lip directly behind the maxillary incisors

3)Emotional stress•Increase the intensity and duration of lip sucking

MANIFESTATIONS1)Protrusion of maxillary incisors and retrusion of mandibular incisors2)Lip•Lip sucking can be recognized by reddened irritated and chapped area below the vermilion border•Vermilion border may be relocated farther outside the mouth due to constant wetting of the lips•In some cases, a chronic herpetic infection with areas of irritation and cracking of lip appears3)The mentolabial sulcus become accentuated4)Malocclusion•Lip sucking and lip biting can maintain an existing malocclusion

TREATMENTThe lip habit is not self-correcting and may become more deleterious with age, because of muscular forces interacting with the child’s growth. Treatment of a lip sucking habit should be directed initially towards the etiology of the habit

1)Correction of malocclusion

•Class1 malocclusion with increased overjet - fixed or removable appliance to tip the teeth back•Class2 - growth modification procedures to treat the malocclusionIf the child has an crowded early mixed dentition, an activator may be placed in an attempt to reposition the maxilla to the mandible in a favorable position and allow the child to effect a more normal lip seal

2)Treating the primary habit•The lip habit along with digit sucking can be corrected by aligning the dental arch using hawley’s retainer with a labial bow. •It can be used to retract the maxillary incisors and an acrylic plate can be used as a habit reminder

3)Appliance therapy•Oral shield appliance for class1 malocclusion•It helps to stop habit and also in incisal alignment

4)Lip bumper•Used as an adjunctive therapy in both comprehensive and interceptive treatment regimens•Lip bumper can be a combined, fixed and removable appliance

CHEEK BITING

INTRODUCTION

Cheek biting is an abnormal habit of keeping or biting the cheek muscles in between the upper and lower posterior teeth. It may injure the soft tissues and may cause an open bite or an individual tooth malposition in the buccal segment where a persistent cheek biting habit exists.

Clinical features

1) Ulcer at the level of occlusion2) Openbite3) Tooth malposition in the buccal segment

Treatment•A removable crib may be constructed to break the habit•A vestibular screen may also be used

NAIL BITING

Introduction

Nail biting is one of the most common habits in children and adults. It’s a sign of internal tension

Age of occurrence•Nail biting is absent before 3 years of age•The incidence rises sharply from 4-6 years and remains at a fairly constant level between 7 and 10 years•It rises again to a peak during adolescence.

Etiology•Persistent nail biting may be indicative of an emotional problem.•After the age of 15 the nail biting habit is replaced by pencil biting, hair twirling or gum chewing

Effects1)Dental effects

The common effects of nail biting on the teeth are crowding, rotation and attrition of incisal edges of the mandibular incisors.

2)Effects on the nails

•Inflammation of the nail beds and also of the nails

Management•Mild cases no treatment is indicated.

•Avoid punitive methods, such as scolding, nagging and threats.

•Treat the basic emotional factors causing the act.

•Encourage outdoor activities which may help in easing tension.

•Application of nail polish, light cotton mittens as a reminder.

(Masochistic habits, Sadomasochistic habits, Self mutilating habits)

SELF INJURIOUS HABITS

DefinitionRepetitive acts that results in physical damage to the individual. These habits show an increased incidence in the mentally retarded population

Etiologya)Organic: Syndromes and syndrome like maladies such as Lesch - Nyhan disease and De Lange’s syndrome in which symptoms such as repetitive lip, finger, tongue, knee and shoulder biting are common

b) Functional:

Type A•These are injuries superimposed on a pre-existing lesion•The lesion shows no evidence of healing as it is perpetuated by this injurious habit which occurs mainly at the night

Type B:•They include injuries secondary to another established habit. The self injurious habit may exacerbate the features existing due to a primary habit

Type C:•This type of behavior has a greater psychogenic component•The child may resort to various self injurious habits as a form of stress release

f

FRENUM THRUSTING

This habit which is rarely seen is also a form of self injurious habit. If the maxillary incisors are slightly spaced apart, the child may lock his labial frenum between these teeth and permit it to remain in this position for several hours. On constant repetition this may turn into a habit which may displace the tooth

Treatment1) Psychotherapy•Some children experience a feeling of neglect, abandonment and loneliness and through the use of self injurious behavior attempt to solicit attention and love

2)Palliative treatment•Adjunctive therapy in the form of bandages for any oral ulcerations will help in healing of the wounds as well as serve as a habit reminder

3) Mechanotherapy

•An oral shield will also deter the child from the unconscious continuation of the habit. Treatment for self mutilation may also include use of restraints and protective padding

BOBBY PIN OPENING

•Usually seen in teenage girls wherein opening bobby pin with anterior incisors is done

•Clinically we see notched incisors and partially denuded labial enamel.

•At this age, calling attention to the harmful habit is generally all that is necessary to stop the habit

•Tongue thrusting The tongue thrust habit should be intercepted by using habit breakersThe patient should be trained and educated on the correct technique of swallowing

CONTROL OF ABNORMAL HABITS•Thumb suckingThumb sucking habit is intercepted by using removable or fixed habit breakers

•Mouth breathing Interceptive procedure should involve identification and removal of the causePersistence of habitual oral breathing is an indication to use a vestibular screen to intercept the habit

PREVENTION OF MALOCCLUSIONThere are a number of procedures that can be undertaken to prevent or intercept a malocclusion that may develop or is developing. Preventive orthodontics is that part of orthodontic practice which is concerned with the patient’s and parent’s education, supervision of the growth and development of the dentition and the cranio-facial structures, the diagnostic procedures undertaken to predict the appearance of malocclusion and the treatment procedures instituted to prevent the onset of malocclusion. Interceptive orthodontics has been identified as that phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions of the developing dentofacial complex.

The procedure undertaken include:1) Serial extraction2) Correction of developing cross bite3) Control of abnormal habits4) Space regaining5) Muscle exercise6) Interception of skeletal malrelation7) Removal of soft tissue and bony barrier to

eruption of teeth

CONCLUSION

Normal alignment of teeth not only contributes to the oral health but also goes a long way in the overall well being and personality of an individual. Correct tooth position is an important factor for esthetics, function and for overall preservation or restoration of dental health. While most malocclusions may not adversely affect the health of an individual, they nevertheless are capable of producing undesirable functional and esthetic imbalances.

REFERENCE >TEXTBOOK OF PEDODONTICS - SHOBHA TANDON

>ESSENTIALS OF PEDODONTICS - T.N.TILAKARAJ

>ESSENTIALS OF PREVENTIVE AND COMMUNITY DENTISTRY - SOBEN PETER

>TEXTBOOK OF ORTHODONTICS - S.I.BHALAJI

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