Maloclusiones dentarias y su relación con los hábitos bucales lesivos / Dental malocclusion and its relationship to harmful oral habits

RESUMEN Introducción: La ruptura del equilibrio de las fuerzas extrabucales e intrabucales debido a una función anómala, desencadena maloclusión. Estas funciones musculares anómalas se conocen como hábitos bucales lesivos. Objetivo: Actualizar conocimientos y analizar los factores relacionados con las maloclusiones dentarias como los hábitos bucales lesivos en niños, en función de la frecuencia y duración de la succión nutritiva y no nutritiva, respiración por la boca y el empuje lingual atípico. Métodos: se realizó una revisión bibliográfica en cuatro bases de datos digitales Pubmed, Lilacs, Ibecs y Cumed correspondiente a los últimos 5 años. Se usó tesauro para el idioma inglés malocclusion, habits, finger sucking, pacifiers, bottle feeding, tongue habit, mouth breathing y en español maloclusión, hábitos, succión del dedo, chupete, biberones, hábitos linguales, respiración por la boca. La búsqueda reveló 65 artículos, de estos solo 19 cumplieron los criterios de inclusión. Análisis e integración de la información: El 89,5 por ciento de los artículos pertenecen a estudios de hábitos de succión no nutritivos solo o en conjunto con otros hábitos; y el 10,5 por ciento realizan investigaciones en niños respiradores bucales. Teniendo en cuenta la duración y frecuencia de los hábitos solo el 26,31 por ciento de las pesquisas seleccionadas tomaron en cuenta estas variables. En hábitos de succión nutritivos presentaron resalte horizontal aumentado, mordida cruzada posterior y escalón distal. Existe una asociación entre períodos cortos de amamantamiento y prevalencia de hábitos de succión no nutritivos; presentan además de maloclusiones anteriormente citadas, mordida abierta anterior. En respiración por la boca citaron clase II, mandíbula corta y retruida y disminución del tercio inferior de la cara. Conclusiones: Numerosas investigaciones se han realizado para asociar la duración de los hábitos de succión nutritivos y no nutritivos con maloclusiones, sin considerar la frecuencia de estos, además existe una reducida información científica en las bases electrónicas exploradas en lo que refiere a estudios de respiración por la boca y empuje lingual atípico en los niños(AU)

ABSTRACT Introduction: Malocclusion is triggered by rupture of the balance between extraoral and intraoral forces as a result of an anomalous function. Such anomalous muscular functions are known as harmful oral habits. Objective: Update knowledge and analyze factors related to dental malocclusions, such as harmful oral habits in children, in terms of the frequency and duration of nutritive and non-nutritive sucking, mouth breathing and atypical tongue thrust. Methods: A bibliographic review was conducted of papers published in the last five years in the digital databases Pubmed, Lilacs, Ibecs and Cumed. The search terms used were malocclusion, habits, finger sucking, pacifiers, bottle feeding, tongue habit and mouth breathing in English, and maloclusión, hábitos, succión del dedo, chupete, biberones, hábitos linguales and respiración por la boca in Spanish. 65 papers were obtained, of which only 39 met the inclusion criteria. Data analysis and integration: 89.5 percent of the papers corresponded to studies about non-nutritive sucking habits alone or in combination with other habits, whereas 10.5 percent dealt with studies about mouth breathing children. Only 26.31 percent of the studies selected took into account the variables duration and frequency of the habits. Nutritive sucking habits were found to be associated with overjet, posterior crossbite and distal step. A relationship was also found between a short breastfeeding period and the prevalence of non-nutritive sucking habits, with the presence of anterior open bite alongside the aforementioned malocclusions. Mouth breathing was related to class II, small retrognathic jaw and a decreased lower third of the face. Conclusions: Numerous studies have been conducted to determine the relationship between malocclusions and the duration of nutritive and non-nutritive sucking habits, without considering the frequency of such habits. On the other hand, the electronic databases consulted contain few studies about mouth breathing and atypical tongue thrust in children(AU)

[Hypnosis and orthodontic treatments]. / L'hypnose dans les traitements d'orthodontie.

INTRODUCTION: After being discarded from hospitals due to its lack of scientific evidence, medical hypnosis is once more in the spotlight thanks to neuroscience and medical imaging, which have proven its specificity. Medical hypnosis is currently enjoying real enthusiasm, and now the doors are opening not only to medical and surgical units but also to our orthodontic clinics. MATERIALS AND METHODS: This article defines hypnosis and its different levels of application and the required techniques. It also explores all the different fields in which it can be used in orthodontic treatment. DISCUSSION: Hypnosis can be applied from the very first contact with the patient and can be useful and therapeutic at every step of the process. It is useful to think of it in our discipline as a treatment in its own right contributing to heal parafunctions and tongue disorders more efficiently.

Self-Report of Waking-State Oral Parafunctional Behaviors in the Natural Environment.

AIMS: To determine if retrospective self-report of oral parafunctional behaviors potentially relevant to pain conditions is valid, by comparing oral parafunctional behaviors via a self-report instrument (Oral Behaviors Checklist [OBC]) with in-field reports of oral parafunction. METHODS: Individuals with a range of oral parafunctional behaviors, as identified by the OBC, were recruited, and 22 completed the field study. Using the Ecological Momentary Assessment paradigm, each subject was randomly prompted about eight times per day, for a target of 7 days, via portable handheld computer to report current behaviors among 11 queried items. Before and after the field study, a paper version of the OBC was administered. Separately, 74 individuals participated in a test-retest study of the paper OBC. Analyses included regression, correlation, intraclass correlation coefficient (ICC) and area under the receiving operating curve (AUC). RESULTS: Pre- and postfield study administration of the OBC exhibited substantial reliability (ICC = 0.65), indicating no reactivity during the intervening in-field data collection. Reliability across in-field days was low, indicating high variability in which behavior occurred on which day. Nonobservable behaviors were reported more frequently than observable behaviors. Self-report via OBC was linear with in-field data collection methods (R2 values ranged from 0.1 to 0.7; most values were within 0.3 to 0.4). The predictive value of the self-report total score was AUC (0.88) relative to the in-field study score. Separate test-retest reliability of the OBC was almost perfect (ICC = 0.88). CONCLUSIONS: The OBC is a reliable and valid way to predict behaviors in the natural environment and will be useful for further pain research.

Individual oral symptoms in burning mouth syndrome may be associated differentially with depression and anxiety.

BACKGROUND: Burning mouth syndrome (BMS) is an idiopathic disease characterized by the feeling of burning in the oral cavity. Ten per cent of patients presenting to oral medicine clinics have BMS. Anxiety and depression are common co-morbidities in BMS, but it is not known if they are associated with specific BMS symptoms. OBJECTIVE: In an exploratory analysis, this study examined the association of generalized anxiety and depression with individual BMS symptoms. METHODS: Forty-one patients were recruited from a dental outpatient clinic (30 with BMS and 11 with other oral conditions), evaluating specific BMS symptoms and their intensity. Anxiety and depression symptoms were assessed using a standardized measure (Clinical Interview Schedule-Revised). RESULTS: Taste change (p = 0.007), fear of serious illness (p = 0.011), metallic taste (p = 0.018) and sensation of a film on the gums (p = 0.047) were associated with an excess of psychiatric symptoms. More specifically, metallic taste (coefficient = 0.497, 95% CI = 0.149-0.845; p = 0.006) and sensation of film on gums (coefficient = 0.625, 95% CI = 0.148-1.103; p = 0.012) were associated significantly with higher scores for depressive symptoms; taste change (coefficient = 0.269, 95% CI = 0.077-0.461; p = 0.007), bad breath (coefficient = 0.273, 95% CI = 0.065-0.482; p = 0.012) and fear of serious illness (coefficient = 0.242, 95% CI = 0.036-0.448; p = 0.023) were associated with higher anxiety scores. CONCLUSION: Specific BMS symptoms are associated differentially with generalized anxiety and depression. Dental practitioners should ascertain which BMS symptoms are predominant and be mindful of the association of certain symptoms with anxiety or depression and, where necessary, consider medical consultation.

Psycho-Neurological Status in Children with Malocclusions and Muscle Pressure Habits.

Non-nutritive sucking behaviors such as finger- and tongue-sucking, tongue thrust, lips- or cheek-sucking, nail-, lip- or tongue-biting and other pressure habits represent risk factors for malocclusion. The association between psycho-neurological disorders and different types of malocclusion in children with sucking habits was long studied. During neurological examination, many children with sucking habits are diagnosed as Minimal Cerebral Dysfunction or Attention Deficit Hyperactivity Disorder (ADHD) bearers. The aim of this study is to assess the psycho-neurological status and motor disorders in children with malocclusion and normal occlusion. 135 children, aged between 8 and 12 years old, were examined, 42 children with normal occlusion and 93 children with different types of malocclusion. Besides clinical examination, all children were studied by the following psychoneurological methods: 1) Parent's Questionnaire, 2) Diagnostic interview Kiddie-Sads 3) Physical and Neurological Exam for Subtle Signs and 4) stabilometric tests. This study shows as in presence of dentofacial anomalies, pressure habits, ADHD reports significant effects on the functional state of the motor system: increases are noted in all basic parameters of statokinesiograms (crossed distance, sway area and ellipse surface), which lead to increased physiologic energy costs to maintain the vertical position of the body.

Case history: improved maxillary growth and development following digit sucking elimination and orofacial myofunctional therapy.

Orofacial myologists are frequently called upon to address retained oral habit concerns. During this process, current I.A.O.M. recommended treatment includes addressing tongue, lip, and jaw rest posture concerns. Following digit sucking remediation, we may also be called upon to address these rest posture issues, and tongue thrust more aggressively together. In this process, facial growth and development and jaw structure may coincidentally improve as a result of 'nature taking its course' by addressing both swallow AND rest posture. In a select subset of clients, dramatic improvements may occur if the timing is right. This article discusses one such case that appears to have yielded a significant improvement in oral postures influencing improved facial and oral growth and development.

Tongue movement and intra-oral vacuum of term infants during breastfeeding and feeding from an experimental teat that released milk under vacuum only.

BACKGROUND: Recent literature supports the theory that vacuum is integral to the removal of milk from the breast rather than peristaltic compression of the breast. AIM: We aimed to determine if breastfed infants could remove breast milk from an experimental teat designed to release milk only when a vacuum is applied. METHODS: Submental ultrasound images and intra-oral vacuum measurements were recorded simultaneously during both a breastfeed and a feed with the experimental teat. RESULTS: Infants placed the nipple and teat a similar distance from the nipple hard-soft palate junction when the tongue was lowered (4.7 mm vs 5.3 mm). As the tongue lowered the nipple and teat expanded evenly although the nipple expanded more than the teat (3.1mm vs 1.5 mm). Both baseline (-31 mm Hg vs -12 mm Hg) and peak vacuum (-122 mm Hg vs -67 mm Hg) applied to the breast were significantly higher than for the teat. CONCLUSION: Breastfed infants are able to remove milk from a teat using only vacuum with a similar tongue movement to that of breastfeeding. This evidence supports the theory that vacuum is a critical factor in the removal of milk from the breast.

A prospective, randomized study on the efficacy of tongue protector in patients with burning mouth syndrome.

OBJECTIVE: To apply a tongue protector with habit-modifying therapy through self-control, in the patients with burning mouth syndrome (BMS). METHODS: A prospective, randomized study was made of 65 consecutive patients with BMS. Fifty subjects were randomized to two groups: group A (informed) and group B (informed and the application of a tongue protector). The symptoms were evaluated by VAS, whereas the psychological profile was assessed using the HAD, with application of the quality of life questionnaires SF-36 and OHIP-49. The duration of treatment was 2 months. RESULTS: Fifty patients (46 females and 4 males) completed the study. The VAS scores in group B were 8.2 at baseline and 4.5 after 2 months. The respective scores in group A were 7.1 and 5.6 - the differences between the two groups being significant (P < 0.001). In group B the OHIP-49 yielded lower scores for most of the scales, with significant differences vs group A. In group B the SF 36 yielded significant differences vs group A in physical role, bodily pain, general health and emotional role. CONCLUSIONS: Parafunctional traumatism of the tongue should be taken into account in the pathogenesis of BMS with a view to exploring new therapeutic options.

Changes in the oral cavity might reflect psychological disorders in some patients.

AIM: The treatment of oral dysesthesias, such as burning mouth syndrome, can be challenging. Patient acceptance of the role of psychological etiological factors might be improved if there are clinical signs that patients could confirm themselves, which could be used as reinforcement of clinical discussions. Published associations between psychological disorder and various oral signs and symptoms are not suited to this purpose, as they are ambiguous in origin and implication. Others, used clinically in this situation, are not supported by published literature. Therefore, the purpose of this study was to determine if a demonstrable relationship could be established between psychological profile and the appearance and function of the oral cavity. METHODS: Seventy-nine participants underwent an oral examination and completed a Depression Anxiety Stress Scale-21 questionnaire. Correlations were calculated between clinical variables and the raw Depression Anxiety Stress Scale scores. Univariate analyses determined variables with significant differences between a high-risk and normal group, and multiple logistic regression models were calculated for these. RESULTS: Various oral signs and symptoms were found to correlate with depression, anxiety, and/or stress, with some predictive of psychological disturbance. CONCLUSIONS: These signs and symptoms might be used to reinforce the psychological aspects of an oral dysesthesia.

Traumatic lingual ulcer in a child: Riga-Fede disease.

Riga-Fede disease RFD is an extremely rare, benign inflammatory disorder characterized by reactive, traumatic ulceration of the oral mucosa especially located on the tongue. It is most commonly associated with natal or neonatal teeth in newborns. Mucosal lesions are often caused by repetitive traumatic damage due to backward and forward motions of the tongue over the lower incisors. Failure to diagnose and treat these lesions properly may result in inadequate food intake, growth retardation and permanent lingual deformity. We report a 15-month-old healthy infant with tongue ulcer diagnosed as RFD based on history and clinical features.

Frequency of parafunctional oral habits in patients with cerebral palsy.

Cerebral palsy (CP) is one of the most frequent conditions encountered in the daily practice of dentists who treat special-needs patients and it seems that parafunctional oral habits are often present in such individuals. The aim of this study was to investigate the frequency of occurrence of parafunctional habits in individuals with CP. Sixty-five patients with CP were evaluated through a questionnaire and clinical observation, regarding the following habits: pacifier-sucking, finger-sucking, biting objects, tongue interposition, and bruxism. The results showed that nine (13.8%) patients presented with pacifier-sucking, four (6.1%) showed finger-sucking, 12 (18.4%) had the habit of biting objects, 27 (41.5%) presented with tongue interposition, and 24 (36.9%) had eccentric bruxism. The significance of the presence of oral parafunctional habits in individuals with CP, revealed in this study, justifies the need to establish protocols for adequate prevention and clinical intervention in order to minimize the deleterious consequences that may result from such habits.

Automatic prompting to reduce persistent tongue protrusion in a woman with severe to profound mental retardation.

This study assessed whether an intervention approach relying on auditory prompting delivered automatically through a portable device was effective to reduce tongue protrusion in a woman with severe to profound mental retardation. The device involved (a) an optic sensor, i.e., a miniphotocell kept under the lower lip with medical tape, (b) a small signal transmission box, and (c) a Walkman for presenting the prompts. Initially, the automatic prompting condition was combined with occasional praise from a research assistant for having the tongue in the mouth. Analysis showed that the occurrence of tongue protrusion dropped from about 65% of the observation time during the initial baseline to less than 5% through the intervention. The study lasted 4.5 mo.

Effects of bite raising and occlusal awareness on tongue thrust in untreated children.

The purpose of this study was to determine the influence of conscious bite (occlusal awareness), with or without immediate bite raising, on tongue thrust during swallowing and speech. A total of 110 untreated children (age range, 7-12 years; mean, 9 years 8 months) were examined with various extraoral and intraoral observation tests. Subjects were divided according to sex and score on the labiolingual dysfunction index (LLDI) into high (LLDI-H) and weak (LLDI-W) dysfunction groups. A special, previously tested chocolate paste was used to map tongue and tooth contacts during task performance, including conscious bite (occlusal awareness) with and without bite raising. The bite was raised with an overlay or provisional occlusal plane placed unilaterally on the maxillary right molar. The results did not show any difference between boys and girls, but other findings were related to the LLDI score. Habitual mouth closure and swallowing without the provisional occlusal plane produced less pronounced bite contact in the LLDI-H group. Swallowing with conscious bite increased the bite contact in both groups but predominantly in the LLDI-H group. Tongue thrust reacted inversely to bite contacts: it was reduced when occlusion was perceived with and without bite raise but somewhat more with the provisional occlusal plane. The LLDI-W group was less affected. Tongue thrust was inhibited in both groups during speaking with bite raising and occlusal awareness. These results indicate that conscious bite helps to control the tongue. Slight raising of the bite increases occlusal awareness and its inhibiting effect on tongue thrust. A provisional occlusal plane or a similar overlay might be a useful adjunct in training the tongue to retrude in subjects with oral dysfunction.

Suffer the little children: fixed intraoral habit appliances for treating childhood thumbsucking habits: a critical review of the literature.

A critical review of the literature is presented covering the treatment of childhood thumbsucking habits using fixed intraoral habit appliances (hayrake, palatal crib). The habit appliances are classified into type and function. Data is tabulated for key references revealing the fragmented and distorted nature of the literature and its lack of consistency. A chronological approach is presented to confirm the confused and idiosyncratic character of the literature. Information is provided on the early work of Massler and Graber and the paradox of Mack, Korner and Reider. Haryett's seminal studies at the University of Alberta regarding aspects of the treatment used are critically reviewed. Reflections are presented on why Larsson's study, casting doubt on the wisdom of using habit appliances, continues to be ignored. The emergence of the Bluegrass Appliance is discussed in terms of its being a more humane appliance and the seeming reluctance of practitioners to apply it as a kinder form of appliance therapy. Information is reported on the pain and serious injuries inflicted on children by habit appliances. A comparison of the use of appliances in the USA is made with the UK, where fixed habit appliances are not popular. Concludes that fixed intraoral habit appliances are cruel and inflict pain and suffering on children out of all proportion to their necessity. Questions why these appliances continue to be used, implying that it could be a combination of financial inducement, professional insularity and the absence of concerted opposition from behavioural therapists.

Prevalence of oral habits in 563 Nigerian preschool children age 3-5 years.

One of the contributory factors in the establishment of occlusion is the child's oral habits. A limited amount of information is available on oral habits of pre-school children especially on Nigerian pre-school children. With an increasing interest in the early recognition of mal-occlusion and a corresponding emphasis on preventive procedures, more information on pre-school children may prove to be useful. This study revealed the prevalence of oral habits among 563 Nigerian pre-school children aged 3-5 years at 13.14%: 6.74% for males, 6.4%for females. The acquired data were tested with chi-square(chi2). The results indicate significant gender difference for tongue thrusting/sucking only (P=0.01) using the fisher's exact test. The relationship between digital sucking habit and mal-occlusion was very significant (P<0.01).

Burning mouth syndrome: the relationship between the HAD scale and parafunctional habits.

This study investigated 84 patients with burning mouth syndrome (BMS), who were asked to complete a hospital anxiety and depression (HAD) scale questionnaire. A control group of 69 patients was also included. All patients were interviewed regarding parafunctional habits and were subjectively examined for signs of occlusal wear of the natural teeth or dentures. The results demonstrated that parafunctional habits were present in 61% of patients with BMS. There was a statistically significantly relationship between parafunctional habits and anxiety as indicated by the HAD scale, but not with depression.

Treatment of a dental phobic with pronounced aversion to rubber gloves.

This case illustrates where excessive dental stress on the swallowing reflex caused retching then nausea and eventually dental phobia. Swallowing relaxation enabled normal variable function to be quickly restored, which allowed the phobia to be brought under control.

Treatment of tongue thrust with hypnosis: two case histories.

Tongue thrust is a relatively infrequent habit which can result in disruptive, permanent oral malocclusion, bone changes, and facial disharmony. The use of hypnotic phenomena can augment myofunctional therapy. Temperature control, glove anesthesia, relaxation, and imagery enhance demonstration of the proper way to swallow. The cornerstone of having the patient actually feel the contraction at the insertion of the masseter muscles provides an inner biofeedback which provides a very positive signal that the improper habit is being corrected. Hypnosis can then be used in the manner described to achieve a good clinical result.

Castillo-Morales' orofacial therapy: treatment of 67 children with Down syndrome.

Infants with Down syndrome often present with a typical orofacial disorder, the features of which include hypotonicity of the perioral muscles, lips and chewing muscles, and a protruding tongue, later followed by active tongue protrusion, as well as problems with sucking, drooling, etc. This study presents the effects of Castillo-Morales' therapy with 67 Down syndrome children (average age at start of therapy 13.9 months), who wore the palatal plate intermittently for an average of 12.1 months. Significant positive results were obtained in spontaneous tongue position, upper and lower lip tonicity and position, mouth closure, drooling and sucking.