Incompetent lip seal and nail biting as risk factors for malocclusion in Japanese preschool children aged 3-6 years.

BACKGROUND: Malocclusion is a multifactorial condition associated with genetic and environmental factors. The purpose of this study was to investigate the prevalence of occlusal traits, oral habits, and nose and throat conditions by age and to assess the association between malocclusion and its environmental factors in Japanese preschool children. METHODS: A total of 503 Japanese children (258 boys and 245 girls aged 3-6 years) were recruited. Occlusal traits were assessed visually to record sagittal, vertical, and transverse malocclusion, and space discrepancies. Lip seal was recorded by an examiner, and oral habits (finger sucking, lip sucking or lip biting, nail biting, chin resting on a hand) and nose and throat conditions (tendency for nasal obstruction, allergic rhinitis, palatine tonsil hypertrophy) were assessed by a questionnaire completed by the parents. The prevalence of each item was calculated, and binary logistic regression was used to examine the factors related to malocclusion. RESULTS: 62.0% of preschool children in the present study exhibited malocclusion, and 27.8% exhibited incompetent lip seal. Nail biting was the most frequent oral habit with a prevalence of 18.9%. Nasal obstruction was recorded in 30.4% of children. The results of binary logistic regression showed that incompetent lip seal was significantly related to malocclusion, and that nail biting was significantly negatively related. CONCLUSIONS: Incompetent lip seal is significantly associated with malocclusion, but nail biting may not necessarily be a deleterious habit for the occlusion in Japanese preschool children.

Trichotillomania: a perspective synthesised from neuroscience and lived experience.

Trichotillomania, or hair-pulling disorder, is one of a family of disorders called body-focused repetitive behaviours (BFRBs), which also include disordered skin-picking (dermotillomania) and nail-biting (onychophagia). The disorders affect 1%-2% of the population, cause high levels of distress and have high levels of comorbidity with other psychiatric diagnoses. The key facts and figures are briefly reviewed and some important points are further explored: (1) BFRBs are associated with psychological distress, but are distinct from other diagnoses, (2) The pathological behaviours mirror excessive self-grooming behaviours in other species, and may relate to immune-system mediated feedback loops, and (3) The resulting behaviours are stigmatised and cause intense shame and isolation for those who suffer, which might in itself maintain the feedback loop. These observations lead to the hypothesis that the core disorder is one of pathological grooming, which may have a basis in an immune response, with shame being both a consequence and a maintainer of the disorder. The major barrier to testing the hypotheses and potential interventions remains the stigma that keeps these disorders, and those who suffer from them, in the shadows.

Why not to pick your nose: Association between nose picking and SARS-CoV-2 incidence, a cohort study in hospital health care workers.

BACKGROUND: Hospital health care workers (HCW) are at increased risk of contracting SARS-CoV-2. We investigated whether certain behavioral and physical features, e.g. nose picking and wearing glasses, are associated with infection risk. AIM: To assess the association between nose picking and related behavioral or physical features (nail biting, wearing glasses, and having a beard) and the incidence of SARS-CoV-2-infection. METHODS: In a cohort study among 404 HCW in two university medical centers in the Netherlands, SARS-CoV-2-specific antibodies were prospectively measured during the first phase of the pandemic. For this study HCW received an additional retrospective survey regarding behavioral (e.g. nose picking) and physical features. RESULTS: In total 219 HCW completed the survey (response rate 52%), and 34/219 (15.5%) became SARS-CoV-2 seropositive during follow-up from March 2020 till October 2020. The majority of HCW (185/219, 84.5%) reported picking their nose at least incidentally, with frequency varying between monthly, weekly and daily. SARS-CoV-2 incidence was higher in nose picking HCW compared to participants who refrained from nose picking (32/185: 17.3% vs. 2/34: 5.9%, OR 3.80, 95% CI 1.05 to 24.52), adjusted for exposure to COVID-19. No association was observed between nail biting, wearing glasses, or having a beard, and the incidence of SARS-CoV-2 infection. CONCLUSION: Nose picking among HCW is associated with an increased risk of contracting a SARS-CoV-2 infection. We therefore recommend health care facilities to create more awareness, e.g. by educational sessions or implementing recommendations against nose picking in infection prevention guidelines.

Avaliação da eficácia do acessório mamilo na remoção dos hábitos deletérios / Evaluation of the effectiveness of the nipple accessory in the removal of the deletery habits

Objetivo: avaliar a eficácia do acessório mamilo aplicado a aparelhos ortopédicos/ ortodônticos no tratamento de hábitos deletérios de sucção de chupeta, língua, lábio e dedo, e onicofagia em pacientes tratados nos últimos 20 anos com o aparelho. Métodos: Trata-se de um estudo clínico observacional, retrospectivo, no qual a amostra foi composta de prontuários de pacientes de ambos os gêneros, atendidos por profissionais habilitados pelo aparelho mamilo, que os utilizaram em crianças de 03 a 16 anos portadoras de hábitos deletérios. Os prontuários utilizados, correspondem a pacientes tratados entre os anos 2000 a 2020. Todas as análises foram realizadas no programa R, com nível de significância de 5%. Resultados: Foram analisados 142 prontuários, nos quais 122 foram incluídos, por estarem dentro dos critérios de inclusão propostos no estudo e 20 foram excluídos da pesquisa por apresentarem informações incompletas e/ou não preenchidas corretamente. O hábito com maior incidência foi o de sucção digital, em 71,3% dos pacientes, 91,8% dos pacientes deixaram o hábito, destacando que nos casos de sucção de chupeta e onicofagia, o sucesso na remoção do hábito foi de 100%, em ambos os casos. O tempo médio de uso do aparelho foi de 4,8 meses, variando de 0,6 a 14 meses. O tempo médio para a remoção do hábito após a instalação do aparelho foi de 1,6 meses, variando de 0 a 12 meses. Conclusão: O aparelho mamilo, mostra-se como uma alternativa de alta eficácia na remoção de hábitos deletérios de sução de chupeta, dedo, língua e onicofagia.(AU)

Objective: Evaluate the effectiveness of the nipple accessory applied to orthopedic/orthodontic appliances in the treatment of harmful pacifier, tongue, lip and finger sucking habits, and onychophagia in patients treated in the last 20 years with the device. Methods: This is an observational, retrospective clinical study, in which the sample consisted of medical records of patients of both genders, assisted by professionals qualified by the nipple device, who used them in children aged 03 to 16 years with deleterious habits. The medical records used correspond to patients treated between the years 2000 and 2020. All analyzes were performed in the R program, with a significance level of 5%. Results: 142 medical records were analyzed, in which 122 were included, as they were within the inclusion criteria proposed in the study and 20 were excluded from the research because they presented incomplete information and/or not filled in correctly. The habit with the highest incidence was digital sucking, in 71.3% of patients, 91.8% of patients quit the habit, noting that in cases of pacifier sucking and onychophagia, success in removing the habit was 100%, in both cases. The average time of use of the device was 4.8 months, ranging from 0.6 to 14 months. The mean time to remove the habit after installing the device was 1.6 months, ranging from 0 to 12 months. Conclusion: The nipple device is a highly efficient alternative for removing harmful habits of pacifier, finger, tongue and onychophagy sucking.(AU)

A Hierarchical Personality Approach Toward a Fuller Understanding of Onychophagia and Compulsive Buying.

PURPOSE: Employing a hierarchical model of personality, prior research suggests that cardinal traits such as conscientiousness and agreeability predict central traits such as materialism and need for arousal that in turn impact surface traits such as onychophagia and compulsive buying. More research is needed to explore additional central traits and their effect on onychophagia and compulsive buying. Thus, the goal of the current research is to examine how another central trait-negative perfectionism-impacts onychophagia and compulsive buying. DESIGN/METHODOLOGY/APPROACH: A survey was administered both online and face-to-face resulting in a sample of 634 subjects of which 391 were individuals with onychophagia. Through a multi-group analysis, a causal model was tested to identify personality traits and their relationship with compulsive buying. RESULTS: Results showed that onychophagia was affected by other obsessive-compulsive disorders-particularly trichotillomania, and excoriation disorder, which significantly increased the likelihood that the participant was a compulsive buyer.

Prevalence of nail biting and its chronological relationship with tics in child and adolescent outpatients with Tourette syndrome: a single-centre, retrospective observational study.

OBJECTIVE: To evaluate the prevalence of nail biting in child and adolescent outpatients at a single institution and the chronological relationship between nail biting and tics in patients with Tourette syndrome (TS) with or without attention-deficit hyperactivity disorder (ADHD). DESIGN: Retrospective observational study. SETTING: Teaching hospital in Taiwan. PARTICIPANTS: All participants were aged 4-18 years, including 535 patients with TS, 230 patients with provisional tic disorder and 1460 patients without neurological or psychiatric disorders (controls). OUTCOME MEASURES: Presence of nail biting, starting age for nail biting and starting age for motor and/or vocal tics. RESULTS: Nail biting was more commonly observed in patients with TS (56.6%) than in patients with provisional tic disorder (27.4%) or controls (15.0%), regardless of sex (all p<0.020). Nail biting was also more common in patients with TS with ADHD than in those without (75.0% vs 47.6%; p<0.001), but the starting age was significantly later in those with concomitant ADHD than without (5.3 vs 3.8 years; p<0.001). In patients with TS, the onset of nail biting occurred earlier than that of tics, regardless of ADHD status. CONCLUSION: Nail biting was more prevalent and occurred earlier than tics in patients with TS, regardless of ADHD status, in the study population.

The Potential of N-Acetylcysteine for Treatment of Trichotillomania, Excoriation Disorder, Onychophagia, and Onychotillomania: An Updated Literature Review.

BACKGROUND: Trichotillomania (TTM), excoriation disorder, onychophagia, and onychotillomania are categorized as body focused repetitive behavior (BFRB) disorders, causing damage to the skin, hair, and/or nails with clinically significant psychosocial consequences. Currently, there are no standardized treatments for these compulsive, self-induced disorders. Studies on treatment of these disorders using psychotropic drugs (i.e., selective serotonin reuptake inhibitors, tricyclic antidepressants, anticonvulsants) have shown variable efficacy. Recently, there is a growing interest in N-acetylcysteine (NAC) for treating BFRBs. NAC is a glutamate modulator that has shown promise in successfully reducing the compulsive behaviors in BFRB disorders. This article provides an updated review of the literature on the use of NAC in TTM, excoriation disorder, onychophagia, and onychotillomania. METHODS: Relevant articles were searched in the PubMed/MEDLINE database. RESULTS: Twenty-four clinical trials, retrospective cohort studies, and case reports assessing the efficacy of NAC in TTM, excoriation disorder, and onychophagia were included. No studies for onychotillomania were found in our search. CONCLUSIONS: Although NAC has proven successful for treatment of BFRB disorders, data is derived from few clinical trials and case reports assessing small numbers of patients. Larger studies with longer durations are needed to fully establish the efficacy of NAC in these disorders.

Update on Diagnosis and Management of Onychophagia and Onychotillomania.

Onychophagia (nail biting) and onychotillomania (nail picking) are chronic nail conditions categorized as body-focused repetitive behavior (BFRB) disorders. Due to a limited awareness of their clinical presentations, embarrassment on the part of patients, and/or comorbid psychiatric conditions, these conditions are frequently underrecognized and misdiagnosed. This article reviews the prevalence, etiology, diagnostic criteria, historical and physical exam findings, and treatment options for these conditions. The PubMed/MEDLINE database was searched for relevant articles. Onychophagia and onychotillomania are complex disorders necessitating a detailed patient history and physical examination and a multidisciplinary treatment approach for successful diagnosis and management. Due to the dearth of clinical trials for treatment of nail biting and nail picking, large clinical trials are necessary to establish standardized therapies.

Onychophagia: detailed clinical characteristics.

BACKGROUND: Onychophagia is a common disorder affecting 20% to 30% of the general population. It is defined as habitual nail biting and can cause various changes in the nail units. However, to date, there has been a paucity of data focusing on nail deformities related to onychophagia. This study was performed to investigate the clinical characteristics of onychophagia in Korea. METHODS: This study included 53 patients with onychophagia who visited the Pusan National University Hospital (Busan and Yangsan) over a 10-year period (2011-2020). We retrospectively reviewed medical records and clinical and dermoscopic photographs. RESULTS: All 10 fingernails were affected in 37.7% of the patients. The left thumbnail was the most predominantly affected site (81.1%). Clinical findings showed that short nails with ragged distal borders were the most common presentation (100.0%), followed by generalized or patchy rough areas (50.9%), linear and pinpoint hemorrhage (32.1%), longitudinal melanonychia (30.2%), transverse groove (28.3%), brittleness (28.3%), macrolunula (24.5%), washboard nail (13.2%), and pterygium (3.8%). Of the patients, 88.7% had periungual complications, such as periungual exfoliation (77.4%), absent or ragged cuticle (52.8%), hyponychial hyperkeratosis (37.7%), and paronychia (15.1%). CONCLUSIONS: Although onychophagia is a common disorder, its clinical characteristics have not been reported in the literature. The results of this study may be helpful in managing patients with onychophagia.

Clinical and dermoscopic characteristics of onychophagia and onychotillomania: a retrospective study of 63 cases.

Onychophagia and onychotillomania are common forms of nail-biting and nail-picking disorders, but there is insufficient literature documenting their comparison and coexistence. In fact, overlapping features can be involved in different nail self-injuries, and significant variations also exist. We conducted a retrospective study aimed at identifying differences between onychophagia and onychotillomania, and providing more detailed findings of both conditions.

Onychophagia as a clinical symptom: A pilot study of physicians and literature review.

Although onychophagia is a medical condition and is associated with poorer health, there are no guidelines for assessment or treatment. The purpose of this study was to investigate the clinical aspects of nail biting from doctors' points of view, to estimate the prevalence of onychophagia among physicians, and to review the literature on and treatment methods for onychophagia. Twenty-four percent of doctors reported nail-biting periods during their lifetimes, and 2% of them remained active nail biters. A total of 64.4% of doctors see nail biting in their practices, and 60.6% never or only on request ask patients about nail biting and examine their nails. Family doctors and pediatricians ask their patients about nail biting most often. Attitudes and opinions on the treatment of nail biting are undefined and vary. Doctors reported usually treating nail-biting patients by referring them to another specialist or offering special nail polish. There is a need to improve physicians' knowledge of nail-biting treatment methods, but a lack of studies evaluating the clinical aspects of onychophagia and its relation to mental health and emotion dysregulation. Further research is needed. Clinical attitudes toward nail biting could be more precise in training and medical practice.

Maloclusiones funcionales y su relación con hábitos orales en niños con dentición mixta / Functional malocclusions and their association with oral habits in children with mixed dentition

Objetivo: Relacionar la prevalencia de maloclusiones funcionales con hábitos orales en niños con dentición mixta. Materiales y métodos: La muestra estuvo constituida por 61 pacientes que asistieron a la Facultad de Odontología de la UNNE entre los meses de abril y noviembre de 2018, seleccionados mediante un muestreo al Azar Sistemático. Se evaluó en ellos la presencia de maloclusiones funcionales como mordidas abiertas y cruzadas, líneas medias desviadas, apiñamiento dentario, resalte maxilar. Como hábitos orales se consideró la succión digital, interposición lingual y deglución atípica, interposición de labios y objetos, respiración bucal, onicofagia. Se realizó un análisis descriptivo empleando el software estadístico InfoStat Versión 2019 y para conocer la asociación entre las maloclusiones funcionales y los hábitos orales se emplearon pruebas de Chi cuadrado (nivel de signi- ficación de P ≤0,05). Resultados: Se observó la presencia de maloclusiones funcionales en un 64% de los niños, y se encontró que el api- ñamiento dentario fue el predominante con un 39%. La pre- valencia de hábitos orales fue de 66%, la interposición labial y de objetos fue la que se detectó con mayor frecuencia con un 39%. Se observó mayor presencia de mordida abierta en pacientes con hábitos parafuncionales como ser succión digi- tal e interposición lingual. La asociación entre maloclusiones funcionales y hábitos orales fue estadísticamente significativa (χ 2 = 6,17, P = 0.0130). Conclusión: Se identificó una alta prevalencia de malo- clusiones funcionales en niños con dentición mixta, asociadas a hábitos orales (AU)

Aim: To determine the association between prevalence of functional malocclusions and oral habits in children with mixed dentition. Materials and methods: The sample consisted of 61 patients who attended the UNNE School of Dentistry from April to November 2018, selected through systematic random sampling. Presence of functional malocclusions such as open bite, crossbite, deviated midlines, dental crowding, and maxil- lary protrusion were evaluated. The oral habits of finger suck- ing, lingual interposition and atypical swallowing, interposi- tion of lips and objects, mouth breathing, and onychophagia were considered. A descriptive analysis was performed using the Statistical Software InfoStat Version 2019. Chi-square tests were used to determine the association between function- al malocclusions and oral habits (significance level P ≤0.05). Results: Functional malocclusions were present in 64% of the children, with dental crowding being the most prevalent, in 39%. Prevalence of oral habits was found in 66%, with la- bial and object interposition having the highest frequency, in 39%. Open bite was more frequent in patients with parafunc- tional habits such as finger sucking and lingual interposition. The association between functional malocclusions and oral habits was statistically significant (χ2 = 6.17, P = 0.0130). Conclusion: High prevalence of functional malocclu- sions was identified in children with mixed dentition, associ- ated with oral habits (AU)

Recurrent Osteomyelitis Requiring Surgical Management Secondary to Nail-Biting: A Case Report.

CASE: Onychophagia, or nail-biting, is a common habit seen in both children and adults. Harmful effects include oral exposure to a variety of pathogens and concomitant damage to dentition and fingers. This report focuses on the most severe reported case of recurrent osteomyelitis of the bilateral hands with destructive changes secondary to onychophagia. CONCLUSION: Successful treatment relies on a multidisciplinary approach which in this case included surgical management and counseling on cessation, with referrals to other providers to address underlying psychiatric and/or psychologic conditions that may predispose to this compulsion.

Associação de hábitos parafuncionais e DTM em pacientes classe II / Association of parafunctional habits and TMD class II patients

Introdução: A Disfunção Temporomandibular (DTM) é a dor orofacial crônica mais comum, encontrada por dentistas e outros profissionais de saúde. Sua etiologia tem caráter multifatorial, e pode envolver, desde fatores hereditários, hábitos parafuncionais, maloclusões, até ansiedade e estresse. Objetivo: Este estudo investigou a frequência da DTM e a sua relação entre hábitos parafuncionais em uma população de pacientes classe II esquelética. Método: Uma amostra composta por pacientes classe II esquelética foi selecionada de forma não probabilística. Setenta e três indivíduos concordaram em participar da pesquisa, se submetendo ao exame físico que consistia na aplicação do Eixo I do (RDC/TMD). Resultados: Quarenta e seis por cento dos pacientes examinados apresentaram diagnóstico positivo. A média de idade dos pacientes foi de 27 anos+ 8,73 anos, 82% do gênero feminino e 80% brancos. Trinta e quatro pacientes referiram alguma atividade parafuncional. Desses a onicofagia representou o grupo com maior frequência, seguido pelo bruxismo, interposição de objetos entre os dentes e por último o apertamento. As variáveis não apresentaram associação estatisticamente significante com o desfecho primário estudado. Conclusão: Na amostra estudada não se observou associação entre a ocorrência de DTM e hábitos parafuncionais em pacientes classe II esquelética... (AU)

Introduction: Temporomandibular disorder (TMD) is the most common chronic orofacial pain, found by dentists and other health professionals. Its etiology has a multifactorial character, and may involve, from hereditary factors, parafunctional habits, malocclusions, to anxiety and stress. Objective: This study investigated the TMD frequency and its relationship among parafunctional habits in a population of skeletal class II patients. Method: A sample composed by a class II patients was selected in a non probabilistic manner. Seventy-three members agreed to participate in the research, submitting themselves to a physical examination that consists in the application of Axis I (RDC/TMD). Results: Forty-six percent of patients diagnosed with a positive diagnosis. The average age of the patients was 27 years ± 8.73 years, 82% female and 80% white. Thirty-four patients reported some parafunctional activity. Of these, biting nail represented the group most frequently, followed by bruxism, interposition of objects between the teeth and lastly clenching. As variables did not present a statistically significant association with the primary outcome studied. Conclusion: In the sample studied, it is observed that there is no association between TMD occurrence and parafunctional habits in skeletal class II patients... (AU)

Factores asociados a enterobiosis en niños de dos comunidades nativas Ese'Eja del departamento Madre de Dios, Perú / Factors associated with enterobiosis in children of the Ese'Eja native communities in department of Madre de Dios, Peru

Introducción: La enterobiosis es una de las principales infecciones intestinales del mundo. Objetivo: Determinar los factores asociados a la infección por Enterobius vermicularis en niños de dos comunidades nativas Ese'Eja en Madre de Dios, Perú. Métodos: Estudio transversal analítico. Se trabajó con niños (77) de 1 a 11 años durante los meses de febrero a marzo de 2014. Para diagnosticar la enterobiosis se usó el test de Graham. Las manifestaciones clínicas fueron evaluadas por un médico y los factores asociados mediante una encuesta aplicada a los padres de los niños evaluados. Se usó estadística descriptiva y analítica, se utilizaron razones de prevalencia crudas y ajustadas con un IC 95 por ciento se consideró p< 0,05 como significativo. Resultados: La prevalencia de enterobiosis fue de 32,47 por ciento (25). Los factores asociados (RP e IC 95 por ciento) en el análisis bivariado fueron onicofagia 2,1 (1,1-3,9), chuparse los dedos 5,4 (2,1-2,7), uñas largas 7 (2,6-18,6), intercambio de ropa 2,3 (1,1-3,7), cambio de ropa interior 3,3 (1,8-5,9), uso de calzado 7 (2,6-18,4), juego con tierra 6,9 (1,7-27,3), juego con mascotas 6,4 (2,1-19,7), lavado de manos antes de comer 7,9 (3,6-17,1), lavado de manos después de comer 1,9 (1,7-3,66), 6 o más personas en la casa 3,9 (1,9-7,9), disposición de excretas a campo abierto 3,3 (1,7-6,2) y el menor nivel socioeconómico 2,6 (1,3-5,4). No hubo asociaciones en el análisis multivariado. Conclusiones: Existe una alta prevalencia de enterobiosis en la población estudiada y los factores de riesgo son similares a los antecedentes locales. Urge hacer programas de prevención y promoción de salud respecto al tema para reducir este problema(AU)

Introduction: Enterobiasis is one of the main intestinal infections worldwide. Objective: Determine the factors associated to Enterobius vermicularis infection in children from two native Ese'Eja communities in Madre de Dios, Peru. Methods: An analytical cross-sectional study was conducted in February-March 2014 of 77 children aged 1-11 years. Enterobiasis diagnosis was based on Graham's test. Clinical manifestations were evaluated by a physician, whereas associated factors were determined through a survey applied to the parents of the children studied. Use was made of descriptive and analytical statistical analysis, and crude and adjusted prevalence ratios with a CI of 95 percent. A p value of 0.05 was considered significant. Results: Enterobiasis prevalence was 32.47 percent (25). The associated factors (PR and CI 95 percent) in the bivariate analysis were onychophagia 2.1 (1.1-3.9), finger sucking 5.4 (2.1-2.7), long nails 7 (2.6-18.6), exchanging clothes 2.3 (1.1-3.7), changing underwear 3.3 (1.8-5.9), wearing shoes 7 (2.6-18.4), playing with earth 6.9 (1.7-27.3), playing with pets 6.4 (2.1-19.7), handwashing before eating 7.9 (3.6-17.1), handwashing after eating 1.9 (1.7-3.66), six or more people in the household 3.9 (1.9-7.9), feces disposal in open areas 3.3 (1.7-6.2) and a lower socioeconomic level 2.6 (1.3-5.4). Multivariate analysis did not find any association. Conclusions: Enterobiasis prevalence is high in the population studied, and the risk factors are similar to the local antecedents. It is urgent to develop health prevention and promotion programs about the topic to reduce this problem(AU)

Orthodontic treatment in times of Covid-19.

During the first two months of the Coronavirus Disease 2019 (Covid-19) pandemic, Romania was in lockdown, and all dental practices were closed, so orthodontic patients had to postpone their check-ups for at least eight weeks. This led not only to a delayed end of treatment but also to accidents and complications. The present study tried to evaluate the orthodontic situation both from the patient's and orthodontist's point of view, so the patients were given a few questions to answer, and the orthodontist analyzed each treatment before and after the two-month lockdown and decided if it was mildly or severely affected by the absence of check-ups. The study group consisted of 105 patients evaluated by three orthodontists in the same private practice. Patients that have gotten worse after the lockdown or who had problems were included in the study. Also, all the patients were given a 7-question form in order to find out their opinion. After two months without check-ups, our orthodontists found that 9.52% got worse because of the lack of intermaxillary elastics, broken brackets, broken removable orthodontic appliances, and others. Most of the patients believe that their treatment was delayed by the Covid-19 pandemic, but none of the patients felt unsafe when visiting the clinic. The Covid-19 pandemic had severe effects on orthodontic treatments. Orthodontists noticed a delay for about one-third of their patients. However, from the patient's point of view, half believe that their treatment was negatively affected by the Covid-19 pandemic in different degrees.

Prevalence of onychophagia and its relation to stress and quality of life.

INTRODUCTION: Onychophagia is defined as putting one's fingers into the mouth and biting the nails. We sought to evaluate the prevalence of onychophagia in university and high school students and its relation to sociodemographic factors, perceived stress, and quality of life. METHODS: A total of 3,475 students were included in the study. A questionnaire including sociodemographic characteristics, items about onychophagia, the Perceived Stress Scale (PSS), and the European Health Impact Scale were used. RESULTS: The prevalence of onychophagia among university students was 17.6%, and among high school students it was 29.2%. In university students with onychophagia, the median score on the PSS was higher than the median score of students without onychophagia. In high school students, the median score on the PSS was 28.2 for students without onychophagia and 28.0 for students with onychophagia; the difference was not significant. The median scores on the quality of life scale for both university and high school students with onychophagia were lower than the mean score of students without onychophagia. CONCLUSIONS: Onychophagia is a common problem in the general population with a multidimensional etiology. It has dermatological, dental, and psychiatric consequences and comorbidities, and so a multidisciplinary approach is necessary for the prevention and treatment of onychophagia.