Oral Parafunctional Habits: Things you should know

A parafunctional habit refers to any abnormal behavior or functioning of any part of the body In a way that is not normal. In the mouth, they involve habitual behaviors like Bruxism, Thumb Sucking, or Tongue Thrusting. 

 

Bruxism

Bruxism is the grinding of the tooth that occurs as an involuntary, chronic response. It usually occurs while sleeping. It may be caused due to increased stress, anxiety, sleep disorders or malocclusion. Over time, the tooth tends to wear down and cause si gnificant damage to the temporomandibular joint (TMI). 

Bruxism can occur as a result of the side effects of certain medications like Antidepressants. Bruxism, due to sleep apnea, can be associated with snoring. Patients with Bruxism usually complain of having headaches and sore / stiff muscles, especially on waking up, as these muscles undergo contractions during clenching / grinding of teeth. 

A dentist usually looks for the signs of Bruxism like broken, chipped or worn out teeth, receding gum lines, broken / worn out hllings and teeth indentations on the cheeks or tongue, especially in patients with Macroglossia (large tongue). Dentists also check for a narrow airway which can occur when the jaws are not properly developed, or due to oversized tongue or tonsils. 

The primary approach to eliminating the habit of Bruxism is to identify the associated causes and formulate a customized treatment plan to correct them. Concurrently, Muscle relaxants, Intramuscular Botox toxin injection, and Bite guards are employed to ease the biting force and reduce the load on the tooth. Facial massages and physiotherapy may help reduce the discomfort. Symptomatic relief medications are also provided in certain cases. 

 

Thumb Sucking

Sucking reflex is an automatic response that helps infants in feeding. It gives them a sense of security and contentment. Many infants suck their thumbs when they fall asleep, since it gives them a sense of relaxation. This habit also helps in their functional growth process.
With age. these children usually grow out of this habit. However. this habit tends to continue in some cases. Sucking a finger or pacifier can significantly impair the development of orofacial structures. 

During thumb sucking. the thumb exerts an upward pressure against the roof of the mouth and the upper front teeth. causing the palate to arch further and the upper front teeth to “are outward. This results in high-arched narrow palate with protruding upper front teeth.
Thumb sucking also results in anterior open bite and the position of the bite can vary depending on the teeth where the finger is placed. As a result of this. lower front teeth are pushed inward. 

This can cause a significant alteration in aesthetics. function and speech as well.
Management of thumb-sucking usually involves counseling. education and motivation of these children at a young age with regular reinforcement.

Habit-breaking techniques usually involve the use of mittens or fixation of a habit-breaking appliance in the palate where the finger is placed. Once an open bite occurs, it needs to be corrected orthodontically.

Tongue Thrusting

 

Tongue thrusting habits are common in babies. With age. the pattern of swallowing changes and tongue thrusting habits disappear. Persistence of this pattern, beyond four years of age, can be attributed to a parafunctional habit. 

While swallowing, your tongue is positioned on the hard palate behind the upper front teeth and the lips are closed to create a seal. However, in patients with tongue thrusting habits, the tongue rests on the back of the upper front teeth. During swallowing, a forward and upward force is exerted on teeth, making them move forward and outward. This results in an anterior open bite. The lower teeth also tend to flare forward, depending on the severity of the habit. Because of the protrusive position of teeth, the lips will not close and hence, proper seal cannot be established.
There are many contributing factors for tongue thrusting. Any obstruction to the nasal passages can contribute to tongue thrusting and this will in turn, gradually change the anatomy of the face. Consequently, the face gets elongated and palate becomes high and narrow.
Other factors that contribute to tongue thrusting are thumb-sucluing, difficulty in swallowing, Macroglossia, deformities in the development of the jaws, Neuromuscular abnormalities and 

 

Ankyloglossia (tongue-tie).

Dentists make certain functional assessments cliniccally to see if a tongue thrusting habit is present in a child. The signs of tongue thrusting in babies include:  0 Mouth breathing (with dry, inflamed, reddened gingiva) 0 Puckered lips while swallowing 0 Open bite 0 Drooling

Depending on the teeth where the pressure is exerted by the tongue, different malformations of teeth can occur. A detailed assessment of the pattern of teeth can help determine the type of thrust present in a child.

Anterior Open Bite

It is very common. As a result of anterior open bite, the lips cannot be closed properly and the tongue will protrude through the lips. Macroglossia is usually present in those with this condition.

Unilateral Thrust

In this condition, the tongue thrusts to one side of the mouth. 

 

Bilateral Thrust

In this condition, the tongue thrusts to either side of the mouth. As a result of this, open bite occurs in the posterior teeth. Treatment is challenging for the patients with this habit. 

 

Closed Bite Thrust

Due to closed-bite thrust, the upper and lower teeth tend to spread apart and flare out.

Mandibular Thrust

Mandibular thrust is usually associated with inherited abnormal growth patterns. The tongue is held low and forward causing the protrusion of the lower jaw.

Conclusion

Along with the treatment for tongue thrusting habits, the correction of alignment and rehabilitation of the jaws and teeth may also become necessary. As long as a parafunctional habit persists, teeth will keep moving away from their ideal position. Myofunctional I Corrective appliances may help a baby get proper tongue position and movements.

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