 Hello everyone, in this session we are going to discuss about Oral Habits. Now let's see what is Habit. Habit may be voluntary or involuntary act performed by a person repeatedly or compulsively. It produces a harmful effects on development of maximum official complex and produces an unbalanced pressure on the immature and highly malleable allura ridges thereby causing potential changes in the position of the teeth and occlusion. All these habits are normal or considered as normal during the preschool age that is beyond up to 3 to 4 years age. However, oral habits versus beyond this preschool age have been implicated as an important physiological factor associated with the development of malocclusion. So early diagnosis and proper treatment planning of these habits will reduce the occurrence of malocclusion. Now let's see the definition of Oral Habit. According to 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. Now let's see what are the factors that make a habit pernicious. First one, the frequency. That is how often the habit is performed from in density. How vigorously it is practiced. Then coming to the duration, that is the 40 number of years or months a week since the habit is being performed. Now let's see the classification of habits. According to James, a habit can be classified as useful and comfortable. According to James, Habit may be complete or not completely normal. According to James, Habit may be mainly full or an individual habit. According to James, Habit may be extremely happy, especially happy by being happy. Now let's see the detail about the habit. So as I told earlier, most of the children below 3 years of their thumb go thin. It's a common finding in a newborn and it is meant to meet both physiological and nutritional needs. And it says spontaneous activity that develops soon after birth. Most of the children discontinue the habit by the age of 3 to 4 years. If the habit continues beyond this period, then there are definite chances that it may lead to dendrofacial changes and severity depending on the frequency, duration and intensity of the habit. Now coming to definition for thumb sucking habit. Gillian defines digital sucking as the placement of thumb or one or more fingers in revealing depth into the mouth. According to Moyers, it's the repeated forceful sucking of the thumb with associated strong buckle and lip contractions. Now let's see the class beginning. Sucking habit can be classified as no-pretty sucking habit under which there's freedom and body. Then no-pretty sucking habit thumb sucking, fingers sucking, specify a toy or plant that is separate. According to September, thumb sucking is classified into different groups. First group, there is group 1 in group, thumb is inserted beyond the first joint pressing against the paractal myoposa and alveolar tissue. At the same time, lower incisors press against the thumb. Then group 2 thumb extends up to the first joint or just anterior tip. No paractal contact and there is contact pressing with only with the anterior tip. In group 3, thumb is placed fully into the mouth in contact with the palette as in group 1 but the lower incisors do not contact the thumb. There is only paractal contact is present. Then group 4, the thumb does not progress appreciably into the mouth. It's the lower incisors contact the thumb at the nails. It's the classification given by subtly. According to this theory, a human possess a biologic sucking drive and infant associate sucking with pleasurable feelings such as hunger, satiety and being healthy. These events will be replaced in later life by transferring the sucking action to the most suitable object available namely the thumb or fingers. According to this theory, the strength of the oral drive is in part a function of how long a child continues to be by sucking. It is not the frustration of waning that produces thumb sucking but in fact it is the prolonged nursing that causes it. Then the rooting reflex by Benjamin. The rooting reflex is the movement of the infant's head and thumb towards an object touching its cheeks. This is a normal reflex point usually seen in newborns. He suggested that thumb sucking arises from the rooting and placing reflexes common to all mammalian infants during the first three months of life. According to Davidson, this theory advocates that non-nutritive sucking stems from an adaptive response. Infant associates sucking with feelings like pleasure and hunger and recalls these events by sucking the suitable objects available which is mainly thumb or fingers. Let's see what are the etiological factors for thumb sucking. First one, the socio-economic status. In high socio-economic status the mother is in a better position to feed the baby and in a short time the baby's hunger is satisfied whereas in low socio-economic group mother is unable to provide sufficient dismissal to the infant. So in the process, infant suckles intensively for a long time thereby exhausting the sucking energy. So this theory explains the increased incidence of thumb sucking is present in industrialized areas when compared to rural areas. So thumb sucking is common in high socio-economic group. Then if the working mother, if the parent mother is working, then children are brought up in the hands of care takers and they develop a feeling of insecurity. In order to overcome that insecurity the child starts thumb sucking and slowly it becomes a habit with number of siblings. The development of habit can be related to the number of siblings because more the number increases the attention met by the parent to the child gets divided. A child who feels neglected by the parent may attempt to compensate his feelings of insecurity by means of this habit. Then order of birth of the child. It is a sibling that in the family greater is the chance of having an oral habit. But the smaller, the youngest children have greatest tendency for developing at the habit. Then social adjustment and stress. Digit sucking has also been proposed as an emotionally based behavior related to difficulty with social adjustment or with stress. Then feeding practice. Thumb sucking is seen to be more frequent among breastfed children and age of the child. In the neonate insecurities are related to primitive demands as hunger. During first few weeks of life related to feeding problems and during the eruption of primary molars it is considered as a teething device. Then still later use the habit for the release of emotional tensions or taking refuge in regressing to an infantile behavior pattern. Then coming or coming to diagnosis of physical habits. First one is history. History is important to determine the psychological component involved. Question regarding the frequency, intensity and duration of the habit. Then we have to inquire about the feeding factor and spiritual care of the child. Presence of other habits also evaluated. Then diagnosis of digit habit also be obvious when child is actively performing the habit. Then extraordinary examination. This digit can be examined. Examination we can find out. Redden exceptionally clean chapped and with a short finger nail. This is a clean this happened. This shape and thumb is an indication for the child is indulging in the habit. Also fibrous rough and careless may be present on the superior aspect of the finger. This habit also cause a deformation of the finger. The typical presentation of the finger of a thumb sucking child. Then patient for analysis. Check for mandibular retrosion, maxillary retrosion, high mandibular play that way and profile. Then when patient is when swallowing, patient is observed for presence of a facial gimmick or an excessive mentalist muscle contraction. The facial profile of a thumb sucking child may be either a strike, straight profile or a convex profile. Then coming to intangible examination. Thumb should be examined or correct size and position of the thumb address tongue action during swallowing. Then dendro angular structures. Individuals with severe finger or thumb sucking hands. What is it applied? Applied on anterior superior vector to the upper definition upper dentition and palate will have a flared and proclined maxillary anterior with diastremas and tetroclined mandibular anterior. This is the typical endoral feature of a thumb sucking child. There is proclination of the upper anterior and there is the flaring of upper anterior septicline diastremas and an incompetent lip. According to Nanda the type of malocclusion produced by digit sucking is dependent on a number of variables that is position of the digit in associated oral facial bustle contractions, mandibular position during sucking, facial skeletal pattern, intensity, frequency and duration are of course applied. Now we can see the clinical feature as our serial patient comes up. There may be maxillary anterior proclination and mandibular retroclination and anterior open right. This type of malocclusion arises through the combination of factors that is the child is placed with the thumb over the upper incisor region. So there will be a gap and the posterior teeth are free to erupt. Because of this gap, posterior teeth are free to erupt and causing anterior open right. There is concern of maxillary arteries because white property is placed in a lower position inside the oral area and there will be enough host action. There will be some cheek muscles and also buccinator there will be severe pressure occurring over the buckle surface of the posterior teeth causing constriction of the maxillary arch. Now postural prospect is always due to the consequence of constriction of the maxillary arch. That's the unbalanced muscle forces on the maxilla exerted by the cheek muscles are unmet by the pressure from the libel musculature that is the tongue which are normally present. While this result in a maxillary constriction there is no restriction to the mandibular growth eventually leading to a rose white. If it's on maxilla there will be proclination of the maxillary incisors and there is the maxillary abstinence and here placement of a focal base of the maxilla increased clinical ground length of incisors, high palatal arch etc. And on a lower incisors there will be retroclination and retrosion of the mandibular. And if it affects on intras relationship there will be increased over jet, decreased over bite, posterior cross bite and anterior open bite. And effect on lip placement and function there will be development of tongue thrust lower tongue position, hypotonic upper lip, hyperactive lower lip. Now how we can be proven to be happy? Mainly many approaches are there for the prevention of oral transacting happy. Motive based approach. The history, Tara's history will help diagnose the etiology of the happy and child's engagement in various activities. Child practices the happy when both are left to himself or it could be just because he goes to sleep. So parents can be counseled on keeping the child engaged in various activities and distracting the child from this habit and engaging in various other interesting activities. The important of parents involvement in the prevention. When parents are at home they should be advised to spend ample time with the child. So it will put away child's feeling of insecurity. At night this can again be reimposed by playing, soothing music or by settling good bedtime stories till the child falls asleep. Then duration of breastfeeding, care should be taken when feeding the baby. In that duration of breastfeeding should be adequate so as to enable the child to exhaust the certain urge and feel comfortably satisfied. Then mothers present an attention during bottle feeding. In case of bottle fed child they should be held by the mother and enough attention should be given in the process. Now the treatment considerations. Psychological status of the child. We have to find out the reason behind why the child is indulging in this habit. Any psychological problem is there or why we have to take the proper history in order to find out the reason behind the habit. If the oral habit was associated with an emotional problem this should suggest the need for a psychological consultation. And motivation of the child to stop the habit. It is also important to assess the maturity of the child in response to new situations and to observe child's reactions to any suggestion. The treatment approach for the digit-sucking habit should deal directly with the child. First ingredient needed to stop the habit child's desire to stop. The child himself have a desire to stop the parental concern regarding the habit. If the parent is unable to go to the situation positively then both parent and child should be dealt with during treatment. Parent should become a silent partner and child should not be embarrassed or criticized. Negative reinforcement in the form of threat, nagging and would only entrench the habit. Psychological therapy screen the patient for underlying psychological disturbance. If there is any psychological problem we should cover the parent's child to professional for counseling. Children between age of 4 and 8 years of age need only reassurance, costy reinforcement and friendly reminders. To develop speed and hypothesis, he states that the best way to break a habit is by its conscious purposeful repetition. That is the child should be asked to sit in a locked mirror and ask to suffer some observing himself as he indulges in the habit. This procedure is very effective if the child is asked to go to the same at a time when he is involved in an enjoyable activity. Remind them to learn. There are several approaches and extraordinary approaches. Extraval approaches, there are chemical treatment. Various chemicals are available such as hot tasting bitter flavored preparations or distasteful agents that are applied to finger of tongues. For example, pepper canine SFHGDA. Commercially available products are Femite, compost or Denatonium Benzoate. A bitter compound which prevents children from sucking their digit on application. This is applied over the skin and nails and allowed to dry for 10 minutes. A new pot should be applied morning and evening till the habit is broken. Extraval approaches, very thermoplastic compost was revised by Allen. For a thermoplastic material was placed on the offending digit. A total of 6 weeks of treatment was required for elimination of habit. Then A's bandage approach. This method is helpful in patients or in children who wish to discontinue their habit and have no psychological contraindication or candidates. It involves a mildly use of an elastic bandage wrapped across the elbow. The pressure exerted by the bandage removes the digit from the elbow as the child tries and falls asleep. A use of long sleep light. Such a effective care therapy and use of long sleep may not prevent the child from practicing some certain habits and you actually stop it from recurring. Some things are out of the process. 3 days off-bonding appliances are available. These removal appliances used may be charged, liquids burst, haulage retainer with and without burst. Fixed appliances such as lingual downstreams are effectively more effective in breaking this habit. If the child has made appreciable changes in habit by 3 months, appliance can be broken. The design of the removal or fix it by 3 weeks it creates the suction force of the digit on the end of the habit and makes the habit a non-pleasurable one. Now, aural split. Aural split is a functional appliance introduced by Neville. It produces its split by redirecting the pressure of the muscular and soft tissue curtain of the cheek and lips. It prevents child from placing the thumb or finger into the oral cavity during sleeping hours. Then, hail raise. MAP advocated the use of children over 3 and a half years of age to our poor system. Thumbs up first. Bluegrass appliance developed by Bruce Haskell is a fixed appliance using Bethlehem Brawler together with a positive reinforcement. Used to manage thumb-sucking in children between 7 to 13 years of age. The benefit of this appliance is that patient believes that he has acquired a new toy to play with. So, the child is instructed to use this roll roller instead of sucking the digit and the child gradually removes this habit. Quad helix. Quad helix is a fixed appliance used to expand the constructed mastery art. The helix of that appliance served to remind the child not to place the finger in the mouth. Modified bluegrass substance. This is a modification of the original appliance with a difference being that this has two rollers of different colors and instead of one. The patient tries to suck on his thumb the suction will not be created and the thumb will slip turn rollers thus breaking the act. Now, it's a recent product from home concept. A small bag is given to the child to tie around the wrist due in shape. The child is explained that child and the child sleeps in his home thumb also sleep in its house. Now, about thumbs-sucking book. The little bear who served his thumb is a beautifully illustrated storybook written by a dentist Dr. Dragon Antios. It's a story about a little bear that sucks his thumb with the help of a mystical dragon able to overcome his thumbs-sucking problem. This book approaches the issue in a fun and non-returning way providing subtle motivation and inspiration for children to stop the habit when they are ready. Now, we will move into the specific habits. The specific habits have been used by man and for more than thousands of years. These have been identified to help children in transitioning to sleep created by specific habits are similar to thumb habits. Increased duration of specific habit is related to an increased prevalence of anterior orbit by reduced over bulk and posterior. Safety issues regarding the specific habits. Physical safety. Material and design of specific habits that have been associated with asphyxia, infection and the chemical safety due to presence in specific habits which are proven to be carcinogenic, then immunological safety, latex, allergy and early sensitization. Management. Educate the parent and caregiver about the safe use of specific habits. Withhold the use of specific until the speeding is established. After that point, limit their use for soothing specific events. Clean specific routinely and avoid sharing between siblings in the third child beginning at two years of age. So that's all about tongue safety and specific habits. Now moving on to the next habit tongue safety. In embryology life, developing tongue is considered disproportionately large in comparison to the developing mandible. That is the tongue fills the embryonic nasal cavity. During the infantile swallow, tongue bats and enclose a position with lips and its contraction of the facial muscle help to stabilize the mandible. Later half the first year of life, several maturation events occur that alter the functioning of the aurotational musculature. With arrival of incisors, tongue assumes a retracted posture and initiate the learning of mastication. As soon as bilateral seroclonal is established, through chewing motions are seen to start and the learning of mature swallow begins. Now we can see the definition of tongue safety. According to the book, the tongue trust is sensitive to sound. If the tongue is observed trusting between other people or close friends and with close friends during the day. According to the book, he states tongue trust as the forward moment of the tongue to meet a lower lip during big luteation and in sounds of speech so that the tongue becomes indagendal. In classification of tongue trusting, the psychophysiologic tongue trusting and habitual tongue trusting physiologic embraces the normal tongue trust swallow of infantile and habitual tongue trust swallow is present as a habit even after the correction of the maleplosion. In the tongue trust mechanism adaptive behaviour developed to achieve an oral see can be viewed as functional. In anatomy, persons having enlarged tongue can have an anterior tongue trust. James Brogan, tongue trust classification of tongue trust type 1 non-deferring tongue trust type 2 deforming anterior tongue trust. This again anterior open butt and associated circumvency of anterior teeth. In subgroup 3, associated posterior cross bite and type 3 deforming lateral tongue trust like this. Another 3 subgroups that is posterior open butt, posterior cross bite, deep oval bite and type 4 deforming anterior and lateral tongue trust that is anterior and posterior open butt that is subgroup 1 then subgroup 2 associated circumvency of anterior teeth then subgroup 3 associated posterior cross bite. According to Moira, normal swallow, simple tongue trust swallow complex tongue trust swallow retain infantile swallow. Before going to the tongue trust habit let's see what are the infantile swallowing pattern and what is the adult or mature swallowing pattern during all the infants trust their tongue during swallowing. That is tongue lies between the thumb pads. So adaptive mechanism which helps the child for suckling helps in feeding also. The mandible is stabilized by contraction of facial muscles. It is seen during usually seen in the unit and disappears with the eruption of teeth and growth of the mandible. And there are the swallowing tongues and the face between the thumb pads. The tongue force is also low but it is also adult swallow the person swallows tip of the tongue on that stuff. Collected okay post surgery anterior teeth and mid portion products the hard palate and the posterior aspect as soon as a 45 degree activation against the posterior perigial wall to permit the bolus to move into the digestive tract as a adult swallowing pattern. Facial expression muscles are passive but mandibular elevators are contracted and there is no contraction of muscles of facial expression including the lips and cheek. The feature of mature swallow as a normal swallowing pattern. And the feature of swallow with simple thumb thrusting simple thumb thrusting is associated with teeth together swallow and there will be associated contraction of lip mandialis and mandibular elevators. There will be well circumscribed anterior open fight. It's an adaptive mechanism that is when a child wants to swallow anterior open fight is sealed by the tongue to create a vacuum swast to complete the act of swallowing resulting in anterior thumb thrusting. So swallow associated complex thumb thrusting. The teeth apart swallow there will be more occlusion interdictation with generalized anterior open fight. Combined lip, facial and mandialis interaction is observed. There will be lack of contraction of mandibular elevators that tongue thrusting between the teeth. That is the feature of complex tongue thrusting with apart swallow. Now the features of retained infantile swallow. This is due to a new persistence of the infantile swallow. Usually a flu button one molar on each quadrant strong contraction of facial muscles during swallowing tongue thrusting markedly and in between all the teeth during the initial stages of the swallow. And the face will be expressionless. Children restrict themselves to soft diet. The retained infantile swallow is very difficult to reach. That is the feature of complex tongue thrusting between infantile swallow. Confess is merely retention of the infantile sacrum and cancer. With the erection of incisors on the face, thumb does not drop back as it should and continues to swallow. Continuation of infantile swallow. That is the feature of complex tongue thrusting. Such as migrating chronic tonsillitis, allergies etc. promote a more forward tongue thrusting due to pain and decrease in the amount of space which ring about tongue thrusting. And also to maintain a physiological need to maintain an adequate airway tongue pushed to pores. Now the regulatory factors are called the type of maxillary structure that favors the development of tongue as maybe military. For example, inherited hyperactivity of orbicularis auras with specific anatomy configuration and neuromuscular activity. Tongue size as well as tongue function is an important constitution. Coming to the diagnosis of tongue thrusting. Examination of the tongue by the size, shape of the tongue. In functional examination tongue position during the rest. Observe the tongue during swallow. Patient is seated upright and little water is placed in the patient's mouth and patient is asked to swallow. During normal swallowing, antibody rises as teeth draw together and it touches each other lightly. Scales leave contractions. And facial muscles there will be no marked contractions. There is a new normal swallow. During abnormal swallowing teeth will be upright. Clips are close to tightly and active contractions is seen and contractions of muscles of facial expression. And next to the back surgery examination. Place hand over temporalis muscle and ask the patient to swallow. During normal swallowing temporalis muscle contract as the manipulates and eventually. During tether pad swallow there will be no temporalis contractions. Then hold the lower lip and ask the patient to swallow the water. During normal swallowing patient able to swallow normally. In case of tongue thrusting swallow will be inhibited strong mentalis and lip contractions are needed for magica stabilisation and the water will spill out of the mouth. Coming to the features clinical features of tongue thrusting The features depends on variables such as the intensity duration, frequency and type of contractions. The extraural findings lip poster lip separation is later in the contractions group and this is consistent finding both at first time functions. Contractions are more likely to have various reasons. For example, sibling distortion less pain problems in articulation disping there will be disping and problems in articulation of certain sounds that is visible these sounds that children cannot be trans clearly in facial form there will be increase in anterior facial health. What are the in-drawal findings? Some moments that swallowing so we can start seeing to be jerky and inconsistent in the tongue thrusting Chin point is found to be posterior in the tongue thrusting group as compared to the normal position. Tongue thrusting the tongue thrusting is lower in the tongue thrusting group this could be because of the anterior open wide thrusting and also because of the longer period of time required for the tongue thrusting to move from rest to second stages swallowing in the tongue growth. Various malocclusion have been reported this can be further divided into features pertaining to the maxilla there will be proclination of maxillary anterior resulting in an increase in overgift there will be generalized spacing between teeth then features pertaining to the magical proclination of manga that is depending on the type of tongue that is present. Intermaxilla relationship posterior open wide based on the posture of the tongue posterior teeth posterior teeth cross bite etc Diagnosis first one is faith to determine the swallow pattern of siblings and parents to check for hereditary etiological factors to determine whether there is any remedial speech force ever provided information regarding upper respiratory infections upkeep habits and neuromuscular problems. Finally past and present information regarding overall abilities, interests and motivation of the patient should be noted examination this swallowing habit should be detected and corrected only to facilitate normal development of the palate and image and study the posture of the tongue while the mantel is in postural position can be done if lips rest apart tongue posture can also be noted in the lateral the kilogram of the mantel then observe the tongue during various swallowing procedures first the unconscious swallow commands saliva and the commands swallow water and purchase swallow during chewing and also the complexity of the tongue should be observed whether it is a simple tongue rest, lateral tongue rest found in various types of tongue resting simple tongue resting there will be normal tooth contact in postural region but there will be open bite there will be postural open bite with tongue resting accurately and observe the role of tongue during mastication and speech in case of complex tongue resting there will be generalized open bite the access of contraction of lip muscles and teeth and active population and overall treatment conservations usually tongue rest self correct by age or 9 years of age the time of complete correction of the form and period orthodontic correction is usually more successful if initiated during the early mixed emission stage of dental development but between the ages of 9 to 11 the presence or absence of associated manicurations usually treatment not started recommended if transusting is present without malaclotion or any speech problem if there is malaclotion but no speech problem orthodontic correction usually eliminate the tongue resting if there will be other habits such as tongue resting in such cases tongue resting should be triggered first and overall treatment option during the initial visit we should explain which are the type of behavior what a tongue rest value and is carefully begins to establish a record to motivate a child to go on to part of the strategy in the second appointment child is instructed in correct position of the tongue or correct swallow inclination plays its finger firmly on the questions associated papilla teaches the child the same finger placement child is then instructed to hold an orthodontic plastic or a sugar free candy with tip of the tongue on the insensitive papilla child is instructed to practice the tongue swallow factor and eventually practice tongue resting through minimum of 20 to 20 months replacing on the elastic orthodontic elastic for the child to correct position of the tongue the training of correct swallow and posture of the tongue orthodontic elastic and sugar less food drop exercise these can be held by thumb tip against the palate or the tongue as the pose 4 is exercise as a sport saliva squeeze the sport and swallow use the pressure point on the papilla to show the sport is and tip is again sport at press position child then learns the 2 ways exercise that is sport and squeeze child learns the correct posture and correct method of swallow other exercise child has to perform a series of exercise such as grizzling, reciting the countdown 60 to 69 garbling, yawning etc turn the respiratory muscles and lipid sight, chagopa and button pull exercises subconscious therapy once the voluntary swallow is employed and patient is proceed to subconscious supplementary therapy patient has to place a reminder sign although suggestion which requires patient to give self instruction like repeat 6 steps I will swallow correctly all life all life long for 10 nights now coming to mechanotherapy previous appliance to be educate tongue so that dosung of tongue approximate the radical goal and tip of the thumb protect paltel movement during development using appliances as a guide in the correct positioning of tongue mobile appliances can be facilitated to respond to the thumb movement during saluting with the objective of restraining the tongue to a more force clear, secure position in the oral cavity plan should be as sufficient to be cleared by the max area engineers to open the life and lead by cases thus creating the scope of retraction of the incisors additional modifications improved placing grip into the paltel acrylic to serve as a tongue effecting a window to the acrylic leading to the grip this helps to train the child in correct placement of the tongue posture after the appliances removed the loop on the fixer tongue grip are removed one by one as the patient will be in different the habitat appliance over the 6 steps moving on to mouth breathing soundly defined mouth breathing has a habitual respiration through the mouth instead of nose is common among 5 to 15 years of age now coming to the classification of mouth breathing habit according to PIM a mouth breathing can be classified as anatomical or obstructive or habitual anatomical mouth breathing is due to a sharp acrylic obstructive or breathing due to any obstruction in nasal passage nasal polyps or any deviation in the nasal septum etc. and habitual once any obstruction in the nasal cavity is corrected after that also the person or the child continues to breathe through the mouth it is habitual mouth breathing any infection or any inflammation let's suggest chronic inflammation of nasal mucosa hemorrhagic stomatitis and atrophic rhinitis and large anodized tonsils, mucic nasal polyps etc. then genetic factor let's see the clinical features for mouth breathing will be anodized a long narrow space similar to the nose and nasal passage in no steeper superiorly than flat nasal bridge plastic lips short and collapsed upper segment of maxilla high palatal valve with tolico-facial pattern in expressionless space further the dental effects will be proportioned with facing of upper intestine decreased over bite open bite and there will be lower tongue position and posterior cross bite and also there will be increased ovargic and constricted maxilla and the lips there will be incomplete and upper lip or inverted heavy lower lips then there will be gummy smile then external nails there will be a straight like external nails with narrow nose and atrophic nasal mucosa and in jiva there will be chronic keratinitis and marginal gingivitis then there will be classic rolled margin and enlarged to be flat to position salivary flow and bacterial overgrowth and pocket formation and inter proximal bolos also we can see in more breathing patients and other effects there will be narrow maxillary sinus and nasal cavity then swollen and engulfed to the turbinates atrophic nasal mucosa there will be nasal torn infection of lymphoid tissue keratinitis media dull sense of smell loss of taste etc then how we can diagnose first to history we can check the lip posture then we can ask about the history of any tonsillitis or allergic rhinitis or keratinitis media etc then come into examination observation of the breathing pattern and lip posture area contraction then nasal orifices to mirror test also known as fork test we can use a two surface to mirror which is placed on the patients upper lip with air condensers on the upper side of the mirror we can say that he is a nasal breather and if it is opposite side he is a mouth breather then next test is maxillus water holding test patient is asked to hold mouth full of water mouth breather cannot hold water for long time then humans butterfly test take few fibres of cotton and clean features below the nasal opening or exhalation cotton flutter downward then he will be a nasal breather if it is going upward then he will be a mouth breather then rhinometry total airflow through nose and mouth can be quantified we can even treatment concentration we can say age of the patient then END examination for evaluating many tonsillitis already the ideal timers makes a deletion period in symptomatic release like to prevent the ginger that is we can give a ginger well cotton for plaque deposition and all we can give an auric profile like this now coming to the treatment for mouth first one elimination of force before going to the treatment of breathing habit we have to speed up for nasal any obstruction or any tonsillitis for very underlying systemic disease so we have to find out and we have to refer to END transplantation then coming to interception of habit like exercises like physical exercises like deep inhalation exercise can be performed then upper lip extension exercise upper lower lip combined exercise to improve the tonicity of the lip then playing a wind pipe then maxillothorax myosalaptic this is oral screen it's introduced by nimble it's just solid acrylic which rests over the labial fold conforms to vestibule and there will be a phrenum ray should be worn in day and entire night the modifications available for oral person breathing holes given by cross the holes may be gradually reduced in size with acrylic as the patient becomes accustomed to the wearing of the acrylic other variation of cross is the combined oral and vestibulas the double office for eliminating mouth breathing tongue thrusting and dental protection so that's all about mouth breathing habit according to gram 4 braxism can be defined as the habitual grinding of teeth when the individual is not chewing or swallowing these are the other definitions for braxism now coming to classification all it's types daytime braxism or diurnal braxism it's the conscious or subconscious grinding along with para functional it is silent the nighttime or nocturnal that is subconscious grinding in rhythmic pattern of muscle and we can see the total enjoyment of this is 3-4 minutes may be due to reactions when a blooper is there for high respiration or in a dating dendro condition for any CMS like particle lesion, cerebral palsy or mental retardation this is clinic and this is my fingers double back they are very good very good experiences the nutrition deficiencies magnesium deficiency then enzymatic disperse allergy any fluid allergy endocrine disorders then psychological theory associate with feeling of anger aggregation or stress in other courses may be genetics or occupational factors this enthusiastic student compulsive overachiever in convitation, sports etc now what are the indicators for braxism we can see the presence of dental wear, accretion then braxo facet or maybe grinding or clenching clinical manifestation there is a upclose drama mobility of tooth functional or clausal wear there will be sensitivity to atypical shiny wear facets with sharp edges there may be purple exposure then fracture of crown or vestration there will be muscular tenderness pain in the region of femoralis or lack of the real muscle on palpation then fatigue on weight hypertrophy or plasticity restriction of muscular movement deviation of the chin there is a dull pain there are some of the clinical there will be also headache in other science and thinkom there is sound grinding and tapping sounds then soft tissue drama then small ulceration or redging or buccal mucosa opposite to molar teeth we can see the treatment options as in psychotherapy we have to send the patient for a counseling and given a tension relief and also have it awareness then auto sedition and hypnosis when patient becomes conscious of his nervous habit and understands possible consequences then relaxing, exercise, and appreciate everything so to decrease muscle tension and rough system and also exercise and massage can be used then we can use drugs and ophthalmology to reduce stress and not to bioperate then let the patient reflect and let for general stimulation to come to an orthodontic correction we can give an occlusal adjustment in case of any occlusal discrepancies then gradually there will be disappearance of habitual grinding and we can even go for a coronoplasty or high point correction then we can opt for a occlusal spritz for night time wear this made from vulcanite and it's a photopspring to cover occlusal surfaces it all introduces the increased muscle tone and also TMJ appliances the prefabricated intraoral appliances for TMJ disorders so that's all about the praxis we want to flip lip habit normal lip anatomy and function are important for speaking, speaking and maintaining a balanced approach a classification of lip biting habit like lip licking or licking lips by the tongue or lip sucking habit like pulling lips in two mouth between teeth the etiology for lip biting any other habit emotional stress what are the clinical features there will be protrusion of upper incisors protrusion of lower incisors there will be lip trap increased over jet and lip has reddened and sharp the area below the vermilion border and also there will be an accentuated mentolabial sulcus in how we can manage the lip biting habit in our first visual education we can show the patient his lips and we can motivate the patient to stop the habit and also we can use lip bumber either a removable or fixed lip bumber we can use so this acrylic portion of the lip bumber that hold the lips away from the teeth and lip protector then we can also use oral screen cheek biting keeping or biting the cheek muscles in between the upper and lower posterior teeth the clinical features there will be ulcers at the level of closer line and there will be open bite then tooth male position in buccal segment the treatment vestibular sprain, removable grip male biting may be a sign in our stressful condition according to visual 43% in adolescence and it is 25% in college students with geology any emotional problem, stressful condition psychosomatic successor of thamsa once the patient stops the habit may be continuous male biting habit there will be inflammation of male bits and irregular male margins then the dental effects are crowding of teeth, rotator teeth and accretion of incisal edges of incisors so coming to the management of male biting habit we can discuss with the child and the parent to find out any reason behind the habit or any psychological background we should not nag and scold the child should encourage to do outdoor activities and distract from the habit we can even use polish or chemicals like u9 and can write so that's all about male biting habit when we want to self-introduce so it's known as masochistic or sad or masochistic or self-motulating habit the patient enjoys inflicting on their mainstream self it's usually seen in mentally retarded child so it's defined as a repetitive act that results in physical damage to the individual ideology associated with certain syndromes like Lashnihan syndrome then D-Lang syndrome and dental features there will be biting of fingers nose, nose, shoulder, genome, thrusting pricking on skin driver or sharp objects under management of self-indulgent habits the parent should not take a harassing approach instead they should diagnose if there is any psychology reason why the parent child is indulging in this habit if we can find any such reason we can refer the patient to a psychiatrist or a pediatrician and also we can take identity therapy for healing answers like oral bandage and even oral screening how much is premium the locking of labelled premium between teeth for several hours clinical features pays to maxillary insights the premium is pulled between teeth for several hours treatment, psychotherapy, palliative treatment, mechanotherapy the shield this body could commonly be damaged parts they use their teeth for opening the body clinical features will be launching after incisors and partially demuted labelled in your mind and treatment you will use of raised frames so that's all about oral practice it is important to identify the underlying reason for oral habit that's why that child is indulging in habit rather than directly proceeding for a mechanotherapy for such treatment and the more important is that we should identify the habit as early as possible to minimize the potential deleterious effect on the endopatial complex