Oral Habits

Non-nutritive Sucking Habit
Tongue thrust and atypical swallow
Mouth breathing
Bruxism
Lip Sucking

Non-nutritive Sucking Habits

Sucking habit usually with either a finger/thumb or with a pacifier that does not result in food/milk taken in.
Common in about 40-90% of infants. Has benefits such as:

  • Calms baby, aids with sleeping
  • Maintains airway patency as tongue is kept forward
  • Stimulates respiration
  • May reduce gastric reflux
  • Shown in pre-term infants to help them transition to oral feeding quicker than those who did not use it.
  • May help stimulate vagal innervation and production of enzymes such as lipase, insulin, motilin to aid in digestion.

Depending on the duration, magnitude and intensity of the sucking habit changes to the shape of palate and dental arch can occur. If the habit is eliminated by age 4, and a tongue thrust habit does not develop the position of the teeth will improve. We can offer some suggestions to help with eliminating an oral habit. If the habit persists we can offer appliance therapy to help stop the habit.

Tongue Thrust and Atypical Swallow:

Atypical swallow: teeth apart swallow with tongue thrusting anteriorly between the teeth to create a seal.

This pattern of swallowing is an infantile type swallow and may be seen in children who have difficulty breathing with their nose, or develop as a compensation to an open bite created by a sucking habit.

The best treatment for tongue thrust is to improve patent nasal breathing, appliance therapy and myofunctional therapy. Myofunctional therapy are exercises to improve the resting position of tongue and to strengthen lips to provide a proper seal during swallowing.

Bruxism: Teeth Grinding

  • Repetitive jaw-muscle activity characterized by clenching, grinding teeth and/ or bracing or thrusting of mandible
  • Sleep Bruxism: involuntary trigeminal motor activity characterized by episodic and repetitive jaw muscle activity with occasional tooth grinding or jaw clenching during sleep. Quantified by RMMA electromyography with audiovisual recordings are a marker of sleep bruxism
  • 5-40% prevalence in children

More common in children with:

  • sleep disordered breathing, neuromuscular dysfunction, anxiety, respiratory reactivity, traumatic brain injury, neuromuscular disorders, personality traits towards negativity, oral habits, early loss of posterior teeth, pain, immaturity of developing neuromuscular system
  • Children with bruxism have been shown to have higher levels of catecholamines (epinephrine, dopamine, norepinephrine)
  • Second hand smoke may activate the trigeminocardiac reflex leading to sleep bruxism, restless sleep.
  • Can lead to tooth wear, periodontal disease, hypertrophy of masticator muscles, TMD pain.
  • Sleep bruxism appears to decrease in prevalence with age

    • Mouth breathing

    • Normal physiologic breathing at rest occurs through the nose with lips closed or 2-3mm apart. No facial muscle involvement.
    • Reasons for mouth breathing: choanal atresia, nasal atresia, nasal septum deviation, adenotonsillar hypertrophy, nasal polyps, rhinitis, allergic rhinitis. Sinusitis, neoplasms.
    • More common in asthmatic children
    • May be simply just a habit?
    • Nasal breathing ensures “normal” growth of the craniofacial complex.
    • Mouth breathing leads to altered positioning of the mandible (downward and posterior), tongue positioned downward to allow air in /out.
    • Leads to mandibiluar retrusion, increases facial height, maxillary transverse discrepancy (crossbites), anterior open bite (facies adenoidea). Narrowed nostrils, incompetent lips, hypotonic upper lip.
    • Mouth breathers have higher caries rate because of drying of the mouth, tend to be grazers eating smaller amounts but more frequently.
    • Sleep disorders more common in mouth breathers.

      • Treatment of mouth breathing is multidisciplinary and depends on assessment. Could include nasal sprays or surgical intervention of nasal obstructions (removal of adenoids), orthodontic palatal expansion, myofunctional devices and exercises.