ITS A PROJECT OF PEDODONTICS DEPARTMENT.. !!

1. Management of bruxism,
lip biting and
masochistic HABITS
by:SNEHA SURAPALLI.
Final year BDS
PEDODONTIC PRESENTATION

2. Definition:
RAMFJORD(1966):Bruxism is the habitual
grinding of teeth when the individual is not
chewing or swallowing.
Rubina(1986):Bruxism is the term used to
indicate non-function contact of teeth which
may include clenching,gnashing and tapping
of teeth
BRUXISM

4. Etiology:
• The etiology of bruxomania could be from certain
definite cortical lesions.
• A tendency to gnash and grind the teeth has been
seen associated with the feelings of anger and
aggression.
• Occlusal discrepancies-Improper interdigitation of
teeth may lead to bruxism.
• Mg++ deficiency has been reported as an etiological
cause for bruxism and has treated several cases with
therapeutic doses.
• Allergies have also been related to noctural bruxism.
• An overenthusiastic student over achievers may also
develop the habit.

5.  Management:
1. Occlusal adjustment-
• This would result in immediate disappearance of
habitual grinding of teeth.
• Any prematurities or occlusal interference in
restorations should be able to withstand the forces of
bruxism.
• Cronoplasty plays an important role in occlusal
treatment.
• However extensive occlusal adjustments are
contraindicated.
• Before any occlusal adjustments are done the muscles
should be brought back to a relaxed position to allow
the jaw to resume its normal physiologic movements

7. 2.Occlusal splints:
• Vulcantic splints have been recommended to cover
the occlusal surfaces of all the teeth as a treatment
for bruxism.
• A reduction in the increase muscle tone is
observed with its use.
• In the case of children the use of a soft splint is
advisable.
• The splint is made on the mandibular models using
dental bioplast material.
• Little adjustment is required in children where
intercuspation is less.

9. THE TMJ APPLIANCE
It is a prefabricated intraoral
appliance designed mainly for the
treatment of TMJ disorders habits
such as bruxism are prevented by
the patented aerofoil shaped base
and a double mouth guard design

11. 3.Restorative treatment:
• If the abrasion is so severe that penetration into
the pulp chamber is imminent,pulpal therapy
with full coverage stainless steel crowns is
indicated.
4.Psychotherapy:
• Counselling the patient can lead to a decrease in
tension and also create a habit awareness.
• This may result in an increase in voluntary
control that can lead to reduced tooth para
functions.

12. • Behavioral modality is initiated by the dentist
through explanation and arousal of the patient’s
awareness of the habit.
5.Relaxation training:
• In this technique,the patient is instructed to
tense the muscle group in consideration and
relax ,thereby training the patient to relax the
muscle group voluntarily.
• Hypnosis,conditioning,etc.,are also indicated for
subjects in whom bruxism is due to central
cause.

14. 6.Physical therapy:
• If musculoskeletal pain and stiffness are
associated with bruxism,a brief course of physical
therapy is appropriate.
7.Drugs:
• Vapo coolants such as ethylchloride for pain
within the TMJ area,local anaesthetic injections
directly into the TMJ or into the
muscles,tranquilizers,sedatives and muscle
relaxants are used
• Placebo may be used to rule out the psychological
etiology

15. • Medications can be prescribed for few days to
alter the sleep arousal and anxiety
level,eg.,diazepam.
• Low doses of tricyclic antidepressants may be
used to inhibit the amount of REM sleep.
8.Biofeedback:
• This is a technique that utilizes postive feeback to
enable the patient to learn tension reduction.
• It is accomplished by allowing the patient to view
an EMG monitor, while the mandible is postured
with a minium of activity.

16. 9.Electrical method:
• Electrogalvanic stimulation for muscle relaxation
is currently being utilized for treatment of
bruxism.
10.Acupuncture technique for muscle relaxation :
• They are under evaluation
11.Orthodontic corrections:
• Malocclusions such as classII and classIII
relation,frontal open bite and crossbite when
associated with functional malocclusion may
create a predisposition to bruxism.

18. LIP BITING
DEFINITION:
Lip biting:Habits that involves manipulation of
the lips and peri-oral structures are termed as lip
habits.
CLASSIFICATION:
Wetting the lip with the tongue.
Pulling the lips into the mouth between the
teeth(Schneider,1982)

20. ETIOLOGY:
1) Malocclusion
2) Habits
3) Emotional stress
Management of lip biting:
Lip habit is non-self correcting and may become
more deleterious with age,because of muscular
forces interacting with the child’s grown.
Treatment of a lip habits should be directed initially
towards the etiology of the habit.

21. 1.CORRECTION OF MALOCCLUSION:
• If there is a classII division I malocclusion or an excessive
overjet problem,the abnormal lip activty may be adaptive
to the dentoalveolar morphology.
• In such cases it is deemed wise to correct the
malocclusion before onto break the habit.
• ClassI malocclusion with increased overjet fixed or
removable appliance to tip the teeth back.
• ClassII growth modification procedures to treat the
malocclusal.
• If the child has an uncrowded early mixed dentition and
activator may be placed in an attempt to reposition the
maxilla to the mandible in a favorable position and allow
the child to effect a more normal lip seal.

22. 2. Treating the primary habit:
• The lip habit along with digit sucking can be corrected
by aligning the dental arch using hawley’s retainer with
a labial bow,which can be used to retract the maxillary
incisors and an acrylic plate can be used as a habit
reminder.
3.Appliance therapy:
• Oral shield is also an useful appliance classI
malocclusion
• It helps to stop the habit and also incisal alignment.

23. • The additional to a small loop to the labial oral
shield improves the lip tonus by helping in lip
exercise.
• Performed for 10 minutes , 3times a day.

24. Lip bumper
• A lip bumper may be used as an adjunctive
therapy in both comprehensive and
interceptive treatment regimens.
• The lip bumper is positioned in the vestibular of
the mandibular arch and serves a prohibit the
lip from exerting excessive force on the
mandibular incisors and to reposition the lips
away from the lingual aspect of the maxillary
incisors
• This enables the distal repositioning of the
maxillary incisor resulting in a decrease overjet
and overbite.

25. • Either the second deciduous molars are the first
permanent molars are banded and the buccal tuber
and soldered to them
• The labial screen assembly may be either soldered
to the band or crowns or slipped into the buccal
tubes.
• The labial shield keeps the wire away from the lower
incisor, preventing it from cushioning to the lingual
of the maxillary incisor during posture functioning.
• With no labial restraining lip habit, the tongue will
then stimulate the lower incisors to move
labially,which increases the arch length, reduces
crowding and excessive overjet.

27. Masochistic habits
It is a self-injurious habits are those in which the
patient enjoys inflicting damage to himself.It is
rare in normal children but is mostly seen in
mentally retarted children.(10-20%) and children
with psychological abnormalities.
DEFINITION:
Receptive acts that result in physical damage to the
individual.This habits show an increased incidence
in the mentally retarted population.

28. Etiology:
The etiology may either be :-
a. Organic:
Syndromes and syndrome like maladies such as
lesch-nyhan disease and de lang’s syndrome In
which symptom such as repetitive
lip,finger,tongue,knee and shoulder biting are
common
b. Functional:
This can be further divided into-
• Type A-this are injuries superimposed on a pre-
existing lesion.eg.,a child with a finger nail finger
habit is under treatment for a skin lesion.

29. • Type B:The self-injurious habit may exacerbate
the feature existing due to a primary
habit.eg.,rotation of the thumb while thumb
sucking can harm the soft tissue.
• Type C:They may be injurious of unknown or
complex etiology.This type of behavior has a
greater psychological component.There may be
multiplicity of symptoms of greater intensity.

30. Management :-
They are initiated by=
1) Pharmacological
2) Psychological
3) Physical restraints
4) Palliative treatment
5) Mechano therapy

31. 1) Pharmacological method
• Most of the existing literature or pharmacological
treatment of SIB has adressed the postulaTed
defects in the dopaminergic ,opiate or serotonin
system.
• But there are disadvantages to pharmacologic
treatment as it usually requires chronic use of
drugs and this agents often places patience in a
chronic stupor.

32. 2)Psychological treatment
• Some children experience a feeling of
neglect,abandonment and loneliness and through
the use of self-injurious behavior attempt to solicit
attention and love .
• Treatment of self-injurious behavior generally
requires a multi-disciplinary approach.
• Care should be taken in dealing with this form of
behavior because of the underlying emotional
component.
• Continued concerned for the habit may support or
reinforce the habit.

33. 3)Physical restraints
• Restraint may be reliable means of preventing
injury of the SIB-affected individual,physical
restraints include mitten’s,arm,borders,facial
masks,helmets and restrictive clothing,but
requires constant wear if they are to be successful.

34. 4)Palliative treatment
• Adjunctive therapy in the form of bandages
for any oral ulcerations will help in healing of
the wound as well as a habit reminder

35. 5)Mechano therapy
• Oral shield will also determine the child from
the unconcious continuation of the habit.
• Treatment for self-multilation may also
include use of restraints protective padding.

36. Bobby pin opening
• Usually seen in teenage girls where is opening
bobby pin with anterior incisors is done.
• Clinically we see notched incisors and partly
denuded labial enamel.
• At this age,calling attention to the harmful
habit is generally all that is necessary to stop
the habit.

38. THANK-YOU