Oral Habits That Cause Problems

Maloklusi Yang Terjadi Akibat Kebiasaan Buruk Pada Anak

Rudy Joelijanto1

1Departement of Orthodontic Faculty of Unversity of Jember

Abstract

Oral habits that place pressure on the teeth may slowly move the teeth out of place. The aim of this study was to review the literature for articles referring the most common oral habits that cause malocclusion. The oral bad habits that cause malocclussion problems include: Thumb sucking, It is a normal habit for babies, but causes serious orthodontic problems if it continues long after the eruption of permanent teeth. Prolonged thumb sucking can create crowded, crooked teeth, or bite problems and speech problems. Protrusion and displacement of front teeth are usual results of thumb sucking. Lip-biting or fingernail biting, both habits can shift the teeth out of alignment. Tongue thrusting, some children thrust their tongue for- ward, pressing it against the lips with a force that can result in teeth such as ‘open bite’ or teeth protrusion (overjet). While parents can not do much to prevent an ortho- dontic problem caused by hereditary factors, they can help their kids to avoid the need for braces, by maintaining good oral hygiene and avoiding bad oral habits that could cause teeth malocclusion problems. Modern are usually able to treat most teeth malocclu- sions successfully, but prevention can help the family to avoid the large cost of orthodontic treatment and the child will not have to wear dental braces and feel uncomfortable.

Keywords : oral habits, malocclusion, orthodontic treatment

Abstrak

Adanya kebiasaan buruk yang menimbulkan tekanan pada gigi-gigi dapat secara perlahan akan menggerakkan gigi ke luar lengkungnya. Tujuan dari penulisan ini adalah mengulas berbagai artikel tentang kebiasaan-kebiasaan buruk yang dapat menimbulkan maloklusi. Ke- biasaan buruk (oral bad habits) meliputi diantaranya: Menghisap jempol (thumb sucking), meskipun kebiasaan ini sesuatu yang normal pada bayi, namun dapat menyebabkan masalah orthodontik yang serius. Hal ini terutama bila terus berlanjut hingga periode erupsi gigi per- manennya. Kebiasaan ini dapat menimbulkan gigi berdesakan, miring, atau munculnya masa- lah oklusi dan bicara. Selain Protrusi dan displacement gigi anterior. Menggigit bibir (Lip- biting or fingernail biting), juga dapat mengganggu dan merubah letak gigi pada lengkung yang benar. Cara menelan yang salah (tongue thrusting), yaitu dengan menjulurkan ujung li- dah dan menekan pada bibir, kebiasaan ini dapat mengakibatkan maloklusi seperti gigitan ter- buka (open bite) atau protrusi. Pada beberapa kasus dapat timbul karena adanya faktor heredi- ter, orang tua dapat membantu tindakan pencegahan pada anak-anaknya dengan pemeliharaan kesehatan mulutnya dan menghilangkan kebiasaan buruknya agar tidak terjadi maloklusi. Or- todontik modern saat ini umumnya dapat menangani kasus maloklusi dengan sukses. Namun tetap diperlukan tindakan pencegahan dari pihak keluarga untuk menghindari besarnya biaya yang diperlukan pada perawatan ortodontik dan ketidaknyamanan pada penggunaan alat orto- dontik.

Kata kunci : oral habits, malocclusion, orthodontic treatment

Correspondence: Rudy Joelijanto, Departement of Orthodontic Faculty of Dentistry Unversity of Jember,

e-mail: [email protected]

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Introduction Malocclusion is abnormality of teeth ar- rangement or abnormality of the relationship There are various bad habits in the child- between the upper jaw and lower jaw. The ren’s mouth, i.e , tongue word of “malocclusion” literally means as thrusting, finger biting, finger biting, finger bad bite. This condition can be either irregu- sucking, lip sucking. Bad habits on someone lar bites, , or . Malocclusion can stand independently or occur together can also be tilted teeth, protrusion, or with other bad habits. It means the same pa- crowded. This can interfere with the appear- tients may occur some bad habits.1 ance, phonetic, or mastication. Based on research, that performed to 92 Malocclusion still remains one of the major children of Yayasan Bahtera Bandung with problems in oral health in Indonesia, espe- 6-12 years of age, reported that about 50% of cially in the children’s oral and dental health. children have a oral habits, with the propor- Many factors that can lead to the occurrence tion of thumb sucking habit 43.8%, lip biting of malocclusion in children. In addition to and lip sucking 34,8%, and tongue thrusting dental caries, the behavior in children has an 8.7%, nail biting as well as mouth breathing sufficient important role in the process of each 6.55%. 2 malocclusion. Such behavior can be either Oral bad habits that are abnormal often oral and dental health measurement as well associated with disorders of growth of the as a bad habit. Bad habits in the child, partic- jaw, teeth malposition, respiratory disorder, ularly oral bad habits, if continued until the difficulty speaking, muscle imbalances, and age where permanent teeth begin to erupt, it face psychological problems2. will lead to the risk of malocclusion. In dentistry, there are three major prob- Malocclusion can lead to the occurrence lems that occur frequently, i.e. caries, peri- of speaking disorder, where most letters of odontal disease, and malocclusion. Preven- the alphabet need teeth to pronounce clearly. tion of caries and periodontal disease has Results of studies about the relationship with been a lot of done but prevention against ma- malocclusion disorder in adolescents with an locclusion still requires serious research. 3 average age of 18 years old that occurred as The aim of this study was to review about much disruption with an mesial occlusion malocclusion caused by oral bad habits and 33,8% of students, 27,8% with mandible over how to prevent increased malocclusion jet, 25.6% with incisal open bite and 12.8% caused by oral bad habits. with lateral crossbite. Malocclusion can also The occurrence of malocclusion in child- lead to the occurrence of mastication disord- ren ers in which the occurrence of pain in jaw Occlusion according to Dewanto (1993) when chewing. Studies results of Oktavia on is teeth surface of the upper jaw contact to the high school student in Medan shown that occlusal surface of lower jaw teeth at the there were difficulties in mastication in indi- time of the upper jaw and lower jaw closes. viduals with malocclusion amounted to An occlusion is the change in the relationship 11.8%, food stuck up 35.1%, pain when of teeth surface (maxilla) in the upper jaw chewing 22.3%, any discomfort when chew- and lower jaw (mandible) that occurred dur- ing 44.1%. ing the movement of the mandible and ended Malocclusion in addition to have an im- with full contact to the teeth of both jaw . An pact on the phonetic and mastication, maloc- occlusion occurs due to the interaction be- clusion can also have an impact on the aes- tween the dental system, skeletal system, and thetic and affect social relationship of the muscular system. An occlusion of teeth is not child. The results showed as much as 41,89% a state condition during the mandible move- children have difficulties to associate, easily ment, so there are various forms of an occlu- offended of 47,22%, lazy to go out home of sion such as: centric, eccentric, habitual, su- 16,71%. pra-infra, mesial, distal, lingual. 4

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Bad habits can occur to child in the can affect the whole or half-jaw, teeth, or growth and development. There are finger a single only. sucking, mouth breathing, lip sucking and Based on the location, cross bite can be biting, jaw pushing forward, tongue thrust- divided into two: ing, or nail biting. The habit is more com- 1) Anterior crossbite monly known as oral habit. Oral habit is A state of centric relations in the normal behavior in infants. Usually tempo- jaw, but there are one or more anterior rary and disappear by itself at the age of teeth maxilla that its position is next to about 3-4 years. Oral habit will not cause a the lingual of mandible anterior teeth. problem which means the mouth cavity at 2) Posterior crossbite that time, because basically the body can Abnormal relationship of bucolin- give a response to the stimulus from the out- gual from one or more mandible. post- side since in the womb. This response is a erior teeth sign that the psychological development of d. Deep bite the child has already started, which is visible Deep bite is a condition where the from the spontaneous or repetitive reaction. distance of maxilla incisivus incisal Problems will arise when recurring oral habit contact to the mandible incisivus incisal in that continues until the child enters school the vertical direction is more than 2-3 mm. age where this habit continued to do because In the case of deep bite, posterior teeth is parents are less regard for their children. often linguo version or tilted to the mesial Oral bad habits is a perversity oral ac- and mandible incisivus often crow ded, tivities and surroundings that continuously linguoversion, and supraocclusion. occur, which is one of the environmental fac- e. Open bite tors that causes malocclusion. Open bite is condition if there is pres- Malocclusion is a form of relationship of ence of a occlusal or incisal space of the the upper and lower jaw which deviate from teeth when the upper jaw and lower jaw in the standard form that is accepted as a nor- centric occlusion. open bite according to mal form, malocclusion can be caused by the location are : imbalance of dentofacial. 5 1) Anterior open bite Class I Angle of anterior open bite Classification of Malocclusion occurs because of upper jaw narrowing, forward inclination of a. Protrusion anterior teeth , and supraocclusion of Protrusion is a tooth that its position anterior teeth, whereas division of class is forward. Protrusion can be caused by II angle caused by bad habits or heredity, bad habits as finger sucking and hereditary. lower lip sucking, pushing the tongue 2) Posterior open bite on premolar and forward, wrong habit of swallowing as molar region well as mouth breathing. 3) Combination of anterior and posterior b. and Extrusion (a total of open bite) exists in both the Intrusion is the movement of the teeth anterior and posterior, unilaterally or away from the occlusal. The movement of bilaterally. the intrusion requires good control of f. Crowded forces. Extrusion is the movement of the Crowded is a condition when teeth ar- teeth near occlusal plane. ranged outside the normal arrangement. c. Crossbite Crowed due to basal arch are smaller than Crossbite is a state if the jaw is in Coronal arch. Basal arc is a place of pro- centric relation. There are abnormalities cessus alveolaris which are teeth lied on, of the teeth in a direction transverse of coronal arch is the most width of the co- maxilla teeth to the mandible teeth that ronal teeth or the number of the most mas-

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sive of mesiodistal teeth crown. The de- thumb and change patterns of pressure gree of severity of crowded teeth are: cheeks and lips. Cheek pressure on the 1) Mild Crowded mouth corner is the highest pressure, the There are little of crowded teeth, of- pressure of cheek muscle to the posterior ten occur in mandible anterior teeth, teeth of upper jaw increased due to the and considered as normal variation . contraction of buccinators muscles during This no need a treatment. sucking at the same time so it makes 2) Severe crowded maxilla into shaped V. 6 There are severe crowded teeth so 3. Tongue thrusting habit that may lead to bad oralhygiene. Tongue thrusting habit can caused by improper bootlefeeding and is usually ac- Classification of oral bad habit in children companied by other bad habits such as thumb sucking, lip biting, and nail biting. 1. Mouth breathing If this habits occur continously, it will Mouth breathing can be classified into cause an open bite and incomplete over- three as follows: bite as well as the position of tongue tip a. Obstructif : Children who have had in- more anterior than normal. terruptions in inhale air through the 4. Objects biting habit areconsits of : nose (nasal passage). a. Nail biting b. Habitual : This is due to habit although This oral bad habit which is position abnormal disorder has been eliminated of upper and lower incisive teeth have c. Anatomical: when the anatomy of up- pressured by nail. According to Finn per and lower lip is short so it can’t be (1971), the habit of nail biting habit is closed perfectly without effort to close normal in children who previously it. have a habit of finger biting. In addi- Children who are mouth breathing tion, according to Alexander and Lane usually narrowfaced, anterior teeth for- (1990), etiology of nail biting due to ward to the labial direction, and the lips stress, imitation of family members, open with the lower lip lies behind the hereditary, the transfer from the habit upper incisive. Due to lack of normal of finger sucking, and fingernail is not muscular stimulation of the tongue and neat. In some cases these habits can because of the excess pressure on the ca- cause atrision in the lower anterior ninus and in the molar area due to the or- teeth. 7 bicularis oris and buccinators muscles, b. Finger biting then segment buccal of maxilla contracted Finger sucking habits in children and result in shaped V of maxilla and pa- occurs at age 1-2 years. If left constant- latal height. So according to some opi- ly until the age of 5 years or more can nions, mouth breathing tend to present result in abnormalities in the position clinically has long faced and narrow. of the teeth. The fingers will press the When this is performed continously, it can upper jaw teeth forward and the lower result in abnormalities in the anterior teeth jaw inward, so it appears to be protru- of upper jaw (protrusive) and the anterior sive.5 bite will be open (open bite). Children bad habits in addition to the above 2. Thumb sucking habit are : Thumb sucking is a habit that is com- 1. Bruxism mon in children. The habit of thumb suck- This is a bad habit of scraping upper ing that prolonged can cause malocclu- jaw and lower jaw teeth, it can arise at sion. According to Profit (2000) 6, charac- childhood as well as adults. Usually this is teristics malocclusion related to the com- done at the time of sleep at night and they bination of pressure directly from the don't realize that they have a bad habit.

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Bruxism is often occured by women com- of mixed teeth. One of them is the habit of pared to men. Bruxism can cause abrasion finger sucking habit, it leads to permanent (wear out) of teeth surface in the upper insisivus upper teeth protrusion and also in- jaw and lower jaw, both in decidous teeth hibit the development of mandible arch. and permanent teeth. Email layers (outer A bad habit that is often carried out repeated- layer of the teeth) that protects the surface ly by the children can result in teeth and a of the tooth is missing, so it make pain in their support tissue, which are include: the teeth. When this habit was continued and prolonged, can cause damage to the 1. Sucking thumb periodontal tissue (tissue that supports Thumb sucking is not a cause or a teeth), malocclusion, teeth fracture due to symptom of a physical problem or psicho- excessive pressure, and abnormalities in logic. Some cases show the thumb suck- the Temporo Mandibular Joint (joints that ing habit can be a problem because there connect the lower jaw and head bones). is the possibility of misalignment of per- For the treatment of these cases, the dent- manent teeth if a child aged five or six ist will make certain tools that are special- years still doing the thumb sucking habit . ly designed and built in accordance with This Oral habit can cause change field of the arrangement of patients teeth, these incisal incisors, which retroclination on tools are called night guard and used the lower jaw incisor and teeth proclina- while sleeping at night. This tool will tion on the upper jaw incisor jaw thus in- form the boundary between the teeth up- creasing overjet and creating a unilaterally per jaw and lower jaw so there will be pit- crossbite bucal as it relates to the shift of ted against each other. Use this tool will the mandible. It can also change the ratio prevent further damage on teeth and assist between the top and bottom anterior face patients in stopping bad habits. When the height. As a result, anterior teeth position main cause of bruxism is stressed out, is much more advanced than the lower then doing a consultation with a psychol- teeth, and going on an open bite. 8,9 ogist is the one thing that can help in eli- Finger sucking habit arising in children minating these bad habits. aged 1 to 2 years. And if it is left conti- 2. Sustaining chin habit nuously until the age of 5 years or more Due to excessive pressure on joints are can result in abnormalities in the position prolonged or continuously, it can cause of the teeth. Finger sucking habit can the disc (meniscus) tear and suffered a cause abnormality cavum oris and sur- dislocation is in front of condilus. In cir- rounding structures, anatomically can cumstances like this, the opening move- cause anterior open bite that is a form of ment of mouth caused the condilus to upper and lower anterior teeth abnormali- move forward and pressing the disc in ties and there is overlapping when an oc- front of it. If this is occurs continously, clusion, thus formed a gap open when an condilus can just skip the disc and clash occlusion. At the time of sucking finger with bone causing a either a cliking sound. pressure changes occur in the cavum oris. This can also occur in the opposite This is because while sucking, tongue was movement. Often, this sound is not ac- pushed down by the finger so that it is companied by pain so that the patient does separate from the palatum. Then the orbi- not realize that the sound is a symptom of cularis muscle contraction and buccinators temporomandibular joint disorders. continually separate causes leading to make colaps maxillaris arch so it occurs Discussion crossbite, i.e. a disorder in which the supe- rior teeth on sis buccal go deeper into than Oral Bad habits have a great impact on the inferior teeth. 8 malocclusion, particularly during the period 2. Mouth breathing

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If the child has nasal cavities disorder, tal tissue (tissue that supports teeth), ma- then he/she will breathe through the locclusion, teeth fracture due to excessive mouth cavity. The habit of breathing from pressure, and abnormalities in the Tempo- the mouth can cause malocclusion with re- ro Mandibular Joint (joints that connect trution of the upper anterior teeth with, or the lower jaw and head bones). crowded or protrusion. 4. Lip Sucking Breath pathway has two way that are Lip sucking is a abnormal habit that is the nose cavity and the mouth cavity, one conducted continuously either consciously individual has its own variations in breath- or unconsciously. Generally conducted on ing, one of which is by from mouth cavity the lower lip. The habit of lip sucking of- often use on the nose. Breathing in this ten bring up the bad habits of other new manner can change posture bone jaw, that is tongue sticking. The presence of head and tongue, and this can change the oral bad habits are no longer considered as pressure balance of jawbone and tooth po- normal in children aged up to three years.1 sition. Breathe in the mouth can decrease The habit of lip sucking more rare the position of the mandible and the ton- compared to other oral bad habits, but ab- gue, as well as extend the head, facial normal sucking habits whatever its shape height will increase and the posterior teeth may cause malocclusion. The cause of will experience super-eruption (excessive someone has a habit of lip sucking alle- eruptions) occur a little vertical growth of gedly due to environmental factors and the mandible ramus, anterior open bite, psychological factors. overjet, as well as increasing the pressure Some researchers reported that there is of the buccal area of muscles caused by manifestation in the mouth cavity due to constriction on maxila arch. Breathing the habit of lip sucking that is over a fairly from the nose also has risk but rather is an large overjet, second molar relationships, infection resulting from prolonged chronic as well as the existence of open-bite ante- inflammation of nasal mucosa caused by rior and posterior crossbite. Sucking is of- allergen materials. 9 ten a compensation activity stemming 3. Bruxism from excessive overjet and difficulty of This is a bad habit of scraping upper closing the lips at the moment of swallow- jaw and lower jaw teeth, it can arise at ing. 1 childhood as well as adults. Usually this is 5. Tongue thrusting done at the time of sleep at night and they The habit of tongue thrusting is a form don't realize that they have a bad habit. of ingestion, which pushes the tongue Bruxism is often occured by women com- forward or lateral or between the teeth pared to men. during ingestion. The habit of tongue In children, sometimes this habit arise thrusting shows the tongue movement in the time of teeth development. in adults against teeth development during the in- bruxism usually occurs due to malocclu- gestion and at the time of the break. There sion (good relationship between the upper is also an opinion that the habit tongue jaw and lower jaw teeth), stress, anger, stick (tongue thrust) is the habit of tongue pain, or frustrating. pushing and pressing anterior teeth (gen- Bruxism can cause abrasion (wear out) eral definition) or tongue in thrust out and of teeth surface in the upper jaw and lower lying between the upper and lower incisal jaw, both in decidous teeth and permanent anterior teeth surface (conservative defini- teeth. Email layers (outer layer of the tion). This habit illustrates imbalances of teeth) that protects the surface of the tooth orofacial muscle. 10 is missing, so it make pain in the teeth. The habit of tongue thrusting can be- When this habit was continued and pro- come a bad habit if the tongue pushes the longed, can cause damage to the periodon- upper and lower teeth because it could

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lead to an open bite and many other 1. Yuniasih EN, Soenawan H, 2006. malocclusion. If the tongue cannot work Menghilangkan kebiasaan menghisap well, a patient may not be able to swallow bibir dengan alat bumper. Jurnal appropiately and trouble swallowing pills Kedokteran Gigi Universitas Indonesia. tablet drug. Some of the typical symptoms Edisi Khusus KPPIKG XIV. are shown in the tongue thrusting habit in- 2. Trasti. 2007. Pertumbuhan dan pekemba clude: 10 ngan orokraniofacial yang normal. Fakul tas Kedokteran Gigi Universitas Indone b. the patient has over jet or open bite sia. c. patients speak unclearly 3. Enarti. 2010. http://eprint.ui.ac.id/ 1281 d. the patient breathe through the mouth. 12-R17-pro-176-hub%20 antra pendahu e. lip licking before ingestion luan. pdf f. face grinning when swallowing 4. Dewanto H. 2004. Aspek-aspek epidemiologi maloklusi. Yogyakarta: 6. Lip biting habit Gajahmada University Press. Lip biting habit is a habit which is con- 5. Suanto C. 2010. Need and demand serta ducted repeatedly in the lower lip. Lip bit- akibat dari maloklusi pada siswa SMU ing will cause the upper teeth to move in negeri. anterior abnormally. Lip biting in the low- 6. Proffit WR, Fields HW. 2000. er teeth will also move the lower jaw teeth Contemporary Orthodontics. 4th edition. towards the lingual and upper jaw teeth to Mosby Inc, St.Louis. 154-158 the anterior. As a result of lower lip biting 7. Finn SB. 1962. Clinical Pedodontics. is protrusion of upper jaw anterior teeth, 2nd edition. Philadelphia and London. lower jaw anterior teeth retrusion, soft tis- W.B. Saunders co. 325-328, 311-312. sue inflamation and anterior open bite. 11 8. Dionne W. 2001. Little thumbs. Los Angeles: Pelican publishing company. Conclusion 9. Stuani AS, Maria BBS, Maria da CPS, Mirian ANM. 2006. Anterior open bite Child bad habit is a perversity activities chephalometric evaluation of dental and surroundings that are continuous, which pattern. is one of the environmental factors cause ma- 10. Jusuf L. 2005. Kebiasaan men-julurkan locclusion and complaints on the part of the lidah dan penanggula-ngannya. Medan: mouth such as dry mouth, mucocel, perleche Universitas Sumatra Utara. and stomatitis. There are various of bad ha- 11. Astuti L, Ratna S. 2007. Pemakaian lip bits, include mouth breathing, tongue thrust- bumper pada anak-anak dengan ing, finger biting, finger sucking, lip sucking. kebiasaan jelek menggigit bibir bawah dan menghisap ibu jari. Dental Journal References Kedokteran Gigi FKG-UHT. Vol 1 no 2.

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