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Parafunctional Habits

A para-functional habit or parafunctional habit is the habitual exercise of a body part in a way that is other than the most common use of that body part. The term is most commonly used by dentists, orthodontists, or maxillofacial specialists to refer to parafunctional uses of the mouth, tongue and jaw.

Oral para-functional habits may include

1.bruxism (tooth-clenching or grinding),
2.tongue thrusting,
3.mouth breathing,
4.thumb sucking, and
5.any other habitual use of the mouth unrelated to eating, drinking, or speaking.
Contrary to common belief, functional habits such as chewing are not the main cause of the wearing of teeth. Parafunctional habits are the most destructive forces for several reasons. Whereas teeth rarely come into contact during normal chewing, grinding of teeth may occur 1 – 4 hours in a 24 hour period, most often during sleep.

Bruxism

What is bruxism or teeth grinding?

Bruxism

Bruxism or teeth grinding is an abnormal human behavior wherein the human being gnashes, grinds or clenches his teeth in a habitual manner. Both the adults and children are affected by this. It has been assessed that the number of persons affected by bruxism is between 30m and 40m and this includes both children and adults.
This habit can occur both in the day and the night. It occurs in children mostly in the night when the individual is fully asleep whereas the adults get affected both during day and night. The individual is conscious of this habit when it occurs during the day whereas they hardly realize it when it occurs during sleep. This sleep related bruxism is also known as nocturnal bruxism. This habit of grinding the teeth occurs in children mostly during night whereas in the adults this could occur both in the day and night. If this habit is severe it could fracture dental fillings or cause damage to the tooth.

The word bruxism originates from the greek word – βρυγμόσ (brugmós) which means gnashing of teeth.

What are the signs and symptoms due to teeth grinding?

teeth grinding
The symptoms and signs of bruxism are as under.
1.tooth wear out – tooth attrition will cause wearing of tooth thereby making the tooth short.
2.tooth flattening – occurs that make the yellow/ creamy dentine visible.
3.tooth chipping – occurs due to grinding of teeth.
4.tooth sensitivity, pain and looseness – increases because of worn out/ cracked tooth.
5.tooth enamel wear out – exposes the inside of tooth.
6.restricted jaw movement – occurs because excessive tooth wear cause the jaws to close too far and this results in facial changes.
7.eating disorders – restricted jaw movement causes pain while eating.
8.untreated bruxism – might cause the teeth to wear to the level of the gums.

teeth grinding2
9.unsightly creasing – is seen at the mouth corners.
10.nuisance to others – clenching or grinding of teeth in the night might cause discomfort to persons sleeping in the same room.
11.tenderness and pain – earache, facial pain, headache, jaw pain etc.
12.prominent jaw muscles – are likely to develop.
13.depression
14.insomnia
15.chewing of the tissue inside the cheek

What are the reasons for teeth grinding disorder?

The following are the possible causes for bruxism in adults.

1.abnormal alignment of upper and lower teeth
2.medical conditions – cerebral palsy and learning difficulties
3.persons who are having aggressiveness, competitiveness and hyperactive
4.psychological problems – anger, anxiety, frustration, stress and tension
5.stress

Bruxism in children

Parents would be interested in seeing their child sleep peacefully with easy breathing. However, there are parents who find that their child gnashes and grinds teeth. Bruxism is very common in kids under the age of five and according to experts 2% to 3% of the kids in this age group are affected by bruxism. Fortunately, most of the children overcome this problem after they get adult teeth.

Some of the reasons for this disorder in children are as follows.

1.misalignment of top and bottom teeth at the time of tooth eruption
2.hyperactive children
3.children tend to grind teeth if they have pain while teething or having earache
4.stressful situations due to tension or anger
5.medical conditions such as cerebral palsy
In addition to the above, huntington’s/ parkinson’s disease could also cause this disorder because of the usage of medications – psychiatric medicines and antidepressants.
More than 50% of the children stop this habit before they attain the age of 13.

How do you treat bruxism?

Most of the bruxism cases do not require any treatment. Children overcome bruxism without any special treatment once they get adult teeth; on the other hand adults rarely have severe bruxism.

In severe cases, it has to be treated by dentally psychologically and with medication. Psychological and medical issues have to be attended to by the specialists in the respective fields – medical practitioners, psychologists etc.

The dental treatments will depend on the current situation on the tooth wear out. If the attrition is severe it is essential to restore the teeth with crowns and overlays. This will bring the size of teeth to normal thereby making the jaws normal and also improving the aesthetics of your teeth and face.

If the wear out is in the initial stages it is necessary to take actions to prevent further damage to the teeth.

How do you prevent further damage to your teeth?

teeth

The following are the actions to be taken to prevent teeth grinding.

1.mouthguards – your dentist might ask the child to wear a mouthguard or splint to avoid any damage occurring to the teeth. The mouthguard can either be a standard one or custom built. Custom built mouthguard is expensive but fits well.
2.repositioning splint – this appears like a traditional night guard; this is basically meant for changing the bite or occlusion of the patient. This has not shown any extra advantage over conventional methods and hence to be used only if essential.
3.nti-tss plus™ – this suppresses the contraction of parafunctional muscle by 70% thereby protecting your teeth, joints and muscles. The nti covers only the front teeth and prevents the rear molars from coming into contact, thus limiting the contraction of the temporalis muscle.
4.stress management – stress related grinding of teeth can be prevented by exercising, meditation and counseling by a professional. If the child grinds his/ her teeth due to fear or tension you must talk to the child or read a story book before the child goes to sleep so that the child relaxes.
5.correction of teeth misalignment if bruxism is due to misalignment of teeth
6.use of overlays and crowns to correct the chewing surface
7.behavior therapy – you can prevent bruxism by adjusting the position of mouth and jaw. Rest your tongue in such a way that it keeps your teeth apart and keeping your lips closed.
8.medications – generally medications are ineffective for bruxism. If this is caused as a side effect for taking antidepressants your doctor might change the prescription.


9.botox – botulinum toxin or botox can be used for treating bruxism. Botox is an injectable medicine which weakens the muscles; this is largely used in cosmetic procedures for relaxing the facial muscles so as to reduce the facial wrinkles. You could consider bruxism as a disorder wherein the masseter muscle i.e. The large muscle that moves the jaw has repetitive and unconscious contraction. Botox can be used for weakening this muscle sufficiently to stop the grinding and clenching; however it should not cause problems for chewing and facial expressions. The botox gets into the muscle and weakens it but does not get absorbed in the body. The procedure involves five or six injections into the masseter muscle.
10.dietary supplements – some dietary supplements containing pantothenic acid, magnesium and calcium have been useful in treating bruxism.

Mouth breathing

Mouth breathing refers to the state of inhaling and exhaling through the mouth.

A healthy individual normally breathes through the nose while resting or doing light exercise, and breathes simultaneously through both the nose and mouth during vigorous aerobic exercise, in order to supply sufficient oxygen. Excessive mouth breathing is problematic because air is not filtered and warmed as much as when inhaled through the nose, as it bypasses the nasal canal and para nasal sinuses, and dries out the mouth. Mouth breathing is often associated with congestion, obstruction, or other abnormalities of the upper respiratory tract. Mouth breathing is a diagnostic sign of adenoiditis especially with persistent rhino rhea. Co morbidities include asthma, obesity, snoring, halitosis, and obstructive sleep apnea.

Social perception

Mouth breathing in public is sometimes considered to be less socially acceptable or attractive than nose breathing, as mouth breathers can appear to have a somewhat “slack jawed” look, and mouth breathing can cause or exacerbate bad breath. Consequently, the term “mouth breather” may be used in a pejorative sense for someone lacking in hygiene or intelligence. Such usage is generally considered insensitive.

Tongue thrusting

Tongue thrust (also called “reverse” or “immature” swallow) is the common name given to orofacial muscular imbalance, a human behavioral pattern in which the tongue protrudes through the anterior incisors during swallowing, speech and while the tongue is at rest. Nearly all young children exhibit a swallowing pattern involving tongue protrusion, but by the age of 6 most have automatically switched to a normal swallowing pattern.

Tongue thrusting can have extreme negative effects on your teeth and mouth. Many people who tongue thrust have open bites. People who tongue thrust do it naturally and are usually unaware that they are even doing. Therefore, people who tongue thrust should seek treatment to break their habit immediately before more damage to the mouth is done.

Treatment recommended was to consider the following:

1.treat the open bite with a dental appliance (often called a crib).
2.treat any oral habits (like thumb or finger sucking) if they are starting to cause a bite opening problem.
3.consider counseling if the child has a habit which may be a sign of more significant problems.
4.evaluate the possibility of problems with tonsils, adenoids, breathing problems.
5.have the dental professional check to see if the patient’s tongue is too large or if the patient is “tongue tied” (where the attachment below the tongue does not allow it to move forward freely).
By treating the actual cause of the open bite, the tongue will automatically go to the correct position without the need for training.

Thumb sucking

Thumb sucking is the act of putting the thumb into the mouth and rhythmically repeating sucking contact for a prolonged duration. It can also be accomplished with any piece of skin within reach (such as the big toe) and is considered to be soothing and therapeutic for the person. Thumb sucking is commonly associated with babies and young children.

Children suck on objects (including pacifiers) to soothe themselves; sucking is one of a baby’s natural reflexes and completely typical for babies and young children.

Although some adults do suck their thumbs it is rarely performed in public, which leads many to believe that adults do not suck their thumbs at all. The private act of thumb sucking by adults is due to the fear of embarrassment or shyness. There are some stigmas attached to thumb sucking in public for adults.

Thumb sucking can start as early as 15 weeks of growth in the uterus or within months of being born. Most thumb-suckers stop gradually by the age of five years. Rarely does it continue into adulthood. It is not uncommon for thumb-suckers to suck both thumbs or their fingers. Finger sucking is synonymous with thumb sucking in effect and treatment, but less common.

Dental problems

Thumb-sucking can cause problems for dental development. To prevent their children from sucking their thumbs some parents put hot sauce or sour potions on their child’s thumbs — although this is not a procedure encouraged by the american dental association or the association of pediatric dentists. During the 1950s, parents could get a series of sharp prongs known as “hay-rakes” cemented to a child’s teeth to discourage sucking. Most children stop sucking on thumbs, pacifiers or other objects on their own between two and four years of age. No harm is done to their teeth or jaws until permanent teeth start to erupt. The only time it might cause concern is if it goes on beyond 6 to 8 years of age. At this time, it may affect the shape of the oral cavity or dentition