The existence of an oral habit should be noted during the clinical examination of a child. If this habit is creating an abnormal skeletal pattern or occlusal scheme, appliance intervention is usually indicated. However, the child must want to stop the habit. To achieve success, the child’s cooperation and willingness to work with the dentist is essential. Habits can be responsible for a number of orthopedic and orthodontic problems and should be addressed as soon as they are recognized. When treated immediately most of the problems caused by a habit can be reversed. However when no intervention occurs, a serious malocclusion is inevitable. Rarely (with the exception of a physically or mentally challenged individual) is the problem severe enough to cause serious dental problems. If excessive wear becomes apparent, the use of a splint or an orthopedic appliance may be indicated.
Thrusting problems often remain throughout adulthood. In fact, it is not uncommon to see an anterior open bite recur even after orthodontic therapy has been completed. At bare minimum some form of long-term retention is often needed to prevent this recurrence from happening. Another unusual habit that occurs in adults is cheek biting. This habit is difficult to control, but with the help of an appliance it is often possible to change this pattern or, at least, prevent further damage to the occlusion and tissue from occurring. As our society becomes more complex, the incidence of the bruxism seems to be on the increase. A wide variety of treatment approaches and appliance designs are available for the treatment of these disorders.
Regardless of the treatment technique, early intervention can prevent many of the severe problems associated with this problem. SML prides itself on producing the finest splint appliances for the treatment of habits.
Featured Appliances
Blue Grass Appliance U
The Blue Grass Appliance is a counter-conditioning device that is particularly useful in the mixed dentition stage of development. A teflon roller is placed in the most superior aspect of the palate.
When patients try to suck their thumbs, the roller prevents them from experiencing the satisfaction of suckling. Instead, their tongue spins the roller. More positive than a strict habit-control approach, this presents the roller as entertainment — a new toy. Note: With all habit appliances, an opposing model and bite relationship are required.
Fixed Tongue Loops U
Fixed Tongue Loops may be used to control the effects of tongue thrusting or to prevent a patient from thumb sucking.
This interference is often enough to allow the facial muscles to act upon the anteriors and return them to their normal position. Myofunctional therapy is initiated by adding a spinner. If more aggressive treatment is needed, simply cut off the apex of the loops and straighten the wires to create a modified Hay Rake.
Note: An opposing model and bite relationship are required with all habit appliances.
Myo-Functional Tongue Bead
The Myo-functional Tongue Bead device is used to retrain proper tongue position. Patient cooperation is generally not required.
The appliance evokes a spontaneous reaction to play with the spinner and thus position the dorsum of the tongue against the soft palate.
Note: Many practitioners incorporate this type of myo-functional therapy into their fixed orthodontic treatment. When this is the case, lingual sheaths are often used to maintain this appliance so that the bands do not need to be replaced when tongue therapy is complete.
Lip Biting Inhibitor L
Lip sucking or biting is a common habit in both children and adults. A labial shield is one method used to break this habit.
A lip shield can also be incorporated into a removable appliance. Caution: Be sure to carefully monitor use of this appliance. Facial muscles used during swallowing are strong enough to distal drive the molars.
Lower Tongue Thrust Inhibitor L
This tongue-thrusting appliance is used to prevent the tongue from exerting a labial force against the lower anteriors.
It can be attached to bands on the primary or permanent molars and is often used in conjunction with anterior bracketing when closing anterior open bites. When the bite is closed, the prongs can be reduced in length, but should be kept in until lip seal has been established. In severe open-bite cases, it may be necessary to place prongs like these on a banded bicuspid-to-bicuspid lingual retainer. Note: With all habit appliances, an opposing model and bite relationship are required.
Cheek Biting Inhibitor U
Cheek biting can be habitual or due to an improper occlusal relationship. Buccal shields can be used to prevent the habit of sucking or chewing of the cheeks.
While it may not address the underlying cause of the problem, the appliance is useful in controlling the habit and allowing the tissues to heal.
Note – It is essential to take impressions that reach into the vestibule to properly design and place the buccal shields.
Upper Hay Rake U
The Upper Hay Rake discourages thumb sucking by making it as uncomfortable as possible.
This interference is often enough to allow the facial muscles to act upon the anteriors and return them to their normal position. It should be noted here that most clinicians consider this to be the appliance of last resort. Note: With all habit appliances, an opposing model and bite relationship are required.
Tongue Fence U
When extra strength is needed to control the effects of tongue thrusting or to prevent a patient from thumb sucking, a double wire fence with inter-connecting supports may be used.
This interference is often sufficient to allow the facial muscles to act upon the anteriors and return them to their normal position. If the appliance is to be maintained for 6-8 months, bonding additional rests into position with composite resin helps to stabilize the appliance. When so doing, it is best to prepare a rest seat in the supporting tooth to keep the bite clear of any occlusal interference. Note: With all habit appliances, an opposing model and bite relationship are required.
Removable Tongue Loops U
With a cooperative patient, habit loops can be added to a removable Hawley Retainer to control the effects of tongue thrusting or to prevent thumb sucking.
As with its fixed counterpart, Removable Tongue Loops offer sufficient interference to allow the facial muscles to act upon the anteriors and return them to their normal position. However, this appliance is also designed to allow you to actively move flared anteriors lingually. Simply relieve the acrylic from the lingual aspect of the anteriors and tighten the labial bow. Note: With all habit appliances, an opposing model and bite relationship are required.
Removable Tongue Positioner
In patients exhibiting an aberrant swallowing pattern, the tongue often comes forward with tremendous force against the anteriors, causing them to move labially.
The Removable Tongue Positioner — a Hawley Retainer constructed with a 5mm hole in the acrylic at the center of the palate ( lingual to the anteriors) — can correct this pattern. The patient is instructed to position the tip of the tongue in the 5mm hole hole during swallowing and to practice this new pattern as much as possible. Note: With all habit appliances, an opposing model and bite relationship are required.
Dillingham Habit-Expansion Appliance U
A tongue thrusting habit is often the cause of a narrow maxilla. When such is the case, simply correcting the narrow arch through lateral development is often not enough to ensure a stable result.
To maintain the correction, everything must be done to address the muscle imbalance that caused the problem in the first place. In other words, you cannot ignore the tongue habit. The Dillingham not only functions as an expansion appliance, it also discourages tongue thrusting and/or thumb sucking with the use of adjustable habit loops. When the appliance is delivered, these habit loops will prevent the tongue from thrusting forward against the anteriors. Instead, the tongue pressure is placed against the anterior loops, which flexes the framework laterally and actually aids in developing the maxillary cuspid region. The expansion screw used in this appliance is the same type of screw used to expand the maxilla rapidly. In fact, this appliance can be used effectively in either a slow expansion or rapid expansion approach. Note: Always send both upper and lower casts along with a construction bite to assure proper appliance fabrication.
Bionator to Close
Also referred to as The Bionator II, this appliance is designed to correct anterior open bites in Class I and Class II malocclusions.
The posterior teeth are covered with acrylic to prevent their eruption, while the acrylic is kept away from the incisors to permit closure of the open bite. The mid-line expansion screw can be used for arch development, when indicated. Adding a “Balters Type” labial wire will also enhance lateral arch width development. Note: If desired, the lower incisors can be capped with acrylic if you wish to prevent their eruption. If so, please be sure to include this on your lab prescription.