1Ogbomade, Ronami S., *2Ephraim-Emmanuel, Benson C., 3Okorie, Uzoma C.
- Department of Science Foundation, Bayelsa State College of Health Technology, Otuogidi, Ogbia town, Bayelsa, Nigeria.
- Department of Dental Health Sciences, Bayelsa State College of Health Technology, Otuogidi, Ogbia town, Bayelsa, Nigeria.
- Department of Community Health Sciences, Bayelsa State College of Health Technology, Otuogidi, Ogbia town, Bayelsa, Nigeria.
Corresponding author*: Ephraim-Emmanuel, Benson Chukwunweike.
Phone Number: +234-806-003-8135 Email: firstname.lastname@example.org
Background and Aim: Oral habits are complex patterns of learned behavior that is characterized by muscle contractions which are usually related with a number of factors occurring in the individual practicing the habit. They have the capacity of causing dental health problems. It is thus the aim of this study to determine the prevailing oral habits and related factors.
Materials and methods: A descriptive research design was used. This study was conducted among primary school children. Using an effect size of 0.5 and error probability of 0.05, a minimum sample size of 176 respondents was calculated for this study. The instrument for data collection was a structured self-administered questionnaire. The instrument was distributed to the children at school to take home to their parents or guardians with the instruction to complete and return them the following day. Ethical considerations, permission, consent and confidentiality were ensured for this study.
Results: 77.2% of children of study respondents were affirmed to have practiced oral habits in the past. Fingernail biting (24.8%) was the most reported habit to be practiced. However, the practice of oral habits had reduced with 15% of the study participants no longer practicing oral habits. The majority of the respondents practiced these oral habits when sleeping (30.4%) as well as when bored (20.3%). Major measures utilized to stop these habits included flogging the child as well as punishing the child (22.4%), advising and encouraging the children to desist from the oral habits (19.6%).
Conclusion: The practice of oral habits is a problem within the study area. The most reported habit was fingernail biting and the major initiators of these habits included sleeping as well as the feeling of boredom. Flogging and motivation to stop the habit were mostly used as measures to stop the habit. It is however recommended that oral health education programmes be provided to improve awareness of the deleterious effects of oral habits on oral health. Emphasis should also be placed on the use of positive rather than negative reinforcement as a measure to enhance cessation of the habit.
Keywords: Oral habits, Malocclusion, Primary School Children, Yenagoa, Nigeria
Habits have been described as complex patterns of learned behavior characterized by repetitive actions which occur involuntarily. Within the context of the oral cavity, oral habits are complex patterns of learned behavior that is characterized by complex muscle contractions which are usually related with a number of factors occurring in the persons practicing the habit. These could include fear, anger, ease of tension, hunger, sleep etc. (1,2).
These habits are basically classified as being nutritive and non-nutritive. The nutritive habits include oral habits related with sucking action of a child including bottle feeding as well as breast sucking. However, for the purview of this study, the non-nutritive class of oral habits is more of interest. These oral habits include nail biting, finger sucking, lip sucking etc. They are those habits which occur in relation to the mouth and could be initiated by prevailing events and circumstances being experienced by the individual practicing the habit. These circumstances include boredom, fatigue, hunger, emotional stress etc. (2,3). They are prevalent among children especially in the infantile period of life but have also been reported among older individuals. It is however generally believed that the habit stops spontaneously. (1,3). Various manifestations of poor dental health including dental caries, periodontal disease, malocclusion, poor oral seal, speech defects etc; could occur depending on the nature of an oral habit, onset of the habit as well as its duration (4). Those who practice these habits for more than six hours in a day generally tend to develop more serious dental health problems than those who do so for lesser amounts of time in a day. (1,5-8). In order to stop the occurrence of these habits, a number of measures have been utilized. These include application of interceptive orthodontics, motivation of the child to stop the habit, placing distasteful liquids on the nails or fingers, oral health education, behavioral treatment as well as the use of anti-anxiety medications etc. Seeing that the severity of oral health problems that are likely to occur are directly proportional to the length of occurrence of the offending oral habits, it is essential that oral health education targeted at improving awareness of the adverse effects of these habits be encouraged (1,9). The problem of oral habits being one for which children are especially susceptible and which can be initiated by circumstances normal to every human could certainly be prevalent among children residing in Yenagoa, Bayelsa State, Nigeria. There is however no published reports to confirm this.
It is thus the aim of this study to determine prevailing oral habits within the study area as well as factors known to stimulate its occurrence and measures geared at arresting its occurrence.
Materials and Methods
A descriptive research design was used in the assessment of oral habits practiced among school children in Yenagoa. This was adequate as it effectively enabled description of the study variables in its natural setting. This study was conducted in primary schools located in Ekeki Yenagoa Local Government Area of Bayelsa State and the targeted population was the primary school children attending these schools. Using an effect size of 0.5 and error probability of 0.05, a minimum sample size of 176 respondents was calculated for this study. The spin-a-bottle random sampling technique was then used in selecting the required number of primary schools to make-up our sample size at Ekeki, Yenagoa. The instrument for data collection was a structured self-administered questionnaire. The instrument was divided into two sections. Section A to collect demographic data while section B to elicit information on the oral habits of the children. The questionnaires were distributed to the children at school to take home to their parents or guardians with the instruction to complete and return them the following day. The instrument was retrieved from the children one week later. For the purpose of this study, the research instrument was submitted to a dental professional who assessed it for both content and face validity. Upon collation using the Microsoft Excel software, data was presented on tables, charts and expressed as frequencies and percentages.
Ethics clearance to carry out this research was gotten from the Project Research and Ethics Committee of the Bayelsa State College of Health Technology. Permission to carry out this study was sought from the school authorities. Participation for the study was on a voluntary basis and informed consent was sought from the parents and guardians of the primary school children. Data collected from participants was treated as confidential.
Altogether, 230 questionnaires were distributed and 184 were retrieved and completed properly. This gives a response rate of 80%. Majority of the respondents was female (51.6%) and 48.4% were male. 35.3% of the respondents were aged between 7 and 9 years, 32.1% aged between 4 and 6 years amongst other age groups. The demographic data of our study respondents’ is shown on Table 1.
Table 1: Demographic data of respondents
Practice of Oral Habits
Regarding the practice of oral habits among the participants of this study, multiple responses were entertained regarding oral habits practiced and when the habits were practiced the most. Most of them (77.2%) were affirmed to have practiced oral habits in the past. Fingernail biting (24.8%) was the most reported habit to be practiced among the children. As at the time of this present study, the practice of oral habits had reduced with 15% of the study participants no longer practicing oral habits which they earlier manifested. The majority of the respondents practiced these oral habits when sleeping (30.4%) as well as when bored (20.3%). This information is shown on Tables 2, 3 and 4 as well as on Figure 1.
Table 2: Practice of oral habits
|Practice of oral habits||Frequency||Percentage (%)|
Table 3: Oral habits practiced in the past (before this study)
|Oral habits practised||Frequency||Percentage (%)|
Table 4: Oral habits being practiced presently
|Oral habits practised||Frequency||Percentage (%)|
Stopping the Oral Habit
Among the 142 participants that had practiced oral habits, 24.6% of the parents/guardians of the participants of this study did not do anything to stop the habits. However, among the 75.4% who did something to stop the habit; the major measures utilized to stop these habits included flogging/whipping the child as well as punishing the child (22.4%), advising and encouraging the children to desist from the practice of the oral habits (19.6%), creating distractions such as engaging the children in activities, shouting at the children etc; as well as placing bitter leaf on the hand or in the mouth of the child practicing the oral habit. This information is shown on Table 5.
Table 5: Measures carried out to stop the oral habits
|Measures carried out to stop the oral habits||Frequency||Percentage (%)|
|Flogging and punishment||24||22.4|
|Advice and encouragement to stop habit||21||19.6|
|Giving food to solve root cause of hunger||3||2.8|
|Slapping the hand/mouth/cheek/finger||8||7.5|
|Removing finger from the mouth||7||6.5|
|Placing an obstacle on the finger/tongue||2||1.9|
|Using bitter leaf on the hand/mouth||12||11.2|
|Placing salt in mouth||1||0.9|
|Waking child from sleep||6||5.6|
|Making the child happy||3||2.8|
The occurrence of oral habits has been reported to be a common problem among paediatric patients which has the ability to affect the quality of life of the individual (7). Considering that oral health is an integral part of general health and that the general health plays a role in ensuring general quality of life, it is important that these kinds of problems be tackled as quickly as possible whenever they are noticed (10). Specific initiators of these habits including hunger, boredom, anxiety, anger, tiredness as well as fear should also be quickly addressed whenever implicated. The use of positive reinforcement in these cases is of utmost importance in order to relieve the emotional stress that is likely involved in the practice of the oral habit (5).
This study revealed that a majority of the respondents affirmed that their children practiced oral habits in the past and still continued practicing them. This is a finding that is corroborated by the findings of other authors who reported similar results regarding the practice of oral habits among children (11). The implication of this is that this condition is one that is of public health concern considering the age group it mostly affects as well as the problems it may pose to the quality of life of the affected individuals. This thus calls for a more globalized strategy to adequately prevent its occurrence as well as nip it in the bud in the shortest possible time whenever noticed (11). The findings of Pruthi et al, (2013); however do not support the present study findings as they reported a prevalence of deleterious oral habits of 25.9%. The reason for this could have been because of the ages of 12 and 15 years used in selecting their study population (12).
Fingernail biting, finger sucking and teeth grinding (bruxism) were the most reported habits practiced by the children in this study. This finding agrees with those of authors who reported similar findings in their studies especially regarding nail biting (3,8). There is however a significant implication of this finding in that the reported habits in this study have been reported to be directly related with psychological/emotional disturbances. The occurrence of these habits thus implies that measures need to be taken to relieve or treat the emotional/psychological disturbance which in turn helps in stopping the habit. (5,10,13). However as seen in this study, the most utilized method of stopping the habit was flogging the children or meting out punishments to them. These forms of negative reinforcement have been shown to be capable of further worsening the emotional or psychological disturbance affecting those manifesting the habit and thus strengthen the practice of the habit rather than stop it (5). It is however noteworthy to point out that some form of positive reinforcement through encouragement was also utilized in this study to stop the habits. It is recommended that positive reinforcement methods are utilized in these situations because if the emotional or psychological disturbance can be corrected, it makes it easier for the habit to be stopped as well as boost the self-confidence of the individual especially in children (1,14).
In our study, sleep, boredom, hunger and anger were found to be the most reported factors that occurred during the practice of the oral habits. These are similar to findings in other studies that reported similar circumstances to influence the occurrence of oral habits (13). It is necessary to point out that to any of the circumstances reported to influence the occurrence of oral habits, the specific remedy should be provided in order to aid the cessation of the habit. In the case of hunger, food is required; for emotional disturbances involving anger or anxiety, effort should be made to pacify the angry or anxious emotion. This could be in form of positive reinforcement. Engaging the child in productive activities or distraction with toys following a gentle withdrawal of the part of the body being used during the habit, could also be utilized as a remedy for boredom etc (1). Interceptive orthodontics, a branch of dentistry that provides treatments that effectively help in the cessation of oral habits should however be incorporated when the need arises especially in cases of compulsive oral habits (11,12).
Generally, it is more beneficial to prevent the occurrence of oral habits or to provide necessary information to encourage prompt cessation of the habit when noticed. Preventive measures could include provision of dental health education programmes to provide enlightenment on the issue of oral habits and how to prevent its occurrence. Education should also be provided on how to differentiate between acquired oral habits (which could be easily stopped as the child grows older) from compulsive oral habits which are more inclined towards emotional imbalance initiators (5).
The practice of oral habits is a problem in the area in which this study was conducted. The most reported habit was fingernail biting and the major initiators of these habits included sleeping as well as the feeling of boredom. Flogging and motivation to stop the habit were mostly used as measures to curb the habit. It was however recommended that less of negative reinforcement and more of positive reinforcement methods be utilized in helping to stop these habits considering that most of the habits were non-nutritive in nature and could have been precipitated by emotional or psychological imbalances which are best managed by adequate support and motivation of the child.
Ephraim-Emmanuel, Benson C. and Okorie UC developed the manuscript protocol, were involved in literature search and review for this manuscript. They were also involved in conducting the study and development of the final manuscript. Ogbomade, Ronami S. was involved in the revision process of the manuscript as well as in development of the manuscript transcript. All authors have approved the write-up of the final manuscript for publication. There are no conflicts of interest regarding this manuscript.
- Shahraki N, Yassaei S, Moghadam MG. Abnormal oral habits: A Review. J Dent Oral Hyg,2012;4:12-5. DOI:10.5897/JDOH12.001. ISSN 2141-2472. Available online at http://www.academicjournals.org/JDOH
- Kharat S, Kharat SS, Thakkar P, et al. Oral habits and its relationship to malocclusion: A Review. J Adv Med Dent Sci Res, 2014;2:123-6.
- Almonaitienė R, Balčiūnienė I, Tutkuvienė J. Prevalence of oral habits and their impact on facial parameters in Lithuanian children 4 to 9 years of age. Medicinos,2013;19:31-8.
- Joelijanto R. oral habits that cause malocclusion problems. Int Dent J,2012;1:86-8.
- Jyoti S, Pavanalakshmi GP. Nutritive and non-nutritive sucking habits – effect on the developing oro-facial complex; a review. Dent, 2014;4:203. DOI:10.4172/2161-1122.1000203.
- Chour RG, Pai SM, Chour GV, et al. Assessment of various deleterious oral habits and its effects on primary dentition among 3-5 years old children in Davangere city. J Ped Dent,2014;2:37-43. DOI: 10.4103/2321-6646.137676. Available online at: www.jpediatrdent.org
- Suchita MT, Sheetal R. Tongue thrusting habit: A review. Int J Contemp Dent Med Rev, 2015. DOI: 10.15713/ins.ijcdmr.26.
- Giugliano D, Apuzzo F, Jamilian A, Perillo L. Relationship between Malocclusion and oral habits. Cur Res Dent,2014;5:17-21. DOI: 10.3844/crdsp.2014.17.21
- Gowri SS, Chetan K. Tongue thrust habit – A review. Ann Essences Dent,2009;1:14-23.
- Leme MS, Barbosa TS, Gavião MBD. Relationship among oral habits, orofacial function and oral health-related quality of life in children. Braz Oral Res., (São Paulo), 2013;27:272-8.
- Lagana G, Masucci C, Fabi F, et al. Prevalence of malocclusions, oral habits and orthodontic treatment need in a 7- to 15-year-old schoolchildren population in Tirana. Prog in Orthod,2013;14:12. Available online at: http://www.progressinorthodontics.com/content/14/1/12
- Pruthi N, Sogi GM, Fotedar S. Malocclusion and deleterious oral habits in a north Indian adolescent population: A correlational study. Eur J Gen Dent,2013;2:257-63.
- Seraj B, Shahrabi M, Ghadimi S, et al. The prevalence of bruxism and correlated factors in children referred to dental schools of Tehran, based on parents’ report. Iran J Ped,2010;20:174-80.
- Aasim FS, Manu B, Sudeep CB, et al. Oral habits and their implications. Ann Medicus,2014;1:179-86.