Harmful Habits

Dental problems, arch problems and skeletal problems are all issues with the patient's anatomy that can cause malocclusion. However, some malocclusion is caused by a patient's behaviour and habits.

• Lip sucking and/or biting

Lip sucking commonly manifests itself clinically in the following ways:

1. Proclined upper Incisors
2. Retroclined lower Incisors
3. Enlarged, red lower lip
4. Dryness and chafing beyond the Vermillon border
5. Tooth Indentations on the lip

Lip sucking can undermine efforts to align the teeth and can cause relapse if it persists in retention.

• Thumb Sucking

Thumb or finger sucking commonly manifests itself clinically in the following ways:

1. Proclined upper Incisors
2. Retroclined lower Incisors
3. Distorted upper alveolus
4. Dry, calloused digits

Thumb sucking can undermine efforts to align the teeth and can cause relapse if it persists in retention.

• Tongue Thrusting

Tongue thrusting commonly manifests itself clinically in the following ways:

1. Proclined upper incisors
2. Proclined lower incisors
3. Uniform anterior spacing
4. Tongue darts between teeth as the patient swallows with their lips apart, and can sometimes be seen during speech as well.

Tongue thrusting can undermine efforts to align the teeth and can cause relapse if it persists in retention.

• Nail Biting

Nail biting commonly manifests itself clinically in the following ways:

1. Worn Incisal edges
2. Anterior spacing and misalignment
3. Exposed nail beds

Aligner wear can help prevent and/or reduce the habit of nail-biting because it's impossible to bite your nails while wearing aligners.

However, nail biting can still cause malocclusion if the patient removes their aligner or if the habit comes back in retention.

• Mouth Breathing

Mouth breathing commonly manifests itself clinically in the following ways:

1. Narrow upper arch
2. Posterior crossbite
3. Anterior open bite
4. Increased facial height
5. Low tongue posture
6. Dry, pale lips that rest apart
7. Inflamed, dry gingiva

Mouth breathing can undermine efforts to expand the teeth or close an anterior open bite. Gingival irritation may also be an issue along with a high risk of relapse.

If your patient has a mouth breathing habit, a myofunctional therapy referral should be considered as an adjunct to your plan, in addition to permanent retention or continued nighttime appliance wear as long as the habit persists.

• Teeth Clenching and Bruxism

Teeth clenching and bruxism commonly manifest clinically in the following ways:

1. Enamel and dentin wear
2. Tooth fractures
3. Loss of vertical facial height
4. Prominent masseter muscles
5. Jaw muscle and joint pain
6. Worn aligners and retainers

Clenching and bruxism can quickly wear through aligners and retainers and tooth movements may be impeded prolonging treatment. Deep bites are particularly difficult to correct after treatment, so an occlusal guard may be more effective than a traditional retainer.