|Year : 2017 | Volume
| Issue : 3 | Page : 184-188
Age-wise and gender-wise prevalence of oral habits in 7–16-year-old school children of Mewar ethnicity, India
Pradeep Vishnoi1, Prabhuraj Kambalyal1, Tarulatha Revanappa Shyagali2, Deepak P Bhayya3, Rutvik Trivedi1, Jyoti Jingar1
1 Department of Orthodontics, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
2 Department of Orthodontics, College of Dentistry, Majmaah University, Al Zulfi, Saudi Arabia
3 Department of Paediatric Dentistry, College of Dentistry, Majmaah University, Al Zulfi, Saudi Arabia
|Date of Web Publication||7-Aug-2017|
Tarulatha Revanappa Shyagali
Department of Orthodontics, College of Dentistry, Majmaah University, Al Zulfi 11932
Source of Support: None, Conflict of Interest: None
Objectives: The study aimed to check the age- and gender-wise prevalence of oral habits in the children of 7–16-year-old Indian children. Materials and Methods: A cross-sectional survey involving 1029 (661 males and 368 females) children of age 7–16 years was done to record the presence or absence of the oral habits with the aid of the anamnestic questionnaire. The recorded oral habits were tongue thrusting, thumb or digit sucking, mouth breathing, bruxism, lip biting or lip sucking, and nail biting. The collected data were subjected to Pearson's Chi-square statistical analysis to know the overall difference in the prevalence rate of different oral habits and to evaluate the gender- and age-wise difference in the prevalence of oral habits. Results: Oral habits were present in 594 participants (57.73%). The highest prevalence rate was registered for tongue thrusting habit (28.8%), which was followed by nail biting (201/19.5%) and thumb sucking (128/12.4%), mouth breathing (109/10.6%), lip biting (85/8.3%), and bruxism (29/2.8%). The male participants showed a greater prevalence rate for the oral habits than the female participants (58.55% vs. 56.25%). There was a significant difference in the age-wise prevalence of oral habits with older children showing greater prevalence of oral habits than the younger ones. Conclusion: The prevalence of oral habits in the current group of children is high. It warrants the need for the community-based educational preventive and interceptive programs to spread the awareness regarding the deleterious effects of these oral habits.
Keywords: Bruxism, mouth breathing, thumb sucking, tongue thrusting
|How to cite this article:|
Vishnoi P, Kambalyal P, Shyagali TR, Bhayya DP, Trivedi R, Jingar J. Age-wise and gender-wise prevalence of oral habits in 7–16-year-old school children of Mewar ethnicity, India. Indian J Dent Sci 2017;9:184-8
|How to cite this URL:|
Vishnoi P, Kambalyal P, Shyagali TR, Bhayya DP, Trivedi R, Jingar J. Age-wise and gender-wise prevalence of oral habits in 7–16-year-old school children of Mewar ethnicity, India. Indian J Dent Sci [serial online] 2017 [cited 2020 Apr 4];9:184-8. Available from: http://www.ijds.in/text.asp?2017/9/3/184/212393
| Introduction|| |
Oral habits since long have been the topic of interest to the dentist in general and pediatric dentist and orthodontist in particular. The controversies related to oral habits range from the simple genetic or nongenetic origin to underlying psychological cause.,,,
However, there is a universal agreement regarding the deleterious effects they produce on the oral cavity as well as on the craniofacial region. Oral habits are known to cause certain types of malocclusion such as Angle class II malocclusion, increased overjet, open bite, posterior cross bite, and narrow maxillary width., Even the normal posture of the child can be affected by mouth breathing habit, where the child postures the head forward to breathe.,,, Normal physiological equilibrium (Buccinator Mechanism) between the tongue and the oral musculature is altered  leading to the unesthetic appearance (mask-like appearance) of the face as well.
Vast number of studies have explored the prevalence of oral habits in young children worldwide to develop an effective preventive community measure to stop the development of these habits. Efforts have also been made to understand the etiology behind the development of these oral habits to combat the problem from the root.,,
There are very few studies on the prevalence of oral habits in Indian children,,,,, owing to this factor, the current study aimed to evaluate the prevalence of the oral habits in 7–16-year-old school children of Udaipur city, India and to propose the model for the combating of such problem if persisted.
| Materials and Methods|| |
A descriptive cross-sectional study design was followed to quantitatively analyze the presence or absence of different oral habits. A total of 1029 (661 males, 368 females) participants of age 7–16 years were selected from urban and rural schools of Mewar region of Rajasthan, India. The Mewar region is located in the south-central Rajasthan of India. The population found here is mixed as it includes the certain part of Gujarat and Madhya Pradesh as well. The participants were randomly selected by multistage stratified cluster sampling design. The pilot study was performed on 100 children to check the feasibility of the study and to decide the final sample size.
The study was undertaken after approval of the Institutional Ethical Committee. The examinations were conducted with permission from the education authorities and the principals of the respective schools, and with the informed consent of the participating child's parents. The inclusion criteria for the selection of the participants were presence of deciduous canine and deciduous second molar in primary and mixed dentition, presence of the first molar in permanent dentition, participants of Rajasthan ethnicity and the participants who had not undergone orthodontic treatment. The participants having craniofacial anomalies were excluded from the study. For each subject, a registration chart was designed. It comprised of an anamnestic questionnaire and the child's personal data. The presence or absence of oral deleterious habits such as tongue thrusting, thumb or digit sucking, mouth breathing, bruxism, lip biting or lip sucking, and nail biting was recorded.
Descriptive statistics were calculated for every recorded variable. Categorical variable was analyzed using the Chi-square test of Pearson to determine differences in prevalence rates between different age groups and the gender. P value for statistical significance was set at 0.05. All the statistical analysis was performed using the SPSS version 21 IBM SPSS Software. To examine the intra-examiner reliability, the data were collected twice for the total ten participants consecutively with in the period of 2 weeks and was subjected to kappa statistics which accounted for 89%.
| Results|| |
The descriptive statistics of the sample examined is shown in [Table 1]. A total of 1029 participants, 661 males (64.2%) and 368 females (35.8%) of 7–16-year-old with Mewar ethnicity were examined.
[Table 2] represents the data pertaining to the overall prevalence of each oral habit. Oral habits were present in 594 participants (57.73%). Eighty-seven male (58.55%) and 207 female (56.25%) children had the oral habits [Table 2]. Among the oral habits, the highest prevalence rate was registered for tongue thrusting habit (296/28.8%), which was followed by nail biting (201/19.5%), thumb sucking (128/12.4%), mouth breathing (109/10.6%), lip biting (85/8.3%), and bruxism (29/2.8%).
Gender-wise distribution of oral habits is depicted in [Table 3]. The male participants showed a greater prevalence rate for the oral habits than the female participants (58.55% vs. 56.25%) and the difference found was statistically nonsignificant (P = 0.788). In particular, tongue thrusting habit (P = 0.378) showed a nonsignificant but greater prevalence rate in female participants (30.4% vs. 27.8%).
The prevalence of oral habits according to the age is depicted in [Table 4]. There was a significant difference in the prevalence of tongue thrusting (P = 0.002), thumb sucking (P = 0.000), and mouth breathing and bruxism (P = 0.000). The oral habits were more prevalent in older children than in the younger children.
| Discussion|| |
The objective of the present study constituted the assessment of the prevalence of oral habits by means of the anamnestic questionnaire and to record the presence or absence of oral habit. A total of 594 participants (57.73%); 387 males (58.55%) and 207 females (56.25%) showed one or the other kind of oral habit. The earlier literature was explicit with such findings in different population groups., Compared to the current population, Albanese school children and the Brazilian school children (2617 subjects) showed much greater prevalence of oral habits (78.9% in males and 82.1% in females; 87.4%, respectively). Contrastingly, a very low prevalence of oral habits was reported in Nigerian children (9.9%), opposite to this finding in the Nigerian children belonging to Lagos the prevalence rate of oral habit was 34.1%. There are several other studies done within the Indian subcontinent that quote a lower prevalence of oral habits.,,, This difference in the prevalence of the oral habits in different population group can be either attributed to the difference in the calibration or the ethnicity of the population being examined or the geographic location where the population is based or the variation in the sample size of the examined population.
The education and the awareness of the parents matters a lot in controlling such deleterious oral habits in children. Apart from this, the socioeconomic condition of the population does play a major role in the prevalence of such habits. The facts that the oral habits are the causation of lack of the social and emotional security can be linked to the low socioeconomic group parents, the working class parents, and the large family groups. The degree of modernization and the ability of the child to cope with such a society without the mental tension is the major factor in determining the presence or absence of habit, as the oral habits act as mental stress releasers. The mentioned reason might cause the variations in the noted prevalence for the different oral habits.
In our sample, among the oral habits, the highest prevalence rate was registered for tongue thrusting habit 296 (28.8%) which was followed by the nail biting (19.5%). Contrastingly, lower prevalence of tongue thrusting was noted in different population groups.,,,, The tongue thrusting habit is known to cause the functional imbalance in the oral cavity, thus possibly causing the development of malocclusion. This again is debatable as the frequency of the tongue thrust habit is the main factor for the causation of malocclusion than the habit itself. The prevalence of nail biting was low in the earlier studies in comparison to the results of the present study.,,, The nail biting habit if persists for long can lead to midline diastema, resorption of the roots, the parasitic infections of the intestine, and the temporomandibular disorders. The prevalence of thumb sucking in the present study group was by 12.4%. The thumb and digit sucking habit was reported to be less frequent than the other habits, and the results of the current study are in agreement with this finding.,,,, Even though the prevalence is low, but it still warrants the need for the further monitoring as the thumb sucking is known to cause the anterior open bite and the posterior cross bite tendency in the developing occlusion.,,,
Mouth breathing is considered to be the etiological factor for the craniofacial anomalies., and there are reports on the association of the posterior cross bite tendency with the mouth breathers., The prevalence of mouth breathing in the current sample was 10.6% (109). However, higher prevalence rates of 23.2%, 17%, and 13% were observed in few of the earlier studies of similar nature.,, The contrasting findings of lesser prevalence rates of mouth breathing were seen the literature with the prevalence as low as 6.6% and 4.3%.,
The prevalence rate of lip biting was low in the earlier studies, contrastingly high prevalence of lip biting was seen in a current group of participants (8.3%).,,, In our sample, among the oral habits, the least prevalence rate was recorded for bruxism (2.8%). When the results were compared with the other population groups, varying results were appreciated with 17.3% prevalence in Chhattisgarh population  and 0.4% prevalence in Karad population.
On considering the gender-wise distribution of oral habits, statistically nonsignificant difference was found between males and females, with male participants showing a greater prevalence rate than female participants (58.55% vs. 56.25%). This finding is in accordance to the earlier report on the oral habits in different population groups.,, A couple of other studies , contradicted our results, where they found greater prevalence of oral habits in females than in males. Nevertheless, both male and female children had higher prevalence of tongue thrusting and nail biting habit in comparison to other habits in the present study. However, female children had the higher prevalence rate of tongue thrusting and nail biting habits than their male counterparts. In one of the earlier studies, the statistically significant difference was noted for the gender-wise prevalence of nail biting habits, with high prevalence rate in case of female children. Similar findings of statistically significant difference for the gender was noted for the thumb sucking in the earlier studies by Laganà et al. showing significantly higher male to female ratio (12.3% vs. 8.3%) and by Kharbanda et al. (2003) showing significantly greater female prevalence than males (1% vs. 0.4%). The increased prevalence of mouth breathing habit for the males in the current study is support by the similar findings in the earlier studies., However, the difference noted was nonsignificant.
There was statistically significant difference in the age-wise prevalence of the oral habits such as tongue thrusting, thumb sucking, mouth breathing, and bruxism. These habits were more prevalent in the older age group children than, the younger age group. The reason behind this greater prevalence in the older age group is the stronger association with the years of the indulgence in the particular habit. The literature pertaining to the age-wise difference in the prevalence of the oral habits is scanty.
The study did not explore the relationship between the frequency of oral habits and the consequence of the same on the occlusion and status; this was the minor limitation of the study. This limitation can be the aim for the future studies of similar nature.
| Conclusion|| |
Oral habits were detected in half of the examined population (57.73%), there was a significant difference for the age-wise prevalence of oral habits, with older age children indulging more in such kind of habits. Among the oral habits, the highest prevalence rate was registered for tongue thrusting habit. These findings warrant the need for educating the children and the parents about the deleterious effects produced by indulging in such habits. Parallel to this preventive and interceptive procedure to tackle the oral habits have to be planned meticulously to prevent the further damage caused by such habits to the structures of the orofacial region.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Warren JJ, Levy SM, Nowak AJ, Tang S. Non-nutritive sucking behaviors in preschool children: A longitudinal study. Pediatr Dent 2000;22:187-91.
Warren JJ, Bishara SE, Steinbock KL, Yonezu T, Nowak AJ. Effects of oral habits' duration on dental characteristics in the primary dentition. J Am Dent Assoc 2001;132:1685-93.
Tomita NE, Bijella VT, Franco LJ. The relationship between oral habits and malocclusion in preschool children. Rev Saude Publica 2000;34:299-303.
Onyeaso CO, Sote EO. Prevalence of oral habits in 563 Nigerian preschool children age 3-5 years. Niger Postgrad Med J 2001;8:193-5. [Full text]
Bishara SE. Text Book of Orthodontics. 1st
ed. Philadelphia: W.B. Saunders Company; 2004.
Proffit WR. Contemporary Orthodontics. 3rd
ed. St. Louis: Mosby; 2000.
Chaves TC, de Andrade e Silva TS, Monteiro SA, Watanabe PC, Oliveira AS, Grossi DB. Craniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing. Int J Pediatr Otorhinolaryngol 2010;74:1021-7.
Yi LC, Jardim JR, Inoue DP, Pignatari SS. The relationship between excursion of the diaphragm and curvatures of the spinal column in mouth breathing children. J Pediatr (Rio J) 2008;84:171-7.
Cuccia AM, Lotti M, Caradonna D. Oral breathing and head posture. Angle Orthod 2008;78:77-82.
Neiva PD, Kirkwood RN, Godinho R. Orientation and position of head posture, scapula and thoracic spine in mouth-breathing children. Int J Pediatr Otorhinolaryngol 2009;73:227-36.
Lambrechts H, De Baets E, Fieuws S, Willems G. Lip and tongue pressure in orthodontic patients. Eur J Orthod 2010;32:466-71.
Guaba K, Ashima G, Tewari A, Utreja A. Prevalence of malocclusion and abnormal oral habits in North Indian rural children. J Indian Soc Pedod Prev Dent 1998;16:26-30.
Shetty SR, Munshi AK. Oral habits in children – A prevalence study. J Indian Soc Pedod Prev Dent 1998;16:61-6.
Kharbanda OP, Sidhu SS, Sundaram KR. Malocclusion and Associated Factors, Project Report; Indian Council of Medical Research, New Delhi, India; 1991.
Kharbanda OP, Sidhu SS, Sundaram K, Shukla DK. Oral habits in school going children of Delhi: A prevalence study. J Indian Soc Pedod Prev Dent 2003;21:120-4.
Garde JB, Suryavanshi RK, Jawale BA, Deshmukh V, Dadhe DP, Suryavanshi MK. An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children. J Int Oral Health 2014;6:39-43.
Gildasya E, Syarief H. Prevalence of oral habits in homeless children under care of Yayasan Bahtera Bandung. Dent J 2006;39:165-7.
Laganà G, Masucci C, Fabi F, Bollero P, Cozza P. Prevalence of malocclusions, oral habits and orthodontic treatment need in a 7- to 15-year-old schoolchildren population in Tirana. Prog Orthod 2013;14:12.
Motta LJ, Alfaya TA, Marangoni AF, Agnelli R, Mesquita-Ferrari RA, Fernandes KP, et al
. Gender as risk factor for mouth breathing and other harmful oral habits in preschoolers. Braz J Oral Sci 2012;11:377-80.
Dacosta OO, Quashie-Williams R, Isiekwe MC. The prevalence of oral habits among 4 to 15 year old school children in Lagos, Nigeria. Niger Postgrad Med J 2010;17:113-7.
Shetty RM, Shetty M, Shetty NS, Reddy H, Shetty S, Agrawal A. Oral habits in children of Rajnandgaon, Chhattisgarh, India – A prevalence study. Int J Public Health Dent 2013;4:1-7.
Bhayya DP, Shyagali TR. Prevalence of oral habits in 11–13 year-old school children in Gulbarga city, India. Virtual J Orthod 2009;8:1-4.
Krishnappa S, Rani MS, Gowda R. Mapping the prevalence of deleterious oral habits among 10–16-year-old children in Karnataka: A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:399-404. [Full text]
Klocke A, Nanda RS, Kahl-Nieke B. Anterior open bite in the deciduous dentition: Longitudinal follow-up and craniofacial growth considerations. Am J Orthod Dentofacial Orthop 2002;122:353-8.
Ovsenik M. Incorrect orofacial functions until 5 years of age and their association with posterior crossbite. Am J Orthod Dentofacial Orthop 2009;136:375-81.
Katz CR, Rosenblatt A, Gondim PP. Nonnutritive sucking habits in Brazilian children: Effects on deciduous dentition and relationship with facial morphology. Am J Orthod Dentofacial Orthop 2004;126:53-7.
Góis EG, Ribeiro-Júnior HC, Vale MP, Paiva SM, Serra-Negra JM, Ramos-Jorge ML, et al.
Influence of nonnutritive sucking habits, breathing pattern and adenoid size on the development of malocclusion. Angle Orthod 2008;78:647-54.
Souki BQ, Pimenta GB, Souki MQ, Franco LP, Becker HM, Pinto JA. Prevalence of malocclusion among mouth breathing children: Do expectations meet reality? Int J Pediatr Otorhinolaryngol 2009;73:767-73.
[Table 1], [Table 2], [Table 3], [Table 4]