What Are Habitual Bite Injuries?
Children suffering from developmental or psychological problems often inflict themselves with oral injuries by chronically biting a specific part of the oral mucosa, such as the lips, tongue, cheeks, and the labial and buccal mucosa (inner lining of the lips and cheeks). This chronic biting of oral mucosa is also known as Morsicato mucosae oris and needs to be addressed by a healthcare provider or a dentist. Such biting cases are not usually reported in normal, unaffected individuals as it may be unintentional; however, it can damage the oral tissues, making them prone to diseases, especially in individuals with low immunity. These injuries are usually seen on the buccal, labial mucosa, or the lateral surface of the tongue.
Biting of the oral mucosa may be either acute or a chronic oral habit which is currently deemed prevalent in nearly 750 out of every one million individuals globally. Females are more commonly affected by such habits in comparison to males. This condition, particularly in children, leads to thick and scarred skin of the oral mucosa leading to non-healing scars, swelling at the site of injury, bleeding, and erosions.
What Are Some of the Causes of Habitual Bite Injuries?
Habitual lip or cheek biting is considered chronic and a psychogenic habit in most individuals associated with a wide range of underlying emotions. Lip or cheek biting, even in mild or moderate forms, is a form of self-mutilation. In children, such injuries may occur in response to specific oral stimuli or when the child attempts to gain the attention of its family members or caretakers. In mild injuries precipitated by trauma, they can eventually wane away as they are transient and self-limiting, requiring no management by the dentist. However, in some individuals, the habitual lip or cheek biting becomes a compulsion pattern, increasing in frequency throughout the day; the parents or caretakers should consult a dentist to break such habit patterns and identify the causative or stress factors behind such behavior.
In bite injuries associated with stress, a vicious cycle occurs due to repeated traumatic injuries in the same region, such as the lips, cheeks, or any region of the oral mucosa. This subsequently results in an inflammatory lesion, which may aggravate time and again when the child follows the habit. It is common to go unnoticed by the parents or guardians because of the asymptomatic oral manifestations and its subconscious behavior compared to very obvious habits like digit sucking or nail biting.
What Are Some of the Conditions Similar To Habitual Bite Injuries?
A wide spectrum of oral conditions or diseases would mimic the lesions of chronic bite injuries; hence a pediatric dentist must establish a confirmatory diagnosis. The lesions that may resemble traumatic oral conditions in children include:
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The formation of thick, white, sponge or velvet-like patches is seen in a genetic mucosal disease called white sponge nevus.
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An allergic reaction of the oral mucosa due to heat, chemical substances, or trauma is known as allergic contact stomatitis.
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Thick white patches in the oral mucosa are seen in smokeless tobacco lesions, etc.
How Are Habitual Bite Injuries Diagnosed?
Pediatric dentists can easily notice and diagnose chronic biting lesions in children. A pediatrician or dentist analyses the cause of such behavior or identifies any stress-related compulsive patterns causing repeated injury to the oral tissues. A bond of friendship created between the pediatric dentist and the child would help the child outgrow the fears or stress and helps in the discontinuation of such habits.
How Can Habitual Bite Injuries Be Managed?
Several treatment options have been implemented in the last few decades to prevent or control habitual trauma to oral mucosa in children. The treatment modality for the child is designed and considered carefully by interaction with the child and its parents, depending on the nature of the habit, the cause of the stress, and the severity of the lesion. It includes:
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Reconditioning: The pediatric dentist aims to counsel and educate the child to help them avoid abnormal behavior by following relaxation techniques or, in chronic cases, with the help of sedatives.
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Oral Appliances or Habit-Breaking Appliances: With these appliances, the oral mucosa of the child can be protected from further harm and injury. Removable tongue or lip shields, shields for the cheek mucosa, lip bumpers, silicone shields, oral screens, occlusal splints, and soft mouth guards are all examples of such habit-breaking appliances that can be advised by a pediatric dentist.
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Pediatric Non-surgical and Surgical Options: These include selective grinding of the occlusal surfaces, biting sharp edges of the offending teeth causing oral trauma or maybe even extracting these offending teeth in extreme habit patterns. These options would be considered only when the habits are more progressive with age or in uncooperative children who cannot follow counseling or comply with habit-breaking appliances. It may also be preferred in aggravating and persistent lesions which do not heal due to repeated injuries.
Conclusion:
Habitual biting of oral mucosa is a detrimental habit commonly seen in children and affects the lips, tongue, cheeks, and labial and buccal mucosa. Various treatment options exist for these injuries or chronic oral biting such as dental counseling, psychiatric treatment, or relaxation techniques. Dental management helps treat the effects of such habits along with implementing positive behavior.
