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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 22-27

Oral parafunctional habits among preschool children in Riyadh, Saudi Arabia


1 University Staff Clinic, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
2 Dental Department, Armed Forces Hospital King Abdulaziz Airbase, Dhahran, Saudi Arabia
3 Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt

Date of Web Publication12-Mar-2018

Correspondence Address:
Amel Darwish
Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Alexandria
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjos.SJOralSci_46_17

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  Abstract 


Aim: The aim of the study is to assess the prevalence and the related factors of parafunctional oral habits among preschool children in Riyadh, Saudi Arabia.
Materials and Methods: The study sample included 435 children (3–6 years) randomly selected from public and private preschools in the different regions of Riyadh. Questionnaires were distributed to be filled by children's parents. The questionnaire included questions concerning child's feeding method during infancy, number of the child siblings, and his/her order among them. The other part of the questionnaire included questions concerning the types of parafunctional habits that the child might suffer from. The last part inquired if the child suffered from psychological, social, medical, or sleeping problems. Descriptive statistics were performed and Pearson's Chi-square test was used to observe the relations between categorical study and outcome variables.
Results: Nail-biting habit was highly prevalent among the study samples (27.2%), followed by mouth breathing during sleeping (13.8%), thumb sucking (7.4%), and teeth clenching (6.0%). A statistically significant relation was found between the age groups and teeth clenching and lip sucking habits (P = 0.001).There was a highly statistically significant relation between malocclusion and the habits of thumb sucking and pacifier sucking (P = 0.001 and 0.01, respectively). Protrusion of anterior teeth was statistically significantly related to thumb sucking (P < 0.0001). Respiratory and tonsils problems were related to mouth breathing (P = 0.004 and < 0.0001, respectively). The presence of dental caries was statistically significantly related to the habit of teeth clenching (P = 0.03).
Conclusion: Nail-biting habit was highly prevalent among preschool children in Riyadh, followed by mouth breathing, thumb sucking, and teeth clenching. Malocclusion was the main factor related to the habits of thumb sucking and pacifier sucking. Respiratory and tonsils problems were related to mouth breathing. Teeth clenching was highly related to the presence of carious teeth.

Keywords: Habits, oral, parafunctional, preschool, Riyadh, Saudi Arabia


How to cite this article:
Aloumi A, Alqahtani A, Darwish A. Oral parafunctional habits among preschool children in Riyadh, Saudi Arabia. Saudi J Oral Sci 2018;5:22-7

How to cite this URL:
Aloumi A, Alqahtani A, Darwish A. Oral parafunctional habits among preschool children in Riyadh, Saudi Arabia. Saudi J Oral Sci [serial online] 2018 [cited 2018 May 26];5:22-7. Available from: http://www.saudijos.org/text.asp?2018/5/1/22/227132




  Introduction Top


Oral parafunctional habits are considered to be abnormal motor activities of the masticatory system that differ from its normal functions qualitatively and quantitatively.[1] Three types are included in oral parafunctional habits; biting activities (e.g., nail-biting), a bruxism (teeth clenching) activities, and soft tissue activities (e.g., thumb sucking or finger sucking, pacifier sucking, tongue thrusting, and lip biting). They may be also classified into occlusal (including contacts of opposing teeth) and nonocclusal (biting of labial and buccal mucosa).[2]

Thumb sucking is sucking of the thumb after the period of physiological need because of stress, fear, or psychological problems.[3] A cross-sectional study conducted on Saudi preschool children (3–5 years) living in Riyadh showed that the prevalence of sucking habits was 48.4% and the pacifier sucking was the most common type. Most pacifier suckers had stopped the habit in the first few years of their lives, whereas more thumb suckers were still active at 5 years of age. It was found that gender, birth order, or family income had no significant effect on sucking habits which were found to be only related to parents' education and the child feeding methods.[4]

Tongue thrusting is extending the tongue between the maxillary and the mandibular incisor teeth or alveolar ridges during the initial stage of swallowing.[5] It was reported that the main etiological factors of tongue thrusting were related to the child's physiology (maturation) and anatomy (growth).[6]

Lip biting is placing the lip between the maxillary and the mandibular teeth with more or less active application of the teeth to the lip.[7]

Mouth breathing is the habit, in which the mouth is used for breathing instead of the nose, usually because of an obstruction in the nasal cavity.[8] Adenoids are the main cause of mouth breathing; however, pediatricians should assess other causes if mouth breathing was not corrected after adenoidectomy.[9]

Bruxism is a habit that is characterized by grinding or clenching of the teeth and may occur during sleep (sleep bruxism) as well as during wakefulness.[10] A study conducted on 7-year-old children, showed that children with sleep bruxism presented quality of life scores that were similar to those without the habit, and children from the youngest mothers were more likely to present sleep bruxism.[10]

Fingernail-biting is biting on the fingernail with teeth.[11] A study conducted on Saudi schoolchildren, showed that fingernail-biting was the most common oral parafunctional habit (27.7%) while bruxism was the least common habit (8.4%).[12] All oral parafunctional habits, except bruxism, were significantly related to age. Cheek biting and thumb sucking were observed more in females than in males.[12]

The aim of this study is to assess the prevalence and the related factors of the different types of oral parafunctional habits among preschool children in Riyadh so that the results can be used in successfully directing the oral health education programs to reduce the prevalence of oral habits among children in Saudi Arabia.


  Materials and Methods Top


This observational, descriptive, cross-sectional study was ethically approved by the College of Dentistry Research Center, King Saud University, Riyadh, Saudi Arabia. The study included preschool children in ten preschools in Riyadh which were randomly selected from the five regions of Riyadh (north, south, center, east, and west). Two preschools (one public and one private) were randomly selected from each region.

A questionnaire, which was approved by the Ministry of Education, was distributed to 100 children in each school to be answered by their parents, so the whole number of distributed questionnaires was 1000. The questionnaire began with a brief explanation of the aim of the study; then, a statement indicating to the children's parents that their answers would be stored and transmitted securely for protecting confidentiality.

The first part of the questionnaire included personal information (child's age, gender, nationality and residence, and the parents' education and occupation). The second part concerned the child's feeding method during infancy, number of the child siblings, and his/her order among them. The third part concerned the types of parafunctional habits that the child might suffer from. The fourth part inquired if the child suffered from psychological, social, medical, or sleeping problems. The questionnaire validity was achieved by reviewing literature and asking experts in pediatric dentistry.

Data were analyzed using SPSS Pc + version 21.0 statistical software. Descriptive statistics (frequency and percentages) were used to quantify the study variables. Pearson's Chi-square test was used to observe the relation between categorical study and outcome variables. P < 0.05 was considered statistically significant.


  Results Top


Out of 1000 distributed questionnaires, 435 was the number of respondents, giving a response rate of 43.5%. About 58% were in the age group of 5–6 years, and 55% of the study samples were females. About 55% were from public schools and 84.7% had Saudi nationality. The study participants' fathers' education was “bachelor and postgraduate” in 69.7% and only 7% were with elementary and intermediate school education. About 68.1% of fathers were working as officers and 28.6% were professionals, whereas 68.1% of mothers' education was bachelor and postgraduate and only 19.8% were working as officers; 18.2% were professionals and 58.8% were not working [Table 1].
Table 1: Distribution of sociodemographic characteristics study subjects

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The prevalence of oral parafunctional habits among the study sample was quantified on a binary scale (yes/no), where nail-biting was highly prevalent (27.2%), followed by mouth breathing during sleep (13.8%), thumb sucking (7.4%), and teeth clenching (6.0%) [Figure 1].
Figure 1: Prevalence (%) of oral parafunctional habits among preschool children in Riyadh

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Relation of oral parafunctional habits and the sociodemographic characteristics among the study sample is presented in [Table 2]. The univariate analysis indicates statistically significant relation between the age groups and teeth clenching and lip sucking habits. The prevalence of teeth clenching is statistically significantly higher 12% in 4–5-year age group and 8% in 5–6-year age group when compared to 0% in 3–4-year age group (χ2 = 14.8, P = 0.001). Whereas the lip sucking habit is statistically significantly higher 10% in 3–4-year age group when compared to 4–5-year age group (1.3%) and 0.8% in 5–6-year age group (χ2 = 14.3, P = 0.001). The prevalence of mouth breathing during sleep is statistically significantly higher 18% in male children, when compared to 10.5% in female children (χ2 = 5.1, P = 0.02). The prevalence of tongue thrusting is statistically significantly higher (5.6%) in children studying in private schools when compared to 1.7% in children studying in public schools (χ2 = 4.9, P = 0.03).
Table 2: Relation of oral para-functional habits and the sociodemographic characteristics among the study sample

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The data did not provide any statistically significant relation between oral parafunctional habits and child's birth order, child's number of siblings, child's feeding habits, and general health problems [Table 3].
Table 3: Relation of oral para-functional habits and child's birth order, number of siblings, feeding habits and general health problems among preschool children in Riyadh

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Relation of oral parafunctional habits and social, health, and dental problems among the study sample is presented in [Table 4]. There was a highly statistically significant relation between malocclusion and the habits of thumb sucking and pacifier sucking, where 23.5% and 8.8% of children who had malocclusion were having habits of thumb sucking and pacifier sucking, respectively, when compared to 5.9% and 1.8% who did not have malocclusion (χ2 = 14.4, P = 0.001; χ2 = 6.7, P = 0.01, respectively). Protrusion of anterior teeth was statistically significantly related to thumb sucking, where 40% of children with anterior teeth protrusion were having thumb sucking when compared to 5.4% children without anterior teeth protrusion and having the habit of thumb sucking (χ2 = 34.9; P < 0.0001). The respiratory and tonsil problems of children were related to mouth breathing, where 51.2% of children with respiratory problems and 10.9% of children with tonsils problems were having the habit of mouth breathing, when compared to 9.7% of children without respiratory problems and 3.1% of children without tonsils problems who were having the habit of mouth breathing (χ2 = 54.0, P < 0.0001; χ2 = 8.2, P = 0.004, respectively). The presence of dental caries was statistically significantly related to the habit of teeth clenching, where 9.3% of children with dental caries were having the habit of teeth clenching when compared to 4.1% of children with no dental caries (χ2 = 4.6; P = 0.03).
Table 4: Relation of oral para-functional habits and social, health and dental problems among preschool children in Riyadh

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  Discussion Top


This cross-sectional study was conducted to assess the prevalence of oral parafunctional habits among preschool children in Riyadh. About 1000 questionnaires were distributed, but the number of the respondents was 435. The questionnaires had been sent to mothers through their children and some mothers did not fill the questionnaire which affected the response rate.

Nail-biting habit was highly prevalent among the study samples (27.2%), followed by mouth breathing (13.8%), thumb sucking (7.4%), and teeth clenching (6.0%). This agrees with other study which found that nail-biting was the most prevalent habit among schoolchildren in Mangalore, India.[13] This disagrees with Murshid et al., who concluded that teeth clenching was the most prevalent oral habit in Jeddah followed by mouth breathing. On the other hand, Abou-Atme et al. found that there was a higher prevalence of bruxism (33.9%) compared to this study.[14] Different prevalence values of the previous studies might be attributed to the difference of the regions, age, and socioeconomic status of the populations examined.[15]

Mouth breathing showed a statistically significant relation with gender; male children had higher prevalence (18%) when compared with females (10.5%). This agrees with Kharbanda et al., who found that mouth breathing was more common among male children (7.8%) than female ones (5.3%).[16] This disagrees with Murshid et al., who concluded that there was no statistically significant relation between mouth breathing and gender. Mouth breathing had also a statistically significant relation with respiratory and tonsils problems.[14] This agrees with Albinita and Octavian, who found that the main etiological factors of mouth breathing were adenoids and nasal septum deviation.[17]

Age was found to be statistically related to teeth clenching and lip sucking habits. Teeth clenching was more prevalent (12%) among 4–5-year age group and less prevalent (8%) in 5–6-year age group. The 3–4-year age group included no participants having teeth clenching. This agrees with a previous study which concluded that the prevalence of the oral habits might decrease with age.[4]

Teeth clenching was statistically significantly related to the presence of carious teeth. This might be because teeth clenching results in exposing dentin making teeth more vulnerable to dental caries. However, there was no statistically significant relation between teeth clenching and psychological problems. This disagrees with Antonio et al., who concluded that bruxism might be triggered by psychological disturbances.[18]

It was found that there were highly statistically significant relations between malocclusion and the habits of thumb sucking and pacifier sucking. This agrees with Al-Hussyeen and Baidas, who reported that the prolonged finger sucking habit was associated with major changes in occlusion which included protrusion of upper incisors, anterior open bite, and increased overjet and crossbite.[19] However, Tomita et al. found that pacifier sucking habit was the most common habit associated with malocclusion (odds ratio [OR] =5.46) followed by finger sucking habit (OR = 1.54).[20]

There was no statistically significant relation between oral parafunctional habits and child's birth order, number of siblings, feeding habits, and general health problems. In contrast, Murshid et al. found a relative relation between the habits (bruxism and thumb sucking) and mean number of siblings which might be due to maternal deprivation.[14]

This study was cross-sectional which did not allow the examination of cause and effect relations. Analytical studies are recommended to be conducted to assess the risk factors of oral parafunctional habits among preschool children in Riyadh.


  Conclusion Top


In view of the preceding results, it can be concluded that the nail-biting habit was highly prevalent among preschool children in Riyadh, followed by mouth breathing, thumb sucking, and teeth clenching. Malocclusion was the main factor related to the habits of thumb sucking and pacifier sucking. Teeth clenching was highly related to the presence of carious teeth.

Oral health educational programs are recommended to be performed in all preschools of Saudi Arabia not only for students but also for the parents to enhance the awareness of the problem of oral parafunctional habits among preschool children and its effects on the children's oral and general health.

Acknowledgments

The authors would like to thank Dr. Shaffi Ahamed for helping in statistical analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gowri Shankar S, Arvind M. Evidence levels of parafunctional habits as prominent etiology in facial arthromyalgia: A systematic review. E J Dent 2013;3:318-24.  Back to cited text no. 1
    
2.
Council of Clinical Affairs. Policy on Oral Habits. American Academy of Pediatric Dentistry; 2006.  Back to cited text no. 2
    
3.
Thumb-Sucking. Available from: http://www.merriam-webster.com/ medical/thumb-sucking. [Last accessed on 2014 Apr].  Back to cited text no. 3
    
4.
Farsi NM, Salama FS. Sucking habits in Saudi children: Prevalence, contributing factors and effects on the primary dentition. Pediatr Dent 1997;19:28-33.  Back to cited text no. 4
    
5.
The American Heritage Medical Dictionary; 2007.  Back to cited text no. 5
    
6.
Dean J, McDonald R, Avery D. McDonald and Avery Dentistry for the Child and Adolescent. 8th ed. Ch. 27. Elsevier: A Divisionof Reed Elsevier India Pvt. Ltd.; 2004. p. 649.  Back to cited text no. 6
    
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Lip-Biting. Available from: http://www.medical-dictionary. thefreedictionary.com/lip + biting. [Last accessed on 2014 Apr].  Back to cited text no. 7
    
8.
Mosby's Medical Dictionary. 8th ed. Elsevier; 2009. Available from: http://www.medical-dictionary.thefreedictionary.com/mouth + breathing. [Last accessed on 2014 Apr].  Back to cited text no. 8
    
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Castelo PM, Barbosa TS, Gavião MB. Quality of life evaluation of children with sleep bruxism. BMC Oral Health 2010;10:16.  Back to cited text no. 10
    
11.
Ghanizadeh A. Nail biting; Etiology, consequences and management. Iran J Med Sci 2011;36:73-9.  Back to cited text no. 11
    
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Farsi NM. Symptoms and signs of temporomandibular disorders and oral parafunctions among Saudi children. J Oral Rehabil 2003;30:1200-8.  Back to cited text no. 12
    
13.
Shetty SR, Munshi AK. Oral habits in children – a prevalence study. J Indian Soc Pedod Prev Dent 1998;16:61-6.  Back to cited text no. 13
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Murshid Z, Phil M, Abdulaziz AM, Amin HE, Al-Nowaiser AM. Assessment of parafunctional oral habits among a sample of Saudi dental patients. Med Sci 2007;14:35-47.  Back to cited text no. 14
    
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Abou-Atme YS, Melis M, Zawawi KH. Bruxism prevalence in a selective Lebanese population. J Leban Dent 2004;41:31-5.  Back to cited text no. 15
    
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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.  Back to cited text no. 16
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Albinita C, Octavian C. Mouth Breathing – An Ecological Factor of Dental and Maxillary Abnormality. Vol. 11-B. 2013.  Back to cited text no. 17
    
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Antonio AG, Pierro VS, Maia LC. Bruxism in children: A warning sign for psychological problems. J Can Dent Assoc 2006;72:155-60.  Back to cited text no. 18
    
19.
Al-Hussyeen A, Baidas L. Prevalence of non-nutritive sucking habits among Saudi children and its effects on primary dentition. Pak Oral Dent J 2009;29:69-78.  Back to cited text no. 19
    
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Tomita NE, Bijella VT, Franco LJ. The relationship between oral habits and malocclusion in preschool children. Rev Saude Publica 2000;34:299-303.  Back to cited text no. 20
    


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