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Other body-focused repetitive behaviors include excoriation disorder (skin picking), dermatophagia (skin biting), and trichotillomania (the urge to pull out hair), and all of them tend to coexist with nail biting. As an oral parafunctional activity, it is also associated with bruxism (tooth clenching and grinding), and other habits such as pen chewing and cheek biting.
In children nail biting most typically co-occurs with attention deficit hyperactivity disorder (75% of nail biting cases in a study), and other psychiatric disorders including oppositional defiant disorder (36%) and separation anxiety disorder (21%). It is also more common among children and adolescents with obsessive–compulsive disorder. Nail biting appeared in a study to be more common in men with eating disorders than in those without them.
Nail biting usually leads to deleterious effects in fingers, but also mouth and more generally the digestive system. These consequences are directly derived from the physical damage of biting or from the hands becoming an infection vector. Moreover, it can also have a social impact.
The ten fingernails are usually equally bitten to approximately the same degree. Biting nails can lead to broken skin on the cuticle. When cuticles are improperly removed, they are susceptible to microbial and viral infections such as paronychia. Saliva may then redden and infect the skin. In rare cases, fingernails may become severely deformed after years of nail biting due to the destruction of the nail bed.
Nail biting may have an association with oral problems, such as gingival injury, and malocclusion of the anterior teeth. It can also transfer pinworms or bacteria buried under the surface of the nail from the anus region to the mouth. If the bitten-off nails are swallowed, stomach problems can occasionally develop.
Nail-biting can be a source of guilt and shame feelings in the nail biter, a reduced quality of life, and increased stigmatization in the inner family circles or at a more societal level.
Dermatophagia sufferers chew their skin out of compulsion, and can do so on a variety of places on their body. Sufferers typically chew the skin surrounding their fingernails and joints. They also chew on the inside of their mouth, cheeks, and/or lips, causing blisters in and outside of the mouth. If the behavior is left unchecked for an extended period, calluses may start to develop where most of the biting is done.
Skin chewing can be bolstered by times of apprehension and other unpleasant events. Blisters in particular can cause a feeling of desire to pull or bite off the affected skin (since the skin is dead, thus easily pulled off), which could be detrimental, causing infection. Another disorder, known as dermatillomania , the act of picking at one's skin, can sometimes accompany dermatophagia. People who suffer from dermatophagia can also be prone to infection as when they bite their fingers so frequently, they make themselves vulnerable to bacteria seeping in and causing infection. Dermatophagia can be considered a "sister" disorder to trichophagia, which involves compulsively biting and eating one's hair.
Dermatophagia (from Ancient Greek "δέρμα" - skin - and "φαγεία" - eating) is a compulsion of gnawing or eating one's own skin, most commonly at the fingers. Sufferers typically bite the skin around the nails, leading to bleeding and discoloration over time. Some may consume the flesh during an episode.
Contemporary research suggests a link between impulse control disorders and obsessive–compulsive disorders, and this may be addressed in the "DSM-5", published in May 2013. Further information on OCD, other anxiety disorders, and dermatophagia and other impulse-control disorders can be found in the "DSM-IV TR".
The lesions are located on the mucosa, usually bilaterally in the central part of the anterior buccal mucosa and along the level of the occlusal plane (the level at which the upper and lower teeth meet). Sometimes the tongue or the labial mucosa (the inside lining of the lips) is affected by a similarly produced lesion, termed morsicatio linguarum and morsicatio labiorum respectively. There may be a coexistent linea alba, which corresponds to the occlusal plane, or crenated tongue. The lesions are white with thickening and shredding of mucosa commonly combined with intervening zones of erythema (redness) or ulceration. The surface is irregular, and people may occasionally have loose sections of mucosa that comes away.
The cause is chronic parafunctional activity of the masticatory system, which produces frictional, crushing and incisive damage to the mucosal surface and over time the characteristic lesions develop. Most people are aware of a cheek chewing habit, although it may be performed subconsciously. Sometimes poorly constructed prosthetic teeth may be the cause if the original bite is altered. Usually the teeth are placed too far facially (i.e. buccally and/or labially), outside the "neutral zone", which is the term for the area where the dental arch is usually situated, where lateral forces between the tongue and cheek musculature are in balance. Glassblowing involves chronic suction and may produce similar irritation of the buccal mucosa. Identical, or more severe damage may be caused by self-mutilation in people with psychiatric disorders, learning disabilities or rare syndromes (e.g. Lesch-Nyhan syndrome and familial dysautonomia).
The main BFRB disorders are:
- Skin
- Dermatillomania (excoriation disorder), skin picking
- Dermatophagia, skin nibbling
- Mouth
- Morsicatio buccarum, cheek biting
- Morsicatio labiorum, inner lip biting
- Morsicatio buccarum, tongue biting
- Hands
- Onychophagia, nail biting
- Onychotillomania, nail picking
- Nose
- Rhinotillexomania, compulsive nose picking
- Hair
- Trichophagia, hair nibbling
- Trichotemnomania, hair cutting
- Trichotillomania, hair pulling
The reported symptoms are very variable, and frequently have been present for many months before the condition is diagnosed. Reported symptoms may include some of the following:
- Sharp pain when biting on a certain tooth, which may get worse if the applied biting force is increased. Sometimes the pain on biting occurs when the food being chewed is soft with harder elements, e.g. seeded bread.
- "Rebound pain" i.e. sharp, fleeting pain occurring when the biting force is released from the tooth, which may occur when eating fibrous foods.
- Pain when grinding the teeth backward and forward and side to side.
- Sharp pain when drinking cold beverages or eating cold foods, lack of pain with heat stimuli.
- Pain when eating or drinking sugary substances.
- Sometimes the pain is well localized, and the individual is able to determine the exact tooth from which the symptoms are originating, but not always.
If the crack propagates into the pulp, irreversible pulpitis, pulpal necrosis and periapical periodontitis may develop, with the respective associated symptoms.
Symptoms of an ingrown nail include pain along the margins of the nail (caused by hypergranulation that occurs around the aforementioned margins), worsening of pain when wearing tight footwear, and sensitivity to pressure of any kind, even the weight of bedsheets. Bumping of an affected toe can produce sharp and even excruciating pain as the tissue is punctured further by the nail. By the very nature of the condition, ingrown nails become easily infected unless special care is taken early to treat the condition by keeping the area clean. Signs of infection include redness and swelling of the area around the nail, drainage of pus and watery discharge tinged with blood. The main symptom is swelling at the base of the nail on the ingrowing side (though it may be both sides).
Onychocryptosis should not be confused with a similar nail disorder, convex nail, nor with other painful conditions such as involuted nails, nor with the presence of small corns, callus or debris down the nail sulci (grooves on either side).
Onychotillomania is a compulsive neurosis in which a person picks constantly at the nails or tries to tear them off. It is not the same as onychophagia, where the nails are bitten or chewed or dermatillomania, where skin is bitten or scratched.
It is commonly associated with psychiatric disorders such as depressive neurosis, delusions of infestation and hypochondriasis.
It was named by Professor Jan Alkiewicz, a Polish dermatologist.
The constant destruction of the nail bed leads to onychodystrophy, paronychia and darkening of the nail.
Some cases have been treated successfully with antipsychotics.
One cheap solution suggested by researchers is to cover the proximal nail fold with a Cyanoacrylate glue. "The mechanism of action for improvement is probably related to the presence of an obstacle to picking."
Onychorrhexis (from the Greek words ὄνυχο- "ónycho-", "nail" and ῥῆξις "rhexis", "bursting"), also known as brittle nails, is a brittleness with breakage of finger or toenails that may result from excessive strong soap and water exposure, nail polish remover, hypothyroidism, anemia, anorexia nervosa or bulimia, or after oral retinoid therapy. Onychorrhexis affects up to 20% of the population.
Cracked tooth syndrome could be considered a type of dental trauma and also one of the possible causes of dental pain. One definition of cracked tooth syndrome is "a fracture plane of unknown depth and direction passing through tooth structure that, if not already involving, may progress to communicate with the pulp and/or periodontal ligament."
An ingrown nail (also known as onychocryptosis from ὄνυξ ("onyx", "nail") + κρυπτός ("kryptos", "hidden") or unguis incarnates) is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the paronychium or nail bed.
The common opinion is that the nail enters inside the paronychium, but an ingrown toenail can simply be overgrown toe skin. The condition starts from a microbial inflammation of the paronychium, then a granuloma, which results in a nail buried inside of the granuloma. While ingrown nails can occur in the nails of both the hands and the feet , they occur most commonly with the toenails.
A true ingrown toenail is caused by the actual penetration of flesh by a sliver of nail.
Clinically, there is a number of physiological results that serve as evidence of occlusal trauma:,
- Tooth mobility
- Fremitus
- Tooth migration
- Pain
- Thermal sensitivity
- Pain on chewing or percussion
- Wear facets
A hangnail is a small, torn piece of skin, more specifically eponychium or paronychium, next to a fingernail or toenail.
Microscopically, there will be a number of features that accompany occlusal trauma:
- Hemorrhage
- Necrosis
- Widening of the periodontal ligament, or PDL (also serves as a very common radiographic feature)
- Bone resorption
- Cementum loss and tears
It was concluded that widening of the periodontal ligament was a "functional adaptation to changes in functional requirements".
Abrasion is a pathological, non-carious tooth loss that most commonly affects the premolars and canines. Abrasion frequently presents at the cemento-enamel junction and can be caused by many contributing factors, all with the ability to affect the tooth surface in varying degrees.
Sources of abrasion may arise from oral hygiene habits such as toothbrushes, toothpicks, floss, and dental appliance or may arise from other habits such as nail biting, chewing tobacco or another object. Abrasion can also occur from the type of dentifrice being utilized as some have more abrasive qualities such as whitening toothpastes.
The appearance may vary depending on the aetiology of abrasion, however most commonly presents in a V-shaped caused by excessive lateral pressure whilst tooth-brushing. The surface is shiny rather than carious, and sometimes the ridge is deep enough to see the pulp chamber within the tooth itself.
In order for successful treatment of abrasion to occur, the aetiology first needs to be identified and ceased, e.g. overzealous brushing. Once this has occurred subsequent treatment may involve the changes in oral hygiene or toothpaste, application of fluoride to reduce sensitivity or the placement of a restoration to aid in reducing the progression of further tooth loss.
Hangnails can become infected and cause paronychia, a type of skin infection that occurs around the nails. Treatments for paronychia vary with severity, but may include soaking in hot salty water, the use of oral antibiotic medication, or clinical lancing. Paronychia itself rarely results in further complications but can lead to abscess, permanent changes to the shape of the nail or the spread of infection.
Body-focused repetitive behavior (BFRB) is an umbrella name for impulse control behaviors involving compulsively damaging one's physical appearance or causing physical injury.
Body-focused repetitive behavior disorders (BFRBDs) in ICD-11 is in development.
BFRB disorders are not generally considered obsessive-compulsive disorders.
Dermoodontodysplasia is dental problems, trichodysplasia, and nail and skin problems.
Other kinds of malocclusions can be due to tooth size or horizontal, vertical, or transverse skeletal discrepancies, including skeletal asymmetries. Long faces may lead to "open bite malocclusion", while short faces can be coupled to a "Deep bite malocclusion". However, there are many other more common causes for open bites (such as tongue thrusting and thumb sucking), and likewise for deep bites. Upper or lower jaw can be overgrown or undergrown, leading to Class II or Class III malocclusions that may need corrective jaw surgery or orthognathic surgery as a part of overall treatment, which can be seen in about 5% of the general population.
Oral habits and pressure on teeth or the maxilla and mandible are causes of malocclusion.
In the active skeletal growth, mouthbreathing, finger sucking, thumb sucking, pacifier sucking, onychophagia (nail biting), dermatophagia, pen biting, pencil biting, abnormal posture, deglutition disorders and other habits greatly influence the development of the face and dental arches.
Pacifier sucking habits are also correlated with otitis media.
Dental caries, periapical inflammation and tooth loss in the deciduous teeth alter the correct permanent teeth eruptions.
Erosion is chemical dissolution of tooth substance caused by acids, unrelated to the acid produced by bacteria in dental plaque. Erosion may occur with excessive consumption of acidic foods and drinks, or medical conditions involving repeated regurgitation and reflux of gastric acid. derived from the Latin word "erosum", which describes the action ‘to corrode’. This is usually on the palatal (inside) surfaces of upper front teeth and the occluding (top) surfaces of the molar teeth.
- Gastroesophageal reflux disease (GERD)
- Vomiting, e.g. bulimia, alcoholism
- Rumination
- Eructation (burping)
- Dietary - liquids of low pH and high titratable acids.
Tooth wear (also termed non-carious tooth substance loss) refers to loss of tooth substance by means other than dental caries or dental trauma. Tooth wear is a very common condition that occurs in approximately 97% of the population. This is a normal physiological process occurring throughout life, but accelerated tooth wear can become a problem.
Tooth wear is majorly the result of three processes; attrition, abrasion and erosion. These forms of tooth wear can further lead to a condition known as abfraction, where by tooth tissue is 'fractured' due to stress lesions caused by extrinsic forces on the enamel. Tooth wear is a complex, multi-factorial problem and there is difficulty identifying a single causative factor. However, tooth wear is often a combination of the above processes. Many clinicians therefore make diagnoses such as "tooth wear with a major element of attrition", or "tooth wear with a major element of erosion" to reflect this. This makes the diagnosis and management difficult. Therefore, it is important to distinguish between these various types of tooth wear, provide an insight into diagnosis, risk factors, and causative factors, in order to implement appropriate interventions.
Multiple indices have been developed in order to assess and record the degree of tooth wear, the earliest was that by Paul Broca. In 1984, Smith and Knight developed the tooth wear index (TWI) where four visible surfaces (buccal, cervical, lingual, occlusal-incisal) of all teeth present are scored for wear, regardless of the cause.
Apical abscesses can spread to involve periodontal pockets around a tooth, and periodontal pockets cause eventual pulp necrosis via accessory canals or the apical foramen at the bottom of the tooth. Such lesions are termed periodontic-endodontic lesions, and they may be acutely painful, sharing similar signs and symptoms with a periodontal abscess, or they may cause mild pain or no pain at all if they are chronic and free-draining. Successful root canal therapy is required before periodonal treatment is attempted. Generally, the long-term prognosis of perio-endo lesions is poor.