Search

Featured Application: Nail biting is a very common oral disorder whose dental and clinical implication are not well-known. Therefore, this study is a novelty in the field of oral disease since it considers changes on tooth shape caused by nail biting. Nail biting (NB) is a repetitive and uncontrolled parafunctional activity that can affect oral health by altering tooth shape and intraoral position. Nowadays, there is not enough scientific evidence about the impact of NB on teeth; therefore, this study aimed to evaluate the effects of NB on the length, width and inclination of upper central incisors. This retrospective study involved 76 patients, 40 males and 36 females, with a mean age of 10.6 ± 0.3 years. Digital scans of the maxillary arch of each patient were recorded. Next, the length, width and inclination of upper central incisors used and not used for NB were measured. Finally, data were analysed with a paired t-test. Statistical analysis showed statistically significant differences in the length and inclination of upper central incisors used for NB compared with those of upper central incisors not used for NB, while the width did not show a significant difference. There were relevant changes in upper central incisors subjected to NB, demonstrating that NB impairs the shape, morphology and inclination of teeth. Therefore, because of the potentially negative consequences of NB, it is recommended that NB not be underestimated. [ABSTRACT FROM AUTHOR]

Background: Risk factors of intestinal helminthiasis include helminths isolated. Behavioural aberrations were represented more behavioural aberrations such as finger sucking, nail biting and pica which had been found to enhance intestinal ova transmission. Objectives: To determine risk fac tors of intestinal helminthiasis in poor personal hygiene/care, and in infected subjects than the non Subjects and Methods: Fresh stool samples from 140 children (0 – 17 years) living in 10 orphanages in Benin City, were analyzed using the Kato-Katz technique for the detection of ova of helminths between January-April, 2011. Results: Prevalence of intestinal helminthiasis was 20.7%. Children ages 12 – 17 years had highest prevalence of intestinal helminths. Ascaris lumbricoides and Trichuris trichiura were the intestinal infected children (χ2= 3.94, p = 0.047, O.R = 2.3). use of common towel were the most significant independent predictors of intestinal helminthiasis (p = 0.017 and 0.028 respectively). Hand washing with water and soap after defeacation was significantly asso ciated with decreased prevalence of intestinal helminthiasis (p = 0.016). Conclusion: Behavioural modifica tion, good personal hygiene and provision of towels for each child living in the orphanage should be integral part of intestinal helminths control in orphanages.

Background: Prevalence estimates for body-focused repetitive behaviors (BFRBs) such as trichotillomania differ greatly across studies owing to several confounding factors (e.g. different criteria). For the present study, we recruited a diverse online sample to provide estimates for nine subtypes of BFRBs and body-focused repetitive disorders (BFRDs). Methods: The final sample comprised 1481 individuals from the general population. Several precautions were taken to recruit a diverse sample and to exclude participants with low reliability. We matched participants on gender, race, education and age range to allow unbiased interpretation. Results: While almost all participants acknowledged at least one BFRB in their lifetime (97.1%), the rate for BFRDs was 24%. Nail biting (11.4%), dermatophagia (8.7%), skin picking (8.2%), and lip-cheek biting (7.9%) were the most frequent BFRDs. Whereas men showed more lifetime BFRBs, the rate of BFRDs was higher in women than in men. Rates of BFRDs were low in older participants, especially after the age of 40. Overall, BFRBs and BFRDs were more prevalent in White than in non-White individuals. Education did not show a strong association with BFRB/BFRDs. Discussion: BFRBs are ubiquitous. More severe forms, BFRDs, manifest in approximately one out of four people. In view of the often-irreversible somatic sequelae (e.g. scars) BFRBs/BFRDs deserve greater diagnostic and therapeutic attention by clinicians working in both psychology/psychiatry and somatic medicine (especially dermatology and dentistry). [ABSTRACT FROM AUTHOR]

Self-help may help fill the large treatment gap in individuals with body-focused repetitive behaviors (BFRBs). We examined the efficacy of three self-help techniques for BFRBs: habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is) and also tested whether a video demonstration is more efficacious to written instructions. A total of 224 participants with at least one BFRB were randomly assigned to two intervention groups (video, manual) receiving access to all techniques or a wait-list control group (1:1:1). A 6-week follow-up assessment was conducted. The Generic Body-Focused Repetitive Behavior Scale (GBS-9) served as primary outcome. The intention-to-treat analysis showed significant improvements for the manual group compared to the wait-list control group on GBS total score and severity and impairment scores. For the per-protocol analyses (i.e., participants had at least read/watched the manual/video), 26.9% of completers in the manual group improved at least 35% in GBS compared to 23.3% (video group) and 15.9% (control). A dose–response relationship emerged for the video group. Subjective ratings by the video and manual groups did not differ; treatment satisfaction was greater for HRT and DC than for DC-is. Results suggest that the manual group showed somewhat stronger effects than the video group when usage frequency was low. With more frequent usage, improvements in the video condition increased. Future studies should investigate potential order effects of the techniques as well as add-on effects when techniques are used along with other treatment approaches. [ABSTRACT FROM AUTHOR]

Nail biting (NB) is a repetitive and uncontrolled parafunctional activity that can affect oral health by altering tooth shape and intraoral position. Nowadays, there is not enough scientific evidence about the impact of NB on teeth; therefore, this study aimed to evaluate the effects of NB on the length, width and inclination of upper central incisors. This retrospective study involved 76 patients, 40 males and 36 females, with a mean age of 10.6 ± 0.3 years. Digital scans of the maxillary arch of each patient were recorded. Next, the length, width and inclination of upper central incisors used and not used for NB were measured. Finally, data were analysed with a paired t-test. Statistical analysis showed statistically significant differences in the length and inclination of upper central incisors used for NB compared with those of upper central incisors not used for NB, while the width did not show a significant difference. There were relevant changes in upper central incisors subjected to NB, demonstrating that NB impairs the shape, morphology and inclination of teeth. Therefore, because of the potentially negative consequences of NB, it is recommended that NB not be underestimated.

Abstract Background Malocclusion is a multifactorial condition associated with genetic and environmental factors. The purpose of this study was to investigate the prevalence of occlusal traits, oral habits, and nose and throat conditions by age and to assess the association between malocclusion and its environmental factors in Japanese preschool children. Methods A total of 503 Japanese children (258 boys and 245 girls aged 3–6 years) were recruited. Occlusal traits were assessed visually to record sagittal, vertical, and transverse malocclusion, and space discrepancies. Lip seal was recorded by an examiner, and oral habits (finger sucking, lip sucking or lip biting, nail biting, chin resting on a hand) and nose and throat conditions (tendency for nasal obstruction, allergic rhinitis, palatine tonsil hypertrophy) were assessed by a questionnaire completed by the parents. The prevalence of each item was calculated, and binary logistic regression was used to examine the factors related to malocclusion. Results 62.0% of preschool children in the present study exhibited malocclusion, and 27.8% exhibited incompetent lip seal. Nail biting was the most frequent oral habit with a prevalence of 18.9%. Nasal obstruction was recorded in 30.4% of children. The results of binary logistic regression showed that incompetent lip seal was significantly related to malocclusion, and that nail biting was significantly negatively related. Conclusions Incompetent lip seal is significantly associated with malocclusion, but nail biting may not necessarily be a deleterious habit for the occlusion in Japanese preschool children.

Background: Malocclusion is a multifactorial condition associated with genetic and environmental factors. The purpose of this study was to investigate the prevalence of occlusal traits, oral habits, and nose and throat conditions by age and to assess the association between malocclusion and its environmental factors in Japanese preschool children. Methods: A total of 503 Japanese children (258 boys and 245 girls aged 3–6 years) were recruited. Occlusal traits were assessed visually to record sagittal, vertical, and transverse malocclusion, and space discrepancies. Lip seal was recorded by an examiner, and oral habits (finger sucking, lip sucking or lip biting, nail biting, chin resting on a hand) and nose and throat conditions (tendency for nasal obstruction, allergic rhinitis, palatine tonsil hypertrophy) were assessed by a questionnaire completed by the parents. The prevalence of each item was calculated, and binary logistic regression was used to examine the factors related to malocclusion. Results: 62.0% of preschool children in the present study exhibited malocclusion, and 27.8% exhibited incompetent lip seal. Nail biting was the most frequent oral habit with a prevalence of 18.9%. Nasal obstruction was recorded in 30.4% of children. The results of binary logistic regression showed that incompetent lip seal was significantly related to malocclusion, and that nail biting was significantly negatively related. Conclusions: Incompetent lip seal is significantly associated with malocclusion, but nail biting may not necessarily be a deleterious habit for the occlusion in Japanese preschool children. [ABSTRACT FROM AUTHOR]

OBJECTIVES To find the impact of emotional stability on oral parafunctional habits. METHODOLOGY A Cross-sectional descriptive study was conducted at the College of Dentistry, Sharif Medical and Dental College, Lahore, over five months, from July to November 2021. Data was collected using a medical questionnaire and a ten-item personality inventory scale (TIPI). The medical questionnaire comprised two sections with 11 items. The first section had six demographic statements, including age, gender, marital status, occupation, educational level and medical condition. The second section consisted of a pre-validated parafunctional habits questionnaire. RESULTS There was a non-significant difference in the scores of the personality trait of emotional stability across categories of oral parafunctional habits of nail-biting (p=0.093), tooth grinding (p=0.192), tooth clenching (p=0.055), biting on hard objects (p=0.17) and chewing gum (p=0.116). CONCLUSION Emotional stability was most prevalent in individuals who denied having the habit of nail-biting, teeth grinding, tooth clenching and biting hard objects but neither agreed nor disagreed with having the habit of chewing gum.

Background: The lack of clinical guidelines for the treatment of primary psychodermatologic disorders (PPDs) hinders the delivery of optimal care to patients. The review aimed to identify, appraise, and summarize the currently available evidence about the safety and effectiveness of pharmacological management of PPDs through randomized controlled trials (RCTs). Methods: The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRIMSA) statement and the Global Evidence Mapping Initiative guidance were followed. Medline, Embase, PsycInfo, Cochrane and Scopus were searched, and two reviewers independently completed article review, data extraction, and quality assessment. Results: Among 2618 unique studies, full texts of 83 were reviewed and 21 RCTs were included. Five PDDs were identified: trichotillomania (n = 12), pathologic skin picking (n = 5), nail biting (n = 2), delusional parasitosis (n = 1), and dermatitis from compulsive hand washing (n = 1). Seven different classes of medications were investigated: SSRIs (i.e., fluoxetine, sertraline, and citalopram), tricyclic antidepressants (i.e., clomipramine and desipramine), antipsychotics (i.e., olanzapine and pimozide), anticonvulsant (i.e., lamotrigine), N-acetylcysteine, inositol, and milk thistle. RCT-derived evidence supports the use of antidepressants in trichotillomania (sertraline and clomipramine), pathologic skin picking (fluoxetine), pathologic nail biting and dermatitis from compulsive hand washing (clomipramine or desipramine); antipsychotics in trichotillomania (olanzapine) and delusional parasitosis (pimozide); N-acetyl cysteine in trichotillomania and skin picking. Conclusion: Few pharmacotherapies for primary psychodermatologic disorders are assessed through controlled trials in the literature. This review serves as a roadmap for researchers and clinicians to reach informed decisions with current evidence, and to build on it to establish guidelines in the future. [ABSTRACT FROM AUTHOR]

OBJECTIVES To find the impact of agreeable personality trait on oral parafunctional habits. METHODOLOGY A Cross-sectional descriptive study was conducted at the College of Dentistry, Sharif Medical and Dental College, Lahore, over 5 months, from July to November 2021. Data was collected using medical questionnaire and ten item personality inventory scale (TIPI). Kruskal Wallis test was to find the difference in the scores of agreeable personality trait across groups of oral parafunctional habits. RESULTS There was a statistically significant difference in the agreeable personality trait across the parafunctional habits of tooth grinding (p=0.023) and biting on hard objects (p=0.013). A non-significant difference was seen in the personality trait across the habits of nail biting (p=0.495), tooth clenching (p=0.097) and habit of chewing gum (p=0.371). CONCLUSION The individuals who disagreed to having the habit of tooth grinding had the highest score for agreeableness and the least was seen in those who neither agreed nor disagreed to having the habit. The personality trait was the most prevalent in individuals who strongly agreed to having the habit of biting on hard objects and the least in those who agreed to having the habit.

OBJECTIVE: To determine the frequency of parafunctional oral habits and their association with types of malocclusions in all three planes among the adolescents. METHODOLOGY: This cross-sectional study involved 610 students studying in 8 different schools of Raiwind, Lahore. Ethical approval for the study was obtained from Sharif Medical and Dental College, Lahore. Data was collected by the primary researcher and recorded in predesigned proforma. Each student was inspected while seated in an upright position in natural day light, using disposable wooden blades to retract the cheek to record posterior dental relationships and to retract lips to record anterior dental relationships. Data was scrutinized using SPSS and chi-square test was used to find the statistical significance of the association between various parafunctional oral habits and types of malocclusions. RESULTS: The frequency of parafunctional oral habits was 57.3% among 610 adolescent students, being more prevalent in females (72.9%) than males (52.3%). The most common oral parafunctional habit was bruxism (18.0%) and least frequent was thumb sucking (8.4%). Association between oral parafunctional habits and malocclusion in all three planes was found to be significant (p=0.0). CONCLUSION: The parafunctional oral habits such as bruxism, tongue thrusting, nail biting, mouth breathing and thumb sucking are very commonly found among adolescents in the same descending order. Most common malocclusions found to be associated with parafunctional oral habits are exaggerated over-jet, open bite and deep bite. Parafunctional oral habits have a strong influence on developing malocclusion traits in all three dimensions. [ABSTRACT FROM AUTHOR]

Introduction: Nail biting is an inappropriate habit and its exact cause is debatable. Researchers believe that nail biting disorder is often associated with psychiatric disorders, including anxiety. State /trait anxiety can be considered an unstable emotional state reflecting the individual's interpretation of a stressful situation in a particular time frame and varies depending on the degree to which the situation is perceived threatening. This study aims to determine the evaluation of the effectiveness of habit reversal techniques on reducing nail biting disorder and state/trait anxiety in students. Methods: The present semi -experimental study with pretest, post -test, and follow -up was conducted on six junior high school male students in the age range of 13 -15 years, who asked for help by referring to the school counseling and were selected by convenience sampling method. They received a program of habit reversal techniques individually in 6 sessions for 1 month. Clinical interviewing, frequency recording of nail biting per day, and state /trait anxiety test were used to measure the variables. Results: Data analysis showed that habit reversal techniques reduce nail biting and students' state/trait anxiety. Follow -up one month after the end of treatment indicated the persistence of these results. Conclusion: The habit reversal training is effective on treating nail biting, reducing anxiety, and promoting the person life quality and symptoms from nail biting. Due the low sample size, it is suggested that while repeating the study in a larger sample, its effectiveness on the treatment of other habitual disorders be studied. [ABSTRACT FROM AUTHOR]

Body-focused repetitive behaviors (BFRBs) include skin picking, trichotillomania, nail biting and cavitadaxia/lip-cheek biting, among other behaviors. For the first time, we compared three different self-help techniques aimed at reducing BFRBs. We explored the acceptance and preliminary efficacy of the approaches and whether the techniques exerted differential effects depending on BFRB-type. A total of 113 participants with at least one BFRB were randomly allocated to either habit reversal training (HRT; active elements: awareness and competing response training), decoupling (DC) or decoupling in sensu (DC-is). Reassessment was conducted 4 weeks later. The Generic Body-Focused Repetitive Behavior Scale (GBS) served as the primary outcome. The completion rate was best for DC-is (68.6%) as compared to HRT (57.1%) and DC (53.5%). A total of 34.8% of completers in the DC group showed an improvement of at least 35% on the GBS compared to 10.0% in the HRT and 23.3% in the DC-is group. In accordance with previous work, moderator analyses showed that improvement under DC is best for non-skin-pickers. A dose-effect relationship emerged, particularly for HRT. Subjective appraisal ratings were more favorable for DC-is and HRT than for DC. With respect to completion rate, subjective appraisal and symptom improvement, DC-is yielded consistently satisfactory results, whereas HRT showed good subjective but rather poor objective improvement. Those who performed DC, especially non-skin-pickers, showed good improvement but overall completion and subjective efficacy were low. Future studies should investigate whether the three techniques exert add-on effects when combined and whether demonstration via new media (e.g., video) will augment comprehensibility and thus efficacy of the techniques. [ABSTRACT FROM AUTHOR]

Onychophagia, also called nail biting (NB), is a body focused repetitive behaviors or self-grooming behavior. It is a group of related disorders in which an individual damages his or her appearance or causes physical injury that include pulling, picking, biting, or scraping one's hair, skin, or nails. NB is a very common, and unresolved, problem in the field of psychiatry, psychology, medicine, and dentistry. NB is a simple behavior associated with obsessive–compulsive-related disorders. The present paper focuses on the management of NB.

OBJECTIVES: To find the association of extraversion personality traits with oral parafunctional habits. METHODOLOGY: A Cross-sectional descriptive study was conducted on 200 individuals in the College of Dentistry, Sharif Medical and Dental College, Lahore, over 5 months from July to November 2021. Data was collected using a pre-validated medical questionnaire and a ten-item personality inventory scale (TIPI). The sampling technique used was Convenience sampling. A sample size of 200 was calculated with the help of WHO sample size determination software. RESULTS: There was a statistically significant difference in the scores of extraversion personality traits across the oral parafunctional habit group of nail-biting (p= 0.007). In contrast, that for tooth grinding (0.114), tooth clenching (0.076), biting hard objects (0.74) and chewing gum (p= 0.659) was non-significant. The highest mean rank score for the personality trait of extraversion was found in individuals who strongly agreed to have a habit of nail-biting (129.23), tooth grinding (153.63), and tooth clenching (142.61) and biting hard objects (12.07). The highest mean rank score for the parafunctional habit of chewing gum (107.28) was found in individuals who strongly disagreed with having the habit. CONCLUSION: The highest mean rank score for the personality trait of extraversion was found in individuals who strongly agreed to have a habit of nail-biting, tooth grinding, tooth clenching and biting hard objects. The highest mean rank score for the parafunctional habit of chewing gum was found in individuals who strongly disagreed with having the habit.

Background: Oral parafunctional habits are related to any abnormal hyperactivity of the oromandibular system. They are prevalent in all societies in varying intensity and have potential physical and psychological implications. The aim of this study was twofold: (1) to determine the prevalence of various types of oral parafunctional habits in the Saudi adult population, and (2) to examine their association with and the level of anxiety and personality factors. Methods: This cross-sectional study was conducted with an electronic data collection form distributed to the public through social media. The questionnaire comprised of the following: (a) demographic information, (b) the Hamilton Anxiety Rating Scale (HAM-A), (c) the Ten-Item of Big-Five Personality Traits, (d) a list of oral parafunctional habits. Data were analysed using a Pearson’s Chi square and binary logistic regression. Results: The participants reported several parafunctional habits including daily gum chewing (86%), lip/object biting (59%), clenching (45%), nail biting (36%) and grinding (32%). Males were 3 [2.3–3.7] times and younger age groups were 1.5 [1.1–2.0] times more likely to be associated with nail biting compared to their counter groups (adj.P

Although onychophagia is a medical condition and is associated with poorer health, there are no guidelines for assessment or treatment. The purpose of this study was to investigate the clinical aspects of nail biting from doctors' points of view, to estimate the prevalence of onychophagia among physicians, and to review the literature on and treatment methods for onychophagia. Twenty-four percent of doctors reported nail-biting periods during their lifetimes, and 2% of them remained active nail biters. A total of 64.4% of doctors see nail biting in their practices, and 60.6% never or only on request ask patients about nail biting and examine their nails. Family doctors and pediatricians ask their patients about nail biting most often. Attitudes and opinions on the treatment of nail biting are undefined and vary. Doctors reported usually treating nail-biting patients by referring them to another specialist or offering special nail polish. There is a need to improve physicians' knowledge of nail-biting treatment methods, but a lack of studies evaluating the clinical aspects of onychophagia and its relation to mental health and emotion dysregulation. Further research is needed. Clinical attitudes toward nail biting could be more precise in training and medical practice. [ABSTRACT FROM AUTHOR]

Case: Onychophagia, or nail-biting, is a common habit seen in both children and adults. Harmful effects include oral exposure to a variety of pathogens and concomitant damage to dentition and fingers. This report focuses on the most severe reported case of recurrent osteomyelitis of the bilateral hands with destructive changes secondary to onychophagia. Conclusion: Successful treatment relies on a multidisciplinary approach which in this case included surgical management and counseling on cessation, with referrals to other providers to address underlying psychiatric and/or psychologic conditions that may predispose to this compulsion. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the association of oral parafunctions with the presence of signs and symptoms of craniomandibular disorder in children with cleft lip and palate (CLP). A cross-sectional study was performed in which one hundred and eighty-eight children with CLP and absence of associated syndromes or malformations were investigated. During clinical examination, the presence of wear facets and dental occlusion were observed and palpation was performed in the temporomandibular joint region (TMJ) and orofacial musculature. The children and their guardians were interviewed regarding the presence of oral parafunctional habits (bruxism, the act of biting the lips and/or cheeks, nail biting, sucking of fingers and pacifiers) and signs and symptoms of craniomandibular dysfunction (headache, ear and/or neckache, tiredness or crack in the TMJ during mouth opening and chewing movements). The data were analyzed by means of absolute and relative frequency measurements, and bivariate analysis using Pearson's chi-square test and likelihood ratio test were performed, considering the significance level of 5%. A higher prevalence of cleft lip and palate type (76.0%) and the presence of malocclusion (61.7%) was observed, highlighting the anterior crossbite (58.7%) and midline deviation (48.9%). There was a higher occurrence of teeth grinding (40.4%), onychophagy (28.7%) and biting lips and/or cheeks (28.7%). Onychophagia was associated with headache (p <0.05) and with pain or cracking during mouth opening (p <0.05). It was concluded that parafunctional oral habits may be associated with signs and symptoms of craniomandibular disorder in children with cleft lip and palate. [ABSTRACT FROM AUTHOR]

Onychophagia, also called nail biting (NB), is a body focused repetitive behaviors or self-grooming behavior. It is a group of related disorders in which an individual damages his or her appearance or causes physical injury that include pulling, picking, biting, or scraping one's hair, skin, or nails. NB is a very common, and unresolved, problem in the field of psychiatry, psychology, medicine, and dentistry. NB is a simple behavior associated with obsessive-compulsive-related disorders. The present paper focuses on the management of NB. [ABSTRACT FROM AUTHOR]

Oral parafunctional habits are related to any abnormal hyperactivity of the oromandibular system. They are prevalent in all societies in varying intensity and have potential physical and psychological implications. The aim of this study was twofold: (1) to determine the prevalence of various types of oral parafunctional habits in the Saudi adult population, and (2) to examine their association with and the level of anxiety and personality factors. This cross-sectional study was conducted with an electronic data collection form distributed to the public through social media. The questionnaire comprised of the following: (a) demographic information, (b) the Hamilton Anxiety Rating Scale (HAM-A), (c) the Ten-Item of Big-Five Personality Traits, (d) a list of oral parafunctional habits. Data were analysed using a Pearson's Chi square and binary logistic regression. The participants reported several parafunctional habits including daily gum chewing (86%), lip/object biting (59%), clenching (45%), nail biting (36%) and grinding (32%). Males were 3 [2.3–3.7] times and younger age groups were 1.5 [1.1–2.0] times more likely to be associated with nail biting compared to their counter groups (adj.P < 0.001 and adj.P = 0.007). Lip/object biting was significantly 1.3 [1.1–1.7] times more prevalent in males (adj.P = 0.015). Participants who reported being extroverts were more likely to be associated with clenching (46.4%) (P = 0.024). An emotionally stable person was significantly less likely to be associated with nail biting (28.4%), grinding (24.9%), clenching (35.8%), and lip/object biting (48.4%) (P < 0.001each). Participants who reported conscientiousness and emotional stability were significantly less associated with TMD (P = 0.007, P < 0.001). Oral parafunctional habits are highly prevalent in the Saudi adult population in varying degrees. Possible risk factors include males, younger age groups, single people, and being financially constrained. [ABSTRACT FROM AUTHOR]

Body-focused repetitive behaviors (BFRBs) are recurrent behaviors targeting one or more body regions that may associate with negative outcomes. Little is known on their prevalence and correlates in psychiatric populations. This study examined the preliminary prevalence and correlates of BFRBs in 67 youth aged 9–17 years with primary anxiety-related disorders, mood disorders, or attention deficit and hyperactivity disorder (ADHD), using the Repetitive Body-focused Behavior Scale (RBBS), the Clinical Global Impressions scale, and the Behavior Assessment System for Children—2nd Edition, Behavioral & Emotional Screening System (BASC-2-BESS). Nearly half of the youth and parents reported significant child BFRBs on the RBBS. Additionally, 15% of the youth and 4.5% of the parents reported significant child distress/impairment related to BFRBs. A primary diagnosis of ADHD associated with greater parent-reported BFRB rates, number, and severity. An increased proportion of girls vs. boys presented with child-reported BFRBs and associated distress/impairment. The presence of BFRBs across the sample was associated with increased internalizing and externalizing symptom severity as measured with the BASC-2-BESS. In addition, internalizing and externalizing symptom severity positively correlated with BFRB severity. Our results suggest youth with psychiatric conditions, especially ADHD, who present with elevated symptom severity, may be particularly at-risk for concomitant BFRBs. [ABSTRACT FROM AUTHOR]

purpose of this study was to evaluate the effectiveness of AEBT therapy on reducing anxiety and experiencing avoidance of Mixed Trichotillomania، Skin picking disorder and Nail biting with three month follow up This study was a single-subject experimental design with multiple step-line based and follow-up on six patients (two patients for each disorder) with 10 sessions over the course of three month follow up، Samples were selected using purposeful method. Data was gathering through Massachusetts Hospital – Hair pulling Scale، Keuthen Skin Picking Scale، Beck Anxiety Inventory، Acceptance and Action Questionnaire and Malone- Massler Nail biting scale. The results of this study showed that Acceptance Enhanced Behavioral Therapy can reduce anxiety in patients with trichotillomania، skin picking and Nail biting، as well as experimental avoidance in patients with trichotillomania and skin picking decreased and the results were maintained during the follow-up period، but reduction of experimental avoidance in Nail biting was not significant and requires further studies on this subject.

Habit is the constant and unconscious repetition of an act. Children (usually infants) frequently acquire oral habits that can be temporary, if continued can be permanent & harmful to dental occlusion and supporting structures. This article aims to throw lights on harmful habits, its cause, side effect and treatment available, as ignorance of these habits can cause facial abnormality; hence Dentists play an important role in the identification and removal of habits. [ABSTRACT FROM AUTHOR]

The hygiene hypothesis suggests that a reduction in microbial exposure contributes to an impaired immune response later in life and increases the incidence of immune-mediated diseases such as inflammatory bowel diseases (IBD). Thumb sucking and nail biting are two early habits that modulate the oral microbiota composition and antigen load. We hypothesized a lower risk of Crohn's disease (CD) and ulcerative colitis (UC) in adults with prior thumb sucking and nail biting. 918 IBD cases and their 918 siblings without IBD were asked to fill out a survey containing 32 questions on environmental factors in childhood and early adulthood. Prevalence of thumb sucking and/or nail biting at the usually well-remembered time of (1) school enrollment and (2) coming-of-age ceremonies was the predefined combined risk factor of this study. 65% of the patients were female and 57% suffered from CD. About 49% of IBD patients but only 44% of their siblings reported thumb sucking/nail biting at the time of school enrollment or coming-of-age (p =.007). Sensitivity analysis revealed that this difference was observed in patients with CD (50% versus 41%; RR= 1.22; 95% CI 1.09–1.37, p =.001) but not in patients with UC (49% versus 48%; RR= 1.02; 95% CI 0.90–1.17; p =.83). Contrary to our expectation and challenging the hygiene hypothesis, we found that common oral habits are not protective against IBD. Instead, nail biting at the time of school enrollment and coming-of-age was a statistically significant risk factor for CD in our cohort. Key summary Evidence available before this study: The hygiene hypothesis suggests that a reduction in microbial exposure due to improved health activities has contributed to an immunological imbalance in the intestine and an increased incidence of allergic and autoimmune diseases. A population-based birth cohort study has demonstrated that thumb-sucking and nail biting in children lead to a reduction of the risk of atopic sensitization, asthma, and hay fever. Added value of this study: Contrary to the hypothesis, thumb sucking and nail biting were not associated with a reduced risk of IBD. Instead, thumb sucking and/or nail biting at the usually well-remembered points in time of school enrollment and of religious or secular coming-of-age ceremonies was associated with a higher risk of Crohn's disease but not of ulcerative colitis. Our data did not support the hygiene hypothesis, one pathogenic concept in the context of IBD. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to identify the relation between the deleterious oral habits (DOH) which can cause orthodontic anomalies such as finger sucking, nail biting, lip chewing, bruxism and psychological and socio-demographic factors. Materials and Methods: 64 males, 71 females, between the ages of 9 and 12, including their parents have been included into our study. In our study, a survey form consisting of Clinic Examination Data Form, Socio-demographic Data Form, Children’s Depression Inventory (CDI), Child State Trait Anxiety Inventory (CSTAI) has been applied to patients. Results: DOH have been observed on 62,5 % of the male children and % 52,1 of the female children, but these results are not statistically significant (p>0,05). No statistically significant associations were found between DOH and CDI (p>0,05). No statistically significant associations were found between the CSTAI status section score and trait section score and DOH (p>0,05). Statistically significant associations were found between family type and DOH (p

Aims: To analyze predictors of bruxism, other oral parafunctions, and tooth wear in a group of subjects who had been examined 20 years earlier. Methods: Originally, 402 randomly selected 7-, 11-, and 15-year-old subjects were examined clinically and by means of a questionnaire. Twenty years after the first examination, 94% of the original group could be traced, and 320 (85%) completed and returned the questionnaire. Of the oldest group, 100 (81%) also underwent a clinical examination focusing on occlusal factors and function and dysfunction of the masticatory system. For analyses of predictors of some oral parafunctions and tooth wear registered at the 20-year follow-up, logistic regression was used with recordings at the first examination as independent variables. Results: Subjective reports in childhood of bruxism (defined as tooth clenching during daytime and/or tooth grinding at night), clenching only, grinding at night only, nail biting, and/or other parafunctions were predictors of the same oral parafunctions 20 years later. There were different predictors of the 2 components of bruxism, daytime tooth clenching and tooth grinding at night. Postnormal occlusion (Angle Class II malocclusion) and tooth wear in childhood predicted increased tooth wear in adulthood. Subjects with nonworking-side interference had less anterior tooth wear than those without such interference. Conclusion: Oral parafunctions in childhood may be a persistent trait in many subjects. Postnormal occlusion and tooth wear in childhood predicted increased anterior tooth wear 20 years later, whereas nonworking-side interference reduced the risk for such wear in 35-year-old subjects. [ABSTRACT FROM AUTHOR]

Objective: Nail biting leads to a variety of health issues. Habit reversal treatment is a major approach to cease nail biting, but is often ineffective since patients continue to suffer from anxiety, a major trigger. This study investigated whether the potential anxiety relief provided by auricular acupressure could improve the efficacy of habit reversal treatment, as evidenced by improved stomatological and other outcomes. Methods: In a pragmatic, randomized, crossover, pilot clinical trial, 83 nail biters (8–12 years old) received habit reversal treatment in combination with either auricular acupressure intended to reduce anxiety (Method A) or placebo auricular acupressure (Method B). The alternative protocol was employed after a two-month washout period. The primary outcome measured was the 41-item child self-reported version of the Screen for Child Anxiety Related Emotional Disorders, while the secondary outcomes were the nail growth status (NS), which represented the fingernail growth of each finger during habit reversal treatment, simplified plaque index (SPI), and the simplified gingival index (SGI) as measures of oral health. A paired sample t-test was used to assess the differences between Methods A and B, and the differences in the anxiety scores, NS, SGI, and SPI between the baseline and each time point. Results: Forty-one children successfully completed both arms of the treatments and attended all appointments. There were significant differences in the efficacy of habit reversal treatment, the anxiety score, the nail status, and the SGI in favor of Method A (p < 0.001). Conclusion: Auricular acupressure appears to improve the efficacy of habit reversal treatment, likely by reducing anxiety. [ABSTRACT FROM AUTHOR]

Introduction: Onychophagia is a habit of compulsive nail biting. Nail biting is most commonly seen in both children and youth. Boredom, excitement, fear, stress, and other emotional disorders are the main causes of onychophagia. Modern treatments and measures like manicure are necessary to correct the habit of chronic nail biters. Materials and Methods: This was a survey of 14 questions and was conducted in an online forum, survey planet. This survey was taken by about 103 people who had the habit of nail biting. All their responses were recorded and statistically analyzed. Results: From the survey, it is recorded that all age people take up this nail biting as a habit in various situations to relax their stress, as a sign of breaking their anger, even in immense excitement. Hence, in this study, it is recorded to be that, 64 participants of 103 follow this habit as a stress buster more during their boredom and an interesting event noted from the survey is, 57% of participants stop themselves from biting their nails in front of young people, especially kids, aiming not to influence the growing generation toward a bad habit. From the surveys analysis it is noted that 87.8% of the participants wanted to quit nail biting permanently and they do have tried quitting it by following prevention methods, but ended up as failed attempts and continued with their biting habits again. Conclusion: Hence, among the South Indian population, their perspective among the dangers and risks of onychophagia are clear-cut, and they also aware of the side effects of their own habit. Yet, above all their determination and self-control only plays a key role in quitting this nail biting habit permanently. [ABSTRACT FROM AUTHOR]

Highlights • The prevalence of subclinical and disordered versions of BFRBs is unclear. • The current study examined BFRB prevalence in a large undergraduate sample. • A total of 59.55% met criteria for a subclinical BFRB. • A total of 12.27% met criteria for a BFRB disorder. • While many persons with BFRB disorders reported distress, few reported impairment. Abstract Body-focused repetitive behaviors (BFRBs), such as hair pulling, skin picking, and nail biting are common habits, but their pathological manifestations have been considered rare. Growing evidence suggests pathological forms of these behaviors can be conceptualized as a class of related disorders. However, few previous studies have examined the collective prevalence of related pathological BFRBs. The current study examined the self-reported prevalence of current (past month) subclinical and pathological BFRBs in a large (n = 4335) sample of college students. The study also examined the chronicity and impact of these behaviors. Results showed that 59.55% of the sample reported occasionally engaging in subclinical BFRBs, and 12.27% met criteria for a pathological BFRB, suggesting these conditions may be quite common. Of the various BFRB topographies, cheek biting was the most common. Both subclinical and pathological BFRBs tended to be chronic (i.e., occurring for longer than 1 year). Although persons with pathological BFRBs were distressed about their behavior, few experienced functional impairment or sought help for the behavior. Implications of these findings for the conceptualization and treatment of body-focused repetitive behaviors are discussed. [ABSTRACT FROM AUTHOR]

Objective: this quantitative descriptive study aimed to evaluate the presence of deleterious oral habits and associated factors in children attending the Amadeu Barros Leal day care in Fortaleza, CE, Brazil. Material and Methods: the sample consisted of 75 children (51% of girls) aged 0 to 5 years. Data were collected through the application of a structured questionnaire to the parents or guardians and analyzed statistically with Fisher’s exact or Chi-square test, considering a 95% confidence interval. The results were expressed as absolute frequency and percentage. Results: 89% of the children participating in the study were breastfed, and 43.5% of them were breastfed at least until the first year of age. As much as 19% of the children slept with their mouths open and 39% used a pacifier, 56.7% of which used it constantly during the day and at night. About 91% of children used a feeding bottle, and most of bottles (79%) did not have an orthodontic nipple. In addition, 60% of children aged 24-36 months had the deleterious habit of grinding their teeth. Conclusion: in the present study, we investigated children from 0 to 5 years old and observed that this age group is predisposed to deleterious oral habits. In this way, more studies that trace a safe epidemiological profile aiming to reduce these harmful habits are extremely necessary.

Background: Oral habits like thumb sucking and nail biting are pernicious habits that act as an adaptive function in obtaining pleasure and subduing anxiety. These habits may also act as carriers of numerous microorganisms into the oral cavity, of which, Enterobacteriaceae members are transient pathogens, which might result in debilitating systemic conditions. Aim: To study the oral carriage of Enterobacteriaceae in children having habit of nail biting and thumb sucking. And to study the association of the organism with the individual′s respective plaque indices. Subjects and Methods: Totally, 40 chronic nail biters, 40 chronic thumb suckers, and 20 controls (no habit) (8-15 years old) were enrolled in the study. Appropriate history and their plaque indices recorded. Sterile containers were used to collect the salivary samples and later cultured on Agar plates. Biochemical tests categorized the organisms into subspecies. Statistical Analysis Used: ANNOVA, Student′s t-test. Results: Presence of a nail biting habit indicated a higher plaque index, which in turn showed a higher carriage of Enterobacteria spps, predominantly Escherichia coli. Conclusions: Oral surgical intervention in individuals with pernicious oral habits need to be counseled and educated on the possible complications, which might otherwise provide an environment that disseminates these microorganisms resulting in a broad range of local and systemic infections.

Introduction: Childhood habit behaviors appear in numerous different forms. Many people engage in some degree of habit like behavior in their lifetime. For example, habits can range from seemingly benign behaviors, such as nail biting or foot tapping, to more noticeable physically damaging behaviors, such as teeth grinding (bruxism) and hair pulling. Habit disorders, now subsumed under the diagnostic term stereotypic movement disorder, consist of repetitive, seemingly driven, and nonfunctional motor behaviors that interfere with normal activities or that result in bodily injury. Objectives: To determine the frequency of different habit disorders in children coming to outpatient department of Pediatrics unit of Allied Hospital Faisalabad. Study design: Cross sectional study. Setting: Pediatric department of Allied Hospital Faisalabad. Duration of study: 1 year 06 months. (From 01-03-2015 to 01-09-2016). Results: We determined that majority of the patients i.e. 40.68%(n=72) were between 49-72 months, mean and sd was 54.23+21.45 months of age, 54.80%(n=97) male and 45.20%(n=80) females, frequency of different habit disorders in children coming to outpatient department of pediatrics unit of Allied Hospital, Faisalabad revealed 19.31%(n=34), nail biting, 22.03%(n=39) had thumb sucking, 41.81%(n=74) had bruxism, 11.86%(n=21) had hair pulling and 10.17%(n=18) subjects had other habits. Conclusion: We concluded that the frequency of different habit disorders i.e. nail biting, thumb sucking, bruxism, hair pulling and other is higher among children coming to outpatient department of Pediatrics unit of Allied Hospital Faisalabad and comparable with other studies. [ABSTRACT FROM AUTHOR]

Introduction: Body-focused Behaviors (BFRBS) are repetitive, body-centered and non-functional habits. The aim of this study was to evaluate the effectiveness of AEBT therapy in reducing anxiety and experiencing avoidance of mixed trichotillomania، skin picking disorder and nail biting with a three-month followup. Materials and Methods: This study was conducted with a single-subject experimental design, multiple step-line and follow-up on six patients (two patients for each disorder) in 10 sessions over three months. Samples were selected purposefully. Data was collected through Massachusetts Hospital – Hair Pulling Scale، Skin Picking Scale, Beck Anxiety Inventory, Acceptance and Action Questionnaire and Malone- Massler Nail biting scale. Results: The results of this study showed that Acceptance Enhanced Behavioral Therapy can reduce anxiety in patients with trichotillomania, skin picking and nail biting, as well as experimental avoidance in patients with trichotillomania and skin picking decreased and the results were maintained during the follow-up period, but the reduction of experimental avoidance in nail biting was not significant and requires further studies on this subject. Conclusion: The results of this study showed that AEBT can effectively treat anxiety symptoms and experimental avoidance of patients with trichotillomania, skin picking and nail biting disorders. [ABSTRACT FROM AUTHOR]

A notable number of people struggle to control the desire to bite their nails, resulting in impairment and distress. Understanding this behavior and the inability to control it has received little research attention. One possible mechanism to understand nail biting is through the use of neurocognitive assessments. Neurocognitive assessments of pathological nail biting, however, are lacking. This analysis assesses the clinical presentation and neurocognitive profile of adults with nail biting relative to participants without nail biting. A total of 87 participants (aged 18-29 years) were recruited for a study on nail biting in young adults. Participants completed diagnostic, self-report, and neurocognitive measures which assessed two cognitive domains - motor impulsivity and cognitive flexibility. In the sample, 34 participants reported current nail biting. The nail biting group showed no significant differences in impulsivity or cognitive flexibility compared to the healthy controls. The lack of association between nail biting and cognitive deficits suggests that perhaps identifying meaningful subtypes of nail biting that reflect distinct pathology from normal grooming behavior may be important. [ABSTRACT FROM AUTHOR]

Introduction: Oral habits are parafuctional behaviors that may be normal at some point in life, but when they are persistent on time they can cause morphological and physiological alterations, that can also affect the social and psychological development. Objective: Determine which are the most frequent oral habits in children 5 to 12 years old attending pediatric and orthopedic dental clinic at University del Valle between the years 2007 and 2012. Materials and methods: 209 patient records were reviewed whit ages between 5 and 12 years old, present habits and distribution were determined according to the type of habit and the relationship was analyzed with age and gender. Results: From the total subjects studied 140(67%), at least one oral habit was present, being more frequent in females, it was determined that the most frequent habit was mouth breathing with 36% followed by nail biting with 24% and the least frequent of the oral habits was teeth clenching with 11%. Conclusions: The high prevalence of habits, leads to the need for the general practitioner and pediatric dentist will be able to detect early signs of this conditions whit the purpose to generate dento-maxillary anomalies. [ABSTRACT FROM AUTHOR]

Onychophagia, defined as habitual nail biting, is a common disorder affecting 20–30% of the population and all age groups. It may lead to significant psychosocial problems, have a negative impact on quality of life, and cause complications involving both the nail unit and the oral cavity. The objective of this paper is to review the prevalence, etiology, history, physical examination, complications and management of nail biting. Since onychophagia is a challenging disorder to treat, a multi-disciplinary approach should be taken involving dermatologists, internists, pediatricians, psychiatrists and dentists. [ABSTRACT FROM PUBLISHER]

Objective:This is a parallel, three group, randomized, controlled clinical trial, with outcomes evaluated up to three months after randomization for children and adolescents with chronic nail biting. The current study investigates the efficacy of habit reversal training (HRT) and compares its effect with object manipulation training (OMT) considering the limitations of the current literature .Method:Ninety one children and adolescents with nail biting were randomly allocated to one of the three groups. The three groups were HRT (n=30), OMT (n=30), and wait-list or control group (n=31). The mean length of nail was considered as the main outcome .Results:The mean length of the nails after one month in HRT and OMT groups increased compared to the waiting list group (P

Background: Oral deforming habits are risk factors for malocclusions.Objectives: To characterize the prevalence of oral deforming habits in students between the ages of six and nine enrolled at Julian Santana Primary School during the first semester of 2015.Material and Methods: A cross-sectional descriptive observational study was carried out. The universe was made up of 633 children from the herein mentioned school and the sample included 325 children selected at random. The variables used were age, sex, and type of deforming habit which were related to the presence of malocclusions. To sum up the results obtained measures of frequency and rates of global and specific prevalence to age and sex were used. To determine the relation between the practice of habits and malocclusions the independence x2 test was used.Results: The practice of oral deforming habits was high among the students, being higher in the female sex. Atypical swallowing and onychophagia were the most frequent habits. The number of children who practiced two or more deforming habits at the same time was notable.Conclusions: The alterations in the three space planes were related to the presence of oral deforming habits.

Nail biting (NB) is a common, but unresolved, problem in psychiatry, psychology, medicine and dentistry. While it seems that NB is a simple behavior that can be stopped easily, many of the children with NB have already tried to stop it, but they have not been successful. The frustrations due to failed attempt involve others such as parents and siblings. The present review aims at providing an overview of prevalence, co-morbidities, education and counseling, and management for NB. Overall, the reviewed literatures suggest that co-morbidities of psychiatric disorders and other stereotypic behaviors in clinical sample of children with NB is more than 80%, and more than half of the parents suffer from psychiatric disorders mainly depression. Treatment of NB, however, is not as easy as it seems. The management of NB is much more complicated than just focusing on stopping it. Nail biting cannot be managed without considering its co-morbidities, antecedents and consequences. It might be concluded form the reviewed literature that children with NB, parents, siblings, and teachers should be educated about what to do and what not to do about NB. Punishment is not effective. Moreover, clinical randomized controlled trials are required to make available evidence-based behavioral and pharmacologic treatment protocols

Nail biting may have a significant role in the development of some anomalies and harmful effects upon the oral-facial system.Objective: The objective of the study was to determine the prevalence of nail biting among preschool children in Bitola.Methods: Through an observational, intersection (cross-sectional) study, 890 children who came to medical checkups during the period from January to December 2009 were included. The following methods were applied: psychological testing (Test of Chuturikj), pediatric examination, interview with parents and the questionnaire: Child Behaviour Checklist-Achenbach, 1981.Results: The study included 890 children, 401 of which were at the age of three, 489 were at the age of five, 51.6% of them were males and 48.4% females. The level of prevalence of nail biting was 22.02%. The statistical analysis showed that the habit is more insignificant (p>0.05) in children at the age of 5 and among the male gender. The tested difference in the frequency of nail biting among children from the cities or villages was not statistically significant (p>0.05). Children who do not have their own room more often manifest this habit statistically insignificantly (p>0.05).Depending on the number of members and children in the family, the tested differences were statistically significant (p0.05). Children whose parents have a high education level significantly less bite their nails (p

INTRODUÇÃO: Tricotilomania e alopecia areata em placa possuem características clínicas e dermatoscópicas semelhantes. OBSERVAÇÕES: O exame dermatoscópico da tricotilomania revela densidade capilar diminuída, cabelos fraturados em diferentes tamanhos, enovelados e vellus, tricoptilose, pontos amarelos com ou sem pontos pretos e ausência de cabelos em "ponto de exclamação". CONCLUSÃO: No contexto de alopecia em placa e cabelos fraturados, a ausência de "pontos de exclamação" sugere o diagnóstico de tricotilomania. Por outro lado, o achado de pontos amarelos sem pontos pretos não afasta o mesmo.BACKGROUND: Trichotillomania and patchy alopecia areata have similar clinical and dermoscopic features. OBSERVATIONS: In trichotillomania, dermoscopy shows decreased hair density, short vellus hair, broken hairs with different shaft lengths, coiled hairs, short vellus hair, trichoptilosis, sparse yellow dots, which may or may not contain black dots and no exclamation mark hairs. CONCLUSIONS: In the case of patchy alopecia and broken hairs, the absence of exclamation mark hairs suggests a diagnosis of trichotillomania. On the other hand, the finding of yellow dots without black dots does not exclude it.

Copyright of CES Odontología is the property of Universidad CES and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The use of chewing-gum and piercing has become common among adolescents and might result in increased oral muscle activity and overloading. Aim To investigate the frequency of oral piercing and parafunctions in relation to symptoms of temporomandibular disorders (TMD) among adolescents.Materials and Methods: One hundred and twenty-four third level high school students, living either in a city or in a small town, enrolled in either science or media programmes, were included. The students completed a questionnaire regarding different parafunctions and symptoms of TMD. A clinical examination of the temporomandibular system and estimation of the tooth wear was performed in 116 students.Results: Chewing-gum was used by 86% of the students (25% with a daily use) and 14% had an oral piercing. The science students used more chewing gum than the media students (p = 0.008), while the media students had more piercings (p < 0.001). Symptoms once a week or more were reported with 39% for headache, 18% for clicking, 7% for facial pain and 6% for difficulty to open wide. Girls reported more headaches (p = 0.007) and more severe symptoms (p = 0.003), had more medical consultations and used more analgesics (both p < 0.05) and had more clinical signs (p = 0.01) than boys. Girls had more oral piercings and used more chewing gum than boys (both p < 0.05). The media students had more sick leave (p < 0.01) than the science students. Chewing-gum use was associated with headache (p < 0.01), with difficulty to open wide (p < 0.05) and with tenderness of the temporomandibular joints and muscles (both p < 0.05). Oral piercing was associated with headache and muscle tenderness (both p < 0.05) and daily nail biting with headache (p < 0.05) and tooth wear (p = 0.004).Conclusions: There is an association between use of chewing gum, nail biting, oral piercing, and symptoms of TMD. [ABSTRACT FROM AUTHOR]

Comorbid psychiatric Disorders are seen commonly in people with intellectual disability and in fact they are at greater risk for developing other health disorders. Most prevalent chronic health conditions in children with intellectual disability are epilepsy, cerebral palsy,anxiety disorders, sleep disorders and autism spectrum disorders. Co morbidities multiply the problem of people with intellectual impairment to a great extent and hence an accurate psychological assessment of multiple diagnoses is useful in detecting the specific underlying processes differentiating the co morbid syndrome and in planning an appropriate management and rehabilitation program. This case report is presented to emphasize the fact that though. It is common for intellectually disabled children to have other co-morbid psychiatric disorders, it is important to have accurate, suitable assessment and recording of every co-morbid disorder as it has its own implication in course and outcome of the disability in the child. A comprehensive management approach involving people from various spheres would be required to improve the quality of life and for reduction of burden of care giver.We describe a child of intellectual disability with multiple co morbidities.

Nail biting is a stress removing habit adopted by many children and adults. People usually do it when they are nervous, stressed, hungry, or bored. All of these situations are having a common phenomenon between them is anxiety. Onychophagia is also a sign of other emotional or mental disorders. It is a habit that is not easy to quit and reflection of extreme nervousness or inability to handle stressful conditions. This abnormal habit may cause various malocclusions associated with dentoalveolar segment of the oral cavity. Crowding and rotations of incisors are common with this habit.