Habits and Disorders:
In this section I will discuss other conditions/disorders and their similarities and differential characteristics with tongue chewing.
Please note that it is extremely important to obtain an accurate diagnosis before trying to find a cure for any condition. Many diseases
and conditions share common symptoms:
Adult Thumb Sucking
Thumb sucking in children under the age of 3 or 4 is very common in fact it is probably more uncommon to find a child under that age that
doesn't suck on their thumb or at least a pacifier. After the age of about 6 children suck their thumbs out of habit or because they find it
soothing. They may suck more when tired, bored or tense. Most children require some type of encouragement to get them to stop.
Babies suck their thumbs out of instinct. It's an instinct that is shared with other animals that depend on mother's milk. In one experiment,
puppies were fed with a medicine dropper so that they had no chance to suck during their feedings. They acted just the same as babies
who don't get enough chance to suck at feeding time. They ended up sucking their own paws and skin so hard that the fur came off.
For most adults, thumb sucking is very difficult to stop. The associations built up over a lifetime entrench the habit very deeply within our
personality. However, there have been many who have stopped, usually due to dental problems or due to peer pressure.
I believe that - "Tongue chewing may have started as a convenient alternative to thumb sucking as a way to conceal the habit then mutated
into its own behavioral pattern."
Similarities with tongue chewing and thumb sucking:
Sustained by repetitive, patterned movements i.e.; chewing vs. sucking
Tongue chewing generally begins in early childhood.
Can be consciously or unconsciously suppressed in public
The use of sensory tricks to inhibit the symptoms
Both are types of oral fixations
Worse when tired, bored or tense
Tongue chewing is self-stimulating and there is also a pacifying/pleasure aspect of it.
Differentials with tongue chewing and thumb sucking:
Tongue chewing is not present during sleep and may decrease when lying down (supine position))
Thumb sucking is easier to control by avoiding the thumb completely. You can’t avoid your tongue.
Adult thumb sucking is pleasurable and thumb suckers actually enjoy the habit even though some want to stop. Tongue chewing is more
of a nuisance and can be painful to the tongue and jaw.
Bruxism
Bruxism is defined as the prolonged, unintentional grinding and clenching of the teeth, usually occurring during sleep. 'Bruxers' are often
unaware that they have developed this habit. Symptoms include facial pain, oversensitive teeth, tense jaw muscles, headaches, damage to
the tooth enamel or a popping or clicking in the temporomandibular joint.
Bruxism is more common in children than in adults, but is rarely treated. It is estimated to occur in 5% to 20% of the 3-17 year old age
group. In younger children it often stops by the time the second set of teeth appear.
The traditional concept is that bruxism is due to emotional stress. While stress may be a contributing factor the underlining cause is often
overlooked. Dentists use articulating paper to mark the "high spots" them grind them off in combination with night appliances to protect the
teeth while the patient grinds their teeth during sleep. Both treatments are within the dental standard of care. Both treatments have
attributes and may help, but are self limiting. Often the use of appliances does not solve the underlying problem.
The bones of the skull are joined together by means of sutures, which act as expansion/contraction joints.
The teeth function as the self-correcting mechanism to realign the skull. When the teeth are properly aligned contact during normal
swallowing and chewing "resets" the alignment of the maxillae, which in turn rebalances the rest of the skull. When patients have a
malocclusion or crooked teeth, a distortion occurs to the alignment of the skull. The misalignment in turn causes an increase in tension of
the fibrous membranes affecting the entire cranial mechanism.
The basic premise of craniosacral therapy is that in order for the brain and nervous system to function properly the bones of the skull must
accommodate free and symmetrical motion. The bones of the skull are joined together by means of sutures, which act as
expansion/contraction joints. When a patient has a malocclusion or crooked teeth, a distortion occurs to the alignment of the skull. This
misalignment in turn causes an increase the tension in the fibrous membranes. These fibrous membranes are innervated with sensory
nerves. Bruxism may be a result of bodies attempt to cope with this tension. Even if the patient has seemingly straight teeth distortions may
be present that could setup increased tension.
According to the Mayo Clinic, Factors that may increase your risk of bruxism include abnormally aligned top and bottom teeth, increased
stress or anxiety, and a hyperactive personality. Stimulants such as tobacco and caffeine also may cause your body to produce more
adrenaline, which may worsen your bruxism. There's little evidence to support that bruxism is influenced by hereditary or genetic
factors.
Unfortunately few doctors ever focus on this connection, resulting in treatments that have failed to correct the underlying cause(s).
While bruxism is considered a medical condition or disorder vs. a habit, tongue chewing has yet to be classified. Tongue chewing may be
caused by the same set of conditions as TMJ or bruxism.
Similarities with tongue chewing and bruxism:
Sustained by repetitive, patterned movements i.e.; chewing vs. clenching/grinding
Generally begins in early childhood.
Can be consciously or unconsciously suppressed.
The use of sensory tricks may relieve symptoms
Worse when tired, bored or tense
Differentials with tongue chewing and bruxism:
Tongue chewing is not present during sleep and may decrease when lying down (supine position))
In bruxism the jaw muscles are generally tense.
Tongue chewing is not damaging to the teeth, but it may contribute to a severe cross bite or malocclusion.
Bruxism is consider a medical condition/disorder not a habit.
Also see: Mayo Clinic http://www2.caremark.com/health_info_center/transformContent.asp?type=DC&id=DS00337
Dystonia - (Oromandibular)
Dystonia is a neurological movement disorder characterized by involuntary muscle contractions, which force certain parts of the body into
abnormal, sometimes painful, movements or postures. Dystonia can affect any part of the body including the arms, legs, trunk, neck,
eyelids, face, or vocal cords. There are many sub-types of dystonia that are clinically different and may also have different causes. Dystonia
is also characterized by sustained, repetitive, patterned movements. The term “patterned,” meaning consistently involving the same group
of muscles is particularly helpful in distinguishing dystonia from other movement disorders. Dystonia can begin as an action-induced
dystonia. The most common form is writer’s cramp.
Oromandibular is the name given to dystonia involving the cervical muscles of the jaw and tongue causing dystonic spasms and difficulty in
opening and closing the mouth and often affecting chewing and speech. Lingual or tongue dystonia may be the most prominent sign of
oromandibular dystonia but is often drug-induced. Oromandibular dystonia may persists even during sleep, or it may be task-specific,
occurring only during activities such as speaking or chewing.
Dystonia is believed to be due to abnormal functioning of the basal ganglia, which are deep brain structures involved with the control of
movement. The basal ganglion assists in initiating and regulating movement. What goes wrong in the basal ganglia is still unknown. An
imbalance of dopamine, a neurotransmitter may be responsible.
Treatment for dystonia is designed to help lessen the symptoms of spasms, pain, and disturbed postures and functions. Most therapies
are symptomatic, attempting to cover up or release the dystonic spasms. No single strategy will be appropriate for every case. A multitude
of drugs has been studied to determine benefit for people with oromandibular dystonia, but none appear to be uniformly effective.
The use of sensory tricks may also be effective in dealing with oromandibular dystonia. Sensory tricks include touching the lips or chin,
chewing gum, talking, biting on a toothpick, or putting a finger near an eye or underneath the chin to keep the jaw closed. Different sensory
tricks work for different people, and if a person finds a sensory trick that works, it usually continues to work.
There is a form of dystonia prominent in persons of Ashkenazi Jewish descent, caused by a mutation in a gene called DYT1. This form of
dystonia is hereditary and can, skip generations.
Similarities with tongue chewing dystonia:
Sustained, repetitive, patterned movements
Can begin as an action-induced pattern
The use of sensory tricks to inhibit the symptoms
Can be hereditary
Differentials with tongue chewing dystonia:
Not characterized by spasms or forceful contractions.
Does not affect opening and closing the mouth or normal chewing or speech.
Not drug-induced
Not present during sleep
Tongue chewing can be consciously suppressed
Symptoms of oromandibular dystonia usually begin between the ages of 40 and 70 years old.
For more information on Dystonia visit: www.dystonia-foundation.org
Tardive Dyskinesia
Tardive dyskinesia refers to a wide variety of involuntary, repetitive, persistent, stereotyped movements caused by the use of neuroleptic
drugs that block dopamine receptors.
Tardive Dsykinesia was first described in 1957 and the name was coined in 1964. Prior to this because of the prominence of symptoms
around the mouth, it was given the name "bucco-linguo-masticatory syndrome", meaning “cheek-tongue-chewing” syndrome. It was
most described in patients with schizophrenia.
Symptoms of tardive dyskinesia are characterized by well-coordinated continual movements of the mouth, tongue, jaw, and cheeks. Jaw
movements may be lateral or may resemble chewing motions. The tongue movements may be writhing or twisting.
The involuntary abnormal repetitive movements of tardive dyskinesia may also include lip smacking, cheek puffing, tongue thrusting, finger
flicking, and trunk twisting. Symptoms can range from mild to severe, based on the frequency and intensity of the movements. The
movements are often reduced when the patient voluntarily moves affected body parts and are increased when the patient moves unaffected
body parts. The abnormal movements usually decrease with emotional arousal, increase with relaxation, and disappear during sleep.
Similarities with tongue chewing tardive dyskinesia:
Well-coordinated, continual, sustained, repetitive, patterned movements of the tongue and jaw.
Symptoms can range from mild too severe
Movements are reduced when the patient voluntarily moves affected body parts.
Symptoms increase with relaxation, and disappear during sleep (exception; tongue chewing may decrease when lying down (supine
position))
Differentials with tongue chewing and tardive dyskinesia:
Tongue chewing is not related to neuroleptic drug use that block dopamine receptors
Tongue chewing may increase with emotional arousal
Tongue chewing can be consciously suppressed for long periods of time
Symptoms of tardive dyskinesia subside over time
For more information on tardive dyskinesia visit: www.emedicine.com/Neuro/topic362.htm
Tic disorders and Tourette's syndrome
Tics are intermittent, sudden, none voluntary seemingly normal, repeated, stereotyped movements or sounds. Tics may be "simple," such
as a cough, grunt, facial twitch, or shoulder shrug, or "complex," such as a word, phrase, or a stereotyped sequence of movements. Tics
can be suppressed but there is often a sense of a build-up of the need to tic Once the movement is made, there is a sense of temporary
relief until the sense of the need for the movement begins again. The tic may be incorporated into an apparently voluntary gesture; this is
done in an attempt to avoid embarrassment.
Tic disorders can fall under the category of Tourette's syndrome if there are multiple motor tics, have at least one vocal tic, or last over a
period of more than one year.
Tourette's syndrome is a hereditary neurobehavioral disorder characterized by sudden, involuntary, repetitive muscle movements (motor
tics) and vocalizations (vocal tics). The disorder is also known as Gilles de la Tourette syndrome for the neurologist who first described the
syndrome in 1885.
The nature and complexity of the tics are usually variable over time. Many individuals with Tourette's syndrome also develop associated
behavioral problems, such as obsessions and compulsions, inattention, hyperactivity. Symptom onset typically occurs during childhood or
early adolescence.
The primary characteristics associated with TS are multiple motor tics and one or more vocal tics.
Motor tics are sudden, rapid, recurrent, involuntary movements, particularly of the head and facial area.
Motor tics usually consist of abrupt, brief, isolated movements known as simple motor tics.
Less commonly, motor tics are more "coordinated," with distinct movements involving several muscle groups, such as repetitive squatting,
skipping, or hopping. Complex motor tics, may include repetitive behaviors such as touching of others, deep knee bending, jumping,
smelling of objects, hand gesturing, head shaking, leg kicking, or turning in a circle. Rarely, motor tics evolve to include behaviors that may
result in self-injury, such as excessive scratching and lip biting.
Similarities with tongue chewing and tic disorders:
Sustained, repetitive, patterned movements
Symptoms can range from mild too severe
Tongue chewing may be considered a complex repetitive motor tic.
There is often a vocal component including wining, humming, and clicking.
Tongue chewing can be consciously suppressed for short periods of time but there is often a sense of a build-up or urge to chew.
Symptoms can be suppressed
Tongue chewing subsides during sleep.
Differentials with tongue chewing and tic disorders:
No variability of symptoms over time.
Would not be considered a twitch or sudden movement.
Tongue chewing is self-stimulating behavior, there is a pacifying/pleasure aspect of it.
For more information on Tic disorders and Tourette's syndrome visit: www.wemove.org and www.tsa-usa.org.
Orofacial Myofunctional Habit Disorders
(oro - mouth; facial - face; myo - muscle); and
Oral Habits Of Compulsion
Orofacial Myofunctional Disorders involve behaviors and patterns created by inappropriate muscle functional and incorrect habits involving
the tongue, lips, jaw and face.
There are many possible myofunctional variations. Tongue thrust is the most common orofacial myofunctional disorder. Other improper
oral habits include: thumb or finger sucking, cheek or nail biting, clenching and grinding.
The source an cause of myofunctional disorder is difficult to determine. It is likely the result of a combination of factors including the
following:
Restricted nasal airways due to enlarged tonsils, adenoids or allergies.
Any type of structural or physiological abnormalities including malocclusion or abnormally large tongue.
Neurological or developmental abnormalities.
Hereditary predisposition.
Oral Habits of Compulsion are repeated movements involving the mouth. Including: lip biting, lip licking, lip sucking, tongue thrusting, and
thumb or finger sucking.
Tongue thrust is an abnormal swallowing pattern. It is the way babies swallow when they have no teeth. Most tongue thrusters lick their lip
prior to swallowing. They swallow with the tongue between the teeth instead of on the roof of the mouth. They do this between 800 and
2000 times per day and exert high pressure forces on the teeth.
The forces Orofacial Myofunctional Disordersof are very destructive. The repeated forces caused by these habits move teeth and bone.
All Orofacial Myofunctional Disorders and habits will greatly affect orthodontic treatment.
International Association of Orofacial Myology - http://www.iaom.com
Skin Picking and Trichotillomania
Skin Picking and Trichotillomania are very closely related and may be the most similar habit / disorders to
tongue chewing. Trichotillomania is an impulse control disorder characterized by the inability to control or
resist the temptation to pull out ones own hair.
Sometimes people even express a degree of pleasure after having performed the act.
Nine out of ten people with this condition report other "habits" such as nail biting, knuckle cracking, skin
picking, thumb sucking and tongue biting.
For more information please follow these links:
http://en.wikipedia.org/wiki/Trichotillomania
http://www.trich.org/index.asp
http://en.wikipedia.org/wiki/Compulsive_skin_picking
TMJ (Temporomandibular Joint Dysfunction)
TMJ is an abbreviation for a joint called the temporomandibular joint. The TMJ’s are the joints that connect the lower jaw (Mandible)
to the skull. They are arguably the most important joints in the body because they are active in chewing, talking, swallowing, and any
other motion involving the mouth and face and they provide a great deal of neurological information to the brain and body. TMD
(Temporomandibular Dysfunction) or CMD (Craniomandibular Dysfunction) are also names for this problem affecting millions of
people. The symptoms of TMJ may include but are not limited to jaw pain, headaches, neck pain, trouble walking, fatigue, breathing
problems, lower back pain, tinnitus (ringing in the ears), ear pain, dizziness, hyperactivity, obsessive-compulsive behavior, ADD
(attention deficit disorder), and even dyslexia. The number of different symptoms related to TMJ makes diagnosing and treating the
condition very difficult.
When a patient has problems with the temporomandibular joint it may stem from a malocclusion “bad bite”. The malocclusion sets
up a stress, degradation, or displacement of the joint. Misaligned bites can cause imbalances in the skull and other areas of the
body. The body’s effort to compensate for a misalignment, puts a great deal of stress on the muscles of the face, head, neck and
back. For this reason, many patients start with a chiropractor to straighten them out. The chiropractic adjustments may hold for a
short time, but until the underlining problem is addressed the treatment they are receiving is temporary at best.
The TMJ has profound influence on other aspects of the body, any disturbance of the occlusion or function of the TMJ will affect the
balance of the cranialsacral system the area in which your brain and spinal cord function. This is the very core of the central nervous
system, restrictions in it could also cause sensory, motor or neurological problems.
TMJ is not typically a disorder that people develop over night unless there has been some type of physical injury or trauma and,
unfortunately, by the time a patient seeks treatment, the structural system is already quite compromised.
The birth process is very traumatic, and can cause cranial and spinal distortions in newborns. This trauma is normal and in the
majority of cases these distortions work themselves out over time and never cause serious problems later in life. The problem
occurs when these patterns of trauma persist and impinge and alter normal physiology. In the 1900’s Dr. William Garner
Southerland the father of Cranial Osteopathic medicine published a book called "As the twig is bent so it will grow". We can grow
and have altered health potential around early traumatic events that set themselves up as regenerating patterns later in life.
TMJ, bruxism, thumb sucking habits, and tongue chewing and countless neurological disorders may all have originated as trauma
during the birth process or have developed from some type of accident, or emotional incident during early childhood.
Treatments may include cooperative efforts between a dentist and a chiropractor or Cranial Osteopathic Physician specially trained
in TMJ therapy. See Craniomandibular Practice and Therapy
“TMJ is considered a medical/dental condition or disorder not a habit, tongue chewing has yet to be classified. Tongue chewing
may be caused by the same set of conditions as TMJ or bruxism, although no mention of tongue chewing as a primary concern
has ever been described in association with TMJ disfunction."
Electromyography (EMG) in the treatment of TMJ Disfunction