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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

Background: Parafunctional habit has been associated in the literature with alterations of dental occlusion; it could be a predisposing factor for malocclusion. This cross-sectional study is aimed to assess the prevalence of parafunctional habits and its relation to parent’s education. Subjects and Methods: Convenience sample of 500 children aged between 4 and 6 years of both gender 262 boys and 238 girls receiving their medical care in primary health-care centers and in Raparin Pediatric Hospital of Erbil city to study parafunctional habits and its relation to parents education. Results: Mouth breathing and nail biting were more prevalent habits in the included children than lip sucking and bruxism. The former habits prevalence showed no significant differences in children whose their parents education background are different (high, middle, or low education). Conclusion: Mouth breathing and nail biting were highly prevalent habits among preschool children in Erbil city. No significant association was found between the prevalence of bad oral habits and parents education.

Objectives Little is known regarding the differences in microbiology associated with cellulitis or abscess with or without lymphangitic streaking. The objective of our study is to assess whether there are differences in the pathogens identified from wound cultures of patients with paronychia with and without associated lymphangitis. Methods Retrospective cross-sectional study at a tertiary pediatric emergency department over 25 years. We opted to assess patients with paronychia of the finger, assuming that these cases will have a greater variety of causative pathogens compared to other cases of cellulitis and soft tissue abscess that are associated with nail biting. Case identification was conducted using a computerized text-screening search that was refined by manual chart review. We included patients from 1 month to 20 years of age who underwent an incision and drainage (I&D) of a paronychia and had a culture obtained. The presence or absence of lymphangitis was determined from the clinical narrative in the medical record. We excluded patients treated with antibiotics prior to I&D as well as immune-compromised patients. We used descriptive statistics for prevalence and χ2 tests for categorical variables. Results Two hundred sixty-six patients met inclusion criteria. The median age was 9.7 years [IQR 4.7, 15.4] and 45.1% were female. Twenty-two patients (8.3%) had lymphangitic streaking associated with their paronychia. Patients with lymphangitis streaking were similar to those without lymphangitis in terms of age and sex (p = 0.52 and p = 0.82, respectively). Overall, the predominant bacteria was MSSA (40%) followed by MRSA (26%). No significant differences were found between the pathogens in the 22 patients with associated lymphangitis compared to the 244 patients without. Conclusion Staphylococcus aureus represent the majority of pathogens in paronychia, although streptococcal species and gram-negative bacteria were also common. Among patients with paronychia of the finger, there seems to be no association between pathogen type and presence of lymphangitic streaking.

Background: Anterior open bite (AOB) is the vertical separation between upper and lower teeth when all other teeth are in maximum intercuspation. It is considered abnormal when it affects patient’s function, speech, mastication, future dental health risks and aesthetics. Aim: The current study was conducted to determine the prevalence of anterior open bite and its etiological factors in a group of Egyptian children aged 8 years and above. Methods: The sample comprised 115 participants aged between 8 and 10 years, attending the Outpatients’ Clinic of Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University. AOB was assessed on study cast models using digital caliper. Increased overjet, abnormal oral habits, and parents’ educational level were checked. A close ended questionnaire was answered by patients’ guardians. Data were statistically analyzed with SPSS software package (version 21 SPSS Inc., Chicago, USA). Results: About 24(20.9%) of the 115 participants had AOB, 82 (71.2%) had normal overbite, 9 (7.8%) had increased overbite. Overjet relationship was increased in 51(44.4%). The most common etiological factor was mouth breathing 13(11.3%). Abnormal oral habits revealed higher percentages of tongue thrust 5 (7.2%), thumb sucking 4(5.8%) and lip biting 6(8.7%) in girls. Boys revealed higher percentages regarding mouth breathing 7(15.2%) and nail biting 1(2.2%). There was significant low positive correlation between parents’ educational level and the amount of AOB (r < 0.5, P-value < 0.05). Conclusions: Prevalence of AOB is relatively low, with no sex predilection. Abnormal oral habit may be a causative factor of AOB.

Onychophagia, commonly referred to as nailbiting is a chronic condition that is repetitive and compulsive in nature, and generally seen in both children and young adults. Multiple factors play a role in the development of nailbiting, ranging from genetic components, to underlying psychiatric conditions. Complications of chronic, compulsive nail-biting range from obvious distortion of the nail bed unit, to ungual and oral infection. Dental hygiene is, typically, less well-maintained in patients with nail-biting disorders: teeth may become chipped or notched, and gums many become inflamed. Treatment of nailbiting involves a multidisciplinary team that provides social, psychiatric, dermatologic, and dental care. Treatment ranges from psychotherapy modalities, to medication trials of selective serotonin reuptake inhibitors and N-acetylcysteine. Proper nail hygiene remains a mainstay in the prevention of the complications of chronic nail-biting. Additional supportive measures include the support of self-motivational novels and television episodes that help children learn coping mechanisms.

If humanity has any hope of tackling climate change, it needs to take action in this decade, sustainability researcher Kimberly Nicholas tells Richard Webb – and that challenges every aspect of howsociety works

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.

During the first two months of the Coronavirus Disease 2019 (Covid-19) pandemic, Romania was in lockdown, and all dental practices were closed, so orthodontic patients had to postpone their check-ups for at least eight weeks. This led not only to a delayed end of treatment but also to accidents and complications. The present study tried to evaluate the orthodontic situation both from the patient’s and orthodontist’s point of view, so the patients were given a few questions to answer, and the orthodontist analyzed each treatment before and after the two-month lockdown and decided if it was mildly or severely affected by the absence of check-ups. The study group consisted of 105 patients evaluated by three orthodontists in the same private practice. Patients that have gotten worse after the lockdown or who had problems were included in the study. Also, all the patients were given a 7-question form in order to find out their opinion. After two months without check-ups, our orthodontists found that 9.52% got worse because of the lack of intermaxillary elastics, broken brackets, broken removable orthodontic appliances, and others. Most of the patients believe that their treatment was delayed by the Covid-19 pandemic, but none of the patients felt unsafe when visiting the clinic. The Covid-19 pandemic had severe effects on orthodontic treatments. Orthodontists noticed a delay for about one-third of their patients. However, from the patient’s point of view, half believe that their treatment was negatively affected by the Covid-19 pandemic in different degrees.

Chronic nail biting (onychophagia) is a common habit which negatively impacts on the quality of life of those affected, has a negative social impact, and is accompanied with disabling inflammatory processes like gingivitis and paronychia. Habit reversal is a behaviour treatment procedure used to help patients get rid of the habit. The presented case report describes how a six-month period of habit reversal prescribed by the dermatologist was used to treat a 42-year male suffering from life-long onychophagia. During the treatment period, the patient experienced both an improved growth of nails and an improvement in quality of life, but never got fully cured from the habit. Finally, suggestions for an improved treatment success by prescribing habit reversal in specialized onychophagia clinics run by a multidisciplinary team (consisting of e.g., dermatologists, psychiatrists, and psychologists) who ensure regular follow-ups and patient compliance is provided.

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

Objective: The purpose of this study is to identify the prevalence of parafunctional oral habits among schoolchildren aged 6 to 12 years in Alexandria, Egypt. Materials and methods: A total of 255 Egyptian children, consisting of 158 males and 94 females were randomly examined. The examination included 1-Tongue thrusting: masseteric palpation 2-Thumb sucking: finger examination and intra-oral examination. 3-Mouth breathing: a. medical history. b. Mirror test (fog test) c. Jwemen’s Butterfly test. d. Water Holding Test (Masslers test). 4-Nail biting: fingers, nails examination and intraoral examination. Questionnaires were handed out to the parents to obtain information about the child’s gender, age, medical and dental history and any noticeable oral habits and collected a week later. Data was collected, sorted and registered. The subjects were assigned to different groups according to the habit. Percentile distribution of the subjects was calculated for different habit and their relation to each other, Categorical variables were analyzed using the chi-square test and Student t-test. Significance of the obtained results was judged at the 5% level (P ≤ 0.05). Results: the majority of subjects shows with 41.07% of the subjects had nail biting followed by tongue thrust with 29.4% then mouth breathing with 15.9% and the least prevalent oral habit was thumb sucking with 14.73%. 32.1% of the subjects had no habits at all and 67.9% had at least one habit. conclusion: Nail biting was the most dominant oral habit and the least common was thumb sucking, no patients were found practicing more than 3 habits.

Root resorption is the loss of apical root tissue which is implicated by decrease in root-crown ratio. It usually effects from external surface to pulp chamber if not identified in the early stage. Several natural conditions place roots at risk of resorption without any pathology. Knowing the pressure or etiology of the resorption will help the orthodontist in the treatment aspect. To date literature regarding root resorption due to various malocclusions is deplete in Indian population. To measure and assess the root crown ratios of maxillary incisors with vertical malocclusions, deleterious habits, and validate by two different radiographic techniques.90 Patients enrolled for the orthodontic treatment were allocated to three groups - open bite, deep bite & control groups and were subdivided based on nail biting habit. Panoramic radiographs, Periapical radiographs (by paralleling technique) for maxillary incisors (360 teeth) were taken and traced. Length of the root & crown were assessed and root crown ratios were calculated and the results substituted to statistics using SPSS. Comparison of Root-crown ratios in vertical malocclusions, revealed statistically significant (P < 0.001) differences in Open bite group for all maxillary incisors in both panoramic and periapical radiographs. No statistical significant differences were found in the deep bite group. Significant association was found between nail biting habit and Root-crown ratio. Gender predilection was found to be absent.Decreased Root- crown ratios were observed in open bite patients. Nail biting patients show significant root resorption. Both panoramic radiographs and periapical radiographs with paralleling technique can be used for assessing root resorption.

Extraneous activities of either the mouth, tongue or the jaw comprise the oral parafunctional habits of the stomatognathic system. This denominated habit is expressed through bruxism, digit sucking, nail biting to name a few, have led to hypothesizing the possible relationship of evolution of occluso-facial abnormalities such as malocclusion thereby hindering the conventional developmental process. Hence, the present study aimed to determine the prevalence and the possible relationship of parafunctional oral habits with the types of malocclusions among 12–16 years old females in Jeddah, Saudi Arabia. This cross-sectional study was conducted through questionnaire and clinical examinations, where the sagittal abnormalities within a randomly selected 672 participants who met the eligibility criteria were tabulated and analyzed. A positive history of the presence of parafunctional habit was recorded among all the participants with nasal and mouth breathing [46.6%], nail biting [39.6%] being predominant. 36.4% presented with significantly higher prevalence of bi-maxillary protrusion in mouth breathers while 17.1% with moderate overbite in participants with nail biting habit. Therefore, within the limitations of the present study, the findings do support the literature on the prevalence and the possible association of these habits with the malocclusion development thereby emphasizing on the importance of early recognition, management and prevention of them.

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...

Objective The aim of this study was to determine the prevalence of oral habits in eleven to twelve year old children in Trinidad and Tobago and to determine if there is any association with ethnicity and gender. Design Cross-sectional survey. Methods An epidemiological survey of 975 high school students (566 females (58.1%) and 409 males (41.9%)) was conducted. A questionnaire was developed to record information on the presence of oral habits. A clinical examination was also conducted at the school site. Statistical analysis was undertaken using Chi-square test and binary logistic regression. Results There was a high prevalence of oral habits. The overall prevalence of habits was 93%. 81.3% of children had a tongue thrust, 46.3% nail biting habit, and 34.9% digit sucking habit. Afro-Trinidadian subjects and female subjects were more likely to have habits with tongue sucking in particular exhibiting a female (OR 0.419 95%CI 0.285, 0.616) and Afro-Trinidadian ethnic (OR 0.559 95%Ci 0.433, 0.721) predilection. Conclusion The prevalence of oral habits in eleven and twelve year old children in Trinidad and Tobago is high, with higher prevalence in females and Afro-Trinidadians with tongue thrusting being most prevalent oral habit overall.

Background: The nail disorders comprise approximately 10% of all dermatological conditions. The nail unit may reflect dermatological disorder by its own and may show specific changes that are markers for a wide range of systemic disorders. Aims: To study the clinical spectrums of nail disorders including congenital, developmental, infectious, neoplastic, degenerative, dermatologic and systemic diseases affecting the nail unit. Materials and Methods: 200 consecutive cases with nail disorders attending to the Dermatology. Complete dermatologic and systemic examinations were carried out. Hematological investigations, including hemoglobin, total leukocyte count, differential leukocyte count and urine examination were carried out in all patients. Results: In this study, the involvement of nail was more common among males when compared to females. Onychomycosis was the commonest finding (27%) followed by psoriatic nail change (14.5%), Onycholysis (5.5%), Pitting (4.5%), Onychogryphosis (4.5%), Trachyonychia (4.5%), Chronic Paronychia (4.5%), Clubbing (4%), Subungual Warts (3.5%), Clubbing with resorption of terminal fingers (2.5%) and Ingrowing toe nail (2%). The other uncommon nail changes included Onychomadesis (1.5%), Pincer nail (1.5%), Onycholysis & pitting (1.5%), Nail discoloration (1.5%), Anonychia (1.5%), Half-and-Half nail (1.5%) Koilonychia (1.5%), Longitudinal Melanonychia (1.5%), Nail biting (1.5%), Worn down nail (1%), Transverse grooves (1%), Racket nail with clubbing (1%), Idiopathic total leuconychia (1%) and Beaus lines (1%). Also observed as single cases (0.5%) were Dorsal pterygium, Macrolunula, Longitudinal grooves, Dariers disease, Pachyonychia congenita, Acute Paronychia and Acrodermatitis continua of Hallopeau. Conclusion: Study has revealed onychomycosis, onycholysis, chronic paronychia, ingrowing toenail etc, as the common nail disorders. These conditions were associated with subclinical trauma. Nail biopsy in these patients may clarify this issue further.

Objective This study explored the boundaries of the proposed diagnostic criteria for nonsuicidal self-injury disorder (NSSID) as outlined in the Conditions for Further Study section of the Diagnostic and Statistical Manual, Fifth Edition. We sought to falsify the exclusion of certain NSSI behaviors from a diagnosis of NSSID (Criterion D), arguing that these exclusions are inconsistent with the broader phenomenology of the disorder outlined in the other criteria. METHOD: We describe three case studies involving NSSI (Case 1: scab-picking; Case 2: nail-biting; Case 3: tattooing) that cannot be diagnosed as NSSID because the behaviors are explicitly listed in Criterion D. Results Despite exclusion as a relevant NSSI behavior per Criterion D, each examined behavior is consistent with the intentionality, functionality, and distress/impairment of NSSID that represent core features of the disorder. Conclusion The case studies presented here suggest that Criterion D should be revised or removed from the NSSID criteria.

Objective This study aimed to examine personality profiles and behavioral problems of children with nail biting (NB) to gain insight into the developmental trajectory of pathological NB.Methods 681 elementary school students were divided into non NB (n=436), occasional NB (n=173) and frequent NB group (n=72) depending on the frequency of NB reported in Child Behavioral Checklist (CBCL). Children’s personality was assessed using the Junior Temperament and Character Inventory (JTCI), and behavioral problems were assessed using the CBCL. Latent Profile Analysis (LPA) was performed using JTCI profiles to classify personalities of the children with NB (belonging to frequent and occasional NB group, n=245).Results For subscale scores of CBCL, the total, internalizing, externalizing, anxious/depressed withdrawn/depressed, depression, thought, rule-breaking, and aggressive behavior problems, were most severe in the frequent NB group followed by occasional NB and non NB group. LPA of personality profile in children with NB revealed four classes (‘adaptiveness,’ ‘high reward dependence,’ ‘low self-directedness,’ and ‘maldaptiveness’). The four personality classes demonstrated significant group differences in all of the CBCL subscales. Children who showed low self-directedness and cooperativeness and high novelty seeking and harm avoidance personality profiles demonstrated highest tendency for problematic behavior irrespective of the frequency of NB.Conclusion Children with NB reported significantly more problematic behaviors compared to children without NB. Children with specific personality profile demonstrated higher tendency for problematic behavior irrespective of the frequency of NB. Therefore, accompanying personality profiles should be considered when assessing behavioral problems in children with NB.

In September 2019, the New York Times (NYT) published the article "Fighting the Shame of Skin Picking," which discussed the cosmetic, social and emotional impacts of body-focused repetitive behaviors (BFRBs). BFRBs, including excoriation disorder, trichotillomania, onychotillomania, and onychophagia, are recurring actions that damage one's physical appearance. The aim of this study is to characterize the demographic information provided and themes raised in the 166 comments posted in response to the article. The most commonly reported condition was skin picking (38.2%), followed by trichotillomania and/or trichophagia (30.3%), onychotillomania (24.7%), and onychophagia (23.6%). All conditions had a female predominance. Treatment of body-focused repetitive behaviors was the most common topic of discussion, followed by shame and impact on appearance. Since commenters described significant impairments to quality of life, larger randomized controlled trials on skin picking, trichotillomania, onychophagia, and onychotillomania are necessary to provide evidence-based management to patients.

Purpose Compelling evidence indicates that an addictive process might contribute to overeating/obesity. We hypothesize that this process consists of two components: (a) a sensory addiction to the taste, texture, and temperature of food, and (b) a motor addiction to the actions of eating (e.g., biting, chewing, crunching, sucking, swallowing). Previously, we reported a mobile health application (mHealth app) obesity intervention addressing the sensory addiction component, based on staged food withdrawal. We propose that the motor addiction component can be treated using cognitive behavioral therapy (CBT)-based strategies for body-focused repetitive behaviors (BRFB), e.g., nail biting, skin picking, and hair pulling. Methods The present study tested the effectiveness of CBT-based, BFRB therapies added to the staged withdrawal app. Thirty-five participants, ages 8–20, 51.4% females, mean zBMI 2.17, participated in a 4-month study using the app, followed by a 5-month extension without the app. Using staged withdrawal, participants withdrew from specific, self-identified, “problem” foods until cravings resolved; then from non-specific snacking; and lastly from excessive mealtime amounts. BFRB therapies utilized concurrently included: distractions, competing behaviors, triggers avoidance, relaxation methods, aversion techniques, and distress tolerance. Results Latent growth curve analysis determined that mean body weight and zBMI decreased significantly more than in a previous study that used only staged withdrawal (p Conclusions This study provides further preliminary evidence for the acceptability of an addiction model treatment of obesity in youth, and that the addition of CBT-based, BFRB therapies increased the effectiveness of staged food withdrawal. Level of evidence Level IV, Evidence obtained from multiple time series analysis with the intervention.

Psychological correlates of adult nail biting have received little empirical attention so far, despite its high prevalence and negative associations with physical and mental health. One possible correlate of nail biting is arousal modulation, which has also been linked to smoking (i.e., another oral behavior). Here, we link nail biting to an adaptive (i.e., Task-oriented) and two maladaptive stress-coping strategies (i.e., Emotion-oriented, Avoidance-oriented) as well as smoking while controlling for personality traits and socio-demographic characteristics. In all, 838 German-speaking adults ( Mage = 32.02, SD = 13.48; 431 women) completed measures of stress coping (CISS-SF), the Big Five personality traits (Mini-IPIP), and indicated nail biting and smoking behavior. In three theory-guided, hierarchical linear regressions we predicted each stress coping strategy by nail biting and smoking while controlling for personality and socio-demographic characteristics. Oral behaviors had differential effects on maladaptive stress coping strategies: The interaction between nail biting and smoking predicted Emotion-oriented coping, while smoking predicted Avoidance-oriented coping. Both behaviors were unrelated to adaptive, Task-oriented coping. In sum, our results show that nail biting and smoking are important predictors of maladaptive but not adaptive coping strategies, even when controlling for confounders.

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.

Background: Nail biting can increase the risk of infection and abnormal-looking nails. The purpose of the present investigation was to formulate and evaluate anti-nail-biting lacquers consisting of bitter herbal extracts. Methods: The hydroalcoholic extracts obtained from Andrographis paniculata and Tinospora crispa were determined for phytochemical constituents, total phenolic contents, antioxidant activities, anti-inflammatory activities, and cytotoxicities. Anti-nail-biting lacquers were prepared by using herbal extracts (bittering agent), shellac (film forming polymer), ethanol (volatile solvent), and other indispensable additives with continuous stirring. Thus, attempts to enhance the film property and bitterness is accomplished by using polyvinylpyrrolidone K30 as a copolymer and varying concentrations of herbal extracts. Good accepted formulations were established for drying time, pH, viscosity, smoothness of film, film strength, water resistant, and solubility in simulated saliva and then evaluated their bitterness in human volunteers.Results: Phytochemical constituents including tannins, glycosides, reducing sugars, alkaloids, terpenoids, and flavonoids were found present in both extracts while saponins was only detected in A. paniculata extract. Although T. crispa extract exhibited a significantly higher (p < 0.05) total phenolic content and antioxidant activity than A. paniculata extract, it showed lower protein denaturation inhibition property than A. paniculata extract. Because of the potentials of both extracts without cytotoxicity, anti-nail-biting lacquers containing either A. paniculata extract or T. crispa extract were developed and evaluated. Drying time of formulations were 6-11 min with visually seen glossiness of formulation. Formulations of the nail lacquer showed good pH, viscosity, smoothness of film, film strength, water resistant, and solubility in simulated saliva. The formulations displaying no significant cytotoxicity effect on CRL-2076 cells were assessed on healthy human volunteers to compare bitterness and film characteristics. Conclusion: The optimized formulation containing A. paniculata extract could successfully achieve good film forming property and bitterness release which is considered promising for stopping nail biting.

BACKGROUND Onychophagia is a common disorder affecting 20% to 30% of the general population. It is defined as habitual nail biting and can cause various changes in the nail units. However, to date, there has been a paucity of data focusing on nail deformities related to onychophagia. This study was performed to investigate the clinical characteristics of onychophagia in Korea. METHODS This study included 53 patients with onychophagia who visited the Pusan National University Hospital (Busan and Yangsan) over a 10-year period (2011-2020). We retrospectively reviewed medical records and clinical and dermoscopic photographs. RESULTS All 10 fingernails were affected in 37.7% of the patients. The left thumbnail was the most predominantly affected site (81.1%). Clinical findings showed that short nails with ragged distal borders were the most common presentation (100.0%), followed by generalized or patchy rough areas (50.9%), linear and pinpoint hemorrhage (32.1%), longitudinal melanonychia (30.2%), transverse groove (28.3%), brittleness (28.3%), macrolunula (24.5%), washboard nail (13.2%), and pterygium (3.8%). Of the patients, 88.7% had periungual complications, such as periungual exfoliation (77.4%), absent or ragged cuticle (52.8%), hyponychial hyperkeratosis (37.7%), and paronychia (15.1%). CONCLUSIONS Although onychophagia is a common disorder, its clinical characteristics have not been reported in the literature. The results of this study may be helpful in managing patients with onychophagia.

Onchyophagia or nail biting is the performance of repetitive actions of biting one’s nails often to the level of mutilation of the nail beds. It is a compulsive act most often seen in adolescents but may continue into adulthood, leading to deleterious consequences. Often spurred by anxiety and stress, this oral habit is not so readily addressed by patients and in turn not very much treated by dentists or physicians. This case report describes successful treatment of an adolescent patient with a nail biting habit, with an innovative intraoral fixed habit-breaker appliance.

The main objective was to investigate the socioeconomic status and dependent personality as the predictor of nail biting among adults. A sample of 101 adults that nail bit was selected from Sialkot city that aged above 19 to 75 years using purposive sampling from government and private educational institutes and local communities. The socioeconomic status and nail biting measured in the demographic form asking information about income, education, profession and do you nail bit. Further, dependent personality was checked with Dependent Personality Disorder scale Urdu version (Shahzadi & Bano, 2018). Results showed that there is significant predictive relationship present between these two variables on samples (N= 101), R= .432 which indicates a moderate correlation. The R2= .187 which indicated that 1.8% variation in the dependent variable, can be explained by the independent variable. Adjusted R-square a modify form of R-square which is also 1.7 variation in data. Descriptive results of this study showed that these two variables from sample (N= 320) are co-occur only in (N= 101) participants with 31.5 percentage generally in both male and female of Sialkot city. Structure Equation Modeling was used for the analysis of data. The model fit summary indicated the p value of .000 which indicates that socioeconomic factors and dependent personality was the significant predictor of nail biting among adults. All the model fit indices were also in the best prescribed limits as Chi-square/df (1.106), Goodness of Fit Index (.976), Adjusted Goodness of Fit Index (.940), Comparative Fit Index (.974) and Root Mean Square Error of Approximation (.033). Furthermore, the income regression estimate indicates that when income, profession and dependent personality goes up by 1 standard deviation, the nail biting goes up by 0.21, 0.12 and 0.4 standard deviations respectively whereas in case of education, it goes up by 1 standard deviation and the nail biting behavior goes down by .09 standard deviations. Conclusion: In conclusion, the socioeconomic status and dependent personality was the significant predictor of nail biting behavior among adults.

Aim: to determine the prevalence of malocclusion among adults attending Dental Centers in Ajman and Sharjah, as well as the association of gender, ethnicity, and prevalent oral habits with the types of malocclusion. Material and Methods: The study was conducted on 300 patients with age range 18-30 years. Intraoral dental and Orthodontic classification was performed alongside a questionnaire. Patients’ occlusions were classified based on Angle’s Classification. Results: Among the sample group, it was found that Class I malocclusion was the most prevalent malocclusion with 74% , Class II division 1 was 12% and Class II division 2 was 11% and the least was Class III with 3% with significant difference between males and females. For different ethnic groups included in the study the same pattern of prevalence applied (Class I followed by Class II, Class III came last) except for Caucasians and Far Eastern, where Class II division 2 surpassed division 1 with a significant difference between all Classes of malocclusion except for Class I. As for oral habits, nail biting was the most prevalent oral habit showing 20.7%, followed by teeth grinding 11%, thumb sucking 10%. Tongue Thrust was the least prevalent habit with a significantly higher prevalence in Class II malocclusion of the studied sample. CONCLUSION: Class I malocclusion was the most prevalent malocclusion, followed by Class II division 1, Class II division 2, and the least was Class III. All ethnic groups showed the same pattern of distribution except for Caucasians, Far Eastern, and South Asian. The pattern of distribution was the same for both males and females; however, a difference in the percentage existed between genders. The most prevalent oral habit was nail biting. All oral habits were not related to different types of malocclusions except for tongue thrust (higher prevalence in Class II Malocclusion). This study is a base for further Arab and Middle Eastern studies.

Pediatric body-focused repetitive behaviors (BFRBs) demonstrate significant prevalence and impairment, yet their etiology is poorly understood. Addressing this limitation, the current study sought to explore the relationship between pediatric BFRBs (i.e. skin picking, hair pulling, nail biting, lip biting) and anxiogenic parenting (i.e. conflict, over involvement, accommodation, modeling, emotional warmth) – one potential factor in this pathology given established links between BFRBs and anxiety. Five hundred and thirty parents/caregivers of children ages 7–17 (268 exhibiting one or more BFRBs; 262 exhibiting no BFRBs) completed an online survey including an anxiogenic parenting self-report (i.e., The Parenting Anxious Kids Ratings Scale – Parent Report [PAKRS-PR]) and several questions assessing child BFRB presence and severity. Regression analyses indicated that although child anxiety significantly predicted collective BFRB presence and number of BFRBs in which a child engaged, anxiogenic parenting was not a significant predictor in these models. Conversely, results demonstrated that for every one unit increase in PAKRS-PR total score, children were 1.49 times more likely to engage in skin picking (controlling for anxiety). Further exploratory analyses revealed that specific anxiogenic parenting behaviors (i.e., accommodation, emotional warmth) significantly predicted BFRB severity. Implications for these findings, limitations and future areas of research are discussed.

Background:Periodontal disease is a chronic inflammatory disease of periodontium and is characterized by loss of periodontal ligament and surrounding alveolar bone. It is highly prevalent in adolescents, adults, and older individuals. Numerous risk factors such as smoking, poor oral hygiene, adverse oral habits, medication and stress are associated with periodontal diseases. Aims and Objectives:The aim of this study was to investigate the prevalence of adverse oral habits and its association with the periodontal status among Saudi sub population of age between 15- 65 years. Material and methods:Three hundred and thirty patients, referred for periodontal therapy were selected. The patients were asked for any adverse oral habits and thenperiodontal parameters (Plaque index, gingival index, probing pocket depth and clinical attachment loss) were assessed. Results: Among 330 participants 69 (20.9%) had adverse oral habit of consuming tobacco either in the form of smoking or chewing, 23(7%) had bruxism and 6 (1.8%) nail biting habit. Parafunctional habits were found to be higher in female participants. Participants with adverse oral habit had PI (230/ 69.7%) and GI (284/86.1%) score of 2. Significant association was found between gender, adverse oral habit and mean CAL. Conclusion:The results of the present study revealed a significant increase in parafunctional habits among female participants. Substantial association among type of adverse oral habits and CAL. To minimize the incidence and progression of periodontal disease in these subjects through oral hygiene and regular dental visits should be encouraged.

Background Pathologic grooming disorders can lead to clinically significant distress and functional impairment. Studies on treatment of these disorders with selective serotonin reuptake inhibitors (SSRIs) and anticonvulsants have led to inconsistent findings. N-acetylcysteine (NAC) has shown promise in treatment of obsessive-compulsive and related disorders. The objective of this article is to perform an updated review of NAC in the treatment of grooming disorders. Methods PubMed was searched from inception to October 2017 to identify literature on the use of NAC in the management of trichotillomania, onychophagia, and pathological skin picking. Case reports, case series, and randomized controlled trials were included. Data on study design, dosing regimens, comorbidities, concurrent treatment, and side effects were extracted from the included articles. Results Fifteen articles were included in this review, which consisted of 10 case reports, one case series, and four randomized controlled trials. Dosing of oral NAC ranged from 450 to 2,400 mg per day, and treatment periods lasted from 1 to 8 months. Side effects were uncommon, mild, and usually gastrointestinal in nature, with severe aggression reported in one child. Conclusions While there are multiple reports of the safety and efficacy of NAC in the treatment of grooming disorders, there are currently few randomized controlled trials on this topic, and more research is needed to develop a formal treatment algorithm. While current data should be considered very preliminary, case reports have demonstrated mostly positive results and a lack of significant side effects. A trial of NAC may be a viable option for pathologic grooming disorders, especially in patients who have failed prior psychologic or pharmacologic treatment.

Introduction Onychophagia is defined as putting one's fingers into the mouth and biting the nails. We sought to evaluate the prevalence of onychophagia in university and high school students and its relation to sociodemographic factors, perceived stress, and quality of life. Methods A total of 3,475 students were included in the study. A questionnaire including sociodemographic characteristics, items about onychophagia, the Perceived Stress Scale (PSS), and the European Health Impact Scale were used. Results The prevalence of onychophagia among university students was 17.6%, and among high school students it was 29.2%. In university students with onychophagia, the median score on the PSS was higher than the median score of students without onychophagia. In high school students, the median score on the PSS was 28.2 for students without onychophagia and 28.0 for students with onychophagia; the difference was not significant. The median scores on the quality of life scale for both university and high school students with onychophagia were lower than the mean score of students without onychophagia. Conclusions Onychophagia is a common problem in the general population with a multidimensional etiology. It has dermatological, dental, and psychiatric consequences and comorbidities, and so a multidisciplinary approach is necessary for the prevention and treatment of onychophagia.

The present cross-sectional case-control study aimed to determine if there is an association between specific oral behaviors, sleep bruxism (SB), awake bruxism (AB), and painful temporomandibular joint (TMJ) clicking. Ninety individuals were dived into three groups; Group 1 (n = 30): painful TMJ clicking; Group 2 (n = 30): painless TMJ clicking; and Group 3 (n = 30): control group. The following clinical data were studied: oral behaviors (unilateral chewing, gum chewing, nail biting, foreign objects biting, leaning with jaw against the hand, and sleeping in a position that pressures the jaw), SB, AB (including the frequency in 10 days, evaluated by ecological momentary assessment), and malocclusions investigated based on clinical inspections (anterior open bite, posterior cross-bite, abnormal overbite/overjet, occlusal guidance, mediotrusive and/or laterotrusive interferences, retruded contact position to maximum intercuspation slide, missing posterior teeth). All statistical tests (Kolmogorov-Smirnov, chi-square, and one-way ANOVA) were performed with a 5% significance level. Group 1 had the highest frequency of and a significant association with leaning with jaw in the hand, sleeping position that pressures the jaw, gum chewing, nail biting, and AB (p0.05). It can be concluded that patients with painful TMJ clicking had a higher frequency of and a significant association with some specific harmful behaviors and AB.

Body-focused repetitive behavior disorders are a group of disorders characterized by repetitive actions that include skin picking, hair pulling, nail biting, and other compulsions. These disorders can range from a common habit to a pathological disorder, that negatively impacts the psychiatric health and social well-being of an individual. Diagnosis can be made clinically, and monitored using different scales and assessments. Various treatments have been tried with differing successes. There are currently no first line curative medications for these disorders, but cognitive behavioral therapy has seen the most success in treatment. Specifically habit reversal therapy has shown the most promise in reducing the repetitive behaviors and symptoms seen in these disorders. Habit reversal therapy has also seen success through augmentation with additional therapies such as mindfulness, or treatment with a selective serotonin reuptake inhibitor in a patient with comorbid obsessive compulsive disorder. This paper aims to explore the efficacy of different treatment modalities specifically the effectiveness and approach of habit reversal therapy.

Body-focused repetitive behaviors (BFRBs) include such disorders as compulsive hair pulling, skin picking, nail biting, and cheek biting, which can lead to significant psychosocial impairment (American Psychiatric Association, 2013). As such, social concerns (i.e., concerns about how others view their behavior or affected body sites) are common in these individuals, and may significantly associate with BFRB symptomology (Snorrason et al., 2012). Currently, there are no measures to adequately assess social concerns specific to BFRBs. To this end, we developed a new self-report measure called the Social Concerns in Individuals with BFRBs (SCIB) that aimed to assess these concerns using two independent samples of individuals reporting elevated BFRB symptoms. Results showed that the overall level of social concerns reported on the SCIB significantly explained the variance in hair pulling and skin picking symptom severity even after controlling for the influence of other general social concern and emotional distress measures. Exploratory and confirmatory factor analyses provided psychometric evidence for the two-factor structure of the SCIB: (1) Concern about Physical Unattractiveness and (2) Concern about Social Disapproval, which were found to assess distinguishable aspects of BFRB-relevant social concerns. Overall, the findings suggest that the SCIB is a useful measure that can be used to evaluate social concerns in those with BFRB disorders.

Stereotypies are abnormal involuntary non-goal-directed movement patterns or vocalisations which repeat continuously in the same fashion over a period of time and on multiple occasions and are typically distractible. Stereotypies are common in both children and adults, but they are extensively reviewed only in children. There are very few studies, mainly in the form of case reports and case series, focusing on stereotypies occurring in adults as part of different neurological disorders. In adults, stereotypies can be both physiological and pathological. Common physiological stereotypies in adults are leg shaking, face touching, playing with pens or hair, nail biting, hand tapping, foot tapping, and body rocking. Pathological stereotypies in adults are associated with a variety of neuropsychiatric conditions like neurodegenerative disorders, viral encephalitis, autoimmune encephalitis, stroke, psychiatric illness, and drug use. In this review, we focus on the various causes of stereotypic movements in adults, and their pathophysiology, clinical manifestations, and treatment.

The aim of the present study was to assess the potential role of some biological, psychological, and social factors to predict the presence of painful temporomandibular disorders (TMDs) in a TMD-patient population. The study sample consisted of 109 consecutive adult patients (81.7% females, mean age 33.2 &plusmn, 14.7 years) who were split into two groups based on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnoses: painful TMD and non-painful TMD. The presence of pain was adopted as the depended variable to be identified by the following independent variables (i.e., predictors): age, gender, bruxism, tooth wear, chewing gum, nail biting, perceived stress level, chronic pain-related impairment (GCPS), depression (DEP), and somatization (SOM). Single-variable logistic regression analysis showed a significant relationship between TMD pain and DEP with an odds ratio of 2.9. Building up a multiple variable model did not contribute to increase the predictive value of a TMD pain model related to the presence of depression. Findings from the present study supported the existence of a relationship between pain and depression in painful TMD patients. In the future, study designs should be improved by the adoption of the best available assessment approaches for each factor.

Ingestion of a foreign body is commonly encountered in clinical practice, but most cause no complications, passing spontaneously through the gastrointestinal tract. However, they can cause obstructive signs and symptoms, and surgical intervention for extraction of the foreign body may be required after identifying its location. We present here the case of a 49-year-old woman who presented to our emergency room with abdominal pain localizing to the right lower quadrant. Evaluation was most consistent with acute appendicitis, and she underwent uncomplicated appendectomy. A keratin nail with Actinomyces was identified in her appendix. Foreign bodies in the appendix can cause simple appendicitis, perforation, periappendiceal abscess, and peritonitis. Regardless of etiology, an appendectomy often ends up the primary treatment, but unusual and rare causes are worth noting if only for the clinician to be aware of when evaluating the next patient with abdominal pain and considering treatment options or future prevention. Our case is an example of a rare scenario in which an Actinomyces-contaminated human nail lodged in the appendix of a woman eventually resulting in acute appendicitis.

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.

AIM To determine the prevalence of probable sleep bruxism (PSB) and associated factors among schoolchildren. DESIGN This cross-sectional study was carried out with a representative sample of 440 schoolchildren. The children were submitted to a clinical oral examination for the evaluation of tooth wear and/or muscle discomfort. Parents/caregivers filled out a questionnaire with information related to characteristic sounds of sleep bruxism, sociodemographic factors, and the presence of harmful oral habits of children. The stress of the mothers was measured through the Lipp's Stress Symptoms Inventory for Adults (LSSI) instrument. The child's stress was measured through the Child Stress Scale (CSS). Data analysis included descriptive analysis and hierarchical Poisson regression (95% CI, P