z

Available online at http://www.journalcra.com

INTERNATIONAL JOURNAL
OF CURRENT RESEARCH
International Journal of Current Research
Vol. 10, Issue, 07, pp.71409-71412, July, 2018

ISSN: 0975-833X
RESEARCH ARTICLE

A CONSERVATIVE APPROACH OF TREATING MORSICATO MUCOSAE ORIS

THROUGH MODIFIED ORAL SCREEN
1,*Dr. Subhamay Chakraborty, 2Dr. Shruti Shah, 3Dr. Parvin Sultana, 4Dr. Sudipta Kar,
5Dr. Prof. Gautam kumar Kundu and 6Dr. Abhishek Das

1,2,3,6Post
Graduate Trainees, Department of Pedodontics and Preventive Dentistry, Guru Nanak Institute of
Dental Sciences and Research, Kolkata, West Bengal, India
4Reader, Department of Pedodontics and Preventive Dentistry, Guru Nanak Institute of Dental Sciences and

Research, Kolkata, West Bengal, India

5Professor and Head, Department of Pedodontics and Preventive Dentistry, Guru Nanak Institute of Dental

Sciences and Research, Kolkata, West Bengal, India

In

ARTICLE INFO ABSTRACT

Article History: One of the most challenging tasks for a pediatric dentist is the management of deleterious oral habits
Received 20th April, 2018 which severely affect the dento facial complex. However, if these habits can be intercepted and
Received in revised form diagnosed early, they can save the patient from the psychological impact of undergoing long
diagnosed
02nd May, 2018 treatment therapies. One such deleterious oral habit is Morsicato mucosae oris ie Chronic Cheek
Accepted 27th June, 2018 biting that affects the buccal mucosa. Presented here is a case report that describes the interception of
Published online 30th July, 2018 this deleterious habit in a 6 year old girl child who was a bilateral cheek biter with the help of an
unique design, modifying oral screen.
Key Words:
Chronic Cheek biting,
Deleterious Oral habits,
Modified Oral Screen,
Morsicato Mucosae Oris.
Copyright © 2018, Subhamay Chakraborty et al. This is an open access article distributed under the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Citation: Dr. Subhamay Chakraborty, Dr. Shruti Shah, Dr. Parvin Sultana, Dr. Sudipta Kar, Dr. Prof. Gautam kumar Kundu and Dr. Abhishek Das Das. 2018. “A
conservative approach of treating morsicato mucosae oris through modified oral screen.”,
screen International Journal of Current Research, 10, (07), 71409-71412.

Barrier or screening effect can be achieved by Oral screen

INTRODUCTION which is a simple and versatile myofuncti
myofunctional appliance used
in early interceptive treatment in dental arch deformities. It
Development of dentition is influenced by balance of orofacial was first introduced by Newell in 1912. Oral screen was
musculature and its function. Equilibrium of opposing forces routinely used in England before Second World War (Schwarz,
from buccal soft tissues and tongue maintain the dentition in 1966). Kraus (Kraus, 1956) first differentiated the difference
pleasing form and function. Disruption of this balance affects between oral screen and vestibular screen. The main objective
developing dentition and sets in malocclusion of varying of oral screen has been to eliminate oral dysfunction and
degrees. Morsicato mucosae oris is a form of chronic cheek establish muscular balance, correct or diminish maxillary
biting that is seen commonly on the buccal and labial
labi mucosa incisor protrusion particularly in connec
connection with thumb or lip
and lateral surface of tongue due to untoward deforming forces sucking and tongue thrust and also in relieving chronic cheek
.In cases of chronic cheek biting cases, trauma often leads to bite. Later oral screen has been modified by Hotz (Hotz, 1980),
inflammation and inflammatory lesion may lead to more injury Nord (Nord, 1959) and Fingeroth (Fingeroth, 1958). Different
due to persistent, unconscious, psychogenic habit. So screening
scree modifications of oral screen had been designed by different
or barrier must be created between cheek and buccal mucosa as researchers to fulfil different treatment needs. More recently
screening therapy which works on the principle of eliminating Goyal.S has introduced different variations. Here an effort has
abnormal muscle forces, prevents development
pment of abnormal been made through a modification to relieve patient from
biting forces. ulceration in the buccal mucosa from chronic cheek bite
*Corresponding author: Dr. Subhamay Chakraborty,, through
rough the use of oral screen. The purpose of following article
Post Graduate Trainees, Department of Pedodontics and Preventive Dentistry, is to present efficacy of oral screens in relieving the deleterious
Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, effects of chronic cheek bite.
India.
DOI: https://doi.org/10.24941/ijcr.31505.07.2018
71410 Dr. Subhamay Chakraborty et al. A conservative approach of treating morsicato mucosae oris through modified oral screen

Figure 3. Upper and lower model cast

Figure 1A. Pre operative photograph

Figure 4. Design of the fabricated appliance

Figure 1B

Figure 13

Figure 2. Bilateral cheek bite intra orally Figure 5. Appliance in patients mouth.
71411 International Journal of Current Research, Vol. 10, Issue, 07, pp. 71406-71408, July, 2018

competent lips and tendency of formation of open bite was

presented (although minimum) at the time of first visit(Figure-
1B,1C).The medical history revealed that patient had no
systemic illness . Parents also informed that patient had
minimum breast feeding and had intense pacifier sucking habit
mainly during sleep time in night. Therefore, after counseling
the parent, an immediate interception was planned with relief
from chronic cheek bite.

Fabrication of the appliance: Upper and lower alginate

impressions were recorded giving special emphasis on accurate
reproduction of the depths of vestibular sulcus and labial fold
and was poured with dental stone and working cast was
fabricated (Figure- 3). Wire bending was done by using 20
gauge wire and wire framework was constructed giving proper
curvature keeping in mind the vestibular level of the patient.
Proper relief was given in the frenum area of the maxillary
arch by making a notch in the wire framework. After
completion of wire bending, acrylization was done. Two
buccal shields extending from canine to permanent Ist molar
region on both sides were made adding clear, heat cure acrylic
resin which rested on bent wire. Buccal extensions on both
sides were made in such a manner that they shielded the buccal
cheek mucosa and ensured no contact between teeth and the
soft tissues. After acrylization, the appliance was trimmed,
polished and checked for sharp extensions. and was given a
wing shaped design which ensured no trauma due to biting of
cheek. . Borders of the acrylic extensions were properly
trimmed, polished to smoothen the edges so that appliance
itself does not cause any injury as well as promote healing due
to barrier effect of that particular retromolar region of the
concerned patient (Figure- 4). After appliance delivery, post
insertion instructions were given to the patient and was
recalled at 1, 3 and 6 months follow up (Figure 5). After 2
months, it was observed that buccal mucosa of both sides was
healed with no recurrence of traumatic cheek bite and also at
the same time pacifier sucking habit of the patient reduced
drastically preventing further malocclusions to develop(Figure-
6)

DISCUSSION
Deleterious oral habit in the form of biting of oral mucosa is
Fig 6A, 6B, 6C. Post insertion healing of the mucosa after 2
prevalent in 750 out of every one million indivuals
months
(Saemundsson, 1997). Females are affected more compared to
Case history: A 6year 2 months old girl reported to the males (Flaitz, 2000). In one of the largest studies conducted in
department of Pedodontics and Preventive dentistry, Guru a Mexican dental school clinic comprising 23,875 students,
Nanak Institute of Dental Science & Research with the chief found out that cheek biting is the fifth most common oral
complaint of irritation, occasional bleeding and ulceration in mucosal finding with a prevalence of 21.7 cases per 1,000
the cheek intra orally in approximation with posterior teeth patients (Castellanos, 2008). Repeated and recurrent biting
bilaterally (Figure- 1A). The symptoms were relieved after 1 or leads to a chronically traumatized area which is sometimes
2 days with local application of ointment but recurred again. thickened, scarred and paler than the surrounding mucosa, may
An intra oral examination of the patient revealed soft, bilateral or may not be present with sloughing, may or may not be
ulceration of 2mm x 2mm, involving buccal cheek mucosa tender and sometimes present as edema, purpura and erosions.
near retro molar region. The lesion was slightly tender on When formulating a differential diagnosis, it is important to
palpation and a partially sessile growth was at the level of keep in mind that mucosal areas that approximate the plane of
occlusion near permanent Ist molar teeth (Figure-2). Upon occlusion with clinical features such as irregular sufaces,
eliciting, parents revealed a history of pacifier sucking habit of erythematous zone, white tags of desquamated epithelium and
the patient and also informed that the patient unconsciously many more could be due to traumatic injury. A wide variety of
had cheek biting which occurred not only in daytime but also habitual biting behaviour exists and many treatment methods
during sleep. Intraoral examination revealed mixed dentition have been described and the most important consideration in
stage. Assessment of occlusion revealed class I molar relation managing self injurious behaviour if any is to plan the
bilaterally. On extraoral clinical examination, the patient treatment to the severity of the condition. Individualized
revealed mesoprosopic facial form, convex facial profile with approach is needed for each child in the management of these
type of deleterious oral habit. A variety of dental appliances
71412 Dr. Subhamay Chakraborty et al. A conservative approach of treating morsicato mucosae oris through modified oral screen

have been reported in literature for controlling of Morsicato REFERENCES

mucosae oris, ie chronic biting of oral mucosa9Although, a
dental appliance does not resolve the etiology of oral mucosa Bhatia SK, Goyal A, Kapur A. 2013. Habitual biting of oral
biting, it is an effective means of controlling the trauma mucosa: A conservative treatment approach. Contemp Clin
through remainder therapy10. Appliances like normal vestibular Dent., 4:386-9.
screen, mouth guard and even a crib has been thought of, Castellanos JL, Díaz-Guzmán L. 2008. Lesions of the oral
however none of these was the choice of appliance as the child mucosa: An epidemiological study of 23785 Mexican
was a young adolescent and the habit was deep rooted and patients. Oral Surg Oral Med Oral Pathol Oral Radiol
bilateral in nature. So keeping in mind considerations, such as Endod., 105:79-85.c
patients age, general health, cooperation level, and severity and Fingeroth, A.L., Fingeroth, M.M. 1958. Early treatment:
recurrence of cheek biting, a bilateral cheek biting interception Theory and therapy. Orthod. Record., 1: 87–99.
design was planned through this appliance.This design seemed Flaitz CM, Felefli S. 2000. Complications of an unrecognized
non -interfering with the esthetics of the patient, an unique cheek biting habit following a dental visit. Pediatr Dent.,
design effectively deflected the buccal mucosa bilaterally from NovDec;22(6):511-512.
the occlusal table, thereby preventing trauma, obstructing Hotz, R. 1980. Orthodontia in Everyday Practice. Hans Huber,
cheek bite and thumb sucking and at the same time being Bern.
malleable in design. More over this design does not hamper the Kozai K, Okamoto M, Nagasaka N. 1998. New tongue
transverse growth of the maxilla, does not hamper speech and protector to prevent decubital tongue ulcers caused by
it is a single unit design that can be easily fabricated and tongue thrust with myoclonus. ASDC J Dent Child.,
installed without any discomfort or risk to the patient. 65:474-7
Kraus F. 1956. Vestibular and oral screens. Trans Eur Orthod
Conclusion Soc., 32: 217–224
Nord, C.F.L. 1959. Loose appliances in orthodontia. Trans.
Main role of a pediatric dentist lies in the interception of habit. Eur. Soc. Orthod; 246
The removable prosthesis described in this case presents a Saemundsson SR, Roberts MW. 1997. Oral self-injurious
conservative treatment approach in managing chronic cheek behavior in the developmentally disabled. Review and a
biting or Morsicato mucosae oris. It fulfills criterias from being case. ASDC J Dent Child., 64:205-9
esthetic, functional, non -interfering etc .This modification of Schwarz, A.M., Gratzinger, M. 1966. Removable orthodontic
oral screen may prove useful in timely intervention and appliances. W. B. Saunders Company, Philadelphia.
management of chronic, recurrent cheek biting habit and its
harmful effects.

*******