Lip Biting Research Articles

Deleterious Oral Habits among School Going Children - A Cross-Sectional Study

Aim: The present study was conducted to access the prevalence of deleterious oral habits among school going children as these practices have a great impact on the dental hard and soft tissues. Methodology: This study was conducted among children aged between 7 to 13 years. The sample was selected from urban and rural schools. A closed-ended questionnaire was used in the survey for collecting the information like age, gender, area of residence and presence of deleterious oral habits. These questions were asked to parents for the habits like bruxism, tongue thrusting, digital sucking, mouth breathing, nail biting and lip biting. Chi-square test compared the frequency of oral habits in relation to age, sex and area. Statistical tests were used at a significance level of p<0.05. Results: It was noticed that bruxism (14.4%) was most common habit followed by mouth breathing (12.6%), digital sucking (9.2%), nail biting (8.3%), lip biting (8.1%) and tongue thrusting (7.2%). Bruxism (4.7%) and tongue thrusting (3.4%) had the highest occurrence in (9 to 11 years) group. Digital sucking (3.6%) and mouth breathing (6.3%) was mostly observed among younger age group (7 to 9 years). However nail biting (4.3%) and lip biting (4.7%) was commonly noticed in older sample. Conclusion: The study observed that bruxism was most frequent habit among children. There was also a variation in the occurrence of oral habits in relation to age.

Impulsivity in body-focused repetitive behavior disorders: Disparate clinical associations between three distinct measures

Objective: Research on trichotillomania (TTM) and excoriation (skin-picking) disorder (SPD) has suggested that impulsivity may be an important cognitive underpinning of the behavior, but many studies have produced mixed results. This analysis assessed impulsivity in TTM and SPD using three measures: the Barratt Impulsiveness Scale (BIS), the Eysenck Impulsiveness Questionnaire (EIQ), and the Stop-Signal Task (SST). Methods: Two hundred and eighty three subjects with TTM or SPD completed measurement of impulsivity as a part of participation in several research studies. Subjects scoring one standard deviation above or below measure means were included in the analysis for that scale (SST: N = 45; EIQ: N = 32; BIS: N = 34). High and low impulsive groups were compared within measures on demographic, clinical, and behavioral variables. Results: Results differed by group, with domains of the BIS showing associations with clinical severity, quality of life, and anxiety, and the SST showing several differences, but not clinical severity. The EIQ domains showed no significant differences. No groups differed demographically. Conclusions: These results suggest that the EIQ, BIS, and SST assess distinct characteristics. Notably, only the attentional domain from the BIS predicted higher severity scores. Future research needs to clarify the ideal utility for these scales as they relate to TTM and SPD.Key pointsThe BIS, EIQ, and SST domains are associated with distinct clinical differences between high and low impulsivity groups.Only the subjects in the high attentional impulsivity domain of the BIS showed significantly elevated symptom severity.The high and low impulsivity groups within the EIQ domains did not show any significant differences.These disparate associations may indicate the need for better subtyping of impulsivity, as different measures of specific domains appear to show associations with distinct features.

Spinning My Silent Reverie: Confessions of a Compulsive Hair Twister

In this confessional essay of her compulsive hair knotting habit, the author considers the DSM-5's recent classification of body-focused repetitive behaviors as forms of obsessive–compulsive disorder and also Freud's analysis of this kind of tactile, repetitive motion as a symbolic substitute for masturbation. Yet although both Freud and the DSM-5 take seriously the etiology of habits that are otherwise generally overlooked and dismissed, Daum argues that neither explanation addresses the particularity of the specific compulsion. After all, hair twisting, nail biting, nose picking, skin picking, and beard stroking all involve different movements performed on different parts of the body, and as a result, conjure up different symbolic implications. Daum follows the historical thread of her own compulsion back to the archetypal tangles between women, hair, sexuality, spinning, weaving, and storytelling. As she explores these motifs in art, mythology, and folklore, Daum invites the reader to linger on the possibility that dismissing a “fussy habit” may be throwing away the key to one's intimate inner landscape.

Antioxidant Therapies for Ulcerative Dermatitis: A Potential Model for Skin Picking Disorder.

Skin Picking Disorder affects 4% of the general population, with serious quality of life impacts, and potentially life threatening complications. Standard psychoactive medications do not help most patients. Similarly, Mouse Ulcerative Dermatitis (skin lesions caused by excessive abnormal grooming behavior) is very common in widely used inbred strains of mice, and represents a serious animal welfare issue and cause of mortality. Treatment options for Ulcerative Dermatitis are largely palliative and ineffective. We have proposed mouse Ulcerative Dermatitis as a model for human Skin Picking Disorder based on similar epidemiology, behavior, and its comorbidity and mechanistic overlap with hair pulling (trichotillomania). We predicted that mouse Ulcerative Dermatitis would be treated by N-Acetylcysteine, as this compound is highly effective in treating both Skin Picking Disorder and Trichotillomania. Furthermore, we hypothesized that N-Acetylcysteine’s mode of action is as a precursor to the production of the endogenous antioxidant glutathione in the brain, and therefore intranasal glutathione would also treat Ulcerative Dermatitis. Accordingly, we show in a heterogenous prospective trial, the significant reduction in Ulcerative Dermatitis lesion severity in mice receiving either N-acetylcysteine (oral administration) or glutathione (intranasal). The majority of mice treated with N-acetylcysteine improved slowly throughout the course of the study. Roughly half of the mice treated with glutathione showed complete resolution of lesion within 2-4 weeks, while the remainder did not respond. These findings are the first to show that the use of N-acetylcysteine and Glutathione can be curative for mouse Ulcerative Dermatitis. These findings lend additional support for mouse Ulcerative Dermatitis as a model of Skin Picking Disorder and also support oxidative stress and glutathione synthesis as the mechanism of action for these compounds. As N-Acetylcysteine is poorly tolerated by many patients, intranasal glutathione warrants further study as potential therapy in Skin Picking, trichotillomania and other body-focused repetitive behavior disorders.

Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders

Habits, such as hair pulling and thumb sucking, have recently been grouped into a category of clinical conditions called body-focused repetitive behavior disorders (BFRBDs). These behaviors are common in children and, at extreme levels, can cause physical and psychological damage. This article reviews the evidence base for psychosocial treatment of pediatric BFRBDs. A review of academic databases and published reviews revealed 60 studies on psychosocial treatments for pediatric BFRBDs, 23 of which were deemed suitable for review. Based on stringent methodological and evidence base criteria, we provided recommendations for each specific BFRBD. Individual behavior therapy proved probably efficacious for thumb sucking, possibly efficacious for several conditions, and experimental for nail biting. Individual and multicomponent cognitive-behavioral therapy was named experimental for trichotillomania and nail biting, respectively. No treatment met criteria for well-established status in the treatment of any BFRBD. Recommendations for clinicians are discussed. Reasons for the limitations of existing research in children and adolescents are explored. Several recommendations are presented for future pediatric treatment research on BFRBDs.

An Examination of Executive Functioning in Young Adults Exhibiting Body-Focused Repetitive Behaviors.

Body-focused repetitive behaviors (BFRBs), including hair pulling, nail biting, and skin picking are repetitive, habitual, and compulsive in nature. Although characteristic of disorders such as trichotillomania and skin picking disorder, BFRBs are associated with other psychiatric conditions as well. To date, research has failed to examine neurocognitive risk factors, particularly executive functioning, implicated in BFRBs utilizing a transdiagnostic approach. The present study recruited 53 participants (n = 27 demonstrating BFRBs and n = 26 randomly selected controls) from a larger sample of young adults. Participants completed an automated neurocognitive test battery including tasks of cognitive flexibility, working memory, and planning and organization. Results revealed that participants in the BFRB group demonstrated significantly poorer cognitive flexibility (d = 0.63) than controls. No differences were noted in other neurocognitive domains. However, planning and organization demonstrated a significant relationship with various BFRB severity measures. Implications, limitations, and avenues for further research are discussed.

Cognitive flexibility differentiates young adults exhibiting obsessive-compulsive behaviors from controls

The National Institute of Mental Health has proposed a shift toward classifying clusters of disorders on the basis of underlying biomarkers and neurological correlates. The present study sought to determine whether cognitive flexibility represents one such construct underlying obsessive-compulsive behaviors (OCBs), a cluster of behaviors characteristic of OCD and other body-focused repetitive behaviors (BFRBs), including trichotillomania, pathological skin picking, nail biting, and tic disorders. One-hundred and twenty-four undergraduate students completed the Depression Anxiety and Stress Scales, Padua Inventory—Washington State University Revision, Massachusetts General Hospital—Hairpulling Scale, Skin Picking Scale, and an Intradimensional/Extradimensional Shift (IDED) Test. Analyses were performed using a subsample of participants who met criteria for inclusion in the OCB group and a control group (N=56). Results indicated that young adults in the OCB group demonstrated significantly poorer performance on the IDED compared to controls. However, hierarchical regression analyses revealed that increased deficits in cognitive flexibility failed to predict worsened OCB severity—as assessed via a composite score. These results suggest that while cognitive flexibility differentiates those exhibiting OCBs from controls, it does not appear to be related to OCB severity. Future research is needed to replicate these results in larger clinical samples.

Three-year-olds express suspense when an agent approaches a scene with a false belief.

Research on early false belief understanding has entirely relied on affect-neutral measures such as judgments (standard tasks), attentional allocation (looking duration, preferential looking, anticipatory looking), or active intervention. We used a novel, affective measure to test whether preschoolers affectively anticipate another's misguided acts. In two experiments, 3-year-olds showed more expressions of suspense (by, e.g. brow furrowing or lip biting) when they saw an agent approach a scene with a false as opposed to a true belief (Experiment 1) or ignorance (Experiment 2). This shows that the children anticipated the agent's surprise and disappointment when encountering reality. The findings suggest that early implicit knowledge of false beliefs includes anticipations of the affective implications of erring. This vital dimension of beliefs should no longer be ignored in research on early theory of mind.

A Healing Herd: Benefits of a Psychodynamic Group Approach in Treating Body-Focused Repetitive Behaviors

Body-focused repetitive behaviors, such as trichotillomania and skin-picking, are not well understood in clinical communities. Research and practice with a population exhibiting these behaviors have focused almost exclusively on the usefulness of cognitive-behavioral therapy in symptom reduction. The author specializes in treating patients with body-focused repetitive behaviors and suggests that a holistic, psychodynamic model of treatment for this population creates possibilities for deeper change. Group therapy can be an important component of this work, helping clients to overcome resistance to change, ameliorate shame, work through dissociation, and regulate emotions. This process is explored in an examination of a psychodynamic therapy group with pickers and pullers.

Body focused repetitive behaviors among Salvadorian youth: Incidence and clinical correlates

Body-focused repetitive behaviors (BFRBs; e.g., hair pulling, skin picking, and nail biting) can cause significant physical and psychological distress. However, data examining BFRBs in non-clinical youth is limited. This study examined parent-reports of the incidence and clinical correlates of BFRBs in 315 Salvadorian children (4–17 years). Forty-six percent had at least one BFRB; nail biting was commonly reported (34.6%), followed by skin picking (24.8%), and hair pulling (10.5%). Of those endorsing BFRBs, 13.7% reported elevated distress and/or interference due to these behaviors, including approximately one-third of skin pickers and hair pullers (8.3% and 2.9% of the total sample) and one-fifth of nail biters (7.3% of the total sample). Skin pickers and hair pullers, but not nail biters, had higher levels of internalizing and externalizing behaviors, poorer adaptive functioning, and more difficulties with inattention, compared to those who reported no BFRBs. Skin picking symptom severity was positively correlated with externalizing and internalizing behaviors. Nail biting symptom severity was associated with increased internalizing symptoms, while severity of hair pulling was not significantly associated with behavioral and emotional functioning. These data suggest that BFRBs are commonplace and may be associated with behavioral and emotional functioning.

Body focused repetitive behavior disorders and perceived stress: Clinical and cognitive associations

BackgroundHair pulling disorder (trichotillomania) and skin picking disorder are related psychiatric disorders that can be conceptualized as body-focused repetitive behavior disorders (BFRBs). Stress may play a role in the etiology and maintenance of BFRBs, yet the impact of stress on distinct aspects of BRFBs has yet to be clearly delineated. Methods140 participants with BFRBs were recruited and undertook clinical and neurocognitive evaluation. They were grouped according to mild, moderate, or severe levels of perceived stress. ResultsHigher levels of perceived stress during the past month were associated with greater disease severity (Clinical Global Impression, and time spent undertaking the habit per day), greater disability (Sheehan Disability Scale), worse quality of life, and elevated rates of psychiatric comorbidity. Cognitive function (set-shifting and response inhibition) appeared to have no association with stress level. ConclusionsThese results indicate that levels of perceived stress have a strong association with the clinical presentation of BRFBs, even in the absence of confounding differences in demographic features. The lack of association between stress and cognitive dysfunction may support the utility of these selected cognitive measures (set-shifting and response inhibition) as vulnerability (or trait) markers, rather than being directly related to symptom severity or current stress.

Anaesthetic efficacy of 4% articaine mandibular buccal infiltration compared to 2% lignocaine inferior alveolar nerve block in children with irreversible pulpitis.

Lidocaine is the gold standard anaesthetic solution that has been used since its inception into dentistry till date. Around 80% of failures have been reported when lignocaine has been used for inferior alveolar nerve block in children and adults with irreversible pulpitis. There is a need to use newer drugs which are available which have been reported to be effective like lignocaine, such as articaine. Although articaine has been used in adults, literature supporting its use in children is sparse. The purpose of this study is to compare the anaesthetic efficacy of 4% articaine buccal infiltration and 2% lignocaine inferior alveolar nerve block in children with irreversible pulpitis. It also aims to assess the need for supplemental intrapulpal injections. This study was designed as a randomized double-blind cross over trial comparing the anaesthetic effectiveness of 4% articaine with 1:100,000 epinephrine in buccal infiltration and 2% lignocaine IAN block anaesthesia. The study subject and the pediatric dentist performing the pulpectomy procedures were blinded to the study. A sample size of 40 subjects in the age group of 5-8 y was included in the study. The onset of anaesthesia with 4% articaine was faster as compared to 2% lignocaine. The duration of anaesthesia with articaine infiltration was shorter. The need for supplemental injection in the articaine group was less. Four percent articaine infiltration can be used in children with irreversible pulpitis. It can be used to replace the IAN block in children thereby reducing the post anaesthetic complications like lip biting.

Association Between Harmful Oral Habits and Sign and Symptoms of Temporomandibular Joint Disorders Among Adolescents.

Temporomandibular disorder (TDM) is defined as a heterogenous group of psychophysiological disorders commonly characterised by orofacial pain, chewing dysfunction or both. Various Epidemiological studies had shown occurrence of TMD in all age groups including children. Also research had shown that non nutritional oral habits to be associated with TMD. Present study aimed to find whether harmful oral habits are associated with sign and symptoms of TMD among adolescents in Greater Noida. Schools in Gautam Buddha district and descriptive study. Cross sectional study was carried out among 240 adolescents (10 - 19 years) studying in schools of Greater Noida. Study population were selected by random sampling to whom screening questionnaires recommended by American Academy of Orofacial Pain (AAOP) were distributed. Patient history and clinical examination was used to determine harmful oral habits. Data analysis was done in SPSS version 21 and Chi-square test was applied. Sixty one participants (25.4%) displayed no sign and symptoms of TMD, 34 (14.2%) responded affirmatively to atleast one item on the questionnaire and 108(46%) gave at least three affirmative responses. Headache, Neckpain and Toothache were most frequent reported sign and symptoms of TMD (46.2%). There was statistically significant association between gender and sign and symptoms of TMD on three items of the questionnaire (p < 0.05). Nail Biting (45.8%), Biting Lips/objects (37%) were most common habits among the study group. There was statistically significant association between Nail Biting (p = 0.001), Lip Biting/ object biting (p=0.001), Grinding of teeth (p = 0.01) and sign and symptoms of TMD. A statistically significant association was found between nail biting, lip/ object biting and grinding of teeth with signs and/or symptoms of TMD. Thus there is need for preventive dental treatment and community dental education so that young adults realize importance of early diagnosis and treatment of TMJ disorders.

The impact of emotions on body-Focused repetitive behaviors: Evidence from a non-treatment-seeking sample

Body-focused repetitive behaviors (BFRBs) are repetitive, injurious, and non-functional habits that cause significant distress or impairment, including hair-pulling, skin-picking, and nail-biting. The emotion regulation (ER) model suggests that BFRBs are triggered by negative emotions and reinforced by alleviation of unpleasant affect. The frustrated action (FA) model suggests that BFRBs are triggered by and alleviate impatience, boredom, frustration, and dissatisfaction. Individuals with BFRBs are hypothesized to be particularly susceptible to these emotions because they demonstrate maladaptive planning styles characterized by high standards and unwillingness to relax. ObjectivesThe objective of this study was to test these two models. MethodsThis study compared urge to engage in BFRBs in a BFRB group (n = 24) and a control group (n = 23) in experimental conditions designed to elicit boredom/frustration, stress, and relaxation, respectively. ResultsThe BFRB group reported a significantly greater urge to engage in BFRBs than did the control group across conditions. Participants in the BFRB group reported a stronger urge to engage in BFRBs in the boredom/frustration condition than in the relaxation condition but not in the stress condition. Finally, the BFRB group presented significantly higher scores on maladaptive planning style, and maladaptive planning style was significantly correlated with difficulties with ER. LimitationsFuture studies may wish to exclusively use validated mood induction techniques and more stringent inclusion criteria. ConclusionsThe results highlight the role of boredom, frustration, and impatience in triggering BFRBs, and support the FA model.

구강악습관과 측두하악장애 유병상태와의 관련성

Purpose: This study aims to examine correlation between temporomandibular disorder and oral habits that have been known to cause temporomandibular disorder with both male and female undergraduates. Methods: To figure out correlation between temporomandibular disorder and oral habits, a survey was conducted to 500 students of two universities located in Daegu Metropolitan City and Gyeongsangbuk-do, and excluding the ones unreliably answered or indicating errors, total 427 (85.4%) out of 500 questionnaire sheets were used for final analysis. Results: Female students showed higher prevalence rates than male students in temporomandibular joint pain and temporomandibular joint clicking, and students having the lip biting habit, tongue thrust habit, or bruxism habit indicated a higher prevalence rate of temporomandibular joint pain than normal students. Also, students having the tongue thrust habit indicated a significantly higher prevalence rate of temporomandibular joint clicking than normal students not having it. And about trismus, students having the bruxism habit showed a significantly higher prevalence rate than normal students not having it. Conclusion: The findings imply that oral habits like lip biting, tongue thrust, or bruxism are closely related with temporomandibular joint pain, tongue thrust influences temporomandibular joint clicking, and bruxism does affect trismus.

Meta-cognitions in tourette syndrome, tic disorders, and body-focused repetitive disorder.

To explore if self-reported presence of thinking about tics or body-focused repetitive behaviours (BFRBs; gests) are direct triggers of tic or gest onset in 3 groups: Tourette syndrome (TS; n =18), persistent chronic tic disorders (TDs; n = 42), and a comparison group with BFRB (n = 36). The 3 groups completed a thinking about tics inventory, listing 22 items derived from clinician consensus that asked whether thoughts always, sometimes, or never exclusively triggered tic onset. Other questionnaires measured mood, perfectionism, impulsivity, premonitory urge, and self-rated tension. Sixty-three participants completed the inventory twice, and the inventory was completed pre- and post-behavioural intervention by a further 54. The ranking of the thoughts reported as likely to trigger tics or gests was positively correlated across TD and BFRB groups. Exploratory principal components analysis of a reduced 12-item set (the thinking about tics inventory) in TS and TD groups revealed that such thoughts could be grouped into 3 separate subscales: thoughts about the interference of tics or gests, thoughts anticipating tics or gests, and thoughts about whether the person has permission to perform the tic or the gest. The 3 sets of subscales showed good and acceptable internal consistency and overall score showed good test-retest reliability, suggesting thoughts about tics or gests are robust and measurable. The subscales correlated with impulsivity, tic or behaviour severity, and ratings of frequency decreased post-behavioural treatment. Thinking about tics or gests is reported as triggering tics or gests in both TD and BFRB, and meta-cognition seems independent of premonitory sensations and relates to distinct clinical characteristics in each clinical group.

Lithium treatment of chronic nail biting.

To the Editor: Nail biting or onychophagia has been variously described as a habit to release tension, self-mutilation behavior, or an impulse control disorder. In the DSM-5, nail biting is classified as an obsessive-compulsive and related disorder.1 Studies have found that between 28% and 33% of children between ages 7 and 10 years, 44% of adolescents, and 19%–29% of young adults engage in nail biting.2 Nail biting usually occurs in combination with other problematic body-focused repetitive behaviors such as hair pulling disorder and skin picking disorder. Nail biting in adults is underrecognized because patients often fail to seek help due to feelings of shame and embarrassment, and, consequently, the disorder has received little attention in the psychiatric literature. In most cases, nail biting seems to be only a cosmetic issue, and no treatment is required. But, in severe cases, untreated nail biting can result in a host of complications such as severe damage to the cuticles and nails, paronychia and secondary bacterial infection, dental problems, and temporomandibular dysfunction.3 Studies on drug treatment of nail biting are sparse and limited to antidepressants and N-acetylcysteine.4 We present a case of chronic, severe onychophagia comorbid with bipolar II disorder and substance use disorder and discuss the successful treatment of these disorders with lithium monotherapy. Case report. Ms A, a 28-year-old woman, was referred by her family physician for assessment and management of depression. She met DSM-5 criteria for bipolar II disorder and was noted to be in remission for substance use disorder (alcohol dependence and cocaine use). At the time of initial assessment, Ms A endorsed various symptoms of depression including thoughts of suicide. Due to concerns regarding her safety, lithium 900 mg daily was started, and the dose was optimized to achieve a serum level of 0.7 mmol/L. Within 2 months of lithium treatment, Ms A experienced remission of depression and has been symptom free for 2 years. A serendipitous finding was remission of symptoms of chronic nail biting that Ms A had struggled with since she was 12 years old. Various strategies including habit reversal training, self-monitoring, and competing response had been ineffective.5 The condition was severe because Ms A had to regularly cover the nail beds with Band-Aids to control the bleeding. Moreover, it affected her self-esteem and caused a great deal of emotional distress. The marked improvement following lithium treatment was noted by Ms A’s family and friends, who had not seen her undamaged nails in at least 15 years. Clomipramine and selective serotonin reuptake inhibitors are generally recommended in severe cases of nail biting, but the use of these drugs can cause treatment-emergent mania in individuals with bipolar disorder. Thus, the drug choice for onychophagia should be informed by the nature of the comorbid psychiatric disorder. There are reports of effectiveness of lithium in body-focused repetitive behaviors such as hair pulling disorder and skin picking disorder with comorbid bipolar disorder. It is not known if lithium is effective in patients with onychophagia in the absence of bipolar disorder. To our knowledge, this is the first reported case of lithium effectiveness in nail biting. Studies are needed to clarify the role of lithium in the management of severe nail biting in the absence of comorbid bipolar disorder.

Current concepts in psychodermatology.

Several diagnoses in the new DSM-5 chapter on 'Obsessive-Compulsive and Related Disorders' directly relate to psychodermatology. The new excoriation (skin-picking) disorder (SPD) and trichotillomania (TTM) both manifest as recurrent body-focused repetitive behaviors that have compulsive and dissociative features, the latter being more prevalent in TTM than SPD. The DSM-5 refers to SPD and TTM occurring without full awareness or preceding tension, however does not specifically mention the possible role of dissociation. This has important treatment implications, as patients with high dissociative symptoms are not likely to respond to the standard treatments for obsessive-compulsive disorder. Body dysmorphic disorder (BDD), which is frequently associated with cutaneous body image (CBI) dissatisfaction, is present in 9%-15% of dermatology patients. Treatment guidelines in dermatology are increasingly considering the psychosocial morbidity related to CBI in their treatment outcome measures. The presence of BDD, if unrecognized, may therefore directly affect the dermatologic treatment regimens offered to the patient.

Body Focused Repetitive Behaviors (BFRBs) and Personality Features

Body focused repetitive behaviors (BFRBs) represent a collection of motoric acts that can become ingrained, habitual, and functionally impairing. They often relate to excessive grooming of the body or skin. Although these pathological habits have been described since ancient times, only recently have they been incorporated into psychiatric nosological systems. The relationship between BFRBs and aspects of personality has been scarcely researched. Understanding how formal axis-II personality disorders, questionnaire-based measures of personality, or other putatively enduring traits such as cognitive impairment, relate to the BFRBs may advance our understanding of the core characteristics of the BFRBs and subsequently lead to greater understanding of their pathophysiology and treatment. This article reviews the existing literature surrounding BFRBs and aspects of personality, and highlights limitations in our current understanding of these aspects, along with future research directions.

Use a thorn to draw thorn: Reframing and symptom prescription for habit cessation

Successful pediatric practice involves a combination of good hand skills and proper behavior guidance of children. Reframing can be used effectively to alter children's thought processes. Reframing can be explained using principles of transactional analysis by Eric Berne, Freud's psychoanalytical theory, and Pavlov's associative learning. The art of reframing lies in learning the skill of knowing the ego state of the child, modifying it (reframing) by changing the thought process and associations, and to make him/her communicate with proper ego states. The role of reframing in the treatment of habits such as thumb sucking and lip biting has been observed. Without psychological management for habits, if other methods of treatment are used, the child pairs the treatment with punishment and may become adamant. Hence, dentists can use reframing in the case of habits, such as symptom prescription or reverse psychology, a component of reframing as the first step wherein the patient is asked to increase the frequency of the habit. Children could no longer enjoy the habit and they became more receptive for communication and by showing photographs of children engaged in the habit that lead to disfigurement, we can further alter the children's thinking. Thus, the change in our approach can bring about a change in mind and attitude of our patients, in turn changing their health behavior and quality of life. This poster attempts to explain the concept of reframing and its application in a clinical situation.