Lip Biting Research Articles

Insights into recurrent body-focused repetitive behaviors: evidenced by New York Times commenters.

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.

Treatment of the sensory and motor components of urges to eat (eating addiction?): a mobile-health pilot study for obesity in young people

PurposeCompelling 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.MethodsThe 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.ResultsLatent growth curve analysis determined that mean body weight and zBMI decreased significantly more than in a previous study that used only staged withdrawal (p < 0.01). In the 5-month follow-up, participants maintained overall weight loss.ConclusionsThis 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 evidenceLevel IV, Evidence obtained from multiple time series analysis with the intervention.

Body-focused repetitive behaviors in school-going children and adolescents and its relationship with state-trait anxiety and life events.

Background:Body-focused repetitive behaviors (BFRBs) are nonfunctional self-injurious behaviors. BFRBs fall under obsessive–compulsive and related disorders (OCRDs) and co-occur with anxiety disorders.Aim:The current study plans to assess the presence of BFRBs in schoolchildren and adolescents and find its relationship with state-trait anxiety and significant life events.Materials and Methods:The study identified twenty-one students with BFRBs using the Modified Habit Questionnaire. Along with the 21 matched healthy controls, both the groups were evaluated on the State-Trait Anxiety Inventory for Children (STAIC) and Life Event Scale for Indian Children (LESIC).Results:The study group scored significantly high on STAIC state score (P = 0.004), trait score (P = 0.014), and total score (P = 0.020). On five life events, the study group reported significantly high on stress.Conclusion:The study reports the presence of BFRBs in schoolchildren; state-trait anxiety and significant life events have a significant association with BFRBs.

Association of gender, oral habits, and poor sleep quality with possible sleep bruxism in schoolchildren

The aim of this study was to verify the oral habits, symptoms, and characteristics of some children aged 8 to 10 years that could be associated with possible sleep bruxism. A cross-sectional study was performed. Questionnaires were sent to parents to obtain information on sex, age, school shift, sleep quality, parents' perception of children's behavior, and children's oral habits (nail biting, object biting, and lip biting), and symptoms such as headache or earache. In addition, parents reported the frequency of sleep bruxism (no day to 7 days a week). Descriptive analysis and multinomial logistic regression were performed and the level of significance was set at 5%. A total of 1,554 parents of children aged 8 to 10 years participated in this study. Possible sleep bruxism was reported as mild for 65.7%, moderate for 25.3%, and severe for 9% of the children. In the adjusted multinomial logistic regression, boys were 79% more likely to have sleep bruxism (OR: 1.79; 95%CI 1.23-2.60) and were 2.06 more times at risk of being in the habit of lip biting (OR: 2.06; 95%CI 1.26-3.37). Children with possible severe sleep bruxism were 61% more likely to develop object biting (OR: 1.61; 95%CI 1.09-2.39), 52% more likely to have headaches (OR: 1.52; 95%CI 1.01-2.28), and 3.29 more times at risk of poor sleep quality (OR: 3.29; 95%CI 2.25-4.82). Based on the report, boys with lip and object biting habits, headaches, and poor sleep quality presented a higher chance of possible severe sleep bruxism.

Prevalence of Temporomandibular Joint Disorders and its Association with Para Functional Habits in the Patients Attending Tertiary Care Hospital.

Temporo-mandibular disorders is a collective term used to describe problems involving muscles of mastication and temporomandibular joint. The study aimed to evaluate the prevalence of temporo-mandibular disorders and its association with parafunctional habits in patients visiting department of dentistry, Patan Academy of Health Sciences. A cross-sectional study was carried out among 213 patients coming to Patan Academy of Health Sciences. A screening questionnaire recommended by American Association of Orofacial Pain was used to determine the signs and symptoms of temporo-mandibular disorders. The prevalence of temporomandibular disorders was 31.9 %. The three most common parafunctional habits were chewing gums (32.4 %), mouth breathing (19.7 %) and biting of objects (14.6 %) respectively. Statistically significant association was found between nail biting, grinding of teeth, biting of lips and objects and mouth breathing with signs and symptoms of temporomandibular disorders (p<0.05). Among the signs and symptoms of temporomandibular disorders, getting headaches, neck pain or toothaches often was the most frequent signs of temporomandibular disorders (n=105, 49.3 %). Feeling of recent change in bite was the second most frequent sign reported by 82 participants (38.5 %). The parafunctional habits between nail biting, grinding of teeth, biting of lips and objects and mouth breathing have statistically significant association with signs and symptoms of temporomandibular disorders.

Correlação entre sintomas de disfunção temporomandibular, hábitos orais deletérios e sintomas de estresse em estudantes universitários

Objetivo: investigar os sintomas de disfunção temporomandibular, presença de hábitos orais deletérios e estresse em universitários dos cursos de Fonoaudiologia, Fisioterapia e Biomedicina dos períodos iniciais e finais de um Centro Universitário; comparar os resultados do período inicial em relação ao período final de cada curso; e verificar a correlação entre hábitos orais deletérios, idade, sexo, sintomas de disfunção temporomandibular e sintomas de estresse. Métodos: Questionários foram aplicados a uma amostra composta por 83 acadêmicos. Foram utilizados o Índice Anamnésico de Fonseca para investigação dos sintomas de disfunção temporomandibular; uma lista com hábitos orais deletérios; e, para avaliar o estresse, o Inventário de Sintomas de Stress para Adultos de Lipp. Os dados foram analisados com nível de significância de 5%. Resultados: Encontrou-se alta prevalência de sintomas de disfunção temporomandibular na amostra, sendo a maioria de grau leve. Houve associação com significância estatística entre apresentar sintomas de disfunção temporomandibular e os períodos finais dos cursos, apoiar objeto sob o queixo, morder os lábios e estresse. Houve associação do grau da disfunção temporomandibular com os períodos finais dos cursos, com os hábitos de ranger ou apertar os dentes, colocar a mão no queixo e morder a bochecha e com o número de hábitos praticados. O diagnóstico de estresse apresentou correlação com o período do curso. Conclusão: Os dados sugerem correlação positiva entre presença de sintomas de disfunção temporomandibular, hábitos orais deletérios e estresse em estudantes dos últimos períodos dos cursos da área de saúde.

TICCY, STICKY, AND PICKY: HOW TO UNDERSTAND, DISENTANGLE, AND MANAGE CHILDHOOD ONSET REPETITIVE BEHAVIORS

Obsessive-compulsive spectrum disorders (OCSD), including OCD, body dysmorphic disorder (BDD), body-focused repetitive behaviors (BFRBs, such as trichotillomania and skin-picking disorder), and chronic tic disorders/Tourette’s disorder (TD) share overlapping clinical phenomenology and associated dysregulated subcortical neurocircuitry. The cortico-striatal-thalamo-cortical (CSTC) neural pathway is involved in the regulation of behaviors (cognitive and emotional), and as such, disruption can result in a variety of undesired, repetitive manifestations (ie, tics, obsessions/compulsions, picking/pulling). Given the frequent co-occurrence of OCSD and tic disorders—especially in the pediatric population—delineating between compulsions, symptoms of BDD, complex tics, and BFRBs poses clinical challenges and has significant treatment implications. The aim of this presentation is to teach attendees the epidemiology, phenomenology, underlying neurocircuitry, and treatment approaches for pediatric OCSD and tic disorders.

Gender association of impulse control disorders (ICD-RBS) in patients with Parkinson's disease and its impact on quality of life

ICD-RBs are under-recognized in clinical practice as patients do not spontaneously offer information, either because of shame or they do not understand its correlation to PD and its treatment. Certain ICD relevant in the Indian scenario apart from the criteria set in QUIP-RS have not been studied yet were explored. To study the gender difference and risk factors in the prevalence of ICD-RBs in Indian PD patients and its impact on Quality of life(QOL). Hospital based observational cross-sectional study of PD patients on treatment with dopamine replacement therapy for more than six months visiting movement disorder clinic. After informed consent, patients or informant completed the QUIP-RS questionnaire, in the language of choice (English/Punjabi/Hindi) based on behavior that occurred anytime during PD and lasted >4 consecutive weeks. In addition other ICDs relevant in the Indian population as body-focused repetitive behaviors were also explored as a new part of the QUIP-RS questionnaire. The frequency and impact of ICD on QOL was studied using validated PDQ-39 Questionnaire. 1.Total 80 patients (46 men,34 women) were included in 6 months period.2.Trends show ICD-RBs are more frequent in women (41.8%)compared to men(32%) with punding being the most frequent(Fig. 1).3.At least one ICD-RB was present in 31(38.74%) patients Table 1.4.‘ICD not classified elsewhere’ as trichotillomania was present in 3(3.75%) patients.5.Significant risk factors for ICD-RB are younger age, longer disease, more years of treatment and higher dose of dopamine.6.QOL was much worse in those with any ICD-RB than those without any ICD-RB(Table 2).

Obsessive–compulsive or addiction? Categorical diagnostic analysis of excoriation disorder compared to obsessive-compulsive disorder and gambling disorder

Excoriation disorder (ED) is currently classified in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders’ Obsessive–compulsive and Related Disorders section (OCRD). However, there remain debates regarding whether ED is related to obsessive–compulsive disorder (OCD) or whether it is better conceptualized as a behavioral addiction. The present research compared the diagnostic overlap and psychiatric comorbidities of 121 individuals seeking treatment for ED (n = 40), OCD (n = 41) and gambling disorder (GD) (n = 40). ED was more likely to overlap with OCD (n = 14) than GD (n = 3). Compared to OCD, ED had similar frequencies of other body focused repetitive behaviors (BFRBs), but higher frequency of addictive behaviors (Odds Ratio – OR = 11.82). In comparison to GD, ED had similar frequencies of addictive behaviors, but higher frequency of BFRBs (OR=19.67). The results support the recent classification of ED as an OCRD. However, ED presents an association with behavioral addictions that suggests a mixed impulsive-compulsive nature. A limitation of the present research was the use of a non-validated semi-structured clinical interview to diagnose impulse control disorders. Future research should examine other characteristics (e.g., epidemiology, neurobiology, genetics, treatment response) to further investigate whether ED should remain classified as an OCRD.

N-Acetylcysteine in psychodermatological disorders.

Treatment of psychodermatological conditions, particularly body-focused repetitive behavior disorders, is often unsatisfactory. Various psychopharmacological and non-pharmacological treatments have been used to ameliorate the symptoms of these disorders. N-Acetylcysteine (NAC) is a newer modality in the treatment of these disorders. This short review focuses on pharmacology, mode of action, and use of NAC in common body-focused repetitive disorders such as trichotillomania, skin-picking disorders, and onychotillomania (nail biting). Current research and literature review have been evaluated and will be discussed.

The prevalence and clinical correlates of body-focused repetitive behaviors in pediatric Tourette Syndrome

The association between Tourette Syndrome (TS) and body-focused repetitive behaviors (BFRBs), including skin picking disorder (SPD), hair pulling disorder (HPD) and pathological nail biting (PNB) is rarely studied, especially in TS pediatric samples, even though TS and BFRBs share many characteristics. This study therefore sought to determine the prevalence rates and predictors of SPD, HPD and PNB in a pediatric TS sample. Data from 739 child and adolescent participants who completed validated instruments to assess for tic severity and various other comorbidities were used to calculate prevalence rates for each of the BFRBs. Clinical and demographic predictors were determined via regression modelling. The prevalence rates for SPD, HPD and PNB were 5.8%, 2.4% and 6.0%, respectively. The presence of PNB and worst ever tic severity predicted the presence of SPD. Worst ever tic severity and the presence of SPD were the only significant predictors of HPD and PNB, respectively. When distress was dropped as a diagnostic requirement for the BFRBs, the prevalence for SPD, HPD and PNB increased to 18.4%, 7.6% and 11.8%, respectively, while the predictors were generally the same. The prevalence rates for SPD, HPD and PNB were similar to estimated rates in the general population. However, their association with tic severity suggests a relationship between BFRBs and TS. These findings suggest that more research is needed to further elucidate the nature of the relationship between TS and BFRBs, especially in pediatric populations.

Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3\u20135\u2009years old children

BackgroundPacifier sucking habit has been associated in the literature with alterations of dental occlusion, and it could be a predisposing factor for other poor oral habits among children. Orthodontic pacifiers have been introduced in the market aiming to reduce these disadvantages caused by the conventional type of pacifiers. The aim of this study was to evaluate the prevalence of poor oral habits and malocclusions, after usage of orthodontic pacifiers in children with primary dentition.MethodsA sample of 198 pre-school children, aged 3–5 years, (96 males and 102 females) who had exclusively used an orthodontic pacifier were included in order to assess the level of poor oral habits and the absence/presence of dental malocclusion. Firstly, children’s parents/legal guardians were given a validated questionnaire, then the children were clinically examined at a dental clinic.ResultsMost of the children (79.79%) had started using the orthodontic pacifier within the first 3 months of life, and the 43.49% of them continued using it over a period of 2 years. The recorded percentage for those who had used it throughout sleep was 89.39%. Mouth breathing during the night was reported for 36.04% of the children. Tongue thrust swallow affected 16.16% of the sample. The 5.56% of the data indicated the presence of fingersucking/thumbsucking habit. The noted percentages for children with lip biting, lingual interposition between teeth at rest and those with nail biting, were 5.56, 12.63 and 15.15%, respectively. The regression revealed a significant contribution between early start of using an orthodontic pacifier with the prevalence of fingersucking/thumbsucking (OR 0.13, 95% CI 0.04–0.47, p = 0.0004).This also reported a noticeable increase of the malocclusion prevalence among the female gender (OR 2.74, 95% CI 1.42–5.31), as well as those who were not exclusively breastfed (OR 2.26, 95% CI 1.17–4.37).ConclusionsOrthodontic pacifiers does not favor the development of poor oral habits, even if it has been used for a period of 2 years in children with primary dentition. Children who begin to use orthodontic pacifier between 0 and 3 months, are less likely to acquire fingersucking/thumbsucking habit. The use of an orthodontic pacifier appears not to be correlated with the prevalence of malocclusion in primary dentition, differently from what stated in literature about the conventional type of pacifier.

Increased tactile sensitivity and deficient feed-forward inhibition in pathological hair pulling and skin picking

An increasing body of evidence has linked pathological body-focused repetitive behaviors (BFRBs) to excessive sensory sensitivity and difficulty modulating sensory inputs. Likewise, neurobiological evidence points to deficits in feed-forward inhibition and sensory habituation in conditions with similar symptomatology. There is currently little evidence regarding potential physiological sensory abnormalities in BFRBs. The current study compared 46 adults with pathological hair pulling and/or skin picking to 46 age-matched healthy control participants on a series of self-report measures and objective psychophysical tests of neurophysiological sensory functions. Persons in the BFRB group reported increased scores on the Sensory Gating Inventory (U = 320.50, p < .001) and all of its subscales (all p-values < .001), reflecting abnormal sensory experiences. The BFRB group also showed decreased tactile thresholds (increased sensitivity) (F[1, 76] = 10.65, p = .002, ηp2 = .12) and deficient feed-forward inhibition (F[1, 76] = 5.18, p = .026, ηp2 = .064), but no abnormalities in quickly-adapting sensory habituation were detected on an amplitude discrimination task. Performance on objective psychophysical tests was not associated with self-reported sensory gating symptoms or symptom severity. Implications of these results for the pathophysiology of BFRBs and related disorders are discussed.

P.012 Bilateral pallidal deep brain stimulation in a patient with chorea-acanthocytosis

Background: Chorea-acanthocytosis (ChAc) is a rare autosomal recessive neurodegenerative disease due to mutation of the VPS13A gene encoding the protein chorein. ChAc is a slowly progressive disorder that typically presents in early adulthood, and whose clinical features include chorea and dystonia with involuntary lip, cheek and tongue biting. Some patients also have seizures. Treatment for ChAc is symptomatic. A small number of ChAc patients have been treated with bilateral deep brain stimulation (DBS) of the globus pallidus interna (GPi), and we now present an additional case. Methods: Patient chart, functional measures, and laboratory findings were reviewed from the time of ChAc diagnosis until 6 months after deep brain stimulation (DBS) surgery. Results: Here we present a case of ChAc in a 31 year old male positive for VPS13A gene muations who presented with chorea, tongue biting, dysarthria, weight loss, and mild cognitive dysfunction. GPi-DBS using monopolar stimulation was associated with significant improvement in chorea and dysarthria. Conclusions: This case adds to the current state of knowledge regarding the efficacy and safety of bilateral GPi-DBS for symptomatic control of drug-resistant hyperkinetic movements seen in ChAc. Controlled trials are needed to better assess the impact of DBS in ChAc.

Gambaran kebiasaan buruk dan kejadian maloklusi pada siswa Sekolah Dasar Negeri 19 Pemecutan

Introduction: Dental malocclusion is a deviation of teeth disposition and malrelation of dental arches and jaw beyond acceptable limit of conformity. Malocclusion is formed as a result of multifactorial interactions, either external or internal. Suspected external factors as the cause of malocclusion are oral habits, such as thumb or finger sucking, putting foreign objects into the oral cavity (biting pencils, pens and nails), tongue sticking or tongue thrusting, mouth breathing, and lip sucking or lip biting. The purpose of this study is to evaluate correlation of bad habits towards malocclusion in students of SDN 19 Pemecutan. Method: Descriptive analytic study with cross sectional design was used as the study method. Sampling technique used was total sampling with total of 87 samples of children. Data of bad habit and the incidence of malocclusion were obtained by using questionnaires and HMAR (Handicapping Malocclusion Assessment Record) index. Data was analyzed using chi square test. Result: The results of this research exhibited that respondents conducted bad habits were 23 students (26.4%). Respondent who conducted bad habits and had malocclusion was as many as 13 students (16.7%). Based on statistical test using chi square, p-value = 0.002 (p &lt;0.05) was obtained, which mean there was relationship of bad habits towards incidence of malocclusion in SDN 19 Pemecutan. Conclusion: It is concluded that there is relationship between bad habits towards incidence of malocclusion in students of SDN 19 Pemecutan.

EFEK DENTOSKELETAL PADA MALOKLUSI KELAS II DIVISI 1 DENGAN BIONATOR DAN ALAT ORTODONTI LEPASAN : LAPORAN KASUS

Background: Class II division 1 malocclusion characterized by mandibularretrognation, deep bite and increasement of overjet. Myofunctional appliance could modify the growth and developmental of mandibular at appropriate phase. The purpose of this case report was to present successful management of Class II division 1 by using bionator and removable appliance.Case Management: A 9 years old girl with upper teeth protrusion, crowding and affected the esthetical perception. The diagnosis was Class II division 1 with mandibular retrognation and upper incisor protrusion, upper and lower anterior crowding and palatal bite. Patient also had lip biting and thumb sucking habit. Bionator leads the mandibular moved forward and arch widening. Treatment planning were to reduce overjet by prognating mandibular and bad habit elimination. Followed by retracting the upper teeth and deep bite correction by using removable appliance.Conclusion: Patient profile became corrected in 10 weeks. Overjet reduced in by prognating the mandible, decreasing of palatal bite, molar relation become Class I and bad habit elimination. In 10 months, overjet and overbite were corrected.

Thermal sensors improve wrist-worn position tracking

Wearable devices provide a means of tracking hand position in relation to the head, but have mostly relied on wrist-worn inertial measurement unit sensors and proximity sensors, which are inadequate for identifying specific locations. This limits their utility for accurate and precise monitoring of behaviors or providing feedback to guide behaviors. A potential clinical application is monitoring body-focused repetitive behaviors (BFRBs), recurrent, injurious behaviors directed toward the body, such as nail biting and hair pulling, which are often misdiagnosed and undertreated. Here, we demonstrate that including thermal sensors achieves higher accuracy in position tracking when compared against inertial measurement unit and proximity sensor data alone. Our Tingle device distinguished between behaviors from six locations on the head across 39 adult participants, with high AUROC values (best was back of the head: median (1.0), median absolute deviation (0.0); worst was on the cheek: median (0.93), median absolute deviation (0.09)). This study presents preliminary evidence of the advantage of including thermal sensors for position tracking and the Tingle wearable device’s potential use in a wide variety of settings, including BFRB diagnosis and management.

Self-induced dermatoses: A great imitator

The self-induced dermatoses represent about 2% of dermatology patient visits, and include the recurrent body-focused repetitive behaviors (BFRB) (skin-picking or excoriation disorder, trichotillomania, onychophagia and onychotillomania), dermatitis artefacta, and features of other psychiatric disorders, for example, secondary to excessive grooming in body dysmorphic disorder, skin picking in delusional infestation, or secondary to self-harm in depressive disease. Among the BFRBs, onychophagia and onychotillomania are most likely to be associated with lesions that mimic other dermatologic conditions (eg, nail psoriasis, lichen planus, vasculitis, onychomycosis, melanoma). Dermatitis artefacta (DA) describes lesions that are self-inflicted with the intention of assuming a sick role in the absence of obvious external rewards. DA lesions can be bizarre-appearing or may be created intentionally to mimic dermatologic disease (eg, Munchausen syndrome). The manipulation of the integument can have a focused obsessive-compulsive behavioral style which is more responsive to the standard behavior therapies, or an impulsive-dissociative style where patients have partial or no recollection of having self-induced their lesion; dissociative patients tend to have more severe BFRBs and DA, and greater psychopathology. Self-induced dermatoses may both imitate and co-occur with primary dermatologic disease, and may not be readily identified unless the clinician maintains an index of suspicion.

Efficacy of self-designed intraoral appliances in prevention of cheek, lip and tongue bite after local anesthesia administration in pediatric patients.

BackgroundThe occurrence of self-inflicted soft tissue injuries following administration of local anesthesia in pediatric patients who have received dental treatment has been reported. Aim: To evaluate the attitudes and knowledge regarding cheek, lip, and tongue bite post administration of local anesthesia among dental practitioners in Saudi Arabia. Additionally, the efficacies of three types of intraoral appliances on the prevention of self-harm were evaluated in pediatric patients.Material and MethodsA total of 301 practitioners were provided with a questionnaire consisting of 9 items. In addition, three types of intraoral appliances made of polyethylene terephthalate were designed as follows: design 1 (consisted of an anterior extension with numerous perforations); design 2 (had a buccal flap extension); and design 3 (comprised of serrated borders). The appliances were placed in the oral cavities of 45 children (age, 3–15 years) immediately after the completion of the dental procedure. The patient was asked to retain the appliance for 3 h. After 24 h, both parents and children were required to respond to a checklist to evaluate the effectiveness the appliances.ResultsAlmost half of the dental practitioners had never encountered self-inflicted soft tissue injury in children after local anesthesia administration. About 60% of the dentists were of the opinion that provision of adequate instructions after treatment could prevent the occurrence of lip, cheek, and tongue biting. Furthermore, among the three appliances used, design 1 was most well accepted.ConclusionsIntraoral appliances used in this study may be considered for use to prevent self-inflicted soft tissue trauma in children following administration of local anesthesia. Key words:Cheek biting, lip biting, intraoral appliance, local anesthesia.

Trichotillomania: a psychopathological perspective and the psychiatric comorbidity of hair pulling

Trichotillomania, or hair-pulling disorder, is classified as an obsessive-compulsive spectrum disorder and is seen predominantly in females. This is a non-systematic review article focusing on the psychopathological features of hair pulling. It is speculated that hair pulling may function to provide short-term relief from stress and other unwanted emotional states, thus serving as a method of emotion regulation. The prevalence of trichotillomania ranges from 1 to 3%. The most targeted site is the scalp, and other common areas include pubic hair and facial regions such as the eyebrows, eyelashes, and beard. Individuals suffering from this disorder tend to avoid social environments due to embarrassment regarding their appearance and fears of being judged by peers. Trichotillomania is associated with significant functional impairment and increased risks of comorbid psychiatric disorders such as other body-focused repetitive behaviors, depression, anxiety, and addictive disorders. This article reviews the epidemiology, clinical features, diagnostic criteria, and psychopathology of trichotillomania with an emphasis on psychopathology and psychiatric comorbidity.