Excessive Oral Parafuctional Movement Habit Reversal

Excessive Oral Parafuctional ride Habit ReversalYeseul KIMSelf-Reporting of Excessive Oral Parafuctional Movement withProposal of Future InterventionOral parafunctional activities refer to excessive uses of m egressh, tongue and call in, including continuous chewing, biting objects, leaning on the hand, teeth grinding and jaw clenching (Winocur, Litter, Adams Gavish, 2006). Their preponderance and association with signs and physiological and psychological symptoms of dysfunction have been reported, such(prenominal) as facial muscle pain, headache, and feeling stress (Lobbezoo, Van Der Glas, Van Der Bilt, Buchner Bosman, 1996 Rodrguez, Miralles, Gutirrez, Santander, Fuentes, Fresno Valenzuela, 2011 Winocur et al., 2006).Previous look for has been demonstrated the maintenance of vocal parafunctional habilimentss are resulted from temporomandibular disorders (TMD), occurred by several reasons like joint disturbances (noises, catching, and joint tension), muscular discomfort, po ssibly eating disorder and obsessive-compulsive disorder, and injury (Gramling, Neblett, Grayson Townsend, 1996 Winocur et al., 2006). However, some researchers have pointed bring out these factors are poorly proven as the numerous number of people has the TMD problem even though they do not have other spoken utilisations (Cairns, 2010 Fotek, 2014).Although not many studies has been d atomic number 53 to find out the reasons of maintaining those habits in terms of operant conditioning (e.g. rewards or punishment), tho it is sour to happen due to stressful lifestyle, frustration, or personality traits such as being aggressive or competitive while a subject is vigilant (Glaros Burton, 2003 Lobbezoo, Van Der Zaag Naeije, 2006). Researchers focused on manipulations targeting parafunctional habits to decrease TMD pain which testifys their hearty relationship with TMD (Glaros, Owais Lausten, 2007). In other words, there is possibility of reducing the psychological stress whi ch is the verifying outcomes of maintaining viva examination habits, however, they are more promising to produce negative outcomes such as higher pain and symptoms of TMD by clenching and grinding teeth (Glaros et al., 2007 Peterson, Dixon, Talcott Kelleher, 1993).Treatment for oral habits revolves around repairing the damage to teeth and jaw, thusly dental hinderance such as occlusal splint or mandibular advancement device could be in use. In addition to this, given the strong association between diurnal oral parafunctional activities like bruxism and psychological factors, habit reversal treatment has been suggested to increase a patients awareness of unwanted behaviours, develop an alternative to the habits, for example, relaxation of the masticatory muscles and succeed in reducing TMD pain (Glaros et al., 2007). Research results suggests that group of patients using any habit reversal techniques or splints both experienced a great deal of relief from pain. In fact, hab it reversal treatment is the one of the sound techniques in treating several motor disorder (Azrin Nunn, 1973 Peterson et al, 1993).According to Glaros, Hanson and Ryen (2014), 6-week-period habit reversal treatment was administered to reduce tooth contact and muscle tension in terms of headache by DTMT, dropping their jaws slightly (D), separating their teeth slightly (T), relaxing the muscles in the jaw and face area (M), and performing a deep breathing action (D). Thirty-seven participants with TMD were selected between ages of 18 to 65 and completed the questionnaire to diagnose headache and TMD in the first phase. For the next phase, only 23 participants those who had headache from the phase 1 enrolled the treatment. They were given information about headache, facial pain, the role of oral behaviours in headache, and effect of tooth contact during the treatment session, then practiced DTMD treatment every 2 hours with a pager signal, and whenever they detected the tooth con tact or facial muscle tensions.Although results from application of treatment in the phase 2 interpreted participants reported slight pain and disability but the headache symptom did not change for 6 week trials. However, they showed a significant reduction of intensity of parafuctional habits after the treatment, but the period should be longer to reveal more powerful effects as they did not find a strong relationship between oral habits and headache.Habit reversal treatment was delivered to eliminate the motor behaviours, and negative though reversal method was given as the instructions to remove stress factors (Gramling et al., 1996). 17 qualified participants were recruited through the local newspaper advertisement, who reported TMD, with a symptoms such as mandibular joint sound, locked jaw and tenderness in the jaw. However, only the data collected from nine patients were analysed as they attended at least five sessions to be completers the whole therapy process.Before the t reatment, treatment expectations and satisfaction from participants were measured to find out the relationship with outcomes such as decrease in frequency or intensity of oral behaviours. To get those descriptive information, participants filled out the facial pain diary four times in a day. Also, they answered to the questionnaires about the eleven different oral behaviours with ten-point scale, from never performed to almost always, and about the psychological sadness with State-Trait Anxiety stock-taking (STAI).Treatment conducted over a 24-week period, and three treatment groups of 5 to 6 people met weekly for seven consecutive weeks in 90-minute sessions. During the sessions, participants kept record an oral habit self- observe form to increase awareness of their own oral habits, thereby making habit reversal possible. They also continued and record practices for deep breathing and facial exercises practice throughout the whole sessions, which interrupt and reverse their ora l behaviours.As the result of this study, Gramling et al. (1996) pointed out that habit reversal treatment strategy may be an effective disturbance for many persons suffering from facial pain as participants shown significant decrease of rating pain by the end of treatment, which is consistent with diary data, however, the frequency and intensity of oral habit did not illustrate notable decrease.Peterson et al. (1993) investigated only 3 patients with variety of ages and gender traits who carried habit reversal treatment for 6 week, 1 hour sessions per week. This case study showed different results by individuals, but generally concluded the habit reversal could function reducing pain and increasing maximum opening for some TMD patients, and possibly more helpful for muscle-related problem than joint-related problem. Also, those who have been remaining oral habits for long time, it is more difficult to change such behaviours.The aim of flow research project, self-reporting from o ne subject, is to find out the oral behaviours and reduce the frequency and possibility of TMD. By analysing the potential defecate and background history of behaviours, subject could understand the significance of reducing parafunctions in terms of physical and mental health.MethodParticipantY is a 25 year old female international student at University of Queensland, currently working in a travel agency who recently found out her excessive oral parafunctional activities with 14-month duration and feel anxiety of temporomandibular disorders.Operational DefinitionOral parafunctional activities referred to making excessive movement of mouth and jaw including clenching jaw or grinding teeth while awake, and possibly combined with biting lips and presence of joint sounds. These behaviours were scored when (a) repeatedly occurred in a daytime, (b) whether subject is alone or not, (c) presented one or multiple behaviours at the same time. For example, grinding teeth while sleeping and m aking a single movement in lower jaw were not scored, while clenching teeth for 5 seconds and biting lips after jaw clicking are scored. In addition to this, simply opening mouth while public lecture and eating, or touching the temporomandibular joint could not be scored.Behavioural Recording TechniqueSelf-monitoring method was chosen for this research, because subject was able to collect data when she was alone, or with other people. Also, such behaviours are often not easily to be observed by someone else. For the records, whenever subject noticed the oral parafunctional activities, she made notes on mobile device or paper with specific description of occasion, for the 14 consecutive days. However, accuracy of recording could be contaminated as it is very likely make errors while counting if behaviours occurred unconsciously. Also, Peterson et al. (1993) noted self-monitoring could affects the frequency of habits, by reducing teeth clenching and grinding.ResultsThe general patter n from results of current project are shown in the figure 1. Over the 14 days of monitoring period, the mean of frequency of oral habits occurred in a day is 12.29. The highest number reported during the period is 45, which is from the Day 13 while the lowest point is from Day 8.The possible reasons for these consequences have a strong relationship with the performance generated anxiety related to subjects donnish works on the reported dates. The Day 13 was the due date for the assignment graded higher percentage, it is assumed that the participant had a great level of anxiety. Also, she was awake for long time to complete the assignment, therefore, an excessive repetition appeared because a number of oral parafunctional activities was counted while subject awake.However, on the 8th day, none of oral habits was presented as the participant enjoyed the relaxation from the assignment and took a resting at home with the presence of intimate person. The reduction of anxiety was likely to stabilise her mental status, in contrast to other days of monitoring.According to the similarity in frequency between Day 6 to Day 11, subject maintained everyday routines such as going to university and working. The circumstances that she presented those habits were generally on the bus for commuting and doing task without interaction to others. It could possibly mean the absence of attachment to relatives made her apart(p) and generated slightly stressful situation. On the other hands, when the participants concentrated on non-stressed activity such as mobile game, she did not show many parafunctional habits.This participant who has an oral habits with excessive movement of teeth and jaw, illustrated that those behaviours has been stimulated by different reasons. Awareness of her asymmetric jaw became the trigger of habits when she was young. In addition to this, Changes in her circumstances in work place or university and being alone are significant factors as they generate stress, and currently the level of anxiety of failing academic effect accelerated the frequency of behaviours. Consequences of behaviours can be short term and long term, such as immediate feeling fear or pain, reduction of stress, and significant health disorder related to temporomandibular joint and tooth. These consequences are reinforcers or punishers which increase or decrease the behaviours.DiscussionCurrent research project were developed to understand the oral behaviours and reduce them which could cause unwanted consequences. The general findings from this study are when the participant has a higher degree of negative emotional states such as anxiety of academic achievement, receiving work related complaints, or being alone feeling lonesome. These results of current research partially supported the previous research in terms of the relationship between oral parafunctional behaviours and stressful routines (Glaros Burton, 2003 Lobbezoo, Van Der Zaag Naeije, 2006).In fact, SORCK analysis found out significant cocksure reinforcers of behaviours in this study are related to structures of jaw. In other words, the misbelief that moving mandibular joint can balance the asymmetric jaw leads the repetition of behaviour in pursuit of emend physical appearance. Subject has mentioned the prominent jaw was her physical complex once, and when she heard the joint making sound after movement, she started the excessive movement habits.As discussed previously, habit reversal treatment has been proved as the effective method of reducing the parafuntional activities by many reserchers (Glaros et al., 2007 Gramling et al., 1996 Peterson et al., 1993). However, it is actually difficult to change the shape of jaw with the behavioural therapy that administered by previous researchers. To change her excessive behavioural patterns, the most important aspect of treatment should consider the belief of positive reinforcers. Therefore, habit reversal treatment can be adapted in slightly different way for future intervention.Among the habit reversal treatment, participant need to complete the State-Trait Anxiety Inventory (STAI) to find out the psychological distress which is the main factor of oral habits. About the obsession of physical attractiveness, Self-Esteem Scale (SES) required to be answered to indicate participants feeling towards self-descriptive statements, as well as the scale of pain around mandibular area.During the 2 week treatment period, participant go away carry out the practice of 60-minutes DTMD treatment, dropping their jaws slightly (D), separating their teeth slightly (T), relaxing the muscles in the jaw and face area (M), and performing a deep breathing activity (D), while watching the mirror image of self. After the practice, participant gives verbal compliment to self, with written demonstration of how she proud of herself.The purpose of this intervention is to dismiss the misbelief of jaw movement, and develop new positive r einforcers with new oral habits. Earning self-esteem with attendance of treatment sessions testament be a great positive reinforcer to the habit reversal activities (DTMD) which take the place of the oral parafunctional habits. Participant will record the frequencies of oral parafunctional habits every day during the treatment, and rate the pain from 0 to 10, and self-esteem scale after the whole process was completed.It is expected to participant would decrease the frequency of oral habits and show correlation with more points for self-esteem and little level of anxiety if this intervention is successful. Compliment to self will be the negative reinforcer in relation to the oral parafuntional habits, which will be declined, thus the rating of pain is assumed to be dropped in the later stage. However, it is uncertain the behavioural therapy related to self-esteem has the actual impact on its development. Also, one of the drawbacks for this intervention is designed for one person, thus it can be more effective if another patient engage during the treatment sessions, and give compliment to one another.Similarly, the results from the current self-monitoring has a limited aspect in terms of duration. Participant could suffer some health issues such as flu and extending the duration of monitoring will help to observe more current data. Also, the method of self-reporting has the definite limitation that reporting could be underestimated when participant delivers the behaviour unconsciously, and when the subject is too aware of monitoring self before she commits the behaviours, like Day 8 shown in current research results. These limitation needs to be covered to get more reliable data and better performance of further treatment.