Bad habits are a defining trait of being human – even if we know something is bad for us, we often can’t help but do it anyway. Born out of repetition and impulse, we are often aware of our vices. These can include anything from smoking to unhealthy snacking or spending too much time on our phones.
The average adult will attempt to stop their bad habit twice a year, with January and New Year resolutions often viewed as an opportune moment for a fresh start. However, there are many poor habits that we may be less conscious about – these are harder to stop. For dental practitioners, a patient’s bad habits may impact the success of implant treatment. A greater awareness, both for patient and practitioner, on the consequences of certain harmful routines is needed to better prevent implant failure and optimise outcomes.
Nervous ticks
A poll of the UK’s worst but most common habits had nail biting in third place. This repetitive behavioural act is difficult to suppress and has a high prevalence – 20 to 33 pr cent – among children. Whilst the frequency of nail biting decreases in adulthood, many still continue the habit. It has many effects on the oral cavity: apical root resorption, chipping off incisal edges of the anterior teeth, temporomandibular joint dysfunction, gingival swelling, and destruction of the alveolar bone. The latter two can prevent the successful osseointegration of an implant.
The habit can vary in frequency, duration and intensity. Patients who are stressed or nervous may bite their nails without thinking about it, with higher levels of anxiety found in nail biters than those without the habit. There is also a risk of infection from placing unwashed fingers into the oral cavity, with diseases like periodontitis and peri-implantitis able to manifest from the spread of harmful bacteria.
For optimal implant outcomes, identifying patients who may bite their nails and educating them on the association between that habit and implant failure is essential before any surgical procedure occurs. Encouraging solutions to destress – from breathing exercises to regular sleeping patterns – can also assist in reducing nail biting frequency.
Sleep bruxism
Some patients may not be aware of their damaging habits. Those with notable mechanical wear of the teeth, such as the flattening of the occlusal surfaces, and tender or stiff jaw muscles, among other signs and symptoms, may have bruxism. Sleep bruxism can affect eight to 10 per cent of adults; those that sleep alone may be harder to diagnose without someone else having seen or heard them do it. As sleep bruxism occurs unconsciously, it is harder to stop. Much like nail biting, both awake and sleep bruxism can be exacerbated by stress and anxiety, whilst obstructive sleep apnoea can also be a major risk factor for the latter.
Bruxism leads to excessive occlusal overload and subsequent implant and marginal bone loss. It is the leading cause of implant failure. For diagnosed patients, highlighting the importance of destressing and following a regular sleeping pattern can help minimise the risk of bruxism, but a mouth guard or mouth splint will better protect the implant from mechanical wear.
Other oral hygiene habits
Whereas nail biting and bruxism can occur throughout the day, there are several other less common oral hygiene related habits that can reduce implant success. Over-brushing the teeth every day is damaging, with the rough abrasion wearing away the tooth enamel. This rigorous brushing can also lead to gingival recession, leaving the roots exposed to infection or damage. Similarly, using teeth as tools is another bad habit that can cause cracking and fracturing. Both can cause implant failure.
To advance your understanding of implantology and better recognise patient habits and other risks that can cause treatment failure, consider an advanced course with One to One Implant Education. The PG Diploma in Advanced Techniques in Implant Dentistry is a two-year masterclass for practitioners who want to take their skills and knowledge in implantology to the next level. Under the tutelage of Fazeela Khan-Osborne and Nikolas Vourakis, practitioners can embark on an expansive journey across nine comprehensive modules, including an assessed case of a full arch reconstruction.
Most people have bad habits. Identifying the patients with habits that may be detrimental to their oral health is important; helping them to find solutions to minimise the damage that can impact an implant is even more essential. By working with patients, you can keep their smiles safe.
References available on request.
For more information call 020 7486 0000 or visit https://121implanteducation.co.uk