عادت های دهانی چند نوع است و علت آن چیست؟
عادات دهانی
شست مکیدن
شست مکیدن در بین کودکان شایع است.
شواهدی وجود دارد که بعضی از کودکان مکیدن را از داخل رحم شروع می کنند.
در بقیه کودکان، ۲۰ درصد شست مکیدن را بین ۳ تا ۵ ماهگی شروع می کنند.
۱۵ درصد بین ۶ تا ۹ ماهگی و فقط ۱۰ درصد از آنان شست مکیدن را بعد از ۹ ماهگی شروع می کنند.
با افزایش سن کودکان، میزان بروز شست مکیدن کاهش می یابد.
شست مکیدن تا ۲ سالگی عمدتا با گرسنگی، خواب، ناکامی یا خستگی رابطه دارد.
در 2/5 تا ۳ سالگی معمولا فقط شب ها رخ می دهد .
غالبا با استفاده از اشیای انتقالی و رفتاری دیگر مثل کشیدن یا پیچاندن مو یا گوش، مالیدن لپ یا مکیدن لبه پتو همراه است .
اگر شست مکیدن در طول روز اتفاق بیفتد معمولا با عمل آرامش بخشی مثل تلویزیون دیدن یا داستان گوش دادن همراه است.
در ۵ سالگی اکثر کودکان شست خود را فقط در خواب می کند.
3در صورت موجود بودن پستانک، بسیاری از کودکان پستانک مکیدن را ترجیح میدهند؛
پستانک مکیدن یک نوع شست مکیدن محسوب می شود.
دلایل:
در سبب شناسی شست مکیدن، دیدگاه های مختلفی وجود دارد:
تداعی های لذتبخش مرتبط با تغذیه.
پاسخ شرطی برای کاهش تنش.
ارضای شهوانی .
تغذیه افراطی با پستان یا بطری.
وانگهی کودکانی که شست خود را می مکند مشکلات رفتاری و هیجانی زیادی ندارند.
در عمل به نظر می رسد شست مکیدن اولیه تا حدودی مفید است چون گریه را کم می کند، دندان درآوردن را آسان تر می کند، به کودک کمک می کند بخوابد و به طور کلی کودک را آرام می کند.
شست مکیدن تا زمانی که مزمن نشده و مزاحم سایر فعالیت های کودک نباشد، مشکل در نظر گرفته نمی شود.
مگر آن که مشکلات دندانی ۴ تا ۶ سالگی، در بین باشد.
این مشکلات دندانی عبارتند از روی هم قرار نگرفتن دندان ها، باریک شدن قوس های دندانی، التهاب لثه و از ریخت افتادن انگشت.
سایر مشکلات بچه هایی که دائما شست خود را می مکند عبارتند از:
تحت الشعاع قرار گرفتن جایگاه اجتماعی آنان در بین همسالان.
بچه های دیگر آنها را بچه های کم هوش، غمگین، غیرجذاب می بینند.
وانگهی بعضی از پدر و مادرها، شست مکیدن را خیلی آزارنده و خجالت آور می دانند.
با توجه منفی خود از آن یک مشکل می سازند.
بنابراین مشکلات مربوط به شست مکیدن، به شدت و مزمن بودن عادت و تأثیرات آن بر والدین، مقبولیت اجتماعی کودک و ساختار دهانی و انگشت کودک بستگی دارد.
درمان شست مکیدن :
یکی از این روشها، وارونگی عادت است .
با یک ماده بدمزه و با ایجاد نظام پاداش دهی می توانیم شست مکیدن روزانه و شبانه درمان کنیم.
پدر و مادر بچه ها، ماده ای به نام استاپ – زیت را صبح پس از بیدار شدن فرزندشان، هر بار که در طول روز شست مکیدن فرزند خود را می دیدند و یک بار قبل از خواب، روی ناخن انگشت شست و ناخن انگشت های دیگر او میمالیدند.
نظام پاداش هم یک کیسه شانسی بود که والدین در آن ۵۰ تا ۱۰۰ قلعه کاغذ که روی آنها انواع پاداش های ملموس و ناملموس نوشته شده بود (مثلا خوردن غذاهای سبک، انواع امتیازها، گذراندن مدت زمانی با والدین و غیره) می گذاشتند.
پدر و مادرها درمان را خیلی قابل قبول ارزیابی کردند.
درمان با یک ماده بدمزه به تنهایی کافی است تا شست مکیدن کم شود.
ولی پاداش دادن و نمکیدن شست نیز مهم است چون به مقبولیت درمان کمک می کند.
بسیاری از والدین با برداشتن و حذف شیء متداعی شده با شست مکیدن، به فرزند خود کمک می کنند عادت شست مکیدن را ترک کنند.
هر وقت کودک شست می مکید، یک عروسک قلاب بافی را با دست دیگرش بغل می کرد.
وقتی عروسک را از کودک می گرفتند و به کودک می گفتند تو دیگر بزرگ شده ای، تقریبا بلافاصله شست مکیدن را قطع می کرد.
وقتی دوباره عروسک را به او می دادند، شست مکیدن او به حد خط پایه می رسید.
تا این که کودک بعد از ۳ روز با لحنی عصبانی به والدینش گفت دیگر بزرگ شده است و آن عروسک را نمی خواهد.
بعد شست مکیدن او قطع شد.
در مورد پستانک خوردن هم از فنون مختلفی استناد کرده اند:
از جمله برداشتن پستانک، پستانک خوردن در مواقع و مکان های خاص، مالیدن ماده ای بدمزه روی پستانک و کم کردن تدریجی اندازه و تغییر دادن شکل نوک پستانک.
یک درمان دندانی رایج برای شست مکیدن، استفاده از وسیلدای است به نام « Platal Crib with Spurs» که آن را درون دهان کار می گذارند. با وجود چنین وسیله ای، فروبردن شست در دهان، سخت و دردناک می شود. نتیجه این درمان خصوصا اگر این وسیله حداقل ۶ ماه در دهان باشد خوب است؛ ولی بعضی از مؤلفان اثرات منفی این روش را از جهت مشکلات هیجانی و مشکلاتی که برای غذاخوردن و تکلم ایجاد می کند. گوشزد کرده اند. با توجه به این مشکلات دندانپزشکان و اکثر پدر و مادرها از این نوع درمان استقبال نمی کنند مگر آن که چاره ای نباشد. واتسون و آلن (۱۹۹۳) در رویکردی کمتر متجاوزانه، با پوشاندن شست کودک، جلوی تقویت شست مکیدن از طریق تحریک لمسی – جنبشی شست بر اثر تماس با سقف دهان را در دختر 5 ساله ای گرفتند. لایه ای که شست کودک را با آن پوشانده بودند در شست و دهان کودک دردی ایجاد نمی کرد. فقط نمی گذاشت شست کودک با سقف دهانش تماس پیدا کند. این کودک مدت شست مکیدن و مو کشیدن خود را که همزمان با شست مکیدن انجام میداد، ترک کرد.
ناخن جویدن
ناخن جویدن (اعم از کندن یا جویدن ناخن ها) و رفتار نوک زدن به ناخن ها با کندن پوست انگشتان، دو عادت شایع کودکان هستند.
بر اساس گزارش های والدین، ۲۵ درصد از کودکان، تقريبا بین ۲٫۵ تا ۶ سالگی ناخن می جوند.
میزان ناخن جویدن کودکان در ۶ سالگی افزایش می یابد.
در نوجوانی به اوج خود که 45 درصد است، می رسد.
سپس در بزرگسالان به 4/5 درصد تقلیل می یابد.
محققان، ناخن جویدن را رفتار آموخته شده ای میداند که تنش کاه و اضطراب کاه است و هنگام تمرکز کردن رخ می دهد.
ناخن جویدن، هنگام استرس به بالاترین حد خود می رسد.
ولی ناخن جویدن ظاهرا مؤلفه خانوادگی یا ژنتیکی هم دارد .
چون در دو سوم دو قلوهای یک تخمکی و یک سوم دو قلوهای دو تخمکی هر دو کودک ناخن می جوند.
ناخن جویدن علاوه بر آن که ظاهر ناخن ها را بد می کند.
باعث زخم شدن و عفونت ناخن یا رو پوست اطراف ناخن می شود؛
همچنین مشکلات دندانی ایجاد می کند.
مثلا باعث کوتاه شدن ریشه دندان ها بر اثر فشار زیاد می شود .
برای درمان ناخن جویدن،رویکردهای رفتاری زیادی وجود دارد.
وارونگی عادت .این رویکرد، 40درصد موارد ناخن جویدن را رفع می کند.
رویکردهای دیگر برای رفع ناخن جویدن و میزان موفقیت این رویکردها به شرح زیر هستند:
بازبینی خود صرف (15درصد) ،
استفاده از مواد تلخ (۱۵ درصد) ،
پاسخ های رقیب صرف (۴۰تا 57درصد)
تمرین منفی (15 درصد).
دندان قروچه
دندان قروچه عبارت است از مالیدن بیهوده و بی جای دندان ها به یکدیگر.
شامل ساییدن دندانها به یکدیگر در روز یا شب، فشردن دندانها روی هم، کوبیدن دندانها به یکدیگر ،تق تق زدن دندانها به یکدیگر و سایر عادات مخرب می باشد.
در این میان، ساییدن دندانها روی یکدیگر و روی هم فشردن دندانها از همه رایج تر هستند.
دندان قروچه در حالت شدید خود می تواند باعث ساییدگی نامنظم و زود هنگام دندانها شود و روی هم قرار نگرفتن دندان ها و صدمات چهره ای خصوصا صدمه مفصل آرواره را در پی داشته باشد.
میزان شیوع :
از ۷ درصد با 88 درصد متغیر است که دلیلش بستگی پیدا کردن ان به تعریف دندان قروچه است .
دندان قروچه میتواند از وقتی که کودک دندان در می آورد شروع شود ولی اوج آن ۳ تا ۱۷ سالگی است و در بزرگسالی به 4/5 درصد می رسد.
نسبت دختران مبتلا به دندان قروچه به پسران 3به 1 است.
علاوه بر استرس، عوامل دیگری هم در سبب شناسی دندان قروچه دخالت دارند که عبارتند از
کمبودهای غذایی
آزاد شدن هیستامین در پی آلرژی، سرما خوردگی یا استرس
پر کاری تیروئید؛
مشکلات عصب شناسی مانند صرع و عقب ماندگی ذهنی؛
آرتریت روماتوئید کودکی
مصرف داروهایی مثل آمفتامین ها و مشتقات آنها .
ظاهرا دندان قروچه با مشکلات هیجانی یا رفتاری رابطه ندارد.
معمولا اولین بار دندان پزشک، دندان قروچه را تشخیص می دهد.
درمانهای موثر برای دندان قروچه عبارتند از کار گذاشتن وسایل محافظ دندان یا آتل، بازخورد زیستی شبانه و وارونگی عادت کامل.
سایر عادات
سایر عادات دهانی (مثل کندن پوست لب، گاز گرفتن لب، لیسیدن لب، مكیدن زبان، مکیدن سق و گاز گرفتن لپ) عمدتا مشکل کودکان یا بزرگسالانی هستند که ناتوانی رشدی دارند.
برای مثال، سندرم لسک – نیهان در کسانی دیده می شود که با گاز گرفتن، بخشهایی از بدن خود (مثلا لبها، زبان و حفره دهانی) خود را می برند.
مرکز مشاوره دیدار
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