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THE NAILS AS AN AID TO DIAGNOSIS.
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Treating nailbiting: a comparative analysis of mild aversion and competing response therapies.
This study compared two methods of treating nail-biting. One method involved the use of a mild aversive stimulus in which subjects painted a bitter substance on their nails, and the other required the subject to perform a competing response whenever they had the urge to bite or found themselves biting their nails. Both methods included self-monitoring of the behaviour, and a third group of subjects performed self-monitoring alone as a control condition. The study lasted four weeks. Twenty-one subjects, seven per group, participated. Both methods resulted in significant improvements in nail length, with the competing response method showing the most beneficial effect. There was no significant improvement for the control group. The competing response condition also yielded significant improvements along other dimensions such as degree of skin damage and subjects own ratings of their control over their habit. These were not seen for the other two conditions. The benefits of this abridged version of Azrin and Nunn's (Behaviour Research and Therapy, 11, 619-628, 1973) habit reversal method in terms of treatment success, use of therapist time and client satisfaction, are discussed.
Permanent paresthesia to sculptured nails. A distressing problem.
In order to discourage her habit of nail biting and to repair her damaged nails, a 50-year-old woman sought cosmetic improvement in a beauty salon, where a manicurist suggested the use of sculptured nails. A permanent paresthesia resulted from this procedure without allergic reaction.
When children put their fingers in their mouths. Should parents and dentists care?
We have heard mothers tell their children not to stick their fingers in their mouths because they will get sick. Medical and dental professionals know this is true. Oral habits like thumb sucking and nail biting can damage the structure of the mouth and can lead to the spread of infectious diseases.
Root resorption after orthodontic treatment in high- and low-risk patients: analysis of allergy as a possible predisposing factor.
The development of excessive root resorption during orthodontic tooth movement is an adverse side-effect, which is of great concern. The aim of this investigation was to analyse factors that might be associated with orthodontically induced root resorption. After buccal movement of maxillary premolars in 96 adolescents, the experimental teeth were extracted and subjected to histological analysis and measurement of resorbed root area. Fifty individuals, 18 boys and 32 girls, mean age 13.4 years, were selected and divided into two equal groups: the high-risk group based on measurements of the most severe root resorptions, and the low-risk group on measurements of mild or no root resorptions. After a preliminary screening of possible risk factors regarding root resorption, i.e. root morphology, gingivitis, allergy, nail-biting, medication, etc., only those subjects with allergy showed an increased risk of root resorption, but this was not statistically significant.
Symptoms and signs of temporomandibular disorders and oral parafunctions among Saudi children.
This study aimed to record the prevalence of signs and symptoms of temporomandibular disorders (TMD) and oral parafunctions among Saudi children. A questionnaire and a clinical examination of signs and symptoms of TMD were performed on 1940 stratified randomly selected schoolchildren. The sample was divided into three groups, 505 with primary, 737 with mixed and 734 with permanent dentition. The prevalence of TMD signs was found to be 20.7% and the most common sign of TMD was joint sounds (11.8%). The second most common sign was restricted mouth opening (5.3%). Muscle and temporomandibular joint (TMJ) pain as well as deviation upon jaw opening appeared infrequently. TMJ sounds were significantly increasing with age (P < 0.05). TMD symptoms as reported by the parents were evident in 24.2% of the returned questionnaires (1113). The most common symptoms were headache (13.6%) and pain on chewing (11.1%). The incidence of headache was found to be significantly increasing from primary to permanent dentition (P < 0.01). No sex difference in the prevalence of any symptom was reported. Nail biting was the most common oral parafunction (27.7%) while bruxism was the least common (8.4%). All parafunctions except bruxism were significantly related to age. Cheek biting and thumb sucking were reported more in females than in males. The importance of a screening examination for symptoms and signs of TMD should not be overlooked in the clinical assessment of the pediatric patient.
A review of behavioral and pharmacological treatments for habit disorders in individuals with mental retardation.
This paper reviews the prevalence and behavioral and pharmacological treatment-outcome studies for habit disorders exhibited by individuals with mental retardation. The treatment-outcome studies target the habit disorders identified previously by researchers including nervous habits (nail biting, bruxism, and trichotillomania), motor and vocal tics, and Tourette's disorder. The paucity of behavioral treatments and the lack of controlled pharmacological research warrants further experimental evaluation of treatments for habit disorders affecting individuals with mental retardation. Conclusions and recommendations for future research are made.
Environmental and physiological factors affecting lead and cadmium levels in deciduous teeth.
Shed deciduous teeth lead and cadmium content of children from Cartagena (Spain) was assessed. Parents were provided with an interview containing different questions concerning family socioeconomic status, child's health history, zone of residence, or home antiquity. Besides, physiological variables were considered, i.e., sex of donor, presence of caries, type of tooth donated, tooth weight, age of shedding, and position within the mouth. Tooth lead and cadmium data showed a positively skewed distribution and were log-normalized for further analyses. No statistically significant differences could be observed for lead and cadmium values according to the sex of donor. Both heavy metals decreased in content from incisors to molars and with age of shedding. The one-way analysis of variance (ANOVA) displayed both environmental and physiological risk factors contributing to high tooth lead and cadmium values. When a multifactor ANOVA was carried out, the associations between home antiquity, nail biting habit, and jaw with tooth lead levels, as well as those between zone of residence and tooth cadmium levels were found to persist. However, the only common factor for both heavy metals in the multiple analyses was the type of tooth.
Suicidal age and childhood onychophagia among veterans with personality disorders.
The relationship between childhood onychophagia (finger-nail biting) and the mean age of suicidal and nonsuicidal veterans was investigated among 70 V.A. hospitalized males, diagnosed as personality disorders. The results show that the mean age of suicidal veterans was significantly lower than that of nonsuicidal veterans, and the childhood onychophagia variable, "focal suicide," significantly lowered the mean age of suicidal veterans, but did not significantly lower the mean age of nonsuicidal veterans.
[Significance of bad habits in orthodontics].
The author is concerned with the etiological role of bad habits in the development. Disturbances caused by pacifier habits, finger sucking, various forms of swallowing habits and their therapeutical possibilities are discussed. The role of mouth breathing, nail biting, bruxism and self-mutilation in development of anomalies and their therapy are also mentioned. The attention is called to the fact that dentists have responsibility and task to diagnose as early as can be the oral bad habits and that the adequate therapy in time in co-operation with other specialists helping the child get out of bad habits, preventing the development of severe anomaly.
[Behavioral somatic disorders in hospitalized children].
The research has investigated the occurrence of somatic and behavioural disorders in 100 hospitalised children. A hundred subjects, 55 males & 45 females, aged between 6 and 14 years were asked to fill in questionnaires. These, which were of a completely new type, related to 12 situations in a typical day. The results showed statistically significant differences between the two sexes. Girls manifested a much higher percentage of disorders than did boys. Further, young children and especially pre-adolescents (subjects aged 10-11) manifested more disturbances than did those in the adolescent category. Of the subjects 32% showed a number of disorders below the norm; 36% of the cases were within normal values, 17% were above the norm and the remaining 15% of the subjects were considered to be of particular interest. The most frequent somatic disorders were in heart-rate variations, abnormal sweating (especially of the hands when being orally tested at school), abdominal-aches and headaches. Of the behavioural disorders the most frequent were in the inability to stand still and nail-biting. Also worthy of note, though less frequent, were disorders in eating and in sleeping. It was especially at the end of the day ("before going to sleep") that all these problems occurred. They were also frequent, however, during the periods "at school", "during oral tests" and "watching television". The results obtained in parallel research on 125 primary school children confirm all of the above findings.
[Behavior therapy of onchophagia and trichotillomania. Ethological and behavioral perspectives].
Emphasis is brought to similarities between informations collected from the study and treatment of patients suffering from nail biting and trichotillomania, by behavioural treatment and the concept according to which such troubles are "tics", learned responses which will become non adapted, present in a given situation, reinforced by time and progressively more resistant to extinction on the one hand, and ethological concepts which consider those behaviours as displacement of activity such as "grooming" in primates, ritual activities, free from nutritions activities, triggered by some attitudes and facilitated by the presence of fear affects, aggressivity or sexual drive.
[The aggressive child (author's transl)].
In children a "normal" aggressiveness should be distinguished from "hostile" and "inhibited" aggression; the latter usually become apparent as heteroaggressive or autoaggressive behaviour. Autoaggression is more common with younger children. Different hypotheses about the origin of aggressiveness are discussed. In the younger child nail biting, trichotillomania, rocking, an intensified phase of contrariness and enkopresis may have components of aggressiveness. In older children and adolescents dissocial forms of development, drug taking, attempted suicid, and anorexia nervosa may be parts of aggressive behaviour. Minimal brain dysfunction, autism, and postencephalitic syndromes predominate amongst organic alterations of the brain as causes for aggressive behaviour. Particularly the Lesch-Nyhan-syndrome, but equally the Cornelia de Lange-syndrome show autoaggressive tendencies.
The self-mutilative nature of severe onychophagia: a comparison with self-cutting.
OBJECTIVE: To investigate the psychophysiological pattern associated with severe and mild onychophagia, and to compare this pattern with that demonstrated by previous research on self-cutting. METHOD: Comparisons between the psychophysiological responses accompanying 3 behaviours were made using a guided imagery methodology. Imagery of nail-related, skin-cutting, and neutral events were presented in 4 stages. RESULTS: Experiment I distinguished participants exhibiting severe and mild onychophagia by the severity and frequency of nail-biting and by the pattern of psychophysiological response across the stages. Experiment II indicated that the change in psychophysiological arousal accompanying severe onychophagia was not as dramatic as that demonstrated for skin-cutting. The behaviour seems to be less effective in reducing tension. CONCLUSION: Severe onychophagia appears to manage the level of tension experienced by an individual, instead of dramatically reducing it in times of crisis. Such a process is consistent with that demonstrated in individuals with obsessive-compulsive disorder.
Clinical profile of trichotillomania.
Twenty-four cases of trichotillomania attending psychiatry outpatient department and child guidance clinic at Kalawati Saran Children's and Smt Sucheta Kriplani Hospitals over a period of 2 years from July, 1985 to November 1987 were studied. Females (66.7%) outnumbered the males (33.3%). Majority of cases belonged to age group 6-10 years (54.2%) and nuclear family (68.5%). Nail-biting (25.0%) was the commonest associated neurotic trait, followed by enuresis (20.9%), temper-tantrum (12.5%), etc. A past history of hysterical fits and neurotic depression was found in 3 cases (12.5%) and 2 cases (8.3%) respectively. Family history of neurosis was seen in mothers and fathers of 20.9% and 12.5% cases respectively. Trichobezoars and trichophytobezoars were found in 6 cases (25.0%) and 3 cases (12.5%) respectively. Majority of patients of trichobezoars presented with vague complaints like heaviness in the stomach (55.6%), inability to gain weight (44.4%), etc, while 22.2% cases were asymptomatic and detected only on screening.
Predictive value of neuropathic traits.
The classic textbook concepts of neuropathic traits--enuresis, nail-biting, finger-sucking, sleep-walking, anxiety, nightmares, fear of darkness--have been anamnestically recorded in patients in a somatic hospital who were referred for psychiatric interview. More than 50% of the patients could report having had one or more such traits with an even distribution between males and females except for enuresis, which was recorded more frequently in males. The presence of such traits was correlated to adult mental health. No correlation was found between one single trait and later disorders. There was a positive correlation between two or more traits and neurotic states of anxiety or conversion neurosis, but no correlation with depressive disorders or psychosomatic diseases (after Alexander's concept).