How can you help patients who bite their nails?

By Pooria Shahin, DDS, contributing writer

January 3, 2017 -- As dentists, we are all too familiar with particular oral health problems that could have been avoided if patients refrained from bad dental hygiene practices in the first place. One such common habit that leads to preventable dental health problems is nail biting.

Onychophagia, as we know it, may provide temporary comfort to patients when they feel stressed, nervous, or bored, but the habit does a lot more damage than they know. As their dentists, we need to help them stop biting their nails. Here are a few instances of nail biting gone bad that we can share with our patients to convince them to stop.

Exposure to bacteria

Dr. Pooria Shahin
Pooria Shahin, DDS.

We have to help our patients understand that anytime they use their hands, they risk being exposed to different kinds of bacteria. Even when they wash with soap, some of those germs will remain underneath the fingernails. Biting their nails inevitably passes the germs from their hands to their teeth, tongue, and gums, leading to the spread of bacteria in the mouth.

A study published in the Journal of Oral and Maxillofacial Pathology (May 2013, Vol. 17:2, pp. 163-168) found that individuals with nail-biting habits had a higher carriage of Enterobacteriaceae than those who didn't bit their nails. The findings tell us that nail biting paves the way for the growth of bacteria, which can affect patients' teeth. In addition, nail biting also promotes digestive problems when people ingest bits of their fingernails and the bacteria thriving on them.

Nail biting can damage gums

Nail biting typically produces nails with sharper and more-jagged edges. With the removal of the soft, rounded edge that usually forms after nails are properly trimmed, people with onychophagia have a greater chance of accidentally scratching their gums. And with an open wound exposed to countless thriving bacteria, having an infection is no longer a surprise.

The European Journal of Dentistry (April 2009, Vol. 3:2, pp. 150-154) published a case of gingival injury in a 14-year-old girl caused by her fingernail scratching habit. The girl was admitted to a periodontology clinic where she received surgical periodontal treatment as well as oral hygiene instruction and psychological support. With a one-year follow-up, the case study showed the possibility of treating gingival injury in a person with a destructive nail-biting habit. Maintaining periodontal health is highly achievable through regular follow-up teamed with patient compliance and psychological support.

Teeth grinding

According to the Academy of General Dentistry's Know Your Teeth site, people who bite their fingernails when stressed or those who chew on something or clench their jaw when nervous are at higher risk for bruxism. Grinding teeth adds pressure on the jaw and will, in turn, cause the patient's tooth enamel to wear down. It may also cause facial pain, increased tooth sensitivity, and gum recession, which could lead to eventual tooth loss.

While bruxism or teeth grinding is a stress-induced psychological disorder and not a dental disorder per se, it causes a range of dental problems and even general health issues. As doctors, we have to understand that patients may not even be aware they have bruxism, as it mainly occurs as a reliever of stress, tension, anxiety, and depression. And a result, treatment for teeth grinding requires not just dental care but also behavioral therapies and muscle relaxation exercises.

TMJ disorders

Intense nail biting can also lead to the development of temporomandibular joint (TMJ) disorders; studies have shown a causal relationship. A person with TMJ might also experience what is commonly known as lockjaw and will have difficulty chewing or speaking. An inquiry into the oral habits of those patients with TMJ disorders may be called for.

Treatment suggestions

To help deter nail biting, patients may find wearing a mouthguard useful. Some find that using such protection greatly helps in preventing further tooth damage. Dentists may also instruct patients on techniques such as resting the tongue upward with lips shut and teeth apart to avoid tooth damage.

Whatever the cause of nail biting, here are three techniques to recommend to patients to help them stop the habit:

  1. Cut nails and keep them short so there is less to bite.
  2. Coat nails with a bitter-tasting polish. Some of these have neem oil as a base ingredient, which has a bitter taste that can discourage people from biting their nails.
  3. Find additional ways to manage stress. Activities such as yoga or meditation can help the mind and body relax and eventually curb the patient's urge to bite his or her nails.

It's said that it takes 21 days to break a habit. Try suggesting any of the measures above for your patients to do for as long as they can -- this will help them avoid some serious oral health issues. And while prevention is indeed better than a cure, there are times when patients really need to see a dentist because of their nail-biting habits.

Pooria Shahin, DDS, practices in Brooklyn, NY.

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

Copyright © 2017

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