Cheek biting



Chronic cheek biting, also known as morsicatio buccarum, is a compulsive behavior that causes an individual to repeatedly bite the inside of the cheek.



Cheek biting may be a coping mechanism to relieve emotional pain, physical pain or a blend of the two. 



Similar to skin picking and hair pulling, it is classified as a body-focused repetitive behavior (BFRB). 



It appears to be a repetitive behavior, and can be a sign of a mental health condition similar to obsessive-compulsive disorder (OCD) driven by stress and anxiety.



Cheek biting may be associated with redness, sores, and tears of the the mucosal lining of the mouth. 



The repetitive biting the lining of the cheek can promote an irregularity that increases the urge to continue to bite,  in order to create a smooth surface. 



The behavior may lead  to feelings of guilt, shame, and hopelessness and decreased social activity.



Patients seek to prevent others from observing the behavior.



Chronic cheek biting behavior is more common for people who experience higher levels of stress and anxiety. 



Some people are compelled by the need for a smooth inner cheek lining, and the  perception of  impurity such as a bump or scratch may produce the uncontrollable urge to remove the imperfection by biting the area. 



BFRBs share a similar complex etiology, act via biologic predisposition, and  genetic mechanisms to activates the repetitive behavior. 



BFRB may be initiated or influenced by emotional states.



BFRB can  cause an emotional feedback loop that results in the recurring behavior. 



Chronic cheek biting has both behavioral and emotional components.



Managing the behavior is very difficult,  if individuals are unaware you are doing it or in a trance-like state.



Management includes encouraging acknowledgment of aberrant behavior,  replacement behavior, breathing or relaxation exercises, imagery, and hypnosis.



BFRBs are behaviors that are repeated despite continuing attempts to stop them. 



Termed  disorders when they impair a person’s quality of life and cause injury or distress. 



BFRBs typically start in late childhood and continue into adulthood.



There are five primary types of cheek biting:



Periodic accidental cheek biting. 



Regular accidental cheek biting: 



teeth may not be in proper alignment or there may be something wrong with the jaw. 



Cheek biting while asleep. 



Habitual cheek biting. 



BFRD: obsessive cheek biting that continues despite attempts to stop.



Suggested causes for this behavior include:



a subconscious reaction to stress



a subconscious reaction to boredom or inactivity



a semiconscious coping method for emotional overload



Although self-injurious, chronic cheek biting may feel almost normal to the person biting and chewing.



Cheek biting can lead to injury such as mouth sores and ulcers.



Some cheek biters concentrate their biting and chewing on one area, and the sensation of broken skin can trigger an added compulsion to smooth the damaged area: creating a cycle of worsening injury.



Chronic mechanical irritation from recurrent biting teeth does not cause oral cancer, but it can promote and progress oral carcinogenesis.



Cheek biters may experience guilt, shame, hopelessness, and could limit their social activity and interactions.



Management requires the determination  if the behavior is habitual or compulsive.



Habitual cheek biting can be managed with light guidance, self-discipline, and patience. 



Techniques that have proven successful for some people include:



chewing gum to replace cheek chewing 



Identifying triggers, and then replacing the cheek biting with another activity.



Compulsive cheek biting and cheek chewing is a more complicated condition: emotional and behavioral component support



lowering stress levels



providing healthy anxiety solutions



removing triggers 






meditation for anxiety reduction



mindfulness training 



cognitive behavioral therapy, 



dialectical behavior therapy, 



habit reversal therapy, 



and acceptance and commitment therapy




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