Oral habits like tongue chewing or mouth breathing might seem minor, but dental hygienists know better. These patterns, and the causes behind them, can quietly cause chronic inflammation, soft tissue damage, or even skeletal changes over time. This guide brings together some of the most common (and commonly overlooked) oral habits hygienists encounter in the operatory, and how you can help patients recognize, understand, and address them.
What is tongue chewing?
Tongue chewing is often an unconscious stress coping mechanism and can easily go unnoticed by a patient. They’re often not even aware they’re doing it until you point out their irritated lateral borders. Tongue chewing can also be caused by an unbalanced bite, leading to chronic trauma or discomfort.
What to look for: White lines or keratinized tissue on the sides of the tongue
What to ask: “Have you noticed any soreness or rough spots along your tongue lately?”
Learn more about tongue chewing in this article by Nancy W. Burkhart, EdD, MEd, BSDH.
Why is mouth breathing a problem?
Mouth breathing, when someone habitually inhales and exhales through the mouth rather than the nose, doesn't just cause dry mouth or bad breath. It’s associated with caries risk, soft tissue inflammation, and changes in orofacial development, particularly in children. In adults, it can impact sleep and lead to chronic halitosis, excessive gingival display, and malocclusion.
What to watch for: Anterior gingival irritation, dry tissues, or consistently open lip posture.
Tip: Be the one to gently raise the possibility. Many patients have no idea this is something they should even be aware of.
Explore more about mouth breathing in this article by Shirley Gutkowski, BSDH, RDH.
What should I say when patients ask about tonsil stones?
Tonsil stones are a common concern, especially among patients with chronic bad breath. While they’re usually harmless, they can cause discomfort and embarrassment, and patients often ask about them during hygiene visits.
What to listen for: “Why does my breath still smell bad?” or “I feel something in the back of my throat.”
How to help: Explain what tonsil stones are, how they form, and simple self-care strategies. Recommend medical referral if they’re frequent, large, or painful.
Read more in this comprehensive overview of tonsil stones by Andreina Sucre, MSc, RDH.
Is lip sucking still an issue for adults?
Yes. Lip sucking often starts in childhood, but the effects, such as irritated soft tissues, misaligned anterior teeth, even speech issues, can linger well into adulthood. Hygienists are often the first to catch it.
What to look for: Chapped or callused lips, protrusion of upper lip, tissue trauma.
What to say: “I’m seeing some signs that might be related to an oral habit. Can I ask you a few quick questions about it?”
Read more about lip sucking and oral tissue health by Nancy W. Burkhart, EdD, MEd, BSDH.
What can hygienists do about it?
- Ask nonjudgmental questions to help patients reflect on their unconscious habits.
- Explain how these behaviors can have significant negative affects on oral health, which many people don't realize.
- Refer when appropriate (ENTs, myofunctional therapists, behavioral health).
- Document patterns in the chart so the whole care team stays informed.
Which oral habits should hygienists screen for?
Tongue chewing, mouth breathing, lip sucking, bruxism, nail biting, and anything that causes repeated trauma or inflammation.
How can I bring it up without embarrassing a patient?
Try this: “Can I ask—have you ever noticed yourself doing XYZ? I ask because I see some things in your mouth that could be related.”
Can we fix these habits ourselves?
Sometimes a simple conversation can prompt a patient to reconsider a lifelong habit. When the issue is beyond the scope of a dental practice, a referral can be a good next step.
Want more practical tips?
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