Occurrence Of nail biting amOng
athletes in grassrOOts fOOtball
Ocorrência de onicofagia entre
atletas de futebol de base
Thais Regina Elmadjian1
Luci Alves de Souza1
Reinaldo Brito e Dias1
Neide Pena Coto2
Marcelo Rodrigues Lima3
DDS, Department of
Maxillofacial Surgery,
Prosthetics and Traumatology, School of Dentistry,
University of São Paulo,
São Paulo, SP, Brazil
2
DDS, MsC,
PhD,Department of
Maxillofacial Surgery,
Prosthetics and Traumatology, School of Dentistry,
University of São Paulo,
São Paulo, SP, Brazil
3
Technical coordinator of
the Departament of Grassroots Football, São Paulo
Futebol Clube, São Paulo,
SP, Brazil
1
Recebido em: 30/9/2012
Aceito em: 19/11/2012
ELMADJIAN, Thais Regina et al. Occurrence of nail biting among
athletes in grassroots football. SALUSVITA, Bauru, v. 31, n. 2, p. 133140, 2012.
abstract
Introduction: Nail biting is related to a high degree of anxiety and
low self-esteem and has various repercussions. Objective: The present study aimed to detect the occurrence of nail biting among athletes
of football (soccer) in order to determine possible causes of muscle
imbalance, headaches, discomfort and stress that compromise athletic performance and indicate psychological problems and an inability to cope with pressure during training and games. Methods:
The present study was carried out at the São Paulo Futebol Clube,
São Paulo, Brazil, involving 64 athletes of football between 13 and
20 years of age. They were interviewed and clinically visually examined for the detection of the occurrence of nail biting. Results:
Among the 64 athletes interviewed and examined, 47 (73.5%) had
the habit of nail biting. Discussion: Malocclusion is the most frequent result of finger sucking and nail biting, especially when these
habits are prolonged. Parafunctional activities can overload the masticatory system. Nail biting can affect the performance of an athlete
in terms of dental aspects, with the presence of temporomandibular
disorder and malocclusion, as well as in psychological terms, dem133
onstrating insecurity and an excess of demands. Conclusion: Based
on the present study, planning strategies, multidisciplinary intervention and the organization of educational lectures are being adopted to
discuss the harmful repercussions of this habit for athletes, trainers
and other professionals involved in grassroots football.
Key Words: Nail Biting, Malocclusion, Temporomandibular Joint,
Athletic Injuries.
RESUMO
Introdução: A onicofagia é relacionada a um alto grau de ansiedade e baixa auto-estima e apresenta diferentes repercussões no
organismo, representa uma atividade parafuncional. Objetivo: O
presente estudo investigou a ocorrência de onicofagia entre os atletas de futebol de campo, a fim de determinar as possíveis causas de
desequilíbrio muscular, dores de cabeça, desconforto e estresse que
prejudicam o desempenho do atleta e indicam problemas psicológicos e uma incapacidade de lidar com a pressão durante o treino e
competições. Métodos: O presente estudo foi realizado no São Paulo Futebol Clube, São Paulo, Brasil, envolvendo 64 atletas de futebol
entre 13 e 20 anos de idade. Eles foram entrevistados e clinicamente
examinadas visualmente para a detecção da ocorrência de roer as
unhas. Resultados: Entre os 64 atletas entrevistados e examinados,
47 (73,5%) tinha o hábito de roer as unhas. Discussão: Má oclusão é o resultado mais freqüente de sucção de polegar e onicofagia,
especialmente quando esses hábitos acompanham o indivíduo por
um longo prazo. Atividades parafuncionais podem sobrecarregar o
sistema mastigatório. A onicofagia pode afetar o desempenho de um
atleta tanto em aspectos odontológicos, com a presença de disfunção temporomandibular e a má oclusão, bem como em termos psicológicos como insegurança, demonstrando um excesso de demandas.
O objetivo foi chamar a atenção para este mau hábito oral, o que
prejudica o condicionamento físico e psicológico necessário para a
obtenção de resultados satisfatórios. Conclusão: Com base no estudo, estratégias de planejamento, intervenção multidisciplinar e da
organização de palestras educativas estão sendo adotadas para discutir as repercussões nocivas deste hábito para atletas, treinadores
e outros profissionais envolvidos no futebol de formação.
Palavras-chave: onicofagia, má oclusão, articulação temporomandibular, traumatismos em atletas.
134
ELMADJIAN,
Thais Regina et al.
Occurrence of nail
biting among athletes
in grassroots football.
SALUSVITA, Bauru, v.
31, n. 2, p. 133-140,
2012.
ELMADJIAN,
Thais Regina et al.
Occurrence of nail
biting among athletes
in grassroots football.
SALUSVITA, Bauru, v.
31, n. 2, p. 133-140,
2012.
intrODuctiOn
Sucking is common action of children during breastfeeding. This
function is vital at the beginning of life and generally diminishes
in frequency over time. However, when this action becomes
exacerbated with no functional purpose, as in the case of finger
or pacifier sucking, such habits are harmful to the stomatognathic
system, which then undergoes alterations that are reflected in the
dental structures, muscles and joints of this system (SOUSA et al.,
2010; WINOCUR et al., 2006). The identification of malocclulsion
and parafunctional habits is fundamental to the early diagnosis
of problems in the temporomandibular joint in order to avoid
dysfunctions in the stomatognathic system(CORVO et al., 2003).
Children often abandon non-nutritive sucking habits only to adopt
the habit of nail biting as a means to alleviate stress and anxiety.
Nail biting is common among children, adolescents and adults alike
and pertains to the group of parafunctional habits that also allow
alleviating loneliness and inactivity among children with inadequate
feelings of security, love and close relationships(PACAN et al., 2009).
Nail biting has different clinical symptoms depending on the degree
and form of the injuries produced . It may be explained as a kind of
compulsion (WILLIAMS, ROSE, CHISHOLM, 2006). Nail biting is
easily recognized and may occur in a continual flow running from
mild to severe (PACAN et al., 2009).
Nail biting may be caused by excessive stimulation due to stress
or excitation or by under-stimulation due to boredom and inactivity.
It is also suggested to be related to a high degree of anxiety and low
self-esteem (JOUBERT, C.E, 1993). It cannot be considered merely
a dermatological or esthetic problem (PACAN et al., 2009) as it has
various repercussions, especially with regard to dental aspects. Studies
have shown that malocclusion is the most frequent result of finger
sucking and nail biting, especially when these habits are prolonged
(BRENCHLEY, 1992). Such parafunctional activities can overload
the masticatory system and lead to temporomandibular disorder
(KALAYKOVA, LOBBEZOO, NAEIJE, 2011; MICHELOTTI et
al.;2009; WINOCUR et al., 2006).
Among the different oral parafunctional habits, grinding/clenching
the teeth and nail biting are the most commonly reported (FETEIH,
2006; RICHERT; ANDRE, 2011). Incisor clenching provoked
by nail biting has been reported to cause a reduction in space,
followed by compression of the disc of the temporomandibular joint
(PEREIRA et al., 2010; TAKENAMI et al., 1999). In Brazil, a study
on orofacial pain reports that nail biting accounts for approximately
135
20% of parafunctional habits (ROCHA, MENDONÇA, ALENCAR
JUNIOR, 2007). In the practice of sports, nail biting can affect
the performance of an athlete in terms of dental aspects, with the
presence of temporomandibular disorder and malocclusion, as well
as in psychological terms, demonstrating insecurity and an excess of
demands.
Objective
The present study aimed to detect the occurrence of nail biting
among athletes of football (soccer) of the São Paulo Futebol Clube
(São Paulo, Brazil) in order to determine possible causes of muscle
imbalance, headaches, problems with the temporomandibular
joint, discomfort and stress that compromise athletic performance
and indicate psychological problems and an inability to cope with
pressure during training and games. The additional purpose was
to draw attention to this oral habit, which impairs the physical
and psychological conditioning necessary to the achievement of
satisfactory results.
methODs
The present study was carried out at the São Paulo Futebol Clube,
São Paulo, Brazil, involving athletes of football between 13 and 20
years of age lodged at the Athlete Training Center of the municipality
of Cotia, where the athletes receive assistance in medicine,
physiology, physical education, nutrition, psychology and dentistry as
well as pedagogical guidance. Sixty-four athletes were interviewed
and visually examined for the detection of the occurrence of nail
biting. The study received approval from the Ethics Committee of
the School of Dentistry of the Universidade de São Paulo (Brazil)
(FR 255627 process number: 75/2009). The results were tabulated,
organized and analyzed by descriptive analysis.
results anD DiscussiOn
We found that among the 64 athletes interviewed and visually
examined, 47 (73.5%) had the habit of nail biting.
The lack of scientific information and evidence in the literature
suggests that nail biting does not have serious effects on the dentition,
136
ELMADJIAN,
Thais Regina et al.
Occurrence of nail
biting among athletes
in grassroots football.
SALUSVITA, Bauru, v.
31, n. 2, p. 133-140,
2012.
ELMADJIAN,
Thais Regina et al.
Occurrence of nail
biting among athletes
in grassroots football.
SALUSVITA, Bauru, v.
31, n. 2, p. 133-140,
2012.
even considering its duration, frequency and intensity (RICHERT;
ANDRE; 2011; TANAKA et al., 2008). However, researchers
stress the need to pay greater attention to nail biting as well as its
consequences to dental aspects and its psychological implications
(BATE et al., 2011; CORVO et al., 2003; FETEIH, 2006; PACAN
et al., 2009; SCHNEIDER; PETERSON; 1982). The overload of
a muscle or specific group of muscle fibers, as occurs when one
acquires inadequate postural habits or develops parafunctional
activities such as nighttime or daytime bruxism (teeth clenching/
grinding), nail biting, lip biting or gum chewing, compromises
the correct functioning of the temporomandibular joint, thereby
affecting mastication and causing pain and discomfort (HOU et al.,
2002).
Among the adolescent athletes between 13 and 20 years lodged
far from their families and under psychological pressure (as many
represent familial expectations for a better life), nail biting was present
at an alarming proportion, as demonstrated by the 73% occurrence
of this habit. In contrast, the literature reports rates ranging from
20 to 35% (ABDEL-HAKIM; ALSALEM; KHAN, 1996; FARSI,
2003; LEUNG; ROBSON; 1990; ROCHA et al., 2007).
Nail biting not only provokes injuries, but affects the concentration,
thereby compromising the physical performance of an athlete
(BENSON e et al., 1999; COTO et al., 2007; CROW, 1991; LEVIN;
JEFFET; ZADIK, 2010). Nail biting may caused by an excess of
stimulation due to stress or excitation (WILLIAMS et al., 2006) and
is also related to low self-esteem (JOUBERT, C. E., 1993; LEUNG;
ROBSON, 1990).
According to Schneider & Peterson (1982), with greater family
closeness within the comfort of the home or even outside the home,
anxiety and tension can be more easily released in order to preserve
the physical and psychological integrity of an individual as much as
possible. Adolescents should be reeducated, with the encouragement
of healthy habits and self-awareness, as there is no more effective,
intelligent and satisfactory manner to put an end to this harmful
habit. Nail biting remains an unsolved problem in medicine and
dentistry. It is difficult to analyze and differentiate what is normal
from what is abnormal in nail biting and a multidisciplinary approach
to treatment is necessary (BOURZGUI et al., 2010; TANAKA et
al., 2008).
137
cOnclusiOn
Due to the considerable occurrence of nail biting among athletes
of football at the club surveyed, the results of the present study will
lead to strategies, multidisciplinary intervention and the organization
of educational lectures to discuss the harmful repercussions of
this habit for athletes, trainers and other professionals involved in
grassroots football.
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Thais Regina et al.
Occurrence of nail
biting among athletes
in grassroots football.
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31, n. 2, p. 133-140,
2012.
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Thais Regina et al.
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in grassroots football.
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31, n. 2, p. 133-140,
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ELMADJIAN,
Thais Regina et al.
Occurrence of nail
biting among athletes
in grassroots football.
SALUSVITA, Bauru, v.
31, n. 2, p. 133-140,
2012.