We’ve all been there: you’re chowing down on your food, distractedly listening to the conversation around you, and suddenly you bite down, hear a crunch and quickly realize it’s not your food! The pain is immediate, whether you have bitten your cheek, lip, or tongue, and you become laser-focused on careful chewing. This painful accident can be a regular occurrence for many of us. At South Charlotte Dentistry, chronic biting of the tissues in your mouth can be a concern, as it interferes with your comfort, routines, and ability to eat. Let’s take a deeper dive into biting.
Cheek Biting: What’s the big deal?
Most of us understand cheek biting as a bad habit, maybe in the same category as nail biting — something that happens occasionally, and seems like a benign repetitive behavior. However, cheek, lip, or tongue biting may actually be a sign of a mental health condition similar to an obsessive and compulsive reaction. Cheek biting can be driven by stress and anxiety.
Chronic cheek biting is scientifically known as morsicatio buccarum, and is considered a bod-focused repetitive behavior (BRFB), which is similar to chronic hair pulling (trichotillomania), skin picking (excoriation), or excessive blinking. These behaviors correspond with anxiety-related problems, as they get repeated despite attempts to stop them, often happening unknowingly. Chronic cheek biting is categorized under obsessive-compulsive and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and is complementary with anxiety-related types of problems.
Cheek biting affects 750 out of every 1 million people, and research suggests that the behavior is more common in females than in males. It may be more likely in children in the range of 2 to 17 years old, although it does affect people of all ages.
How would you know if you have chronic cheek biting?
If you’re just biting your cheek on occasion, chances are, it’s simply an accident. If cheek biting is happening constantly, or it is getting in the way of your quality of life and causing you injury or distress, then it may be classified as a disorder. These types of disorders typically begin in late childhood and continue into adulthood, and can be directly impacted by your levels of stress.
What are the different types of cheek biting?
1. Periodic accidental cheek biting. This is the rarely-happening, every-once-in-awhile bite that may result in a canker sore, but is not typically a cause for concern.
2. Regular accidental cheek biting. If you’re realizing you accidentally bite down on your cheeks regularly or more often than you would like, it may be because your teeth or jaw are not in alignment. Talk to your dentist about your cheek biting if it reaches this point, and they can advise on or refer you to an orthodontist, who may further recommend a solution like braces to realign the teeth or jaw.
3. Cheek biting while asleep. If you ever wake up to a sore in your mouth or tender spot, you may be biting in your sleep. This is an unintentional behavior, and your dentist may recommend wearing a soft night guard that will prevent direct contact with your teeth against your cheek.
4. Habitual cheek biting. This type of biting may be psychologically-related, where the biting is happening often enough to be noticeable and cause some interference with daily comfort and habits.
5. BFRD. BDRF biting is truly obsessive cheek biting, where the person may not even realize that they’re biting their cheek. The medical term for chronic cheek biting is chronic cheek bite keratosis.
Why does cheek biting happen?
Many things can cause you to bite the inside of your teeth, ranging from an accident to the structure of your teeth and jaw. Here are some of the most common reasons for cheek biting:
Lack of attention: Scrolling through social media, reading a book, or watching a TV show during meals can make you distracted from the act of properly and safely chewing your food. You may not even realize you have bitten your cheek because you are so engrossed in another activity.
Accidental biting: Like lack of attention, accidental biting can occur when you are eating too fast or talking while eating.
Injury biting: When fighting, playing sports, or getting in an accident, you may bite your cheek.
Depression or anxiety-related biting: As a reaction to being stressed, anxious, or depressed, you might automatically bite your inner cheeks.
Tooth deflection in the dental arch: Your teeth can deflect towards the teeth and cause lesions. Typically this occurs with wisdom teeth, deviated molars, premolars, or badly designed or poorly-constructed crowns.
Psychological-related biting: This is chronic cheek biting, where you are compulsively biting the inside of your cheek, and you may not even be aware of doing it.
Anxiety, stress, and cheek biting
Whether it’s the stress of daily life or anxiety associated with it, compulsive behaviors can manifest as a subconscious solution to ease emotional overload. Cheek biting serves as a coping method to soothe stress and anxiety, just like biting your nails. In other cases, it is common for boredom and inactivity to trigger the behavior. Cheek biting is self-injurious but compulsive since to the cheek biter it can feel normal, accessible, and necessary.
Your bite can affect your biting? Explain! Other times, there may be an anatomical explanation, especially if the bites are a recurring thing and there’s no cause for nervousness or boredom. It’s possible there’s malocclusion or a bad bite. When your teeth don’t close together neatly, there’s a high chance of the cheek or lip getting in between them and becoming much more susceptible to bites. Malocclusion can also lead to more problems like headaches, jaw pain, TMJ, and shifting teeth.
What’s the damage of cheek biting?
The occasional, accidental cheek bites can result in canker sores but aren’t much of a cause for concern. They usually bring some mild discomfort for a few days, but that’s typically it. Continuously biting the soft tissue inside the cheek can lead to oral trauma such as mouth sores and ulcers.
The area can become thick, scarred, and paler than the surrounding tissue.
Chronic cheek biting can result in redness, painful sores, and tears in the mouth’s inner lining, which is also referred to as the mucosa. Since cheek biting usually happens mindlessly, a good amount of damage to the mouth can occur — which isn’t surprising seeing that the average strength of the human bite is 162 pounds per square inch! It’s easy for the biter to bite too deep and injure the mouth. More often than not, chronic cheek biters will bite the same area over and over, repetitively breaking the skin in that favorite area of the mouth. Once bitten, the skin feels chewed, raw, and jagged, creating a compulsion to smooth out the affected area by biting again, or touching it with their tongue or fingers, potentially introducing bacteria to the mouth. This endless cycle only brings continuous injury to the area. In severe cases, dentists may notice eroded tissue in the cheek.
BFRB-related cheek biting might bring feelings of guilt or shame about the self-injurious behavior. This can lead to feelings of hopelessness and loss of control, ultimately leading some people to shy away from social activity. Shame and low self-esteem about the BFRB may lead to trying to prevent other people from seeing the behavior, which can limit their social activity and interaction.
How do you stop cheek biting?
If it’s an anxiety-related issue, an obsessive-compulsive problem, or just a bad habit, cheek biting is not ideal and potentially harmful. Stopping the biting is a challenge because the biter may not be immediately aware of when it’s happening, what the potential triggers are, or why it’s being used as an answer to stress and anxiety.
The first recommendation most doctors and dentists will provide is to lower your stress levels, identify stress triggers, and work on developing alternative and healthy anxiety solutions. Among many other strategies, a baseline to lower stress levels is to exercise regularly and eat healthily. Identifying what triggers your stress biting should be evaluated next, and you should aim to remove stressful situations and triggers as possible. In addition, mindfulness training and meditation can also be useful, as they have been empirically proven to improve mental health. There are a ton of apps, YouTube videos, and books on practicing mindfulness and meditation.
If cheek biting is related to stress or habitual, it’s a great idea to consult with your physician or psychologist to find a treatment plan that makes you feel supported. Body-focused behaviors like cheek biting can also respond well to talk therapy, which draws techniques from cognitive behavioral therapy. No one approach works for everyone, but many therapies are based on the idea that obsessions and compulsions help people experience stress, anxiety, and emotions without reacting to them outwardly in negative behavior. The goal of therapy is to teach you to experience life without needing a compulsive outlet like cheek biting, and learn coping mechanisms to minimize stress and anxiety while processing emotions in a healthy manner.
Habitual cheek biting can be addressed with light guidance and patience. Breath work and relaxation exercises can be an effective treatment for preventing inner cheek bites.
If the cheek biting is related to BFRD, treatment may come in a few forms. A psychologist may recommend keeping track of the behavior by journaling when the cheek biting occurs, and detailing what might have triggered it. Once you’re able to recognize that trigger, one way to alter the behavior is to replace it with a healthier one. For example, you might chew gum or go for a walk or stretch. The goal is to pay attention to when you’re doing it, and work to either avoid those triggers or to consciously intervene and stop yourself when the trigger is unavoidable.
If you feel comfortable sharing your cheek biting habit with others, enlist the help of friends and family to point out when you’re doing it so you can become more conscious of it happening, and can work to stop it.
When to call your dentist
If you find yourself regularly biting the inside of your mouth while chewing or talking, it’s time to schedule an appointment with your dentist. A tooth, or more commonly wisdom teeth, can cause lesions in your cheek; a dentist can recommend an extraction, braces, or Invisalign to correctly align your teeth. As wisdom teeth begin to grow in, they can irritate and cut the inside of your cheek. Your dentist can help you identify whether your cheek biting is regular and accidental (i.e. due to wisdom teeth or an alignment issue) or if it’s severe and compulsive (i.e. BFRB chronic cheek biting). Most cheek biting has a simple cause that can be addressed with dental appliances, and in some cases, surgery.
Sometimes your dentist may prescribe a mouthguard to a regular cheek biter to prevent further damage to the tissue and give it a chance to heal. If you’re experiencing pain from a cheek bite, your dentist may also have a recommendation for applying cold compresses, saline solutions to cleanse the area and reduce swelling, or oral-safe numbing gels.
Cheek biting can occur at any time, and your team at South Charlotte Dentistry is always happy to help with any concerns you have about your oral health. Give us a call today at (704) 759-0908 to schedule an appointment.