Dr. Roach: Cheek chewer reaches out for help preserving teeth

Keith Roach
To Your Health

Dear Dr. Roach: No one seems to understand a bad habit of mine, especially dentists! I bite off the loose skin on the inside of my cheeks. I remove little bits of cheek matter that is loose and sort of just hangs and is rough. It’s sort of like picking at a scab or a hang nail. Once I start, I can’t stop until it’s removed. Usually I end up just nervously hunting with my tongue to find another uneven spot.

I know it’s unsightly to see me maneuvering my mouth around to bite off another fragment of cheek, so I don’t do it when I’m around people. During my 30 minute commute to work and when I’m alone and thinking/pondering, I find myself biting away. It’s automatic and very frustrating.

Every dentist recommends a night guard for nighttime teeth grinding, as I’m wearing my teeth down. My father had this habit, and so does my sister. I’d love your help and insight on this matter.

— M.B.

Dear M.B.: Dentists should know about this not uncommon condition called morsicatio buccarum. I’m sure most do, as the appearance of the inside of the cheek can be similar to other, more serious conditions.

It is a compulsive behavior, which some people are not even aware they have, related to behaviors like trichotillomania (pulling out hair) and bruxism (teeth grinding). These conditions and cheek biting often occur in the same person.

There are two types of treatment for morsicatio buccarum. One is the night guard, which protects your teeth and your cheeks while you sleep. Some people with severe symptoms may be recommended to use the mouth guard during the day.

The second type of treatment is psychological. This starts with recognizing when you are doing it and under what kinds of situations. Emotional stress is a big one, which might be the case during your commute, for example. These compulsive behaviors provide some kind of relief from stress, so the second part of the treatment is to find a less harmful way to get the same relief. Chewing gum or practicing breathing exercises or other relaxation techniques can be helpful. Some people benefit from seeing a therapist to help find ways of managing stress that are healthier than these repetitive behaviors.

I found helpful information at www.bfrb.org/learn-about-bfrbs/cheek-biting.

Dear Dr. Roach: I am having problems trying to gain weight. Should I take an instant breakfast drink or supplement? Any specific foods I should eat? I’m 87 and fairly healthy. Should I see a nutritionist?

— L.S.

Dear L.S.: Difficulty putting on weight and weight loss are significant concerns in people over 80, as there is often an underlying medical cause. Before thinking about the right treatment, a careful evaluation for the common causes is indicated, and your regular doctor is the person to see. This should include a careful dietary history, a medical history and physical exam, and some appropriate blood tests.

Treatment should be aimed at correcting any problems found. If none are found, then nutritional supplements may be of some value. However, consultation with a dietitian nutritionist would likely be of even more value, as they may offer you personalized advice.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.