Compulsive Cheek Biting


Compulsive cheek biting

Cheek biting is a type of compulsive behavior characterized by recurrent biting on the inside of the cheeks. It may be performed unconsciously with an aim to reduce the feeling of anxiety.

Cheek biting belongs to a group of body-focused repetitive behaviors (BFRB). Individuals affected by this group of disorders tend to experience strong urges or routines that result in bodily harm or damage to their appearance.

Episodes of cheek biting tend to be more common at times of stress, such as school exams, sports competitions, etc.

How common is cheek biting?

Cheek biting affects about 2% of children under the age of 17 years and less than 1% of adults. Women are more commonly affected than men.

According to the Third National Health and Nutrition Examination Survey (NHANES III), which evaluated 10,030 children, cheek/lip biting occurs in 1.89% of those aged between 2 and 17 years (1).

NHANES is a scientific survey/research examination performed by the National Center for Health Statistics (NCHS). Its purpose is to evaluate the general health status of children and adults in the United States.

One of the largest studies evaluating the lesions within the oral cavity involved 23,785 Mexican dental school students. In this study, researchers found that cheek biting occurred in 21.7 out of every 1,000 students evaluated (2). This translates to 2.17%, which is very similar to the findings reported by NHANES III.

What to do when you bite your cheek?

Most experts agree that a person who feels an imminent urge to bite or is in the process of biting on the cheek, should immediately stop and focus their attention on another form of comforting behavior, such as deep breathing or chewing on a stick of gum (3, 4)

Is biting your cheeks bad?

Based on the current research data, cheek biting is considered as a relatively benign condition. This means that you will probably not die from it, but the behavior does harm your body and emotions, and should be discouraged.

Repeat injury to the lining of the mouth may result in sores and ulcers, bleeding, infections, or the development of dense tissue in the area of the injury, which may feel like a lump that won’t go away for a long period of time.

Besides the physical injuries, chronic cheek biting may cause psychological distress. It is not uncommon for the affected individuals to experience feelings of shame and guilt. Others may steer away from social gatherings in a effort to hide their compulsive behavior from friends and family.

Can cheek biting cause oral cancer?

Currently, the short answer is: we don’t know for sure.

There have been no large-scale studies evaluating the link between cheek biting (specifically) and oral cancer. However, a number studies analyzed the link between chronic mechanical irritation (CMI) in the mouth and the development of oral cancer.

CMI is a term that defines any prolonged injury to the oral mucosa, which may be caused by loose fitting dentures, cheek biting, etc. One of the shortcomings of CMI is that researchers can’t quite agree on how to exactly define an “irritation”.

One relatively small study published in 2017, analyzed the relationship between CMI and oral cancer in 285 individuals. The researchers did not find clear evidence of CMI directly leading to oral cancer. However, they did observe that in 35% cases CMI facilitated the growth of cancer that was already present due to other factors (5).

Another small case-control study of 153 patients concluded that CMI could be a risk factor for oral cancer (6). The researchers suggested that prolonged inflammation caused by repeated injury to the lining of the mouth may be associated with the development of oral cancer. Chronic inflammation has long been regarded as a risk factor for various types of malignancy. Given the small group of patients evaluated in this study, the outcome is unlikely to result in any changes to the general approach to cheek biting or chronic mechanical irritation as a whole.

As of the time of writing of this article, chronic mechanical irritation (which includes cheek biting) is still considered by most researchers a “controversial” risk factor for oral cancer. This means that you shouldn’t be surprised to find some authors strongly linking cheek biting with oral cancer and others advocating just the opposite. In other words, the information we have from clinical studies published so far, is inconclusive. We really don’t know if cheek biting leads to oral cancer.

A number of studies has clearly identified some of the risk factors for oral cancer. These risk factors include, but are not limited to, old age, tobacco use, alcohol and areca nut consumption ( 7, 8, 9, 10, 11).

Does biting the inside of your cheek cause bad breath?

There have been no clinical studies that would specifically focus on cheek biting and bad breath (halitosis). Given that cheek biting leads to the formation of ulcers, bleeding and infections, it is very likely that it will produce some form of altered breath. Its extent would largely depend on the severity of the injury.

What causes a person to bite the inside of their cheek?

PSYCHOLOGICAL FACTORS – stress and anxiety tend to stimulate compulsive cheek biting.

ACCIDENTAL – it is not uncommon for people to accidentally bite on the inside of their cheek. This usually happens when talking to someone or eating too fast.

TEETH – misaligned teeth (usually the wisdom teeth) may occasionally produce chronic injury to the lining of the mouth.

SLEEP – unconscious biting at night may occur. It it commonly associated with tooth-grinding (bruxism) (12).

How to stop cheek biting

There is no single, proven and 100% effective treatment for cheek biting. However, most experts agree that the primary goal of therapy should be focused on identification and elimination of the cause of cheek biting (13).

There are a few things you can do right now at your home to help reduce your cheek biting behavior.

  1. Identify and eliminate triggers.
    • A trigger could be a place or a situation that makes you more likely to bite on your cheeks. Think about the situations during which you most commonly bite your cheeks. Once you’ve identified the major ones, simply try to avoid them.
  2. Chewing gum.
    • Getting your mouth preoccupied with other activities may help reduce your urge to bite your cheeks.
  3. Wear rubber band on your wrist, pull on it when you begin feeling the need to bite your cheeks.
    • The brief stinging the you will feel may be enough to stop you from biting. Some people swear by it.

Formal treatment options

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Other body-focused repetitive behaviors

  • Hair pulling
  • Nail biting
  • Skin picking
  • Nose picking
  • Thumb sucking

Conclusion

Biting on the inside of the mouth is a benign condition that has no clear link to the development of oral cancer. However, the injuries associated with this compulsive behavior may lead to several complications, which should be avoided. For this reason, cheek biting should be discouraged, just like any other body-focused repetitive behavior.

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