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The nail-biting truth of onychophagists

biting nails 2
Do you bite your nails? If so, you may think you’re doing yourself a favor by efficiently engaging in normal grooming activities. But using your teeth instead of fingernail clippers or nail files typically means that you’re suffering from a pathologic grooming condition known as onychophagia and that you are doing more harm than good.

An onychophagist, or more commonly a “nail biter,” is a person who habitually bites his or her fingernails. Nail biting is a common oral habit among children and young adults, and is the most common of the typical nervous habits such as nose picking, hair pulling, tooth grinding or skin picking (Sachan). According to the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition, nail biting is an impulse control disorder and is classified under obsessive-compulsive disorder (OCD) and related disorders (APA).

Studies have shown that between 26 to 33% of children between the ages of 7 to 10 and 45% of adolescents are nail biters (Leung). Up until age 10, nail biting is observed equally in boys and girls but increases significantly in boys thereafter (Sachan). Quite interestingly, nail biters don’t discriminate between the 10 fingers and tend to bite all of them equally (probably part of the OCD) (Leung).

Several factors have been suggested to cause nail biting, including hereditary, learned behaviors from family members, transference of thumb sucking from childhood, stress, anxiety, boredom and poorly manicured nails (Leung).

Besides being unsanitary, there are several complications that arise from this behavior. In addition to the obvious esthetic concerns, nail biting can damage the cuticles, cause secondary bacterial infections and even dental problems (Leung). Dental students, be aware that some studies have shown nail biting can cause alveolar destruction, malocclusion, crowding or rotation and attrition of the incisors (Sachan).

One study showed that medical students with nail biting behaviors had quality of life impairment and stigmatization as compared to their non nail-biting peers (Pacan).

Being a dental student, it is reasonable to assume that patients can develop a perception of you based on factors such as: your friendliness and level of care; demeanor and disposition; the appearance of your operatory space; and your physical appearance.

A study by Brosky et al found that the attire and appearance of faculty and especially dental students had an influence on the patients’ first impressions, as well as their anxiety and comfort levels. From greeting your patient to taking their blood pressure and filling out health history forms, your hands are in the limelight. It’s expected that they be properly groomed and attractive for the patients.

If you’re reading this and start to become self-conscious about the appearance of your fingernails from your excessive nail biting, you’re not alone, and there is help. This condition is often related to stress, so finding healthier modes of stress relief can help break the habit. Ways to do this include behavioral modification such as positive reinforcement or taking up another hobby, such as exercise, for distraction (Leung). Further, some suggest wearing gloves or replacing the oral habit with another one like gum chewing.

You could consider applying a clear bitter-tasting nail polish such as Bite It, Bite Ender, Control It, and Mavala Stop. For women, investing in frequent manicures can have an extremely positive result, as you may tend to not bite them after spending the time and money to get them done. And if you’re tech savvy, you may even consider trying a meditation or a hypnosis app.

I get it. Life and dental school are stressful. But if you need the stress relief, consider ditching the nail biting oral fixation and replace it with something else. You will enhance your appearance, please your patients, improve your quality of life, and most importantly, preserve your teeth!

~Jasmine R. Shafagh, MBS, LECOM ’16, chapter president


American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Washington, DC: American Psychiatric Association; 2013.

Brosky, Mary E, Keefer, Oliver A, Hodges, James S, Pesun, Igor J. Cook, Gary. Patient Perceptions of Professionalism in Dentistry. August 2003. Journal of Dental Educaiton, Vol 67, No 8. Pp. 909-915.

Leung AK, Robson WL. Nailbiting. Clin Pediatr (Phila) 1990 Dec; 29 (12): 690-2.

Pacan P, Reich A, Grzesiak M, Szepietowski, JC. Onychophagia is associated with impairment of quality of life. Acta Derm Venereol. 2014, Nov: 94(6): 703-6.

Sachan A, Chaturvedi T P. Onychophagia (Nail Biting), anxiety, and malocclusion. Indian J Dent Res 2012;23;680-2.

Jasmine Shafagh

Jasmine is a 3rd year dental student and a member of the inaugural class at LECOM School of Dental Medicine. She is the President of the LECOM ASDA Chapter and also oversees their newsletter, The Composite. She is originally from Philadelphia, PA but enjoys living in sunny Florida. In her free time, she enjoys running and sculpture.

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  2. Lynda57879 says:

    I remember myself as a nail biter right from my childhood days. I had to finally resort for an endodontic treatment procedure at Oshawa due to this, as my oral health had gone down to worse. The sight of my nails were horrible. Stress, boredom, frustration, anxiety and loneliness are some of the common reasons behind nail biting. There are a lot of natural aids that can help you stop biting nails. Application of neem oil, garlic, bitter gourd, nail polish, taking up frequent manicures are some of the effective solutions to this problem.

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