Cheek biting, medically termed morsicatio buccarum when chronic, involves repeatedly chewing or gnawing on the soft tissue inside the mouth. This behavior can range from an occasional, painful incident to a persistent habit that causes significant oral trauma. While an isolated event is a universal experience, the chronic form represents a distinct condition that requires specific attention to its underlying causes. Understanding the differences between these types and the factors that drive the behavior is crucial for finding relief.
Defining Accidental Versus Chronic Cheek Biting
Accidental cheek biting is typically an isolated, infrequent event that occurs unintentionally, often while a person is distracted, speaking, or eating quickly. This momentary trauma usually results in a small, acute injury that heals rapidly on its own. It is a mechanical misstep caused by the temporary misalignment of the teeth during a normal oral function.
Chronic cheek biting is characterized by the habitual and often compulsive repetition of the behavior. This is classified as a Body-Focused Repetitive Behavior (BFRB), similar to skin picking or nail biting, and is often performed subconsciously. The chronic activity creates a self-perpetuating cycle where the resulting rough tissue texture encourages further chewing.
Underlying Causes and Triggers
The reasons behind repetitive cheek biting are typically divided into psychological factors and physical or dental issues.
Psychological Factors
As a BFRB, the chronic form is frequently linked to a person’s emotional state, acting as an automatic response to alleviate internal tension. Stress, anxiety, boredom, and deep concentration are common emotional triggers that can initiate the subconscious biting. The repetitive action provides a form of self-soothing or stimulation, which reinforces the habit loop. The behavior is often performed without full awareness, making it challenging to stop without conscious intervention.
Physical and Dental Issues
Physical factors also play a significant role, particularly in accidental biting that may become a habit. Dental malocclusion, or misaligned teeth, can position the inner cheek tissue directly in the path of the chewing surfaces. Sharp edges from a broken tooth, a filling, or a poorly fitted dental appliance like dentures or braces can also make the cheek more vulnerable to injury.
Some individuals experience cheek biting primarily during sleep, which may be related to nocturnal parafunctional habits like bruxism, or teeth grinding. If the teeth meet in a way that catches the cheek tissue during unconscious jaw movements, the behavior can be sustained without the person being aware of the initial trigger. Addressing these dental factors is a necessary step in stopping the trauma.
Physical Consequences of Oral Trauma
Repeated trauma to the inner cheek tissue leads to physical changes and injuries. In the short term, each biting episode can cause painful sores, inflammation, and ulcers, which are slow to heal if the habit continues. These open wounds are susceptible to bacterial infection due to the constant presence of microbes in the mouth.
With continuous irritation, the body’s protective response is to thicken the lining of the cheek, a process known as hyperkeratosis. This manifests as rough, dense, white or whitish-red patches on the buccal mucosa, typically located along the line where the upper and lower teeth meet. The resulting irregular texture can then become a further trigger for the compulsive chewing.
While the physical damage is a source of significant discomfort and pain, chronic cheek biting alone is generally considered benign. There is some discussion about whether the chronic irritation could potentially increase the risk of oral cancer, but studies suggest it is not a direct cause. The chronic lesions may, however, complicate the healing process or worsen existing oral pathologies.
Strategies for Management and Cessation
Management of cheek biting requires addressing the underlying dental or psychological factors.
Dental and Physical Interventions
For issues related to tooth alignment or sharp dental work, consulting a dentist is the appropriate first action. A dentist can smooth rough tooth surfaces, adjust ill-fitting appliances, or recommend orthodontic treatment to correct bite problems. If the biting occurs during sleep, a custom-fitted mouthguard or dental splint can be worn at night to create a physical barrier between the teeth and the cheek lining.
Behavioral Strategies
For habits rooted in psychological triggers, behavioral modification techniques are often the most effective approach. Cognitive Behavioral Therapy (CBT), specifically Habit Reversal Training, helps individuals identify their specific triggers and develop a competing response to the urge to bite.
Immediate strategies focus on redirecting the behavior:
- Substituting the biting with a less harmful oral activity, such as chewing sugar-free gum or sucking on a mint.
- Increased awareness through mindfulness practices can help a person recognize when the behavior is starting.
- Addressing the underlying stress and anxiety through relaxation techniques.
- Seeking professional mental health support can break the emotional cycle that fuels the BFRB.