Review Article
Volume 10 Issue 4 - 2021
Onychophagia: Clinical Implications and its Comorbidities
Nagendran Jayavel Pandiyan*
Professor, Department of Paediatric Dentistry, Best Dental Science College, Madurai, Tamil Nadu, India
*Corresponding Author: Nagendran Jayavel Pandiyan, Professor, Department of Paediatric Dentistry, Best Dental Science College, Madurai, Tamil Nadu, India.
Received: February 22, 2021; Published: March 31, 2021


Biting of nail is a common stress-relieving oral habit. It involves biting the nail, cuticle and soft tissues surrounding the nail. This behavioural problem has been reported both in children and young adults. Onychophagia cannot be considered as an isolated dermatological or cosmetic problem as there could be associated co-occurring psychological issues. Treatment of nail biting involves multidisciplinary care. Hence practicing dentists should have a comprehensive knowledge in understanding and recognition of these deleterious oral habits.

Keywords: Oral Habits; Onychophagia; Nail Biting; Obsessive-Compulsive Disorder


  1. Pearson GHJ. “The psychology of finger sucking, tongue sucking, and other oral habits”. American Journal of Orthodontics 34 (1948): 589-598.
  2. Singal A and Daulatabad D. “Nail tic disorders: Manifestations, pathogenesis and management”. Indian Journal of Dermatology, Venereology and Leprology 83 (2017): 19-26.
  3. Dufrene BA., et al. “Functional analysis and treatment of nail biting”. Behavior Modification 32 (2008): 913-927.
  4. Ghanizadeh A. “Association of nail biting and psychiatric disorders in children and their parents in a psychiatrically referred sample of children”. Child and Adolescent Psychiatry and Mental Health 2 (2008): 13.
  5. Teng EJ., et al. “Body-focused repetitive behavior problems. Prevalence in a non-referred population and differences in perceived somatic activity”. Behavior Modification 26 (2002): 340-360.
  6. Leung AK and Robson WL. “Nail biting”. Clinical Pediatrics 29 (1990): 690-692.
  7. De Berker D. “Childhood nail diseases”. Dermatologic Clinics 24 (2006): 355-363.
  8. Apley J. “Child care in general practice. Emotional and behavioural disorders: part I”. British Medical Journal 17 (1965): 157-159.
  9. Gavish A., et al. “Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescent girls”. Journal Citation Reports 27 (2000): 22-32.
  10. Feteih RM. “Signs and symptoms of temporomandibular disorders and oral parafunction in urban Saudi Arabian adolescents: a research report”. Head and Face Medicine 2 (2006): 25.
  11. Ghanizadeh A and Shekoohi H. “Prevalence of nail biting and its association with mental health in a community sample of children”. BMC Research Notes 4 (2011): 16-20.
  12. Christensen JR and Fields HW. “Oral habits”. In: Pinkham JR, Casamassimo PS, McTigue DJ, Fields HW, Nowak A, editors. Pediatric dentistry: infancy through adolescence. Philadelphia, PA: WB Saunders Co (1994): 366-373.
  13. Shetty SR and Munshi AK. “Oral habits in children – a prevalence study”. Journal of Indian Society of Pedodontics and Preventive Dentistry 16 (1998): 61-66.
  14. Ballinger BR. “The prevalence of nail-biting in normal and abnormal populations”. British Journal of Psychiatry 117 (1970): 445-446.
  15. Foster LG. “Nervous habits and stereotyped behaviors in preschool children”. Journal of the American Academy of Child and Adolescent Psychiatry 37 (1998): 711-717.
  16. Gregory LH. “Stereotypic movement disorder and disorder of infancy, childhood, or adolescence NOS”. In: Kaplan HI, Sadock BJ, editors. Comprehensive textbook of psychiatry. 6th Baltimore: Williams and Wilkins (1995): 2360-2362.
  17. Pacan P., et al. “Onychophagia and onychotillomania: Prevalence, clinical picture and comorbidities”. Acta Dermato-Venereologica 1 (2014): 67-71.
  18. Winebrake JP., et al. “Pediatric onychophagia: A survey-based study of prevalence, etiologies, and co-morbidities”. American Journal of Clinical Dermatology 6 (2018): 887-891.
  19. Pennington LA. “The incidence of nail biting among adults”. The American Journal of Psychiatry 102 (1945): 241-244.
  20. World Health Organization. The ICD-10: classification of mental and behavioural disorders: clinical description and diagnostic guidelines. Geneva: WHO (1992).
  21. American Psychiatric Association. “Diagnostic and statistical manual of mental disorders”. 5th Arlington, VA: American Psychiatric Association (2013).
  22. Koo JY and Smith LL. “Obsessive-compulsive disorders in the pediatric dermatology practice”. Pediatric Dermatology 8 (1991): 107-113.
  23. Williams TI., et al. “What is the function of nail biting: an analog assessment study”. Behaviour Research and Therapy 45 (2006): 989-995.
  24. Penzel F. “Skin picking and nail biting: related habits”. Articles by Western Suffolk Psychological Service (2008).
  25. Grant JE., et al. “Impulse control disorders in children and adolescents with obsessive compulsive disorder”. Psychiatry Research 30 (2010): 109-113.
  26. Nestadt G., et al. “The identification of OCD-related subgroups based on comorbidity”. Biological Psychiatry 53 (2003): 914-920.
  27. Vafaei B and Seidy A. “A comparative study on the prevalence of emotional and behavioral symptoms in children and adolescents born to mothers with schizopherenia and other psychotic disorders”. Acta Medica Iranica 41 (2003): 254-259.
  28. Saheeb BDO. “Prevalence of oral and parafunctional habits in Nigerian patients suffering temporomandibular joint pain and dysfunction”. Journal of Medicine and Biomedical Research 4 (2005): 59-64.
  29. Sabuncuoglu O., et al. “Breastfeeding and parafunctional oral habits in children with and without attention-deficit/hyperactivity disorder”. Breastfeeding Medicine 5 (2014): 244-250.
  30. Turgeon-O’Brien H., et al. “Nutritive and non-nutritive sucking habits: A review”. Journal of Dentistry for Children - AAPD 5 (1996): 321-327.
  31. Tanaka OM., et al. “Nail biting, or onychophagia: A special habit”. American Journal of Orthodontics and Dentofacial Orthopedics 2 (2008): 305-358.
  32. Bakwin H. “Nail-biting in twins”. Developmental Medicine and Child Neurology 13 (1971): 304-307.
  33. Baydas B., et al. “Effect of a chronic nail-biting habit on the oral carriage of Enterobacteriaceae”. Oral Microbiology and Immunology 22 (2007): 1-4.
  34. Odenrick L and Brattström V. “The effect of nail biting on root resorption during orthodontic treatment”. The European Journal of Orthodontics 5 (1983): 185-188.
  35. Oliveira AC., et al. “Factors associated with malocclusions in children and adolescents with Down syndrome”. American Journal of Orthodontics and Dentofacial Orthopedics 133 (2008): 489.
  36. Winocur E., et al. “Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescents: a gender comparison”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 102 (2006): 482-487.
  37. Krejci CB. “Self-inflicted gingival injury due to habitual fingernail biting”. Journal of Periodontology 71 (2000): 1029-1031.
  38. Lee DY. “Chronic nail biting and irreversible shortening of the fingernails”. The Journal of the European Academy of Dermatology and Venereology 2 (2009): 185.
  39. Szinnai G., et al. “Multiple herpetic whitlow lesions in a 4-year-old girl: Case report and review of the literature”. European Journal of Pediatrics 9 (2001): 528-533.
  40. Joubert CE. “Relationship of self-esteem, manifest anxiety, and obsessive compulsiveness to personal habits”. Psychological Reports 73 (1993): 579-583.
  41. Jiaravuthisan MM., et al. “Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy”. Journal of the American Academy of Dermatology 1 (2007): 1-27.
  42. Goettmann S., et al. “Nail lichen planus: Epidemiological, clinical, pathological, therapeutic and prognosis study of 67 cases”. The Journal of the European Academy of Dermatology and Venereology 10 (2012): 1304-1309.
  43. Silber KP and Haynes CE. “Treating nail biting: a comparative analysis of mild aversion and competing response therapies”. Behaviour Research and Therapy 30 (1992): 15-12.
  44. Woods DW., et al. “Comparing the effectiveness of similar and dissimilar competing responses in evaluating the habit reversal treatment for oral-digital habits in children”. Journal of Behavior Therapy and Experimental Psychiatry 30 (1999): 289-300.
  45. Magid M., et al. “Onychophagia and onychotillomania can be effectively managed”. Journal of the American Academy of Dermatology 5 (2017): e143-144.
  46. Koritzky G and Yechiam E. “On the value of non-removable reminders for behavior modification: An application to nail-biting (onychophagia)”. Behavior Modification 6 (2011): 511-530.
  47. Isaacs S. “Bad habits”. The International Journal of Psychiatry in Medicine 16 (1935): 440-454.
  48. Tosti A and Piraccini BM. “Treatment of common nail disorders”. Dermatologic Clinics 2 (2000): 339-348.
  49. Leshan L. “The breaking of a habit by suggestion during sleep”. Journal of Abnormal Psychology 37 (1942): 406-408.
  50. Rothbaum BO., et al. “Cognitive-behavioral therapy”. In: Foa EB, Keane TM, Friedman MJ, editors. Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York, NY: Guilford Press (2000): 320-325.
  51. Bornstein PH., et al. “Hypnobehavioral treatment of chronic nail biting: A multiple baseline analysis”. International Journal of Clinical and Experimental Hypnosis 3 (1980): 208-217.
  52. Velazquez L., et al. “Fluoxetine in the treatment of selfmutilating behavior”. Journal of the American Academy of Child and Adolescent Psychiatry 39 (2000): 812-814.
  53. Leonard HL., et al. “A double-blind comparison of clomipramine and desipramine treatment of severe onychophagia (nail biting)”. Archives of General Psychiatry 48 (1991): 821-827.
  54. Ghanizadeh A., et al. “N-acetylcysteine versus placebo for treating nail biting, a double blind randomized placebo controlled clinical trial”. Anti-Inflammatory and Anti-Allergy Agents in Medicinal Chemistry 3 (2013): 223-228.
  55. Sani G., et al. “Drug treatment of trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, and nail-biting (onychophagia)”. Current Neuropharmacology 8 (2019): 775-786.
  56. O Marouane., et al. “New Approach to Managing Onychophagia”. Case Reports in Dentistry (2016).
  57. Lorizzo M., et al. “Nail cosmetics in nail disorders”. Journal of Cosmetic Dermatology 1 (2007): 53-58.
  58. Ortiz L and Garzon CR. “Modification of urinating behavior of enuretic preadolescents using a token economy”. Aprendizaje y Comportamiento1 (1978): 75-86.
  59. Massler M and Malone AJ. “Nail biting; a review”. American Journal of Orthodontics 5 (1950): 351-367.
  60. Huebner D. “What to do when bad habits take hold: A kid’s guide to overcoming nail biting and more American Psychology Association. Washington, DC: Magination Press (2008).
  61. The Berenstain Bears Official Updated reference: The Berenstain Bears Official (2014).
Citation: EV Nagendran Jayavel Pandiyan. “Onychophagia: Clinical Implications and its Comorbidities”. EC Paediatrics 10.4 (2021): 71-78.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 15, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.