Some people think of cheek biting as a harmless, bad habit similar to nail biting. Though it appears to be a repetitive behavior, it can be a sign of a mental health condition similar to obsessive-compulsive disorder (OCD) driven by stress and anxiety.
Chronic cheek biting and chewing — scientifically known as morsicatio buccarum — is considered to be a body-focused repetitive behavior (BFRB) similar to hair pulling (trichotillomania) and skin picking (excoriation). It corresponds with anxiety-related problems.
BFRBs are behaviors that are repeated despite continuing attempts to stop them. They become disorders when they get in the way of a person’s quality of life and cause injury or distress. BFRBs typically start in late childhood and continue into adulthood.
There are five primary types of cheek biting:
- Periodic accidental cheek biting. Although this might result in a canker sore, the occasional, accidental cheek bite is not a cause for concern.
- Regular accidental cheek biting. If you accidentally bite down on your cheeks regularly — and more often than you would like — your teeth may not be in proper alignment or there may be something wrong with your jaw. Your dentist can advise you on this problem and may have an orthodontic solution, such as braces.
- Cheek biting while asleep. This unintentional behavior can be addressed with a dentist-provided soft guard that prevents direct contact of your teeth with your cheek.
- Habitual cheek biting. As a habit, this semiconscious activity can be replaced by another, less damaging behavior.
- BFRD. This is obsessive cheek biting that continues despite attempts to stop.
There doesn’t seem to be just one cause for BFRD chronic cheek biting. Some of the suggested causes for this behavior include:
- a subconscious reaction to stress
- a subconscious reaction to boredom or inactivity
- a semiconscious coping method for emotional overload
Although self-injurious, chronic cheek biting and cheek chewing are compulsive and may feel almost normal to the person biting and chewing the inside of their own cheek.
Some cheek biters have a “favorite” portion of the inner cheek, causing them to concentrate their biting and chewing on one area. This can result in a patch of skin that is raw and feels jagged. The broken skin can trigger an added compulsion to smooth the damaged area, creating a cycle of continuing or worsening injury.
Cheek biting and oral cancer
A 2017 study of chronic mechanical irritation (CMI) from teeth suggested that CMI is not able to cause oral cancer. But if cancer is present from another cause, CMI can promote and progress oral carcinogenesis.
The psychological damage of cheek biting
Often, compulsive cheek biters experience feelings of guilt and shame about their self-injurious BFRB. This can lead to a feeling of hopelessness. Sometimes, they will go to great measures to stop other people seeing the behavior, which could limit their social activity and interaction.
Cheek biting and wisdom teeth
As wisdom teeth grow in, they can irritate and even cut the inside membranes of your cheek. This occurrence is typically associated with regular, accidental cheek bites rather than BFRB cheek chewing.
If you are suffering from regular accidental cheek bites, consult with your dentist. There is probably a simple cause that can be addressed with dental appliances and, in some cases, surgery.
If you are a chronic cheek biter, the treatment may be more complicated. The first step is to determine if the behavior is habitual or compulsive.
Habitual cheek biting can often be addressed with light guidance, self-discipline, and patience. Some techniques that have proven successful for some people include:
- chewing gum to replace cheek chewing — your dentist will recommend sugarless
- taking deep breaths when you feel the urge to chew on your cheek
- identifying triggers that make the habit kick in, and then replacing the cheek biting with another activity
Compulsive BFRB cheek biting and cheek chewing is a more complicated condition to address. According to the TLC Foundation for Body-Focused Repetitive Behaviors, treatment for chronic cheek biting should focus on emotional and behavioral components. Some steps that have been recommended include:
- lowering stress levels
- providing healthy anxiety solutions
- removing triggers that instigate the behavior
- meditation for anxiety reduction
- mindfulness training for awareness
- talk therapy including cognitive behavioral therapy, dialectical behavior therapy, habit reversal therapy, and acceptance and commitment therapy
If you find yourself biting the inside of your cheek on a consistent basis, your first step is to identify the type of cheek biting you are doing:
- regular accidental cheek biting
- cheek biting while asleep
- habitual cheek biting
- BFRD cheek biting
Once you understand your type of cheek biting, you can determine how to best address the behavior, whether it be visit a dentist, see a psychologist, or start a self-directed plan.