An Exhaustive Clinical Review of Cheek Biting (Morsicatio Buccarum): Etiology, Pathology, and Comprehensive Management

Introduction

Cheek biting is a common yet frequently misunderstood behavior that exists on a wide spectrum of severity and clinical significance.

For many, it is a fleeting, accidental occurrence, a minor annoyance dismissed as quickly as it happens.

For a significant number of individuals, however, it manifests as a persistent, distressing, and damaging habit that can signal underlying dental, physiological, or complex psychological conditions.¹

The act of repetitively biting the inner cheek tissue is known in medical literature as

morsicatio buccarum, a term derived from the Latin words morsus (“bite”) and bucca (“cheek”).⁴

This clinical designation elevates the behavior beyond a simple “bad habit,” placing it within a formal diagnostic framework that acknowledges its potential for causing physical harm and emotional distress.

The multifaceted nature of this condition necessitates a multidisciplinary perspective, integrating knowledge from dentistry, oral medicine, and psychology to achieve a complete understanding.³

The reasons an individual bites their cheek can be purely physical, such as misaligned teeth; purely psychological, as a response to stress; or, most complexly, a dynamic interplay between the two.

A minor physical anomaly can initiate the behavior, which is then perpetuated by psychological factors, creating a cycle that can be difficult to break without a comprehensive approach.

This report provides an exhaustive clinical review of cheek biting, designed to serve as a definitive guide for individuals experiencing this condition and the clinicians who treat them.

The following sections will provide a logical progression of understanding, beginning with a formal classification of the different types of cheek biting, which serves as an essential diagnostic framework.

It will then delve into the distinct physical and psychological etiologies, exploring everything from dental malocclusion to the complex neurobiology of compulsive behaviors.

Subsequently, the report will detail the physical and emotional consequences of chronic biting, with a critical analysis of the oral pathology involved, distinguishing benign tissue changes from more serious conditions.

Finally, it will outline the complete diagnostic pathway and present a comprehensive, evidence-based guide to management and treatment, empowering individuals with the knowledge and strategies needed to address the behavior and its root causes effectively.

Section 1: The Spectrum of Cheek Biting: Classification and Prevalence

Understanding the nature of cheek biting begins with its classification.

The behavior is not monolithic; it exists on a continuum from incidental and harmless to chronic and compulsive.

This classification is more than an academic exercise; it functions as a critical diagnostic funnel, systematically guiding both the individual and the clinician from the most common and simple explanations to the more complex and less frequent ones.

This structured approach is essential for accurate diagnosis, preventing the over-pathologizing of a minor issue or the under-treatment of a serious disorder, and ensuring that the recommended course of action is appropriate for the specific type of behavior exhibited.

1.1. Categorizing the Behavior: A Diagnostic Funnel

Clinical observation and research have identified five primary types of cheek biting.

These categories can be viewed as a diagnostic hierarchy, moving from the most benign to the most clinically significant, each pointing toward different underlying causes and requiring distinct management strategies.⁵

• Periodic Accidental Cheek Biting: This is a universal human experience. It refers to the isolated, infrequent, and unintentional biting of the cheek that occurs during activities like eating (especially when distracted or eating quickly), speaking, or participating in sports.⁵ These incidents are generally not a cause for concern. While they can be painful and may result in a temporary canker sore or minor inflammation, they resolve on their own and do not indicate an underlying pathology.⁷
• Regular Accidental Cheek Biting: When accidental biting becomes a frequent occurrence, it ceases to be a random event and instead serves as a crucial clinical signpost. This pattern strongly suggests an underlying physical or dental issue that is mechanically predisposing the cheek tissue to trauma.⁵ The most common culprits are dental malocclusion (misaligned teeth) or the eruption of wisdom teeth, which alter the normal architecture of the mouth and increase the probability of the cheek being caught between the teeth during normal function.¹ This category of cheek biting warrants a professional dental evaluation to identify and address the root physical cause.⁵
• Cheek Biting During Sleep: Some individuals bite their cheeks unconsciously during sleep. This behavior is often a component of a broader condition known as sleep bruxism, which involves involuntary teeth grinding and clenching.² The powerful forces exerted by the jaw muscles during sleep can easily trap and damage the soft tissues of the cheek, leading to significant morning soreness, chronic inflammation, and tissue damage. This type of biting is typically managed with protective dental appliances, such as a custom-fitted night guard, which create a barrier between the teeth and the cheek.⁵
• Habitual Cheek Biting: This form of biting is a semiconscious, repetitive behavior. It is not driven by a physical anomaly but rather by psychological or emotional states.¹ Individuals may find themselves biting their cheeks as an automatic response to stress, anxiety, boredom, or periods of intense concentration.¹ The behavior functions as a learned coping mechanism, providing a form of sensory stimulation or a temporary release from internal tension.² Because it is a learned habit, it can often be addressed and modified through behavioral awareness techniques and stress management strategies.⁵
• Chronic/Compulsive Cheek Biting (Morsicatio Buccarum): This represents the most severe end of the spectrum and is recognized as a formal clinical disorder. Morsicatio buccarum is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a Body-Focused Repetitive Behavior (BFRB), placing it in the category of “Other Specified Obsessive-Compulsive and Related Disorder”.⁴ This is not a mere habit but a compulsion. It is characterized by a powerful, often uncontrollable urge to bite the cheek, which the individual finds extremely difficult to stop, even in the face of physical pain, tissue damage, and significant emotional distress, such as feelings of shame or guilt.⁵ This compulsive form is frequently associated with underlying mental health conditions, including anxiety disorders, major depressive disorder, and obsessive-compulsive disorder (OCD).¹

1.2. Prevalence and Demographics

While occasional cheek biting is nearly universal, the prevalence of its chronic, compulsive form is more specific.

Epidemiological estimates suggest that morsicatio buccarum affects approximately 750 individuals per one million adults.⁷

Some research indicates that cheek biting may be the most common of all BFRBs.¹³

The behavior is found to be more common in individuals who are experiencing significant stress or have co-occurring psychological conditions.⁴

Demographic data reveals a notable gender disparity, with prevalence in females being double that observed in males.

There is also an age-related trend, with the condition being two to three times more prevalent in individuals over the age of thirty-five.⁴

However, BFRBs often begin in late childhood or adolescence.¹⁶

Studies conducted on large samples of college students have found that while a majority (59.55%) report engaging in occasional, subclinical BFRBs, a significant minority of 12.27% meet the criteria for a pathological BFRB disorder, highlighting the chronicity and distress associated with these behaviors even in younger populations.¹⁵

Table 1: Classification of Cheek Biting: A Clinical Framework

To provide a clear, actionable summary of these classifications, the following table organizes the types of cheek biting based on their key characteristics, suspected causes, and the most appropriate initial course of action.

This framework can serve as a guide for individuals to better understand their own experience and for clinicians to navigate the diagnostic process.

Type of Biting	Key Characteristics	Primary Suspected Cause(s)	Initial Recommended Action
Periodic Accidental	Infrequent, isolated incidents, often during eating or talking.	Inattention, eating too quickly, distraction.	No action needed; self-resolving.
Regular Accidental	Frequent, unintentional bites that occur consistently over time.	Dental malocclusion (bad bite), erupting wisdom teeth, ill-fitting dental restorations.	Consult a dentist for a comprehensive oral examination.
Cheek Biting During Sleep	Unconscious biting, often accompanied by morning jaw soreness or headaches.	Sleep bruxism (teeth grinding and clenching).	Consult a dentist to be evaluated for and fitted with a custom night guard.
Habitual	Semiconscious, repetitive nibbling or chewing, often without a clear physical cause.	Stress, anxiety, boredom, deep concentration; a learned coping mechanism.	Practice behavioral awareness; implement stress management techniques.
Chronic/Compulsive (Morsicatio Buccarum)	Compulsive, uncontrollable urge to bite; difficulty stopping despite pain and tissue damage.	Body-Focused Repetitive Behavior (BFRB); associated with anxiety, depression, OCD-spectrum disorders, and emotional dysregulation.	Seek a dual-track evaluation: consult a dentist to rule out physical factors and a mental health professional specializing in BFRBs for therapeutic intervention.

Section 2: The Physical and Dental Underpinnings

While the psychological dimensions of cheek biting are profound, many cases originate from, or are exacerbated by, tangible physical and dental factors.

A thorough clinical investigation must begin with an examination of the oral architecture and the mechanics of the bite.

These physical issues are the primary drivers of regular accidental cheek biting and can create the initial conditions for a more complex psychological habit to develop.

2.1. Dental Malocclusion and Oral Architecture: The Mechanics of a Bad Bite

The most common physical cause of recurrent cheek biting is dental malocclusion, the clinical term for a “bad bite” where the upper and lower teeth do not align properly.¹

The oral cavity is designed around a delicate balance of forces.

The tongue exerts an outward pressure on the teeth, while the muscles of the cheeks (

buccinator) and lips exert an inward pressure.

The area where these forces are in equilibrium is known as the “neutral zone,” and this is where the dental arch should ideally be situated.⁴

In individuals with certain types of malocclusion, the teeth may be positioned too far facially—that is, too far toward the cheeks and lips—placing them outside this neutral zone.⁴

This encroachment reduces the space available for the soft tissues.

As a result, the inner lining of the cheek, the buccal mucosa, becomes highly susceptible to being pinched or trapped between the chewing surfaces of the molars and premolars during normal functions like talking and eating.

This can be a developmental issue present from a young age or can arise later in life as teeth naturally shift or drift over time.¹⁰

2.2. The Role of Wisdom Teeth and Dental Restorations

Beyond developmental malocclusion, two other common dental events can disrupt the harmony of the bite and trigger cheek biting:

• Eruption of Wisdom Teeth: The emergence of the third molars, or wisdom teeth, is a notorious cause of cheek biting, particularly in late adolescence and early adulthood.¹ Most modern jaws do not have adequate space to accommodate these final teeth. As they erupt, they can cause a cascade of problems that lead to cheek trauma. They may push adjacent teeth forward, creating new crowding and misalignment. Alternatively, they can erupt at an improper angle, leaning outward toward the cheek and directly impinging upon the soft tissue.¹
• Faulty Dental Restorations: Dental work that is improperly designed, poorly fitted, or has worn down over time can be a significant iatrogenic (medically-induced) cause of cheek biting. Restorations such as dental crowns, bridges, fillings, or dentures are intended to restore the natural form and function of the teeth. However, if a restoration alters the biting surface in a way that creates a sharp edge or an overhanging contour, it can become a chronic source of irritation and trauma to the adjacent cheek tissue.¹⁰ Any change to the occlusal landscape must be carefully managed to prevent such unintended consequences.

2.3. The Connection to Temporomandibular Joint (TMJ) Disorders and Bruxism

The relationship between cheek biting and disorders of the jaw joint and muscles is complex and often bidirectional.

• Bruxism (Teeth Grinding and Clenching): Bruxism is a primary driver of sleep-related cheek biting.² During sleep, an individual with bruxism can exert immense and sustained forces while unconsciously grinding their teeth. This powerful, uncontrolled movement makes it very easy for the relaxed cheek tissue to become trapped between the molars, resulting in significant damage. Furthermore, awake bruxism (clenching or grinding while conscious) is considered a related parafunctional habit, often co-occurring with and contributing to cheek biting.¹⁹
• Temporomandibular Disorders (TMD): TMD refers to a group of conditions affecting the temporomandibular joint (TMJ) and the muscles of mastication.²⁰ While research has largely debunked the older belief that a bad bite causes TMD, dysfunction in the jaw joint can certainly contribute to cheek biting.²² Symptoms of TMD, such as jaw instability, muscle spasms, altered jaw movement patterns, or a displaced articular disc, can lead to imprecise and uncoordinated chewing motions.¹⁸ This lack of smooth, controlled movement increases the likelihood of the cheek being accidentally bitten. In some cases, chronic cheek biting may even be a precursor to the development of TMD symptoms.¹⁸ The link is often reinforced by a common underlying factor: stress. Stress is a well-known contributor to both the onset and exacerbation of TMD and bruxism, and it is also a primary trigger for habitual cheek biting, creating a feedback loop of pain and dysfunction.¹

A crucial dynamic that bridges the physical and psychological realms is the “Physical-to-Psychological Crossover Effect.” This process explains how a condition with a purely mechanical origin can evolve into a psychologically maintained compulsive behavior.

The sequence often unfolds as follows: a physical factor, such as an erupting wisdom tooth or a new dental crown, causes an initial, accidental bite.¹⁰

This trauma leads to localized swelling and inflammation.

The affected tissue no longer feels smooth; it becomes a rough, uneven, or swollen patch that is now more prominent and thus more likely to be bitten again.¹⁸

For most people, this is a temporary annoyance.

However, for an individual with a predisposition to anxiety or BFRBs, this physically altered tissue can become a sensory focal point.

The feeling of a “flaw” or “imperfection” inside the mouth can trigger a powerful, compulsive urge to “smooth it out” or “fix it” by biting or chewing on it.⁷

In this way, an accidental injury transforms into a chronic, psychologically driven compulsion.

This crossover is clinically significant because it demonstrates why treatment must often be dual-tracked.

A dentist might correct the bite, but the ingrained psychological habit may persist.

Conversely, a therapist might address the anxiety, but if the initial physical trigger is not resolved, the cycle of biting and re-injury may continue.

A truly effective treatment plan must account for the possibility that both physical and psychological factors are actively contributing to the behavior.

Section 3: The Psychological Landscape: From Habit to Compulsion

While physical and dental issues account for a significant portion of cheek biting cases, the behavior is frequently rooted in the complex terrain of human psychology.

For many, cheek biting is not a mechanical problem but a physical manifestation of an internal emotional state.

Understanding these psychological drivers is essential, especially when the behavior persists in the absence of any clear dental cause and evolves from a simple habit into an uncontrollable compulsion.

3.1. Common Psychological Triggers: The “Why” Behind the Habit

Habitual cheek biting is often an automatic, semiconscious behavior triggered by a specific set of emotional or situational cues.

The act serves as a maladaptive but readily available coping mechanism.

The most common psychological triggers include:

• Stress and Anxiety: This is the most frequently cited psychological driver. When an individual experiences high levels of stress, anxiety, or internal tension, the body seeks an outlet. Cheek biting can become a subconscious physical response to these overwhelming feelings, with the repetitive motor action providing a temporary, albeit counterproductive, sense of relief or release.¹
• Boredom and Under-stimulation: In situations lacking external engagement or sensory input, the mind may prompt the body to create its own stimulation. Nibbling or chewing on the inner cheek is a simple, accessible way to satisfy this sensory-seeking impulse.¹
• Concentration and Deep Thought: Similar to how some people might tap a pen or twirl their hair, cheek biting can occur unconsciously when the mind is deeply absorbed in a complex task or problem-solving. The behavior becomes an automatic motor pattern that accompanies focused mental effort.¹
• Depression: Beyond general emotional states, specific clinical conditions are also linked to cheek biting. Research has identified a notable association between the behavior and individuals diagnosed with depression, suggesting it may serve as a physical symptom or coping strategy related to the disorder.⁵

3.2. Cheek Biting as a Body-Focused Repetitive Behavior (BFRB)

When cheek biting transcends a simple habit and becomes a compulsive, uncontrollable act, it enters the clinical domain of a Body-Focused Repetitive Behavior (BFRB).

This classification is a critical turning point in understanding the severity of the condition.

• Official Classification: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) formally classifies chronic cheek biting, or morsicatio buccarum, as a BFRB. It is listed under the heading “Other Specified Obsessive-Compulsive and Related Disorder” (code 300.3).⁴ This placement acknowledges that the behavior shares core features with OCD but is also distinct, moving it far beyond the realm of a “bad habit” and into that of a recognized psychiatric condition requiring specialized treatment.
• The BFRB Family: This classification places cheek biting in a family of related disorders characterized by repetitive self-grooming behaviors that cause physical damage. This family includes more widely known BFRBs such as trichotillomania (compulsive hair-pulling), dermatillomania or excoriation disorder (compulsive skin-picking), and onychophagia (compulsive nail-biting).¹ Understanding this connection is important for destigmatization; it shows that the individual is not alone in their struggle and that their condition is part of a well-documented class of disorders with established treatment protocols.³⁰
• The BFRB Cycle: The behavior is often maintained by a powerful psychological cycle. It typically begins with a trigger, which can be an internal state (anxiety, tension, boredom) or a sensory cue (feeling a rough patch of skin inside the mouth). This trigger leads to an intense, mounting urge or craving to perform the behavior. The act of biting provides a moment of relief, pleasure, or sensory gratification. However, this is quickly followed by negative feelings such as guilt, shame, and hopelessness about the inability to control the behavior and the physical damage caused. These negative emotions can then become triggers themselves, perpetuating a vicious cycle.⁵
• Distinction from Classic OCD: While BFRBs are on the obsessive-compulsive spectrum, there is a crucial distinction from classic OCD. In OCD, a compulsion (e.g., hand washing) is typically performed in response to a specific, unwanted, anxiety-provoking intrusive thought, or obsession (e.g., “my hands are contaminated”). The goal of the compulsion is to neutralize this specific anxiety. In contrast, BFRBs like cheek biting are often more automatic or “trance-like.” The triggers are broader, including general feelings of anxiety, stress, or boredom, or even sensory cues, not necessarily a specific obsession. Furthermore, while OCD compulsions are primarily about reducing anxiety, BFRBs can provide a direct feeling of pleasure, gratification, or sensory satisfaction, which is a different form of reinforcement.⁹

3.3. The Neurobiology of BFRBs: The Brain’s Contribution

The field of neurobiology is beginning to uncover the biological underpinnings of BFRBs, revealing that these behaviors are not a matter of willpower but are rooted in genetics, brain structure, and neurochemistry.

While this research is ongoing and much remains to be discovered, several key areas have been identified.³¹

• Genetic Predisposition: There is strong evidence for a genetic component to BFRBs. Family and twin studies consistently show that these disorders run in families; having a first-degree relative with a BFRB significantly increases an individual’s own risk of developing one.¹² This suggests an inherited vulnerability to these behaviors.
• Brain Structure and Circuitry: Neuroimaging studies are pointing toward abnormalities in specific brain regions and circuits that are critical for habit formation, impulse control, and emotional regulation.¹² The cortico-striato-thalamo-cortical (CSTC) loops, which are heavily involved in motor control and habit learning, are a primary area of investigation. Perhaps most compellingly, recent research into the better-studied BFRBs of trichotillomania (TTM) and skin-picking disorder (SPD) has begun to identify distinct structural brain differences between different clinical
  subtypes of the same disorder.³⁴ For instance, studies have found that individuals with a “low awareness,” more automatic style of hair pulling show different patterns of cortical volume compared to those with a more “impulsive/perfectionist,” focused style of pulling.³⁴
• Neurotransmitter Systems: The complex interplay of brain chemicals is also believed to play a crucial role. Research is investigating several key neurotransmitter systems, including:

• Dopamine: Involved in the brain’s reward, pleasure, and habit-formation pathways. Dysregulation in this system may contribute to the reinforcing nature of BFRBs.¹²
• Serotonin: Critical for mood regulation and impulse control. Abnormalities in serotonin signaling are a well-known feature of OCD and related disorders.¹²
• Glutamate: The brain’s primary excitatory neurotransmitter, which is essential for learning and memory. Imbalances in glutamate may contribute to the development of ingrained, hard-to-break habits.³⁶

The emerging neurobiological evidence, particularly the discovery of distinct neural correlates for different clinical subtypes of TTM and SPD, has profound implications for understanding morsicatio buccarum.

Although cheek biting itself has been studied less extensively at a neurobiological level, its classification within the same BFRB family strongly suggests that it is not a uniform disorder.

It is highly probable that individuals who bite their cheeks also fall into neurobiologically distinct subgroups.

For example, the person who bites their cheek unconsciously while reading (an “automatic” or “low awareness” style) may have a different underlying neurobiology than the person who bites their cheek intentionally to “smooth out” a perceived imperfection (a “focused” or “sensory-seeking” style).

This strongly suggests that a “one-size-fits-all” treatment approach is likely to be insufficient.

Instead, the most effective therapeutic interventions will likely need to be tailored to the individual’s specific BFRB subtype, targeting awareness in the automatic biter and impulse control or sensory substitution in the focused biter.

This moves the clinical approach beyond simply stopping a behavior to understanding and addressing the unique neurobiological drivers behind it for each individual.

Section 4: Clinical Manifestations and Consequences

Chronic cheek biting, whether driven by physical or psychological factors, is not a benign habit.

The repetitive mechanical trauma inflicted upon the delicate inner lining of the mouth leads to a cascade of physical consequences, ranging from acute pain and inflammation to permanent tissue changes.

These physical effects are often accompanied by a significant psychological and social burden.

A critical aspect of clinical assessment involves distinguishing the characteristic, harmless tissue changes of chronic friction from other, more serious oral pathologies that can present as white lesions.

4.1. Immediate and Long-Term Physical Effects

The buccal mucosa, the soft tissue lining the inside of the cheeks, is not designed to withstand the repeated crushing and shearing forces of teeth.

The consequences of chronic biting are progressive:

• Acute Effects: The immediate result of biting is trauma to the tissue, which can manifest as painful canker sores (aphthous ulcers), redness (erythema), bleeding, and localized swelling or inflammation.¹ This initial injury can make normal activities like eating, drinking, and speaking uncomfortable and can interfere with routine oral hygiene practices.¹
• Chronic and Long-Term Damage: With continued trauma, the body attempts to protect itself, leading to more permanent changes in the tissue. The mucosa can become thickened and scarred, altering its normal smooth texture.¹ In some areas, the tissue may erode and become thin. The most characteristic long-term effect is the development of a callous-like, frayed white patch in the area of the biting. This cycle of injury and attempted healing can result in a permanently altered and often uncomfortable oral environment.
• Risk of Infection: The mouth is host to a vast and diverse microbiome. The open sores and ulcers created by cheek biting serve as portals of entry for bacteria, creating a significant risk of secondary infections.¹ An infection can exacerbate pain and swelling and may require medical intervention to resolve.

4.2. Psychological and Social Consequences

The impact of a BFRB like chronic cheek biting extends far beyond physical discomfort.

The inability to control the behavior often leads to a heavy emotional toll, characterized by profound feelings of guilt, shame, helplessness, and diminished self-esteem.⁵

Individuals may feel embarrassed by the habit itself or by the visible sores and damage inside their mouths.

This distress frequently leads to social withdrawal and isolation, as people may avoid social situations, intimate relationships, or even dental appointments to hide the behavior and its consequences from others.⁷

4.3. Oral Pathology: Frictional Keratosis vs. Leukoplakia

Perhaps the greatest source of anxiety for someone with chronic cheek biting is the appearance of a persistent white patch inside their mouth, which can raise fears of oral cancer.

It is therefore essential to understand the distinction between the benign lesion caused by biting and a potentially malignant one.

• Frictional Keratosis (Benign): The white lesion caused by chronic mechanical irritation from cheek biting is known as frictional keratosis. When specifically caused by biting, it is synonymous with morsicatio buccarum.⁴ This lesion is not a disease but rather a reactive, protective physiological response. The constant friction stimulates the epithelial cells to produce excess keratin—the same protein that makes up skin and nails—creating a thickened, calloused, white layer.⁴ Clinically, it typically appears as a diffuse, ill-defined, shaggy, or frayed white area, often with peeling or macerated tissue tags. Its location almost always corresponds directly to the occlusal plane—the line where the upper and lower teeth meet.⁴ Critically, frictional keratosis is considered a harmless condition with no inherent potential to become malignant.⁴⁷
• Leukoplakia (Potentially Malignant): Leukoplakia is a clinical term of exclusion. It is defined by the World Health Organization as a white plaque of questionable risk that cannot be characterized, clinically or pathologically, as any other specific disease.⁴⁷ Unlike frictional keratosis, true leukoplakia has no identifiable cause (though it is strongly associated with tobacco and alcohol use). It is classified as an oral potentially malignant disorder (OPMD) because a certain percentage of these lesions will undergo transformation into squamous cell carcinoma over time.⁴⁷

The presence of the biting habit itself serves as a powerful diagnostic clue that strongly points away from a more sinister diagnosis.

In the field of oral pathology, a lesion of unknown origin is always of greater concern than one with a clear, identifiable cause.

Therefore, when a white patch is located in an area that directly corresponds to a patient’s admitted habit of cheek biting, the diagnosis is overwhelmingly likely to be benign frictional keratosis.

This reframes the “bad habit” from being solely a source of shame into a vital piece of the clinical history that aids in reaching a favorable diagnosis.

The key clinical test is the removal of the irritant: if the biting stops (for example, through the use of a protective appliance), a frictional keratosis should resolve or improve, whereas a true leukoplakia will persist.⁴³

While there can be some overlap in the histological appearance (both show hyperkeratosis, or thickening of the keratin layer), true leukoplakia may contain cellular atypia (dysplasia), which are the abnormal cellular changes that signal malignant potential.

Frictional keratosis, by contrast, lacks these dysplastic changes.⁴²

Table 2: Differential Diagnosis of Common Oral White Lesions

To further clarify these distinctions, the following table provides a comparative framework for the most common white lesions found in the oral cavity.

This tool is designed to reduce anxiety about cancer risk and guide appropriate diagnostic thinking.

Condition	Primary Cause	Clinical Appearance	Key Differentiator	Malignant Potential
Morsicatio Buccarum / Frictional Keratosis	Chronic mechanical trauma (e.g., cheek biting, rubbing from dentures).	Shaggy, frayed, macerated white patch, often bilateral, located along the bite line.	Directly related to an identifiable source of trauma; often resolves when trauma ceases.	None.
Oral Leukoplakia	Largely unknown; strongly associated with tobacco and alcohol use.	A well-demarcated white plaque that cannot be wiped off; can be smooth (homogenous) or speckled/nodular (non-homogenous).	A diagnosis of exclusion; persists even after potential irritants are removed.	Yes (Oral Potentially Malignant Disorder).
Oral Candidiasis (Thrush)	Fungal infection (Candida albicans), often in immunocompromised individuals or after antibiotic use.	Creamy, white, curd-like patches that can be wiped or scraped off, leaving a red, raw, or bleeding surface.	Can be wiped off.	None.
Oral Lichen Planus	Autoimmune/inflammatory condition.	Typically presents as fine, lacy, web-like white lines (known as Wickham’s striae), often on the buccal mucosa. Can also have erosive or plaque-like forms.	Characteristic lacy pattern is a key diagnostic clue.	Low, but requires long-term monitoring.

Section 5: The Diagnostic Pathway: Achieving a Definitive Understanding

Given the multifaceted nature of cheek biting, arriving at an accurate and complete diagnosis is a critical step that often requires a collaborative, dual-track approach involving both dental and psychological professionals.

A failure to investigate both the physical and behavioral dimensions of the condition can lead to an incomplete diagnosis and, consequently, ineffective treatment.

The diagnostic process is not merely about labeling the condition but about uncovering its specific underlying drivers in order to tailor a successful management plan.

This integrated care model, where dental and mental health expertise converge, represents the gold standard for addressing this complex issue.

5.1. The Role of the Dental Professional: The First Line of Defense

For most individuals, the diagnostic journey begins in the dental chair.

A dentist or an oral medicine specialist is uniquely equipped to assess the physical factors that can cause or contribute to cheek biting.⁶

The initial comprehensive examination is focused on identifying any mechanical or structural anomalies within the oral cavity.

This involves:

• Evaluating Occlusion and Alignment: The dentist will carefully check for dental malocclusion, observing how the upper and lower teeth come together.⁹
• Assessing for Bruxism: Signs of teeth grinding or clenching, such as abnormal wear patterns on the chewing surfaces of the teeth, will be noted.¹⁰
• Checking Wisdom Teeth: The status of the third molars will be evaluated to see if they are impacted, partially erupted, or erupting at an angle that could traumatize the cheek.⁹
• Inspecting Dental Restorations: Existing crowns, bridges, fillings, and dentures will be examined for any sharp edges, poor contours, or ill-fitting margins that could be irritating the buccal mucosa.¹⁰
• Visual Examination of Lesions: The dentist will perform a thorough visual inspection of the affected tissue, noting the location, size, color, and texture of any lesions.¹⁴ The location is particularly important, as a lesion along the occlusal plane strongly suggests a traumatic origin.

5.2. Clinical and Histological Diagnosis of Morsicatio Buccarum

Based on the initial examination, the clinician will formulate a diagnosis, which may be confirmed with further testing if necessary.

• Clinical Diagnosis: In a majority of cases, a diagnosis of morsicatio buccarum or frictional keratosis can be made based on the clinical presentation alone, without the need for a biopsy.⁴ A diagnosis is strongly supported when there is a clear history of a cheek-biting habit and the lesion exhibits the characteristic appearance—a shaggy, white, macerated patch located along the line where the teeth meet.⁴ The bilateral nature of the lesions is also a common finding.⁴ In some cases, a non-invasive tool called a dermoscope may be used to magnify the tissue surface, which can help differentiate the structureless white areas of morsicatio from the lacy patterns of other conditions like oral lichen planus.⁵⁴
• Histological Diagnosis (Biopsy): While often not necessary, an incisional or punch biopsy is indicated under several circumstances: if the clinical diagnosis is uncertain, if the lesion has an atypical appearance, if it is located in a high-risk area for oral cancer (like the floor of the mouth or lateral tongue), or if it fails to resolve after a suspected physical cause has been eliminated.⁴ The microscopic, or histological, features of
  morsicatio buccarum are distinctive and pathognomonic, allowing for a definitive diagnosis. These features include ⁴:

• Marked Hyperparakeratosis: A significant thickening of the outermost keratin layer of the epithelium.
• Irregular Surface: The surface of the keratin is not smooth but appears ragged, frayed, shaggy, or corrugated, with projections of keratin.
• Bacterial Colonization: The damaged, irregular surface often traps food debris and provides a niche for bacteria, so superficial colonies of bacteria are a typical and harmless finding.
• Acanthosis and Cellular Changes: The underlying spinous layer of the epithelium is thickened (acanthosis), and the cells in the upper portion of this layer often appear swollen, clear, or “ballooned” due to intracellular edema (vacuolated cells).
• Minimal Inflammation: Unless there is secondary ulceration, there is typically a notable lack of significant inflammatory cell infiltrate in the connective tissue beneath the epithelium.
• Absence of Dysplasia: The most critical finding is the absence of epithelial dysplasia, which confirms the benign nature of the lesion.

5.3. Psychological and Psychiatric Assessment

If the dental evaluation rules out any significant physical cause, or if the biting behavior persists even after physical issues have been addressed, a psychological etiology is strongly suspected.

In such cases, or when the behavior is clearly compulsive from the outset, a referral to a mental health professional, preferably one specializing in BFRBs or cognitive behavioral therapy, is the appropriate next step.⁸

The psychological assessment will focus on diagnosing a BFRB based on the DSM-5 criteria.

The clinician will seek to confirm that the behavior is recurrent, that the individual has made repeated but unsuccessful attempts to stop or decrease it, and that the behavior causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.⁹

The assessment will also explore the functional nature of the behavior—that is, what purpose it serves for the individual.

This includes identifying specific triggers (emotional, situational, sensory), understanding the feelings that precede and follow the biting (e.g., tension release, gratification, shame), and evaluating for the presence of co-occurring conditions such as anxiety disorders, depression, or OCD, which frequently accompany BFRBs.¹²

Section 6: A Comprehensive Guide to Treatment and Management

The treatment for cheek biting must be tailored to its underlying cause.

A successful management plan is rarely a single intervention but rather a thoughtful combination of strategies that address the specific physical, behavioral, and psychological factors driving the behavior in an individual.

The most effective approaches are often multimodal and synergistic, where a physical intervention can create a window of opportunity for a psychological therapy to be more effective.

For example, a dental mouthguard can act as a “pattern interrupt” for the physical act of biting, allowing damaged tissue to heal.

This removes the immediate sensory trigger of a rough patch, thereby making the cognitive and behavioral work of therapy significantly easier to implement.

6.1. Addressing Physical Causes: Dental and Orthodontic Interventions

When a clear dental or structural issue is identified as the cause of regular accidental cheek biting, the treatment is focused on correcting that physical problem.

These interventions are typically managed by a dentist or orthodontist.

• Occlusal Splints and Mouthguards: For individuals who bite their cheeks during sleep due to bruxism, a custom-fabricated occlusal splint or night guard is the primary treatment.⁶ This device, usually made of a hard acrylic material, is worn over the upper or lower teeth. It serves as a protective barrier, physically preventing the teeth from making contact with the cheek tissue during unconscious grinding and clenching.¹ This not only prevents further injury but also allows existing sores to heal.
• Orthodontic Correction: In cases where the biting is caused by a significant dental malocclusion, orthodontic treatment offers a permanent solution. Interventions such as traditional braces or clear aligner therapy can move the teeth into their proper positions within the “neutral zone,” correcting the bite and eliminating the mechanical cause of the trauma.¹
• Dental Adjustments and Restorations: If the biting is caused by a sharp tooth cusp or a faulty dental restoration, a dentist can perform simple adjustments. This might involve smoothing and re-contouring a natural tooth or reshaping, repairing, or replacing an ill-fitting crown, bridge, or denture to eliminate the source of chronic irritation.¹⁰ In some cases, the extraction of a problematic wisdom tooth may be necessary.¹⁰

6.2. Therapeutic Interventions for Body-Focused Repetitive Behaviors (BFRBs)

When cheek biting is diagnosed as a habitual or compulsive BFRB, the cornerstone of treatment is psychotherapy.

Several evidence-based models have proven highly effective in helping individuals gain control over these behaviors.

• Cognitive Behavioral Therapy (CBT): CBT is a well-established and highly effective therapeutic approach for BFRBs.⁶ It is a structured, goal-oriented therapy that focuses on the interplay between thoughts, feelings, and behaviors. Key components of CBT for cheek biting include:

• Functional Analysis and Trigger Identification: The first step involves working with a therapist to conduct a detailed analysis of the biting behavior. The individual learns to identify the specific internal triggers (e.g., feelings of anxiety, boredom, thoughts of imperfection) and external triggers (e.g., specific places like the car or bathroom, certain times of day, activities like watching TV) that precede a biting episode.⁵⁸
• Cognitive Restructuring: This technique involves identifying, challenging, and reframing the unhelpful thoughts and beliefs that permit or perpetuate the behavior. For example, the automatic thought “I can’t stop, I’m helpless” can be restructured to a more adaptive thought like, “This is a strong urge, but I have strategies I can use to manage it without biting”.³⁰
• Developing Healthier Coping Skills: CBT equips individuals with a toolkit of alternative, non-destructive strategies for managing the underlying emotions that trigger the biting, such as stress, anxiety, or frustration.⁸ A leading state-of-the-art framework within CBT is the
  Comprehensive Behavioral (ComB) model, which provides a highly individualized treatment plan by assessing five functional domains (Sensory, Cognitive, Affective, Motor, and Place) to understand why a person engages in their BFRB.⁵⁹
• Habit Reversal Training (HRT): HRT is a specific, structured component of CBT that is considered one of the most effective treatments for BFRBs.³⁰ It consists of three core steps:

• Step 1: Awareness Training: The individual is trained to become acutely aware of their behavior. This involves learning to recognize the earliest warning signs—the subtle urges, sensations, or movements that occur just before the biting begins. Keeping a log or journal can be a helpful tool in this phase.⁶²
• Step 2: Competing Response Training: Once awareness is established, the individual develops and practices a “competing response”—a behavior that is physically incompatible with cheek biting. When the urge to bite is detected, the person immediately engages in this alternative behavior for a minute or two until the urge subsides. Effective competing responses for cheek biting include chewing a piece of sugar-free gum, pressing the tongue firmly against the roof of the mouth, gently rubbing the teeth over the lips, or clenching the hands into fists.³⁰
• Step 3: Motivation and Social Support: This phase focuses on strengthening the individual’s commitment to change. It can involve reviewing the negative consequences of the biting, celebrating small successes, and enlisting the help of trusted friends or family members to provide encouragement and positive reinforcement.³⁰
• Other Therapeutic Modalities: Other therapies that focus on emotional regulation and acceptance are also beneficial. Acceptance and Commitment Therapy (ACT) teaches individuals to notice and accept uncomfortable urges and feelings without needing to act on them, while Dialectical Behavior Therapy (DBT) provides skills for distress tolerance and emotion regulation, which are often at the core of BFRBs.⁸

6.3. Self-Help Strategies and Lifestyle Modifications

In conjunction with professional treatment, or as a starting point for managing milder habitual biting, a wide range of self-help strategies can be highly effective.

• Stress Management and Mindfulness: Since stress and anxiety are primary triggers, techniques that calm the nervous system are crucial. Regular practice of mindfulness meditation, deep-breathing exercises, yoga, and progressive muscle relaxation can significantly reduce the background level of tension that fuels the habit.¹
• Sensory Substitution and “Fidgets”: The urge to bite is often an oral-motor or sensory-seeking one. Providing a safe, alternative outlet for this urge can be very effective. This includes chewing sugar-free gum, sucking on sugar-free hard candies or mints, drinking plenty of water to keep the mouth hydrated, or using specially designed non-food items like silicone “chewelry” necklaces or pencil toppers.²⁷
• Environmental Modification: This involves identifying and altering cues in the environment that trigger the behavior. For some, this might mean covering or dimming the lights near a mirror where focused biting occurs, or keeping a stress ball in the car if biting is common during traffic.⁵⁹
• Dietary and Nutritional Considerations: Ensuring a balanced diet rich in essential nutrients, particularly B vitamins and iron, can help prevent oral sensitivities that might contribute to biting.¹ Practicing mindful eating—eating slowly, taking smaller bites, and paying full attention to the act of chewing—can reduce the frequency of accidental bites.¹
• Care for Existing Sores: Proper oral hygiene is essential to promote healing and prevent infection in areas damaged by biting. This includes regular brushing and flossing, as well as using gentle, alcohol-free antiseptic mouthwashes. Home remedies like rinsing with warm salt water can soothe sore tissues. Topical treatments such as over-the-counter oral anesthetic gels, or natural remedies like applying a small amount of aloe vera or honey, can also provide relief and aid in healing.¹

Table 3: Summary of Treatment Approaches for Chronic Cheek Biting

The following table consolidates the diverse treatment options into a clear, organized reference guide, connecting specific interventions to their primary indications and mechanisms of action.

Intervention Category	Specific Treatment	Primary Indication	Mechanism of Action
Dental / Physical	Custom Mouthguard/Splint	Sleep bruxism, physical protection from biting.	Creates a physical barrier between teeth and cheek tissue.
	Orthodontics (Braces/Aligners)	Dental malocclusion causing accidental bites.	Permanently corrects the bite alignment, eliminating the mechanical cause.
	Dental Adjustments	Sharp tooth cusps, ill-fitting restorations.	Smooths or reshapes the offending surface to remove the source of trauma.
Psychological / Behavioral	Cognitive Behavioral Therapy (CBT)	BFRB, anxiety, negative thought patterns, emotional dysregulation.	Identifies and changes the relationship between triggers, thoughts, feelings, and behaviors.
	Habit Reversal Training (HRT)	Specific, ingrained BFRB habit.	Increases awareness and replaces the unwanted habit with a physically incompatible behavior.
	ACT / DBT	Difficulty with emotional regulation and accepting urges.	Teaches skills for distress tolerance and accepting internal experiences without acting on them.
Self-Help / Lifestyle	Sensory Substitution (e.g., Gum)	Oral-motor fixation, sensory-seeking behavior.	Redirects the oral-motor urge to a safe, non-damaging alternative.
	Mindfulness / Meditation	General stress and anxiety.	Reduces sympathetic nervous system arousal and increases awareness of internal states.
	Home Remedies (e.g., Salt Water Rinse)	Existing sores, pain, and inflammation.	Soothes traumatized tissue and helps prevent secondary infection.

Conclusion

Cheek biting, or morsicatio buccarum, is a condition of significant complexity, spanning a spectrum from a minor accident to a debilitating compulsive disorder.

A comprehensive understanding reveals that it is not a single entity but a symptom that can arise from distinct physical and psychological etiologies.

The key findings of this review underscore that a successful approach to management hinges on a precise diagnosis that considers both the mechanics of the mouth and the landscape of the mind.

The classification of the behavior—whether accidental, sleep-related, habitual, or compulsive—serves as an essential first step, guiding the diagnostic process and preventing mismanagement.

The evidence strongly supports a dual-track, integrated care model as the gold standard.

A thorough dental evaluation is imperative to rule out or correct any physical factors, such as malocclusion or faulty restorations, that may be initiating or exacerbating the behavior.

Simultaneously, when the biting is habitual or compulsive, a psychological assessment is crucial to address the underlying drivers, such as stress, anxiety, or a diagnosable Body-Focused Repetitive Behavior.

The most effective treatment plans are often synergistic, combining dental interventions like protective mouthguards with evidence-based psychotherapies such as Cognitive Behavioral Therapy and Habit Reversal Training.

For individuals struggling with this condition, the path forward is one of empowerment through knowledge and action.

The recommended steps are clear:

1. Begin with Self-Awareness: Start by observing the behavior. Keep a mental or written log to identify the specific situations, emotions, and sensations that trigger the biting. Implement self-help strategies, such as stress management techniques and sensory substitution with sugar-free gum, to begin managing the urges.
2. Schedule a Comprehensive Dental Evaluation: Consult a dentist to conduct a thorough examination of the teeth, bite, and oral tissues. This step is non-negotiable to address any potential physical causes and to receive a professional assessment of any tissue damage, providing peace of mind by distinguishing benign frictional keratosis from other conditions.
3. Seek a Mental Health Consultation if Necessary: If the behavior is compulsive, causes significant distress, or persists after physical causes have been ruled out, it is vital to seek a referral to a mental health professional who specializes in BFRBs. Therapies like CBT and HRT offer proven, practical skills for regaining control.

Ultimately, morsicatio buccarum is a highly treatable condition.

While the journey to overcome it requires patience, self-compassion, and professional guidance, relief is attainable.

By understanding the root causes of their behavior and engaging with the appropriate evidence-based treatments, individuals can break the cycle of biting, heal both physically and emotionally, and restore their oral health and overall well-being.

Works cited

1. Why Do I Keep Biting My Cheek? Causes & Solutions – Mooresville Dental Group, accessed August 11, 2025, https://mooresvilledentalgroup.com/blog/why-do-i-keep-biting-my-cheek/
2. Why Do I Keep Biting My Cheeks? – Rocky Mount Dentistry, accessed August 11, 2025, https://rockymountdentalarts.com/why-do-i-keep-biting-my-cheeks/
3. Cheek Biting: Causes, Consequences & Care – Andrew Cohen, DMD, accessed August 11, 2025, https://www.firstclassdentalpa.com/cheek-biting-causes-consequences-and-care/
4. Morsicatio buccarum – Wikipedia, accessed August 11, 2025, https://en.wikipedia.org/wiki/Morsicatio_buccarum
5. Morsicatio buccarum (chronic cheek biting): Treatments and how to stop – Medical News Today, accessed August 11, 2025, https://www.medicalnewstoday.com/articles/morsicatio-buccarum
6. Understanding and Treating Cheek Biting: Causes, Prevention, and Solutions, accessed August 11, 2025, https://www.westriverdentalcare.com/cheek-biting-causes-prevention-treatment/
7. Cheek Biting: Causes, Impact, and How to Stop – Healthline, accessed August 11, 2025, https://www.healthline.com/health/cheek-biting
8. Cheek Biting: Causes, Effects, and How to Stop | Jefferson Dental & Orthodontics, accessed August 11, 2025, https://www.jeffersondentalclinics.com/blog/how-stress-and-anxiety-can-lead-to-problematic-cheek-biting
9. Why do I keep biting the inside of my mouth? – NOCD, accessed August 11, 2025, https://www.treatmyocd.com/what-is-ocd/info/related-symptoms-conditions/why-do-i-keep-biting-the-inside-of-my-mouth
10. Ouch! Are You Biting Your Cheeks More Often? – Ruland Family Dentistry, accessed August 11, 2025, https://www.rulandfamilydentistry.com/blog/1310097-ouch-are-you-biting-your-cheeks-more-often
11. Treatment of Morsicatio Buccarum by Oral Appliance: Case Report, accessed August 11, 2025, https://www.journalomp.org/journal/view.html?doi=10.14476/jomp.2021.46.3.84
12. Body-Focused Repetitive Behavior (BFRB) Disorder – Cleveland Clinic, accessed August 11, 2025, https://my.clevelandclinic.org/health/diseases/body-focused-repetitive-behavior-bfrb
13. What Is A Body-Focused Repetitive Behavior (BFRB)? – Psych Central, accessed August 11, 2025, https://psychcentral.com/health/body-focused-repetitive-behaviors
14. Habitual biting of oral mucosa: A conservative treatment approach …, accessed August 11, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC3793567/
15. Body-focused repetitive behaviors: More prevalent than once thought? – PubMed, accessed August 11, 2025, https://pubmed.ncbi.nlm.nih.gov/30300869/
16. Body-Focused Repetitive Behaviors (BFRBs): Causes, Signs, and Treatment – NOCD, accessed August 11, 2025, https://www.treatmyocd.com/blog/ocd-bfrb
17. Body-Focused Repetitive Behaviors | Psychology Today, accessed August 11, 2025, https://www.psychologytoday.com/us/basics/body-focused-repetitive-behaviors
18. Cheek Biting May Be Due to Bad Bite, Poor Restorations | Savannah, accessed August 11, 2025, https://www.beyondexceptionaldentistry.com/patient-education/cheek-biting-may-be-due-to-bad-bite-poor-restorations/
19. TMD / TMJ Disorder & Bruxism – Neurology Solutions, accessed August 11, 2025, https://www.neurologysolutions.com/movement-disorders/tmd-tmj-disorder-bruxism/
20. TMJ disorders – Symptoms and causes – Mayo Clinic, accessed August 11, 2025, https://www.mayoclinic.org/diseases-conditions/tmj/symptoms-causes/syc-20350941
21. Temporomandibular Disorder (TMD) – Johns Hopkins Medicine, accessed August 11, 2025, https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disorder-tmd
22. TMD (Temporomandibular Disorders) Causes, Symptoms, Diagnosis, Treatment, accessed August 11, 2025, https://www.nidcr.nih.gov/health-info/tmd
23. Common Facial Pain Disorders – Nova Southeastern University College of Dental Medicine, accessed August 11, 2025, https://dental.nova.edu/orofacialpain/common-facial-pain-disorders.html
24. TMJ disorders Information | Mount Sinai – New York, accessed August 11, 2025, https://www.mountsinai.org/health-library/diseases-conditions/tmj-disorders
25. Temporomandibular disorder (TMD) – NHS, accessed August 11, 2025, https://www.nhs.uk/conditions/temporomandibular-disorder-tmd/
26. TMJ Disorders: Symptoms & Treatment – Cleveland Clinic, accessed August 11, 2025, https://my.clevelandclinic.org/health/diseases/15066-temporomandibular-disorders-tmd-overview
27. Understanding Body-Focused Repetitive Behaviors – WebMD, accessed August 11, 2025, https://www.webmd.com/mental-health/ss/slideshow-understanding-body-focused-repetitive-behavior
28. Cheek Biting | Body-Focused Repetitive Behavior | BFRB, accessed August 11, 2025, https://www.bfrb.org/cheek-biting
29. Biting Inside Of Cheek: Chronic Cheek Biting And Mental Health Solutions | BetterHelp, accessed August 11, 2025, https://www.betterhelp.com/advice/anxiety/biting-inside-of-cheek-understanding-your-habits/
30. Understanding and Treating Chronic Cheek Chewing, accessed August 11, 2025, https://www.bfrb.org/post/understanding-and-treating-chronic-cheek-chewing
31. Body-focused repetitive behavior – Wikipedia, accessed August 11, 2025, https://en.wikipedia.org/wiki/Body-focused_repetitive_behavior
32. Common Side Effects Of Cheek Biting, accessed August 11, 2025, https://www.bfrb.org/post/common-side-effects-of-cheek-biting
33. BFRBs vs. OCD: Similarities and Differences, accessed August 11, 2025, https://www.bfrb.org/post/bfrbs-vs-ocd-similarities-and-differences
34. Neurobiology of Subtypes of Trichotillomania and Skin Picking …, accessed August 11, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC7614223/
35. BFRB Awareness – The TLC Foundation for Body-Focused Repetitive Behaviors, accessed August 11, 2025, https://www.bfrb.org/what-are-bfrbs
36. Body Focused Repetitive Behavior Disorders: Behavioral Models and Neurobiological Mechanisms – PMC – PubMed Central, accessed August 11, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10552165/
37. Neurobiology of subtypes of trichotillomania and skin picking disorder – PubMed, accessed August 11, 2025, https://pubmed.ncbi.nlm.nih.gov/34730081/
38. Body-focused repetitive behaviors: Beyond bad habits – ResearchGate, accessed August 11, 2025, https://www.researchgate.net/publication/357615016_Body-focused_repetitive_behaviors_Beyond_bad_habits
39. www.firstclassdentalpa.com, accessed August 11, 2025, https://www.firstclassdentalpa.com/cheek-biting-causes-consequences-and-care/#:~:text=Oral%20Tissue%20Damage%3A%20Continuous%20cheek,perform%20regular%20oral%20hygiene%20routines.
40. How Compulsive Biting and Chewing Affects Your Oral Health, accessed August 11, 2025, https://sdm.rutgers.edu/news/2019/05/how-compulsive-biting-and-chewing-affects-your-oral-health
41. What are the harmful consequences of inner cheek biting? – Sendhil Dental, accessed August 11, 2025, https://www.sendhildental.com/inner-cheek-biting-and-oral-problems/
42. Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa – PMC, accessed August 11, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC6405791/
43. Frictional Keratosis of the Tongue: A Case Report – CORE, accessed August 11, 2025, https://core.ac.uk/download/pdf/233902949.pdf
44. Frictional keratosis – Goccles, accessed August 11, 2025, https://www.goccles.com/frictional-keratosis/
45. Prevalence of Keratosis in the Oral Cavity: A Clinical Retrospective Study – PMC, accessed August 11, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10859883/
46. Complications of an Unrecognized Cheek Biting Habit Following a Dental Visit – AAPD, accessed August 11, 2025, https://www.aapd.org/globalassets/media/publications/archives/flaitz-22-06.pdf
47. Oral White Lesions: An Updated Clinical Diagnostic Decision Tree, accessed August 11, 2025, https://www.mdpi.com/2304-6767/7/1/15
48. Morsicatio Mucosae Oris—A Chronic Oral Frictional Keratosis, Not a Leukoplakia – Exodontia.Info, accessed August 11, 2025, https://exodontia.info/wp-content/uploads/2021/07/J_Oral_Maxillofac_Surg_2009._Morsicatio_Mucosae_Oris_A_Chronic_Oral_Frictional_Keratosis_Not_a_Leukoplakia.pdf
49. Leukoplakia: Causes, Symptoms & Treatment – Cleveland Clinic, accessed August 11, 2025, https://my.clevelandclinic.org/health/diseases/17655-leukoplakia
50. Leukoplakia – NHS, accessed August 11, 2025, https://www.nhs.uk/conditions/leukoplakia/
51. A Guide to Understanding Cheek-Biting from Future of Dentistry, accessed August 11, 2025, https://futureofdentistry.com/blog/a-guide-to-understanding-cheek-biting-from-future-of-dentistry/
52. Morsicatio Labiorum/Linguarum – Journal of Pathology and Translational Medicine, accessed August 11, 2025, https://www.jpatholtm.org/upload/pdf/kjp-43-2-174.pdf
53. Morsicatio Labiorum/Linguarum: Three Cases Report and a Review of the Literature. – Journal of Pathology and Translational Medicine, accessed August 11, 2025, https://www.jpatholtm.org/journal/view.php?number=2715
54. Whitish patches on the buccal mucosa: Role of dermoscopy – PMC, accessed August 11, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9944038/
55. Morsicatio buccarum et labiorum (excessive cheek and lip biting) – PubMed, accessed August 11, 2025, https://pubmed.ncbi.nlm.nih.gov/1867357/
56. How to Stop Biting Your Cheek: Causes & Treatment – Lakeview Dental Care, accessed August 11, 2025, https://www.lakeviewdentalcare.com/ways-stop-biting-cheeks/
57. Morsicatio buccarum dan labiorum kronis terkait kondisi depresi, kecemasan, dan stres: sebuah laporan kasus | Artika | Jurnal Kedokteran Gigi Universitas Padjadjaran, accessed August 11, 2025, https://jurnal.unpad.ac.id/jkg/article/view/41858
58. Behavioral Therapy for Cheek Biting, accessed August 11, 2025, https://www.bfrb.org/post/behavioral-therapy-for-cheek-biting
59. Evidence-based Therapeutic Treatment for BFRBs, accessed August 11, 2025, https://www.bfrb.org/post/evidence-based-therapeutic-treatment-for-bfrbs
60. Overcoming Body-Focused Repetitive Behaviors – ABCT, accessed August 11, 2025, https://www.abct.org/books/overcoming-body-focused-repetitive-behaviors/
61. Introduction – Comprehensive Behavioral (ComB) Treatment of Body-Focused Repetitive Behaviors – Cambridge University Press, accessed August 11, 2025, https://www.cambridge.org/core/books/comprehensive-behavioral-comb-treatment-of-bodyfocused-repetitive-behaviors/introduction/8D67E8325681F375BECB5EFFF8048A1D
62. Habit Reversal Training: What It Is & How It Works – Cleveland Clinic, accessed August 11, 2025, https://my.clevelandclinic.org/health/treatments/habit-reversal-training
63. 104 Habit Reversal Training – Florida Tech News, accessed August 11, 2025, https://news.fit.edu/archive/104-habit-reversal-training/
64. How to Stop Biting Inside of Cheeks, accessed August 11, 2025, https://www.bfrb.org/post/how-to-stop-biting-inside-of-cheeks
65. Cheek Biting In Adults: What You Need To Know | Colgate®, accessed August 11, 2025, https://www.colgate.com/en-us/oral-health/adult-oral-care/cheek-biting-in-adults-what-you-need-to-know
66. Dental Hygiene – Woodlands Dental – Top Ways to Stop Biting Your Cheeks – Shirley E. Cagle, DDS, accessed August 11, 2025, https://www.shirleycagledds.com/2017/02/22/top-4-ways-stop-biting-cheeks/
67. Body Focused Repetitive Behaviors – Psychology Tools, accessed August 11, 2025, https://www.psychologytools.com/professional/problems/body-focused-repetitive-behaviors
68. Inner Cheek Bite Treatment Options You Should Know – The White …, accessed August 11, 2025, https://www.thewhitetusk.com/blog/inner-cheek-bite-treatment-options-you-should-know/