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\def\RunningAuthor{Mohamed Arsath N and Gayatri Devi R}
\firstPage{5569}
\articleType{Original Article}
\receivedDate{23 Apr 2020}
\acceptedDate{29 Jun 2020}
\revisedDate{20 May 2020}
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\title{\textbf{Knowledge, Attitude and Practice Towards on Nail Tic Disorders}}
\author{Mohamed~Arsath~N, 
            Gayatri~Devi~R\textsuperscript{*}~\\[5pt]{Department of Physiology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences(SIMATS), Saveetha University, Chennai, Tamil Nadu, India}}

\begin{abstract}
Nail tic disorder is one such disorder which has been reported in the nineteenth century. Nail tic disorder is a body focused repetitive behavior. Nail tic disorders are developed by individuals to cope up the stress and anxiety level. Nail tic disorder are effectively treated with the help of multiple aids like psychological methods, pharmacological methods. A cross sectional online survey was conducted between dentist and genital students with a self prepared questionnaire and the knowledge and awareness level among the participants about nail tic disorder was analyzed using online platform survey monkey. It is evident from the study conducted that most of the people develop this habit from childhood and it is practiced to cope up with stress levels and it is clear that most of them are aware about the consequences and treatment modalities of this disorder. Nail tic disorder is a example for overlap between dermatology and psychiatry. It is one of the problems that everyone practices in their life time but yet it is a poor studied topic and it is rarely understood. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Nail tic disorder,\newline onychotillomania,\newline nail bitting,\newline habit
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Gayatri~Devi~R~\\ Phone:\ 8248016505~\\  Email:\ gayatri.physio88@gmail.com
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\section{Introduction}
Nail tic disorder is one such disorder which has been reported in the nineteenth century \unskip~\citep{833340:19836862}. It is considered as an involuntary repetitive behaviour which is learned by children to cope up their problems and anxiety. Nail tic disorder is associated with everyone life time in one or the other situation, but it is yet a poor studied and understood topic. 

Nail tic disorder is a body focused repetitive behavior \unskip~\citep{833340:19836858}. It consists of onychophagia, onychotillomania, habit tic disorder, onychotemnomania, onychoteiromania, onychodaknomania, bidet nails, perionycotillomania, onycholysis semilunaris. Body focused repetitive behaviour acts as a coping mechanism during stress; it exhibits equally self harming potential. 

Onychophagia is the condition which is generally called as nail bitting habit \unskip~\citep{833340:19836857}. In this habit the individual develops a habit of bitting the nails with teeth. Onychodaknomania is a rare condition which is associated with the habit of bitting his or her nails in between the teeth \unskip~\citep{833340:19836863}. Onychotillomania is an auto aggressive condition that results in recurrent picking and manicuring of nails \unskip~\citep{833340:19836859} . All these habits are conditions are caused due to the overlap between domains of dermatology and psychiatry \unskip~\citep{833340:19836866,833340:19836864}.

Nail tic disorders are caused due to many factors such as lack of proper feeding habits given to the individual at young age may enhance this habit to satisfy the urge of the erogenous zone \unskip~\citep{833340:19836860}. It might be caused due to stress related conditions; anxiety might also be the cause for this habit to reduce tension. 

Nail tic disorder are effectively treated with the help of multiple aids like psychological methods, pharmacological methods. An individual with this habit is informed about the consequences caused due to this habit. Topical preparation or plastic spikes like equipment are the available methods to prevent this habit. 
    
\section{ Materials and Methods}

\bgroup
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\caption{\boldmath {When all do you bit your nails}}
\label{f-e550742498b4}
\end{figure}
\egroup

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\caption{\boldmath {Do you feel prolonged nail bitting leads to gum disease}}
\label{f-621d6900b8e7}
\end{figure}
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\caption{\boldmath {How long do you have the habit } of nail biting}
\label{f-6d5ba5915235}
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\caption{\boldmath {Do you feel some relief after nail bitting}}
\label{f-204ab8bc207d}
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\caption{\boldmath {Does the skin around the nails} become inflammatory after Long \mbox{}\protect\newline time nail bitting}
\label{f-12f6f9d17cc3}
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\caption{\boldmath {Do people with nail bitting habit are nervous, inattentive persons lacking social skills}}
\label{f-cd4248e94a2d}
\end{figure}
\egroup

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\caption{\boldmath {Does temporary removable plastic } spikes help you reduce this habit}
\label{f-e397b0e25ef3}
\end{figure}
\egroup

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\caption{\boldmath {Do you think applying topical preparation on fingers prevent this habit}}
\label{f-7662af1f745f}
\end{figure}
\egroup
A survey was conducted with the self prepared questionnaire with a sample size of 100 comprising of dentists and dental students to analyze the awareness level and to determine the cause of this habit among dentist and persons with close relations to dental profession such as dental hygienist, technician. At first the general information about the nail tic disorder were explained to dentists and dental students. The questionnaire consists of sociodemographic questions, facts related questions, questions which help them correlate with the cause of this syndrome and questions that check the knowledge, awareness that people posses towards this habit. 

This survey results was analysed used an online platform ``survey monkey''. 
    
\section{\textbf{\space }Results and Discussion}
It is evident from this survey conducted that around 34.69\% of the people practice this habit during stressed times and around 11.22\% practice when then are stuck in any problem and around 48.98\% of the participants do not practice this habit (Figure~\ref{f-e550742498b4} ).

It is evident that people develop this habit from late childhood days around 10 years and 37.63\% people are into this habit believing that they would feel some relief out of this habit (Figures~\ref{f-6d5ba5915235} and~\ref{f-204ab8bc207d})

It is clear from the Figure~\ref{f-12f6f9d17cc3} that around 56.25\% of the participant believe that this nail biting habit has a role to play with sin inflammation and infections thereby validating that nail tic disorders are capable of causing gum diseases also in the later stagesFigure~\ref{f-621d6900b8e7}.

The results of Figure~\ref{f-cd4248e94a2d}  depicts the fact ``that people with this habit are nervous, inattentive and lack social skills'' is true form the result, around 53.61\% of the people says that the fact holds true with this disorder.

It is also evident from the Figures~\ref{f-e397b0e25ef3} and~\ref{f-7662af1f745f} that people are aware about the treatment methods available to quit or prevent this habit and it also depict us that around 60.42\% people believe that applying topical preparation prevent or helps in quitting this habit when compared to usage of temporary plastic spikes but around 56.99\% of the participants also believe that plastic spikes could also be effective in treating person with this habit.  

 It is very much evident from this survey conducted that around 52.72\% of the people develop this habit from childhood and a small group of people around 27.78\% are into this habit due to stress and to reduce anxiety accompanied along with their work. This study aimed at creating a awareness about the treatment options to quit this habit which has not been reported previously in any of the studies done and we come to know that around 56.99 of the participants are aware about it. 

This study holds true with few of the pervious studies done since the results for that things are quite similar. Onychophagia is developed by children not in them before 3 or 4 years of age and mostly many develop this habit at the age of 7-10 holds almost the same result that is got in the pervious study that 20-33\% of children develop this habit at the age of 7-10 and it increase to 45\% in adolescence \unskip~\citep{833340:19836865,833340:19836856}.The results of this survey is almost similar to the pervious study done that around 74.6\% of the people with this habit are with attention deficient hyperactivy disorder and around 20.6\% are with anxiety disorders and they a few of them are with mental retardation \unskip~\citep{833340:19836855}.
    
\section{Conclusions}
 Nail tic disorder is a example for overlap between dermatology and psychiatry. It is one of the problems that everyone practice in their life time but yet it is a poor studied topic and it is rarely understood. Further research on this topic could be done in preventing people from this habit and to test the efficiency of pharmacological drugs in curing this habit. 

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that they have no conflict of interest for this study.
    

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