Oral Habits - Thumb Sucking
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Transcript of Oral Habits - Thumb Sucking
ORAL HABITS
Oral habits are habits that frequently children aquire that may either temporarily or permanently be harmful to dental occlusion for and to the supporting structures.
When habit cause defect in orofacial structure it is termed as pernicious oral habit.
Buttersworth(1961):defined a habit as a frequent or constant practice or acquired tendency, which has been fixed by frequent repetition.
By William James:-
• Useful habits (nasal breathing)
• Harmful habits (eg:- Thumb sucking, Tongue thrusting)
Useful habits:- The habits that considered essential for normal function such as proper positioning of tongue, respiration, normal deglutition.
Harmful habits:- Habits that have deleterious effect on the teeth and their supporting structures.
By morris and Bohana:-
• Pressure. (lip sucking, thumb sucking, tongue thrusting)
• Non pressure (mouth breathing)
• Biting habit (nail biting, pencil biting, lip biting)
Pressure habit:- Habit that apply force on teeth & supporting structure.
Non-pressure habit:- Habit that does not apply force on teeth & supporting structure.
By Finn:-
• Compulsive
• Non-compulsive
Compulsive :- These are deep rooted habits that have acquired a fixation in child. The child tends to suffer increased anxiety when attempt made to correct.
Non-compulsive:- These are habits that easily learned and dropped as the child matures.
By klein:-
• Empty/unintentional habits
• Meaningful/intentional habits
• Empty habit:- They are habits that are not associated with deep rooted psychological pattern.
• Meaningful habits:- They are habits that have psychological bearings.
Various Habits :
Thumb sucking.
Tongue thrusting.
Mouth breathing
Bruxism
Nail biting
Lip biting.
THUMBSUCKING
INTRO
It is observed that most children below 3 year suck their thumbs & finger.
Thumb sucking in infants is common and is meant to meet both psychological and nutritional needs.
Most children discontinue the habits 3-4 year of age.
If habit continues beyond this period there is definite chance that may lead to dentofacial changes.
DEF
According to Gellin “It is placement of thumb or one or more finger in varying depth into the mouth”.
Theories
(1) Psychoanalytical/psychosexual theory:-
Formulated by Sigmund freud in 1928.
According to which thumb sucking habit evolves from an inherent psychosexual drive where child derives pleasure during thumb sucking.
(2) Oral drive theory:-
Formulated by sears and wise 1982.
According to this theory prolongation of nursing strengthen the oral drive & child begins thumb sucking.
(3) Benjamin’s theory:- Rooting reflex:-
In this movement of infant’s head & tongue towards an object touching its cheek.
This primitive reflex is maximal during first 3 month of life.
(4) Learning theory:-
Given by Davidson (1967)
The infants associates sucking with such pleasurable feelings as hunger & recall these events by sucking the suitable object available.
Etiology
Classification O’BRIEN(1996)
a) Nutritive sucking habits: Provides essential nutrients Ex- Breast feeding , Bottle feeding.
b) Non-nutritive sucking habits: Ensures a feeling of well-being, warmth and a sense of security. Ex- Thumb/ finger sucking, Pacifier sucking
Classification of NNS habits Johnson and Larson 1993 (JDC )
a) Level Description Level 1 (+/-) Boys or girls of any chronological age with a habit that occurs during sleep.
b) Level II (+/-) Boys below age 8yr with a habit that occurs at one setting during waking hours.c) Level III (+/-) Boys below age 8yr with a habit that occurs at multiple sittings during waking hours.d) Level IV (+/-) Girls below age 8yr or a boy over 8 yrs with a habit that occurs at one setting during waking hours.e) Level V (+/-) Girls under age 8 yr or a boy over age 8 yrs with a habit that occurs at multiple sittings during
waking hours.f) Level VI (+/-) Girls over age 8 yrs with a habit during waking hours
Subtelny’s grading(1973)a) Type A:- 50% children , whole digit vault of the palate , man max contact.
b) Type B :- 13-15% children , whole digit, not at vault of the palate , man max contact.
c) Type C :- 18% children , 1st joint digit, not at vault of the palate , max contact.
d) Type D :- 6% children , very little digit, not at vault of the palate , man max contact.
Why
Sucking reflex- Engel 1962 - Seen even at 29 week of I.U. life . First coordinated neuromuscular activity of infant . Disappears during normal growth btw 1-3 ½ yrs.
Purpose:
a) Nutritional/Physiological gratification b) Emotional gratification c) Also experience pleasurable stimuli from lips, tongue and oral mucosa & learn asset’ enjoyable sensations such
as closeness of a parent.
Babies restricted from suckling due to disease or other factors become restless and irritable. This deprivation motivates the infant to suck the thumb or finger for additional gratification
THEORIES: Psychology of Non Nutritive digit sucking Theories to explain the cause of occurrence of this habit • Freudian theory (1905) • Learning theory (Davidson, 1967) • Oral drive theory (Sears and Wise, 1982) • Johnson and Larson (1993)
FREUDIAN THEORY(1905):
Distinct phases of psychological development
Oral and anal phases seen in first 3 years of life.
Oral phase- mouth believed to be Oro-erotic zone.
The child has tendency to place his finger or any object into the oral cavity.
Prevention of such an act : Results in emotional insecurity and passes the risk of the child diversifying into other habits. Thumb sucking is considered as manifestation of insecurity, maladjustment , internal conflicts.
The Learning Theory: Davidson 1967
• Non-nutritive sucking stems from adaptive response
• Infant associates sucking with hunger, satiety & being held.
• These events are recalled by finger or thumb.
• i.e habit stems from an adaptive response and assumes no underlying psychological cause as a result of learning
BENJAMIN’S THEORY (1962):
Thumb sucking arises from “ROOTING REFLEX”, common to all mammilian infants. It is max’ during first 3months of life. If it persists, may lead to abnormal habit.
ORAL DRIVE THEORY - Sears and wise(1950):
Acc to this, theory prolongation of nursing strengthens the oral drive. (i.e prolonged sucking can lead to thumb sucking)
PREVALENCE
Birth to 2 years of age: - 50-67% 2 to 5 years of age:- 24-43% 6 to 10 years of age:- 17% Above 10 years :- 10%
INCIDENCE:
Popovich and Thompson-1973, Kelley et al 1973:
• Higher incidence in girls than boys :11.7% girls and 8.3% boys.
• Subtenly and Subtenly 1973: Equal distribution
• Race: Low incidence in Negroid races. (Brenchley 1992)
Adverse Effects
– Malocclusion – open bite
– Mastication difficulty
– Speech difficulty ( D and T )
– Lisping
– Paronychia and digital abnormalities
CAUSE FAC
SOCI ECO
In high socioeconomic status the mother is in better position to feed baby, where as mother belonging to low socio-economic group is unable to provide the infant with sufficient breast milk. Hence the infants suckles intensively for a long time to get required nourishment, thereby also exhausting the sucking urge.
(2) Working mother:- Sucking habit is commonly observe to be present in children with working parents such children brought up in the hand of a caretaker may have feelings of insecurity n use their thumb to obtain secure feeling.
(3) No. of sibling:- The development of habit can be indirectly related to number of sibling. As number increases the attention meted out by the parents to child gets divided.
(4) Order of birth of child:- It has been noticed that later the sibling ranks in family, greater is change of having oral habits.
(5) Age of child:- The time of appearance of digit sucking habit has significance
In neonates:- Insecurities are related to primitive demand as hunger.
During first few week :- Related feeding problems.
During eruption of primary molar:- It may be used as teething device.
CLINICAL F
Labial flaring of maxillary anterior teeth.
Lingual collapse of mandibular anterior teeth.
Increased overjet.
Hypotonic upperlip and hyperactive lowerlip.
Tongue placed inferiorly leading to posterior cross bite due to maxillary arch contraction.
High palatal vault.
Extra oral:-
Fungal infection on thumb
Thumb nail exhibit dish pan appearance.
DIAGNOSIS
(1) History:-
Determine the psychological component involved.
Question regarding the frequency, intensity and duration of habit.
Enquire the feeding patterns, parental care of the child.
The presence of other habits should be evaluated.
(2) Extraoral Examination :-
(i) The digits:-
Digits that are involved in the habit will appear reddened, exceptionally clean, chapped & short fingernail (dishpan thumb)
Fibrous roughened callus may be present on superior aspect of finger.
(ii) Lips:-
Upper lip may be short and hypotonic.
Lower lip is hyperactive .
(iii) Facial form analysis:-
Check for mandibular retrusion.
Maxillary protusion.
High mandible plane angle .
(3) Intra oral Examination:-
(i) Tongue:-
Examine the oral cavity for correct size & position of the tongue at rest.
Tongue action during swallowing.
(ii) Dentoalveolar structures:-
Individual with severe finger or thumb sucking habits,where the digit applied an anterior superior vector to upper dentition and palate, will have flared & proclined maxillary anterior with diastemas & retroclined mandibular anteriors.
Other intra oral symptoms will include high probability of buccal crossbite.
PSYCOLOGICAL THERAPY:-
Screen the patient for underlying psychological disturbance that sustain thumb sucking habit. Once the psychological dependence is suspected child referred for counseling.
Thumb sucking children between the age of 4 to 8 year need only reassurance, positive reinforcements and friendly reminders.
Various aid are employed to bring the habit under the notice of child such as study model, mirror’s etc.
Dunlop hypothesis:-
Patient is made to sit in front of mirror and asked to suck his thumb this will make him realize how awkward he looks and want to stop sucking his thumb.
Children & parents are informed about existing dentofacial deformities and long term risk of habit.
Patient should presented with positive mental and visual images of dentofacial ideals expected from habit cessation.
During treatment adequate emotional support & concern should be provided to child by parents.
When habit is discontinued the child can be reward with a favorite new toys.
(2) REMINDER THERAPY:-
(A) Extra oral approach:-
Employed bitter flavored preparations or distasteful agent that applied to finger or thumb eg. cayenne pepper, quinine asafetida.
A commercially available product fimite can also be used.
It should be applied on skin and nails allowed to dry for 10 min. A new coat should be applied in mornings n evening till habit is broken.
(B) Ace bandage approach:-
Ace bandage approach involve nightly use of an elastic bandage wrapped across the elbow pressure exerted by the bandage remove the digit from the mouth as child tries and falls asleep.
(C) Use of long sleeve night gown.
It has been found that long sleeve night gown prevent the child from practicing thumb sucking because it interfere with contact of the thumb and oral cavity.
(2) Intra oral approaches:-
Various orthodontic appliances are employed to break the habit.
Removable appliance palatal crib, rakes, palatal and lingual spur.
Fixed appliances such as oral screen is more effective.
(3) MECHANO THERAPY:-
(A) Fixed intra oral anti thumb sucking appliances- An intraoral appliance attached to the upper teeth by means bands fitted to the primary second molar or first permanent molar.
(B) Blue grass appliances - Consist of modified six sided roller machined from Teflon to permit purchase of the tongue.
(C) Quad helix – prevents the thumb from being inserted and also corrects the malocclusion by expanding the arch.
Finger (Thumb) sucking & Nail Biting Management
FACTS
• Most give up by 2 yrs
• If continued beyond 4 yrs – number of squelae
• If resumed at 7 – 8 yrs : sign of Stress
TO DOS
• Reassure parents that it’s transient.
• Improve parental attention / nurturing.
• Teach parent to ignore; and give more attention to positive aspects of child’s behavior.
• Provide child praise / reward for substitute behaviors.
• Bitter salves, thumb splints, gloves may be used to reduce thumb sucking.
• Finger guards / Thumb guards , etc.
HISTORY Once the positive history of habit is determined the question regarding the
frequency, intensity and duration of the habit is determined. The remedies that have been
tried at the home, the feeding patterns, parental care of the child is also ascertained.
EMOTIONAL STATUS It is essential to determine if the habit is meaningful or empty. This
requires an insight into the emotional security and familial well being of the child. EXTRA
ORAL EXAMINATION Digits that are involved in the habit will appear reddened,
exceptionally clear, chapped and a short fingernail i.e. a clean dishpan thumb. Fibrous
roughened callus may be present on the superior aspect finger Lips:The position of the lips
at rest or during swallowing should be observed. A short, hypotonic upper lip frequently
characterizes chronic thumb suckers. Lower lip is hyperactive and this leads to further
proclination of upper anterior teeth.
14. Facial form analysis: Check for mandibular retrusion, maxillary protrusion, high
mandibular plane angle and profile. When swallowing, the patient is observed for presence
of a facial grimace or an excessive mentalis muscle contraction, a normal placement of the
tongue against the teeth and palate and whether the pattern of speech of the child is
essentially normal. Facial profile is either straight or convex. Other features include
Associated symptoms hat should be watched for during the initial examination are habitual
mouth breathers and tongue thrust swallow, particularly in children with anterior open bite.
Active thumb suckers also have a higher incidence of middle ear infection and frequently
have enlarged tonsils accompanied by mouth breathing. INTRAORAL EXAMINATION-
TONGUE- Examine for tongue position at rest, tongue action during swallowing. GINGIVA-
Look for evidence of mouth breathing; gum line etching, decay or excessive staining on the
labial surface of upper central and lateral incisors.
15. CLINICAL FINDINGS The type of malocclusion produced by digit sucking is dependent
on a number of variables (NANDA 1989) Position of digit Associated orofacial muscle
contraction Mandibular position during sucking Facial skeletal pattern Intensity,
frequency and duration of force applied DENTOFACIAL CHANGES ASSOCIATED WITH
THUMB SUCKING (JOHNSON & LARSON 1993)
16. EFFECTS ON MAXILLA EFFECTS ON THE MANDIBLE •Increased proclination of
maxillary anteriors with diastema •Increased maxillary arch length •Increased anterior
placement of apical base of maxilla •increased SNA •increased clinical crown length of
maxillary incisors •increased counterclockwise rotation of the occlusal plane. •Decreased
SN to ANS-PNS angle. •Decreased palatal arch width. •Increased atypical root resorption in
primary central incisors. •Increased trauma to maxillary central incisors •Increased
proclination of mandibular incisors •Increased mandibular intermolar distance •Increased
distal position of B point •Decreased maxillary and mandibular incisal angle •Increased
overjet •Decreased oerbite •Increased posterior crossbite • Increased unilateral and
bilateral Class II occlusion EFFECTS ON THE INTERARCH RELATIONSHIP EFFECTS
ON LIP PLACEMENT AND FUNCTION •Increased lip incompetence •Increased lower-lip
function under hte maxillary incisors EFFECTS ON TONGUE PLACEMENT & FUNCTION
•Increased tongue thrust •Increased lip to tongue resting postion •Increased lower tongue
position •Risk to psycologic health OTHER EFFECTS •Increased risk of poisoning
•Increased deformation of digits •Increased risk of speech defects,especially lisping
17. PREVENTION OF THUMB SUCKING 1) Motive based approach The etiology of thumb
sucking focuses on a predominant psychological background. Its prevention should be
directed towards the motive behind the habit. History serves as an important tool for
diagnosing the etiology. 2) Child’s engagement in various activities Parents when
questioned may reveal that the child practices the habit when bored and left to himself, or it
could be just before he goes to sleep. In such cases, the parents can be counseled on
keeping the child engaged in various activities. This gives little chance for child to practice
the habit. 3) Parents involved in prevention When parents are at home they should be
advised to spend ample time with the child so as to put away his feeling of insecurity. 4)
Duration of breast feeding Care should be taken when feeding infants in that the duration of
feeding should adequate so as to enable the child to exhaust his sucking urge and feel
completely satisfied. 5) Mother’s presence and attention during bottle feeding Bottle fed
babies should be held by the mother and enough attention should be given in the process.
This will promote a close emotional union between the mother and baby similar to that in
breast feeding. 6) Use of physiological nipple A physiological nipple should be used for
bottle feeding and size and number of holes should be standardized to regulate a slow and
steady flow of milk.
18. 7) Use of dummy or pacifier Acquiring a digit sucking habit can be prevented by
encouraging the baby to suck a dummy instead. If the child already has thumb sucking
habit, it will not be easy to introduce a dummy. It is necessary to offer a dummy to a child
whose behavior indicates an urgent desire to suck a digit or dummy. TREATMENT
CONSIDERATIONS Psychological status of the child Diagnosis and management of any
psychological problem should be planned before the treatment of any potential or present
dental problem. The frequency, duration and intensity of the oral habit are important in
evaluating the psychological status of the child. If the oral habit was associated with an
emotional problem this would suggest the need for psychological consultation. Age factor
If the child desists with finger sucking habit within the first three years of life, the damage
incurred such as open bite, is temporary provided the child’s occlusion is normal. No
treatment is provided in this age group. If a malocclusion is caused by digit sucking and the
habit is discontinued between the age of 4-5 years, self correction of habit can be
exempted. When digit sucking continues after 6 years or into mixed dentition, the
malocclusion will not be self corrected. Motivation of the child to stop the habit It is also
important to assess the maturity of the child in response to new situations and to observe
the child’s reactions to any suggestion. The treatment approach for the digit sucking habit
should deal directly with the child.
19. Parental concern regarding the habit If the parent is unable to cope with the situation
positively then both the parents and the child should be dealt with during the treatment. It is
important that the child should not be embarrassed or criticized, rather help should be
offered to deal with this difficult habit. Other factors Self –correction again depends on
the severity of the malocclusion, anatomic variation in the peri oral soft tissue, and the
presence of other oral habits such as tongue thrusting, mouth breathing and lip biting.
MANAGEMENT OF THUMB SUCKING The treatment can be broadly divided into the
following (according to PINKHAM) i. ii. iii. iv. i. PREVENTIVE THERAPY
PSYCHOLOGICAL THERAPY REMINDER THERAPY- a) chemical APPLIANCE
THERAPY b) mechanical PREVENTIVE THERAPY (Hughes 1941) Firstly, feed the child
whenever he is hungry and let him eat as much as he wants. Secondly feed the child the
natural way. Thirdly never let the habit to be started the practice must be discontinued at its
inception. ii. PSYCOLOGICAL THERAPY Screen the patient for underlying psychological
disturbances that sustain a thumb sucking habit. Once psychological dependence is
suspected, the child referred to professionals for counseling. β-HYPOTHESIS OR
DUNLOP’S HYPOTHESIS. He believed that if a subject can be forced to concentrate on
the performance of the act at the time he practices it, he could learn to stop performing the
act. Forced purposeful repetition of habit eventually associates with unpleasant reactions
and the
20. habit is abandoned. The child should be asked to sit in front of the mirror and asked to
observe himself as he indulges in the habit. THUMB SUCKING BOOK-“The Little Bear who
Sucked His Thumb” is a book directed at children, for children. The book has been written
and illustrated by DR.Dragan Antolos, an experienced dentist with a special interest in
thumb sucking habits in children. The book and chart are a non-invasive and effective
strategy for stopping thumb sucking, and have received positive support from psychiatrists,
speech pathologists and pedodontic societies. DR.Dragan Antolos,”It is important to
balance the psychological benefits of thumb sucking with the negative impact it has on
developing, permanent teeth.”The Little Bear who Sucked His Thumb” is a book that the
child will relate to the story and it will deliver a positive message without pressure.
21. iii. REMINDER THERAPY CHEMICAL THERAPY Recommends the use of hot
flavoured,bitter and sour tasting or foul smelling preparations, placed on the thumb or
fingers that are sucked. The chemical therapy uses Cayenne (red) pepper dissolved in a
volatile liquid medium. Quinine and Asafoetida, castor oil which have bitter taste and an
offensive odor respectively, also may be used. This should be done only when the patient
has a positive attitude and wants treatment to break the habit.A commercially available
product FEMITE (Denatonium benzoate) is also used for prevention of digit sucking.
MECHANICAL THERAPY Mechanical restraints applied to the hand and digits like splints,
adhesives tapes. Thumb guard is the most effective extra oral appliance for control of the
habit.
22. a. THERMOPLASTIC THUMB POST was devised by Allen in 1991 where a
thermoplastic material was placed on the offending digit. A total of 6 weeks of treatment
time was required for elimination of habit. b. ACE BANDAGE APPROACH: other approach
include the use of ace bandage which is an at home program to assist children with
nocturnal digit sucking habits. The program involves nightly use of an elastic bandage
wrapped across the elbow. Pressure exerted by the bandage removes the digit from the
mouth as the child tires and fall asleep. c. NORTAN AND GELLIN(1968)- proposed a 3
alarm system often effective in children between 3-7 years Offending digit is taped and
when the child feels the tape in te mouth it serves as the first alarm. Bandage tied on the
elbow of the arm with the offending digit, a safety pin is placed lengthwise. When the child
flexes the elbow, the closed pin mildly jabs indicating a second alarm
23. Bandage tightens if the child persists serving as a third alarm d. USE OF LONG
SLEEVE NIGHTGOWN-This is useful in children who sincerely want to discontinue the
habit and only perform during their sleep. The arms of their night suit are lengthened so
that they cannot reach their thumb during night. e. THUMB-HOME CONCEPT-This is the
most recent concept. In this method a small bag is tied around the wrist of the child during
sleep. It is explained to the child that just as the child sleeps in his home, the thumb also
sleeps in its house. Thus the child is restrained from thumb sucking during night.
24. f. USE OF HAND PUPPETS-Currently the use of hand puppets is gaining popularity.
These help in eliminating thumb sucking. g. MY SPECIAL SHIRT-This helps in minimizing
the damage of the finger sucking by providing a number of tools to address the habit in a
phased manner.
25. iv. APPLIANCE THERAPY Various orthodontic appliances are employed to attenuate
and eventually break the habit. Removable appliances used may be palatal crib, rakes,
palatal arch, lingual spurs, and Hawley’s retainer with and without spurs. Fixed appliances
such as upper lingual tongue screens appear to be more effective in breaking these habits.
Removable or fixed palatal crib-It breaks the suction force of the digit on the anterior
segment, reminds the patient of his habit and makes the habit a non-pleasurable one. Oral
Screen-Oral screen is a functional appliance introduced by Newell in 1912.It produces its
effects by redirecting the pressure of the muscular and soft tissue curtain of the cheeks and
lips. It prevents the from placing the thumb or finger into the oral cavity during sleeping
hours.
26. Hay Rakes-Mack (1951) advocated the use of dental appliance in children over 3 1/2
years of age who persistent thumb suckers. The device was called hay rake as it was
designed with a series of fence like lines that prevented sucking. Blue Grass appliance-
Developed by Bruce S Haskell (1991).It is a fixed appliance using a Teflon roller, together
with positive reinforcement. Used to manage thumb sucking habit in children between 7
and 13 years of age. The patient believes that he has acquired a new toy to play with.
Instructions are given to them to roller instead of sucking the digit. Quad helix-The quad
helix is fixed appliance used to expand the constricted maxillary arch. The helixes of the
appliance serve to remind the child not to place the finger in the mouth.
27. Modified Blue Grass appliance-This is a modification of the original appliance with the
difference being that this has two rollers of different colors and material instead of one. If
the patient tries to suck on his thumb the suction will not be created and his thumb will slip
from the rollers thus breaking the act. GRABER explained the working of these appliances
Render finger habit meaningless by breaking suction Prevents finger pressure from
displacing maxillary central incisors thus avoids/labially from creating worse a
malocclusion. Forces the tongue backwards changing its postural rest position, thus
exerting more lateral pressures
28. HABIT BREAKING APPLIANCE DESIGN FOR HABIT CORRECTION
29. REFERENCES TEXT BOOK OF PEDODONYICS-SHOBHA
TANDON TEXT BOOK OF PEDIATRIC DENTISTRY-NIKHIL MARWA TEXT BOOK OF
PEDIATRIC DENTISTRY- S G DAMLE PRINCIPLES AND PRACTICE OF
PEDODONTICS-AARTHI RAO PEDIATRIC DENTISTRY(INFANCY THROUGH
ADOLESCENCE)-JIMMY PINKHAM;HENRY FIELDS HANDBOOK OF PEDIATRIC
DENTISTRY-AGNUS C CAMERON DENTISTRY FOR CHILD AND
ADOLESCENTDEAN,McDONALD,AVERY CLINICAL PEDODONTICS-SIDNEY B. FINN
GOOGLE SEARCH ENGINE
During the 1950s, parents could get a series of sharp prongs known as "hay-rakes" cemented to a child's teeth to
discourage sucking.
The longer and harder a child sucks his thumb the more harm is done to the teeth and jaws. Regular, strong thumb sucking makes front teeth move and can even reshape the jaw bone. Upper front teeth flare out and tip upward while lower front teeth move back and inward. But, how can something as small as a child's thumb or finger actually move bone?
Children’s jaws are rich in blood supply and fairly low in mineral content like calcium. This makes jaws of children under age eight especially soft and flexible. As a result, prolonged thumb or finger sucking easily deforms the bone around the upper and lower front teeth. The deformity produces a hole or gap when teeth are brought together, known as an open bite.
If a child stops thumb sucking before loss of baby front teeth and arrival of adult front teeth, most or all of the damage may disappear. However, if the habit persists, there may be lasting damage. Flared upper teeth, delayed arrival of front teeth, and open bites are all common problems. This can result in chewing difficulties, speech abnormalities, and an unattractive smile.
The American Dental Association recommends:
Praise children for not sucking, instead of scolding them when they do.
If a child is sucking its thumb when feeling insecure or needing comfort, focus instead on correcting the cause of the
anxiety and provide comfort to your child.
If a child is sucking on its thumb because of boredom, try getting the child's attention with a fun activity.
Involve older children in the selection of a means to cease thumb sucking.
The pediatric dentist can offer encouragement to a child and explain what could happen to its teeth if it does not stop
sucking.
Only if these tips are ineffective, remind the child of its habit by bandaging the thumb or putting a sock/glove on the
hand at night.
Clinical studies have shown that appliances such as TGuards can be 90% effective in breaking the thumb or finger
sucking habit. Rather than use bitterants or piquants, which are not endorsed by the ADA due to their causing of
discomfort or pain, TGuards break the habit simply by removing the suction responsible for generating the feelings of
comfort and nurture.
How Can I Help My Child Quit Thumb-Sucking?
Should you need to help your child end his habit, follow these guidelines:
1. Always be supportive and positive. Instead of punishing your child for thumb-sucking, give praise when he doesn't suck.
2. Put a band-aid on his thumb or a sock over his hand at night. Let him know that this is not a punishment, just a way to help him remember to avoid sucking.
3. Start a progress chart and let him put a sticker up every day that he doesn't suck his thumb. If he makes it through a week without sucking, he gets to choose a prize (trip to the zoo, new set of blocks, etc.) When he has filled up a whole month reward him with something great (a ball glove or new video game); by then the habit should be over. Making your child an active participant in his treatment will increase his willingness to break the habit.
4. If you notice your child sucking when he's anxious, work on alleviating his anxiety rather than focusing on the thumb-sucking.
5. Take note of the times your child tends to suck (long car rides, while watching movies) and create diversions during these occasions.
6. Explain clearly what might happen to his teeth if he keeps sucking his thumb.