Few of my friends have been asking about the different oral habits assosciated with children. As there is a wide array of oral habits we will discuss few in details .
• Today we are gonna discuss about Thumb sucking .
• Thumb sucking and finger sucking can more generally be termed as digital sucking .A broader category of sucking habits includes any form of non nutritive sucking that include pacifiers ,hairs etc.
• Thumb Sucking can be a Normal or Abnormal , Psychological or Habitual .
• Normal Thumb sucking habit is considered normal during the first and second year of life .As the child matures it will disapper as well .The habit at this age doesn’t produce any mal occlusion (mal occlusion means imperfect positioning of teeth when the jaws are closed )
• Abnormal : persists beyond the preschool period .It can cause deleterious effects to the dentofacial structures .
• Psychological : Have deep rooted emotional factor involved .Associated with insecurities ,neglect or loneliness experienced by the child .
• Habitual : Doesn’t have a psychological backing .This is a cause for concern due to its potential to cause mal occlusion .
There is a term that needs to be addressed along with this topic .
THE SUCKING REFLEX
• The process of sucking is a reflex occurring in the oral stage of development and is seen even at 29 weeks of i.u and may disappear during normal growth between the ages of 1 and 3 ½ years.
• IT IS THE FIRST COORDINATED MUSCULAR ACTIVITY OF THE INFANT .
There has been several theories trying to explain the psychology behind thumbsucking viz Classical Freudian theory ,The learning theory by Davidson ,Oral Drive theory by Sears and wise ,Johnson and Larson etc .
So we will jump directly to the commonly observed Clinical problems .
1. Maxillary Anterior proclination and Mandibular Anterior retroclination :
• Maxillary means Upper jaw , Anterior means the front teeth and proclination is teeth being inclined forward .
• Mandibular means lower jaw ,Anterios means the fron teeth and retroclination means tooth being pushed backwards toward tongue
2. The Anterior open bite :
• There will be a space between upper and lower front teeth and no contact will be there
3. Constriction of Maxillary arch :
Due to the placement of thumb between the teeth ,the tongue must be lowered ,the cheek pressure against the teeth is increased which causes the upper jaw arch to become V shaped .
4. Posterior cross bite :
Posterior tooth means Back side tooth . Crossbite is lateral mis alignment of dental arches .
How do we prevent ?
1. Motive based Approach – find the cause !
2. Child’s engagement in various activities
3. Parent’s Involvement in prevention – advised to spend ample time with the child so that child doesn’t feel insecure .Soothing music and bed time stories are also effective .
4. Duration of Breast feeding – Should be adequate to enable the child to exhaust his sucking urge .
5. Mothers Presence and attention during bottle feeding .
6. Use of a psychological nipple
7. Use of a dummy or pacifier
1. Psychological therapy:
• Screen the patient for the underlying psychological disturbances that sustain a thumb sucking habit.
• Once the psychological dependence is suspected, child is referred to professionals for counselling
• Thumb sucking children between the ages of 4 and 8 years of age need only reassurance ,positive enforcement and friendy reminders.
2. Reminder Therapy
i. Extra oral approaches : It employs Hot tasting ,bitter flavoured preparations or distasteful agents applied to finger or thumbs eg : Cayene pepper ,quinine ,asafoetida – effective only when habit is not firmly entrenched . Thermoplastic thumb post is another method .6 weeks of treat ment time is must
ii. Intraoral approaches – Various orthodontic appliances – Removable appliances like Palatal crib ,rakes ,arch ,lingual spurs ,Hawleys retainer with and without spurs . Fixed ones such as Upper lingual tongue screens .
3. Mechano therapy : Fixed Intra oral and thumb sucking appliance
4. Blue grass appliance and Quad helix .
Recent advances include Thumbsucking Silicone thumb sucking stop Guard protector ,electronic habit reminder (extra oral )
1. Shobha Tandon ,Text book of pedodontics