Oral habits are considered as part of the normal human development, however, if these habits are continued for prolonged duration, the development of oral & facial structures could be severely affected.
Oral habits are defined as the habits that are frequently acquired by children that may permanently or temporarily be harmful to the development of dental occlusion & to the supporting oral structures. When the oral habits cause certain defects in the development of the facial &/or oral structures, it is called as Pernicious Oral Habit.
One of the most common oral habits being practised by children is thumb/digit sucking habit. Thumb/Finger Sucking is defined as the placement of the thumb/finger at various depths into the mouth. This habit is usually seen at 29 weeks of intrauterine life and then disappears around the age of 3.5 years. If this habit persists after at the age of 3.5 years, this habit is considered as abnormal.
Before we discuss about the ways to get rid of this oral habit, it is important to understand the reasons why your children like to suck their thumb/finger so much. The motivating factors behind thumb/finger sucking habit are discussed below:
- Number Of Siblings In The Family.
- Those children with a lot of siblings are not able to get adequate attention from their parents, these children may attempt to compensate their feelings of insecurity by means of this habit.
- Feeding Practices.
- Habit of thumb/finger sucking is usually seen in children with breast feeding.
- Working Mother.
- When mother is not around, their children may feel insecure. These children tend to suck their thumb/finger to obtain the feeling of security.
- Social Adjustment & Stress.
- Scolding parents may cause a psychological effect to their children. This could indirectly induce the habit of sucking thumb/finger in the children.
- Parent’s Occupation.
- Parents with low socio-economic income could not feed their children adequately, thus causing the children to suck their thumb/finger to relieve the sense of hunger.
- Order Of Birth Of The Child.
- The younger children often try to imitate their elder siblings who suck their thumb/finger. This may cause a stagnation of this habit.
What Are The Adverse Effects Caused By Thumb/Finger Sucking Habit?
The habit of sucking thumb/finger has caused a lot of problem to the development of the oro-facial structures of the children. Besides that, the thumb/fingers that are being sucked frequently could be deformed as well. The adverse effects caused by the habit of sucking thumb/finger are included below:
- Thumb/Fingers That Are Being Sucked
- The thumb/fingers involved are red, very clean, chapped and have a short finger nail as compared to normal fingers.
- Fibrous, roughened callus on superior aspect of the thumb/fingers that have been sucked for long duration.
- Deformation of the involved thumb/fingers may be seen.
- Lip
- Upper lip may appear shorter and hypotonic.
- Lower lip may appear hyperactive.
- Anterior Proclination Of Maxilla (Forward Position Of Upper Jaw) & Retroclination Of Mandible (Backward Position Of Lower Jaw)
- When the thumb/fingers are put on the palate, the thumb/fingers are applying a direct pressure to the front teeth of both upper and lower jaws. This results in the development of malocclusion.
- Anterior Open Bite
- Thumb/fingers that are being sucked could disturb the path of eruption of the anterior (front) teeth. Separation of the jaws then causes excessive eruption of posterior teeth. All of these factors result in the development of anterior open bite.
- Constriction Of Maxillary (Upper) Dental Arch
- When thumb/fingers are placed into the mouth, the balance between buccinators muscle and tongue are disturbed. This results in the constriction of maxillary arch.
- Posterior Cross Bite
- Posterior cross bite occurs as a consequence of the constriction of maxillary arch.
- Convex Facial Profile
The adverse effects caused by the habits of sucking thumb/fingers should not be overlooked. Before these adverse effects happen, the parents should try to break/stop these oral habits. If the adverse effects as discussed above have already occurred in the children, most probably the children have to go for Orthodontic Treatment in order to correct the dental malocclusion.
The parents play a very essential role in the prevention of thumb/fingers sucking habits in their children before it is too late. Some of the methods that could be used by the parents to prevent their children from developing the thumb/finger sucking habits are discussed below.
- Motive Based Approach.
- In this approach, the prevention of thumb/finger sucking habit is directed towards the motive behind the habit.
- Engaging your children in various activities.
- Keep your child engaged in certain activities so that your child does’t have the chance to practise thumb/fingers sucking.
- The child should be encouraged to follow his/her hobbies of interest such as sketching.
- Parents involvement in the prevention of this habit.
- Parent should spend more time with their children. This could prevent the development of insecurity feelings in the children, thus preventing the development of thumb/finger sucking habit.
- Duration of breast-feeding.
- Duration of breast-feeding the infants should be enough so as to enable the child to exhaust his/her sucking urge & thus feel completely satisfied.
- Use of physiological nipple, dummy or pacifier.
- The development of digit sucking habit can be prevented by encouraging the baby to suck a physiological nipple/ dummy/ pacifier instead.
- These physiological nipple, dummy or pacifier are easier to dispense with at an earlier age than is thumb/finger sucking.
What Are The Treatment Options Available For The Developed Thumb/Finger Sucking Habits?
If the child has already developed the habit of sucking thumb/fingers, treatments must be given to the children in order to break these harmful habits. The treatment options could be divided into the following:
- Psychological Therapy:
- If psychological dependence is suspected, the child should be referred to professionals for counselling.
- Reassurance, positive reinforcement and friendly reminders should be provided to the child.
- Adequate emotional support should be given to the child.
- Constant reassurance and encouragement should be provided to the patient to gain his/her confidence.
- Use of positive behaviour modification techniques. When the habit is discontinued, the child should be rewarded.
- Avoid destructive approaches such as shamming and nagging.
- Reminder Therapy:
- Extra-oral approaches:
- Apply bitter flavoured, hot tasting or distasteful agents to fingers &/or thumbs. Example of these agents include pepper & quinine. This could prevent the children from sucking their thumbs/fingers.
- Ace bandage approach. This approach involves the use of an elastic bandage wrapped around the elbow when the children is going to sleep. The bandage exerts pressure which then results in the removal of the digits from the mouth when the children fall asleep.
- Wear a long-sleeve shirt when the children are going to sleep. Long sleeves shirt could interfere with the contact of the thumbs/fingers and the mouth, thus preventing the digit sucking habit.
- Intra-oral approaches:
- Various orthodontic appliances could be used to break the digit sucking habit.
- Orthodontic appliances that are commonly used for this purpose include Hawley’s appliances, palatal crib , rakes, and upper lingual tongue screens.
- Extra-oral approaches:
- Mechanical therapy:
- Use of Blue Grass Appliance.
- Use of Fixed Intra-oral Anti Thumb Sucking Appliance.
- Use of Quad Helix Appliance.
Please be noted that the dental appliances stated above should be prescribed by qualified dentists or dental specialists (such as pedodontist and orthodontist). When you are in doubt, always bring your children to visit the dentists for consultation.
Article written by,
Dr. Wong Kee Cheong (Tommy)
Dental Surgeon
BDS (AIMST), MBA (SEGi), YCDP