Habits and its management,thumb sucking 1 /certified fixed orthodontic courses by Indian dental academy

HABITS ANDHABITS AND
ITSITS
MANAGEMENMANAGEMEN
TTINDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

William James: An acquired habit, fromWilliam James: An acquired habit, from
psychological point of view, is nothing butpsychological point of view, is nothing but
a new pathway of discharge formed in thea new pathway of discharge formed in the
brain, by which certain incoming currentsbrain, by which certain incoming currents
ever after tend to escape.ever after tend to escape.
Moyers: Habits are learned pattern ofMoyers: Habits are learned pattern of
muscle contraction, which are complex inmuscle contraction, which are complex in
nature.nature.
Finn: A habit is an act, which is sociallyFinn: A habit is an act, which is socially
DefinitionsDefinitions::

According to William James:According to William James:
Useful habits:Useful habits:
These habits include the habits of normal functionThese habits include the habits of normal function
such as correct tongue posture, proper respirationsuch as correct tongue posture, proper respiration
etc.etc.
Harmful habits:Harmful habits:
These are the ones which exert stresses againstThese are the ones which exert stresses against
the teeth and dental arches such as mouththe teeth and dental arches such as mouth
breathing, lip sucking, thumbbreathing, lip sucking, thumb sucking.sucking.
Classification of habits

According to Finn and Sim:According to Finn and Sim:
Compulsive habitsCompulsive habits::
When the habit has acquired a fixation in theWhen the habit has acquired a fixation in the
child to the extent that he retreats to the practicechild to the extent that he retreats to the practice
of this habit whenever his security isof this habit whenever his security is
threatened.This is his safety valve whenthreatened.This is his safety valve when
emotional pressures become too much to copeemotional pressures become too much to cope
with.with.
Non-compulsive habitsNon-compulsive habits::
Habits which are easily dropped or addedHabits which are easily dropped or added
from the child behaviour pattern as he matures.from the child behaviour pattern as he matures.

Various habits are:Various habits are:
Thumb sucking/finger suckingThumb sucking/finger sucking
Tongue thrustingTongue thrusting
Mouth breathingMouth breathing
Lip biting and lip suckingLip biting and lip sucking
Postural habitsPostural habits
Nail bitingNail biting
Masochistic habitsMasochistic habits
Bobby pin openingBobby pin opening
Frenum thrustingFrenum thrusting
BruxismBruxism
Cheek biting/suckingCheek biting/sucking

Gellin: Defines digit suckingGellin: Defines digit sucking
as placement of thumb or oneas placement of thumb or one
or more fingers in variousor more fingers in various
depths into mouth.depths into mouth.
Moyers: Repeated andMoyers: Repeated and
forceful sucking of thumb withforceful sucking of thumb with
associated strong buccal andassociated strong buccal and
lip contractions.lip contractions.
Thumb sucking/finger sucking

Psychology of thumb suckingPsychology of thumb sucking
Freudian theoryFreudian theory:: He suggests that orality in the infantsHe suggests that orality in the infants
is related to pregenital organization and thus, the objectis related to pregenital organization and thus, the object
of thumb sucking is nursing. He believes that abruptof thumb sucking is nursing. He believes that abrupt
interference in such basic mechanism will likely lead tointerference in such basic mechanism will likely lead to
substitution of such antisocial tendency such assubstitution of such antisocial tendency such as
stuttering.stuttering.
Oral drive theory (Sears and Wise):Oral drive theory (Sears and Wise): He suggestsHe suggests
that the strength of oral drive is in part a function of howthat the strength of oral drive is in part a function of how
long a child continuous to feed by sucking. Thus it is notlong a child continuous to feed by sucking. Thus it is not
the frustration of weaning but, rather oral drive which hasthe frustration of weaning but, rather oral drive which has
been strengthened by the prolongation of nursing.been strengthened by the prolongation of nursing.

Benjamins theoryBenjamins theory:: He proposed two theories-He proposed two theories-
1.1. Thumb sucking is an expression of a need to suck thatThumb sucking is an expression of a need to suck that
arises because of association of sucking with primaryarises because of association of sucking with primary
reinforcing aspects of feeding.reinforcing aspects of feeding.
2.2. Thumb sucking arises from the rooting and placingThumb sucking arises from the rooting and placing
reflexes common to all mammalian infants.reflexes common to all mammalian infants.
A multidisciplinary research teamA multidisciplinary research team at theat the
university of Alberta support the theory that digitaluniversity of Alberta support the theory that digital
sucking habits in humans are simple learnedsucking habits in humans are simple learned
response.response.

Clinical aspects of digital sucking:Clinical aspects of digital sucking:
Prenatal/ antenatalPrenatal/ antenatal::
Shortly before the child passes throughShortly before the child passes through
the birth canal, the fetus shows increasedthe birth canal, the fetus shows increased
muscular activity and the thumb may findmuscular activity and the thumb may find
its way into the mouth, thus initiatingits way into the mouth, thus initiating
thumb sucking habit before birth. Thethumb sucking habit before birth. The
fetus seeks a ‘position of comfort’ whichfetus seeks a ‘position of comfort’ which
occasionally interferes with post nataloccasionally interferes with post natal
dentofacial development.dentofacial development.

Postnatal:Postnatal:
AA:: Finger sucking from birth to 4 yrs ofFinger sucking from birth to 4 yrs of
age:age:
Infants generally start sucking habit in theInfants generally start sucking habit in the
first three months of life, which may be duefirst three months of life, which may be due
to feeding problems, emotional stress withto feeding problems, emotional stress with
which they are unable to cope, insecuritywhich they are unable to cope, insecurity
and desire to attract attention.and desire to attract attention.
For the 1For the 1stst
4yrs of life damage to occlusion is4yrs of life damage to occlusion is
confined largely to the anterior segment.confined largely to the anterior segment.
The damage is temporary, provided theThe damage is temporary, provided the
child starts with normal occlusion.child starts with normal occlusion.
An exerciser or pacifier was developedAn exerciser or pacifier was developed
which is hoped to greatly reduce the needwhich is hoped to greatly reduce the need
and desire of the infant for thumb suckingand desire of the infant for thumb sucking
between meals and at bed time.between meals and at bed time.
e.g Nuk sauger nipple.e.g Nuk sauger nipple.
Edwall functional nursing nipple.Edwall functional nursing nipple.
Nuk sauger
nipple
Conventional nipplewww.indiandentalacademy.comwww.indiandentalacademy.com

B Active finger sucking after 4 yrs of ageB Active finger sucking after 4 yrs of age::
The permanence of malocclusion increases if the habitThe permanence of malocclusion increases if the habit
persists beyond 4 yrs of life.persists beyond 4 yrs of life.
Trident of habit factors:Trident of habit factors:
DURATIONDURATION
FREQUENCYFREQUENCY
INTENSITYINTENSITY
Duration: duration of sucking i.e hours per day of sucking,Duration: duration of sucking i.e hours per day of sucking,
plays a major role in tooth displacement.plays a major role in tooth displacement.
Frequency: frequency of habit during day and night affectsFrequency: frequency of habit during day and night affects
the end result.the end result.
Intensity: more the intensity of sucking more the perioralIntensity: more the intensity of sucking more the perioral
muscles function and more is the damage.muscles function and more is the damage.

Effect of thumb suckingEffect of thumb sucking
The of effect of sucking habitThe of effect of sucking habit
depends on:depends on:
Position of thumb in mouthPosition of thumb in mouth
Leverage effect the child gainsLeverage effect the child gains
against the other teeth and theagainst the other teeth and the
alveolus.alveolus.
Apposition of sucking finger onApposition of sucking finger on
the maxilla:the maxilla:
In case the finger rests on theIn case the finger rests on the
lower incisors as a fulcrumlower incisors as a fulcrum
Promotes the development ofPromotes the development of
class I, class II div Iclass I, class II div I
malocclusion.malocclusion.
Anterior open bite.Anterior open bite.
Protraction of maxillary anteriorProtraction of maxillary anterior
teeth.teeth.
Labial tipping of mandibularLabial tipping of mandibular
anterior teeth.anterior teeth. www.indiandentalacademy.comwww.indiandentalacademy.com

In case the finger rests on theIn case the finger rests on the
lower anteriors then linguallower anteriors then lingual
displacement of lower anteriors willdisplacement of lower anteriors will
occur.occur.
Vertical equilibrium is altered onVertical equilibrium is altered on
the posterior teeth leading to morethe posterior teeth leading to more
eruption of posterior teeth causingeruption of posterior teeth causing
open bite.open bite.
Arch form is affected due toArch form is affected due to
alteration in balance betweenalteration in balance between
cheek and tongue pressures i.echeek and tongue pressures i.e
maxillary arch tends to become v-maxillary arch tends to become v-
shaped.shaped.
Thumb sucking is associated withThumb sucking is associated with
tongue thrust to maintain thetongue thrust to maintain the
anterior seal.anterior seal.

Narrower nasal floor and high palatal vaultNarrower nasal floor and high palatal vault
Maxillary lip hypotonic and mandibular lipMaxillary lip hypotonic and mandibular lip
hyperactivehyperactive
Hyperactive mentalis muscleHyperactive mentalis muscle
In case the child bites on both its index fingers, itIn case the child bites on both its index fingers, it
leads to protrusion and open bite correspondingleads to protrusion and open bite corresponding
with the side in which the finger is being heldwith the side in which the finger is being held

Bilateral posterior crossbite as the posterior teeth areBilateral posterior crossbite as the posterior teeth are
forced palatally by the buccal musculature.forced palatally by the buccal musculature.
Apposition of finger sucking on the mandible:Apposition of finger sucking on the mandible:
In case the fingers are pressed on the lingual side of theIn case the fingers are pressed on the lingual side of the
mandibular alveolar process and lower anterior teeth-mandibular alveolar process and lower anterior teeth-
labial tipping of upper and lower incisors is due to forwardlabial tipping of upper and lower incisors is due to forward
and downward displacement of tongue.and downward displacement of tongue.

Can lead to class III malocclusion in which mandible jawCan lead to class III malocclusion in which mandible jaw
is pulled forward by fingersis pulled forward by fingers
Facial asymmetry may be causedFacial asymmetry may be caused
Line of occlusion is changedLine of occlusion is changed
Callus formation and low virus infection on fingers whichCallus formation and low virus infection on fingers which
is continuously been sucked.is continuously been sucked.

ManagementManagement
Most of the children discontinue their habit at the age ofMost of the children discontinue their habit at the age of
4yrs or by 5 yrs4yrs or by 5 yrs
No treatment is recommended as the malocclusion,ifNo treatment is recommended as the malocclusion,if
present, corrects itself as the habit ceasespresent, corrects itself as the habit ceases
Adult approach: As the time of eruption of the permanentAdult approach: As the time of eruption of the permanent
incisors approach, a straight forward discussion with aincisors approach, a straight forward discussion with a
dentist is recommendeddentist is recommended
Reminder therapy: a simple method is to secure anReminder therapy: a simple method is to secure an
adhesive bandage with waterproof tape on the finger that isadhesive bandage with waterproof tape on the finger that is
being sucked.being sucked.

If this fails then elastic bandage loosely wrapped around theIf this fails then elastic bandage loosely wrapped around the
elbow prevents the arm from flexing and finger from beingelbow prevents the arm from flexing and finger from being
sucked.sucked.
If this fails then the reminder appliance is fitted to activelyIf this fails then the reminder appliance is fitted to actively
impede finger sucking. eg ,crib, maxillary lingual arch withimpede finger sucking. eg ,crib, maxillary lingual arch with
crib etc.crib etc.
• Reward system: if the reminder therapy fails then reward
system is used in which small tangible reward daily for not
engaging in the habit.

Psychological approachPsychological approach:: Dunlop theory (betaDunlop theory (beta
hypothesis)-This theory states that by practicinghypothesis)-This theory states that by practicing
a bad habit with the intent to stop it, one learnsa bad habit with the intent to stop it, one learns
not to perform the undesirable act. The child willnot to perform the undesirable act. The child will
not derive any satisfaction from purposefulnot derive any satisfaction from purposeful
repetition of the habit but will experience arepetition of the habit but will experience a
painful reaction in its performance and willpainful reaction in its performance and will
gradually abandon the habit. This is applicablegradually abandon the habit. This is applicable
to older children whose cooperation can beto older children whose cooperation can be
obtained.obtained.
Chemical approachChemical approach: In this a hot flavored, bitter: In this a hot flavored, bitter
tasting or foul smelling preparations can betasting or foul smelling preparations can be
applied on the finger that is being sucked. e.gapplied on the finger that is being sucked. e.g
red pepper, quinine, asafetide.red pepper, quinine, asafetide.

Appliances usedAppliances used
Removable appliancesRemovable appliances::
Tongue spikesTongue spikes
Tongue cribTongue crib
Rake applianceRake appliance
Vestibular screenVestibular screen
Fixed appliancesFixed appliances
Hay rakeHay rake
Maxillary lingual archMaxillary lingual arch
with palatal cribwith palatal crib

A crib is a habit retrainingA crib is a habit retraining
appliance which utilizes a bluntappliance which utilizes a blunt
wire ‘reminder’ which preventswire ‘reminder’ which prevents
the child from indulging into thethe child from indulging into the
habit. It serves the followinghabit. It serves the following
functions:functions:
To break the suction and forceTo break the suction and force
on anterior segment.on anterior segment.
As a reminder.As a reminder.
Make the habit non pleasurable.Make the habit non pleasurable.
Forces the tongue backward,Forces the tongue backward,
changing the shape during restchanging the shape during rest
position from an elongatedposition from an elongated
mass to a more wider position,mass to a more wider position,
nearly like a normal tongue.nearly like a normal tongue.

A rake may be removableA rake may be removable
or fixed. It discourages notor fixed. It discourages not
only thumb sucking butonly thumb sucking but
tongue thrusting andtongue thrusting and
abnormal swallowing also.abnormal swallowing also.
Another appliance byAnother appliance by
Haskell and Mink called theHaskell and Mink called the
blue grass appliance wasblue grass appliance was
used to stop thumb sucking.used to stop thumb sucking.
In this a modified six sidedIn this a modified six sided
roller machine from teflonroller machine from teflon
was used.was used. www.indiandentalacademy.comwww.indiandentalacademy.com

Time of therapyTime of therapy
Check up appointments are made at 3-4 wkCheck up appointments are made at 3-4 wk
interval.interval.
Appliance to be worn for 4-6 months.Appliance to be worn for 4-6 months.
A period of 3 months of total absence ofA period of 3 months of total absence of
finger sucking is good insurance for relapse.finger sucking is good insurance for relapse.
The appliance is removed in parts i.e after 3The appliance is removed in parts i.e after 3
months of habit free interval the spurs aremonths of habit free interval the spurs are
cut off,3 wks later posterior loop extensioncut off,3 wks later posterior loop extension
is cut and 3 wks later palatal bar and crownis cut and 3 wks later palatal bar and crown
may be removed.may be removed.

Thank youThank you
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Habits and its management,thumb sucking 1 /certified fixed orthodontic courses by Indian dental academy

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