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

HABITS AND
ITS
MANAGEMEN
T
www.indiandentalacademy.com

INDIAN DENTAL ACADEMY
Leader in continuing dental education


Definitions:

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

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

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

Various habits are:
Thumb sucking/finger sucking
Tongue thrusting
Mouth breathing
Lip biting and lip sucking
Postural habits
Nail biting
Masochistic habits
Bobby pin opening
Frenum thrusting
Bruxism
Cheek biting/sucking

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

Psychology of thumb sucking
Freudian theory: He suggests that orality in the infants
is related to pregenital organization and thus, the object
of thumb sucking is nursing. He believes that abrupt
interference in such basic mechanism will likely lead to
substitution of such antisocial tendency such as
stuttering.

Oral drive theory (Sears and Wise): He suggests

that the strength of oral drive is in part a function of how
long a child continuous to feed by sucking. Thus it is not
the frustration of weaning but, rather oral drive which has
been strengthened by the prolongation of nursing.

Benjamins theory: He proposed two theories1.

2.

Thumb sucking is an expression of a need to suck that
arises because of association of sucking with primary
reinforcing aspects of feeding.
Thumb sucking arises from the rooting and placing
reflexes common to all mammalian infants.

A multidisciplinary research team at the
university of Alberta support the theory that digital
sucking habits in humans are simple learned
response.


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

Postnatal:
A: Finger sucking from birth to 4 yrs of
age:

Infants generally start sucking habit in the
first three months of life, which may be due
to feeding problems, emotional stress with
which they are unable to cope, insecurity
and desire to attract attention.
For the 1st 4yrs of life damage to occlusion is
confined largely to the anterior segment.
The damage is temporary, provided the
child starts with normal occlusion.
An exerciser or pacifier was developed
which is hoped to greatly reduce the need
and desire of the infant for thumb sucking
between meals and at bed time.
e.g Nuk sauger nipple.
Edwall functional nursing nipple.

Nuk sauger
nipple

Conventional nipple

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

Effect of thumb sucking
The of effect of sucking habit
depends on:
Position of thumb in mouth
Leverage effect the child gains
against the other teeth and the
alveolus.
Apposition of sucking finger on
the maxilla:
In case the finger rests on the
lower incisors as a fulcrum
Promotes the development of
class I, class II div I
malocclusion.
Anterior open bite.
Protraction of maxillary anterior
teeth.
Labial tipping of mandibular
anterior teeth.

In case the finger rests on the
lower anteriors then lingual
displacement of lower anteriors will
occur.
Vertical equilibrium is altered on
the posterior teeth leading to more
eruption of posterior teeth causing
open bite.
Arch form is affected due to
alteration in balance between
cheek and tongue pressures i.e
maxillary arch tends to become vshaped.
Thumb sucking is associated with
tongue thrust to maintain the
anterior seal.

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


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


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


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

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


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

Appliances used
Removable appliances:
Tongue spikes
Tongue crib
Rake appliance
Vestibular screen
Fixed appliances
Hay rake
Maxillary lingual arch
with palatal crib

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

A rake may be removable
or fixed. It discourages not
only thumb sucking but
tongue thrusting and
abnormal swallowing also.
Another appliance by
Haskell and Mink called the
blue grass appliance was
used to stop thumb sucking.
In this a modified six sided
roller machine from teflon
was used.

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

Thank you
Leader in continuing dental education


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

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