Breaking your child's Thumb-sucking habit
Thumbsucking is a common habit of preschool children. The
activity is normal for infants and toddlers, but should decrease by ages three to four and
stop by age five. Unfortunately, many youngsters can't break the habit by this time. Is
parental anxiety over thumbsucking warranted?
Thumbsucking is a very normal response to anxiety and stress and does not point
to insecurity or emotional problems in your child. Most children give up thumbsucking by
age four, when some children continue to suck their thumbs as a means of exerting
independence. Aside from some minor problems with thumb and fingernail infections, the
most damage from thumbsucking occurs to the teeth and jaw.
A well-known pediatrician recently stated on television that continued sucking
of thumbs or fingers does not cause serious dental problems in children and is not cause
for parental alarm. Wrong! In fact, prolonged thumb activity produces significant problems
with chewing, speech, and facial appearance.
The pleasure in the habit is derived from the contact of skin of thumb with oral mucous
membrane. Thumb sucking also creates an intense negative pressure in oral cavity/mouth which
has detrimental effects on over all development of facial area and narrowing of dental arches. These effects
can last life long because the cheek muscles become hyperactive due to over action. BUT
there is NO cause for worry, if the kid stops the habit before the age of 4-5 years.
Not all thumb sucking causes equal harm, three factors affect the outcome of damage. These are
Duration, Intensity and Frequency of the habit. Higher the three, higher will be damage to teeth.
Effects on the jawbone
The more time a child sucks his thumb and the greater the sucking pressure, the
more harm done to teeth and jaws. Day and night forceful thumbsucking makes front teeth
move, and can even reshape the jaw bone. Upper front teeth flare out and tip upward while
lower front teeth move inward. But, how can something as small as a child's thumb or
finger effectively move bone?
The reason that thumbs and fingers are effective tooth-movers and bone shapers
is that the jaw bones of children under age eight are especially soft and malleable.
Children have upper and lower jaws rich in blood supply and relatively low in mineral
content, especially calcium. Unfortunately for children and parents, prolonged thumb or
finger sucking easily deforms the bone surrounding upper and lower front teeth, producing
a hole or gap when teeth are brought together known as an "open bite".
If a child stops thumbsucking before loss of baby front teeth and permanent
front tooth eruption, most or all harmful effects disappear within six months. However, if
the habit persists through permanent front tooth eruption, there can be lasting damage:
flared or protruded upper teeth, delayed eruption of upper or lower front teeth, and the
aforementioned open bite. This can result in chewing difficulties, speech abnormalities,
and an unattractive smile.
Do home remedies work?
Some parents try home remedies to break the habit. Some try placing gloves on
their children before bedtime. Others paint thumbs and fingers with various foul-tasting
substances, while still others wrap bandages around the offending digits. Yet all of these
measures are typically easy to overcome and are usually unsuccessful, because thumbsucking
is a deeply ingrained behavior. One method which might help is to tie/roll a used x ray
film on the elbow of the child so that child can not bend the hand. You can tape the edges
of the film of avoid sharp ends. Any method will work only if child agrees to cooperate.
You should repeatedly educate/motivate the kid that his face will look bad. The kid can also be
asked to coinciously suck thumb sitting in front of a mirror daily for few minutes, this is a biofeedback technique
which has been found to be useful.
It is very important not to get obsessed with this matter, overdoing also will hut the kid, gentle and
consistent approach is needed. It would be considered safe not to initiate any steps until 3 years. Once kid
understands your obsession he can also use this as an ATTENTION drawing technique.
It has been found that kids who are breast fed are less likely to take to thumb sucking.
The dental solution: a crib that's not for sleeping
One answer to this parental dilemma is a simple device called a
"crib." Placed by an orthodontist on the child's upper teeth, the crib usually
stops the habit cold the first day of use.
The appliance's technical name is a "fixed palatal crib," and is a
type of brace that sits full-time on the upper teeth and the roof of the mouth. The crib
consists of semicircular stainless steel wires connected to supporting steel bands or
rings. The half-circle of wires fits behind the child's upper front teeth, barely visible
in normal view. The bands are fastened to the baby upper second molars. There are a number
of different crib designs used by orthodontists, all variations on the same theme.
The first step for parents is to make an appointment for their child with an
orthodontist. At the initial visit, the doctor examines the child for problems with tooth
position and bite. The teeth of confirmed thumbsuckers have the tell-tale pattern
described above, and the doctor will ask about any habit history. With a diagnosis of
intractable thumbsucking, the orthodontist will usually recommend a crib to eliminate the
habit. A second appointment is then arranged, where clay impressions are made for plaster
study models, together with facial and dental photographs and jaw x-rays.
The orthodontist begins crib construction at the third visit, and cements the
appliance at the fourth. The child experiences soreness of upper back teeth for a few
hours, and modified speech for one or two days. Instructions are given on avoiding gum
chewing, hard and sticky candy, popcorn, peanuts and other brace-destroying foods. The
patient is asked to not pull on the crib with fingers. Thorough toothbrushing after each
meal is stressed to prevent food and plaque build-up and gum infections or cavities.
Once the crib is cemented, there is nothing to adjust and no moving or
removable parts. It is one of the simplest, yet most effective orthodontic devices.
Fearsome looking open bites, on the order of 8 to 10 millimeters, can close within a few
months. And at $250-$350 per crib, the price is not too prohibitive, given the amount of
future dental problems that are averted.
Effectiveness of the crib
Why is the crib so effective in stopping thumbsucking? Simply because it takes
away the habit's gratification. Crib wires prevent the thumb or finger from touching the
gums behind the front teeth and on the palate (roof of the mouth), turning a pleasant
experience into an unpleasant one. Deriving no satisfaction from the activity, the child
has no incentive to continue.
Parents should know that the child with a newly placed crib will have a
nonrestful first night's sleep. A child who is accustomed to thumb-provided security will
be very unhappy the first night or so. Be sure to offer lots of tender loving care, words
of support, and congratulations so as to provide a smooth, nontraumatic transition.
After crib placement, the patient is checked in two to four weeks, and then
seen every one to two months until the appliance is removed. These visits are short, and
not painful. In cases where hard or sticky foods have loosened the bands, recementation
may be necessary. Avoidance of the offending foods should eliminate this annoyance.
How long does it take?
Improvement in front tooth position is typically noted within two weeks after
crib placement. It takes four to six months for the open bit to close and the front teeth
to straighten. However, the brace is left on nine to 12 months, a sufficient time for the
habit to be a distant memory and relapse potential minimal.
What is a good age to begin crib treatment? The ideal time is when upper front
baby teeth become loose, just prior to eruption of adult or permanent front teeth. This
usually occurs just before or after age six. Prompt thumb removal at this time allows
permanent teeth to assume a much better position than waiting until their full eruption to
break the habit.
Thumb, finger or blanket sucking may be noted in pre-teens, teen- agers and
even adults. Despite the age differences, the initial orthodontic treatment is the same
for all: placement of a crib to break the habit. For teens and adults, counselling may be
indicated to deal with any underlying psychological problems.
Dental health is certainly important to a child's well-being. So is parental
peace of mind. For the thumbsucking patient, the orthodontic crib provides the answer to
both.
To Read a beautiful book on this topic CLICK HERE
Resources
Bergersen, E.O. "Preventive eruption guidance in the 5- to 7- year old."
Journal Clinical Orthodontics, vol. 29, pp. 382-85, 1995.
Gawlik, J.A., Oh, N.W., Mathieu, G.P. "Modifications of the palatal crib habit
breaker appliance to prevent palatal soft tissue embedment." ASCD Journal Dentistry
Children, vol. 62, pp. 409-11, 1995.
Josell, S.D. "Habits affecting dental and maxillofacial growth and
development." Dental Clinics North America, vol. 39, pp. 851-60, 1995.
Rosenberg, M.D. "Thumbsucking." Pediatrics in Review, vol. 16, pp. 73-91,
1995.
American Academy of Pediatric Dentistry
+1-312-337-2169
http://www.aapd.org
"Thumbsucking"
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