Dr Saba Qureshi discusses the impact of thumb sucking on teeth, how dentists can help patients break sucking habits, and the complex treatment that might be necessary.
Non-nutritive sucking habits are common in babies and young children. This is regardless of socioeconomic background, as they do it for security and to comfort themselves.
These can include the use of dummies, sucking of fingers, thumbs or even blankets.
The prevalence of these habits is greater in girls than boys.
In addition, they tend to reduce with age from a reported 30% at one year of age to 12% at nine years of age. At 12 years of age it reduces to two percent because it becomes less socially acceptable.
The good news is that most non-nutritive sucking habits cease spontaneously by the age of four.
However, the dentoavleolar and skeletal effects of such habits will depend very much upon their frequency, intensity, and duration.
We’ve all seen the effects that prolonged digit-sucking habits can have on the developing dentition:
- Proclined maxillary incisors
- Increased overjet
- Retroclined mandibular incisors
- Posterior crossbite
- Anterior open bite
- Upper anterior spacing.
Prolonged sucking habits
But the real question is…what is ‘prolonged’? How long is too long?
Studies show that there is spontaneous correction of the dental effects of digit sucking habits. However, this is provided it stops by the age of six years old.
Therefore, the magic cut off age is seven. After this, the position of the adult dentition is permanently affected and self-correction is less likely to take place.
As dental health professionals who see our patients on a regular basis, we are ideally positioned to intervene and encourage cessation early to reduce the deleterious effects of prolonged non-nutritive sucking habits.
So, how do we do this?
There are two approaches that can be used separately or in conjunction with each other. These are non-orthodontic and orthodontic interventions.
- Consider using a dummy for younger children as it tends to be easier to phase out than a thumb-sucking habit
- Lots of encouragement and positive reinforcement perhaps with small rewards for milestones reached. Reward charts are available from many retailers, like the Early Learning Centre. Parents may find the use of such adjuncts helpful
- Physical barriers come in a multitude of shapes and sizes. Plasters, gloves, and thumb guards can benefit those who find themselves subconsciously placing thumbs or other fingers in their mouths
- Chemical deterrents, like Stop n Grow, have a bitter taste. As a result, they have been shown to be an effective deterrent in cases on thumb sucking and nail biting.
Most of these methods are cost-effective and easily accessible to the public. Therefore, they can be very useful in the battle against non-nutritive sucking habits. However, they are still reliant on patient compliance.
If non-orthodontic interventions are unsuccessful, fitting patients with a habit breaker may well be the answer. Particularly in the 7-12 year age bracket when such appliances will be better tolerated.
- Removable habit breakers can be used to discourage digit habits. The design tends to comprise of an acrylic base plate and retentive components, with a metal protuberance embedded in the acrylic hanging vertically down from the palate. These prevent patients from being able to place digits in their mouths comfortably. Their biggest flaw is that they are removable, so again, they rely on patient co-operation
- Fixed habit breakers may be the best option for patients who are struggling to break a digit habit. They can be of a similar design to the removable habit breakers, or perhaps a quadhelix, which can be used as an adjunct to comprehensive orthodontic treatment. Once fitted, fixed habit breakers should remain in situ for a minimum of six months to allow for maximum dental and vertical skeletal correction.
If non-nutritive sucking habits continue past 12 years of age, treatment becomes far more complex. This is because the permanent dentition is fully established and tooth eruption complete.
Such cases may require a combination of orthodontics and orthognathic surgery for ultimate correction of both dental and skeletal aspects of the resulting malocclusion.
Therefore, given the impact that digit habits can have for our patients, it should be a big thumbs up to helping our patients put their thumbs down.
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