Digit-Sucking (Thumb/ Finger-Sucking)

One of the commonest oral habits is sucking, a reflex present at birth. Developing an oral habit is considered a natural phenomenon in children upto a certain age. It is a sign of natural growth and development of a child which stops without any intervention. But, the duration, frequency and intensity of these natural habits, if continue for longer, can alter normal development of oral and facial anatomy. Sucking habits could be nutritive (breast and bottle feeding) or non-nutritive. The commonest form of non-nutritive sucking (NNS) is digit sucking.

The habit of digit-sucking can alter normal occlusion of the child leading to aesthetic and functional discrepancies such as non-aligned eruption of front teeth. Though, digit-sucking is a pacifying and satisfying habit which soothes children but also has ill-effects, especially on dentition.

Definition-

Repeated and forceful sucking of thumb (digit) with associated strong buccal and lip contractions (Moyers).

  • Displacement of front teeth leading to proclined upper incisors.
  • Lower front teeth are tipped back on the lingual side.
  • Increased length of tooth that is visible in the oral cavity.
  • Spacing between teeth is also increased (Diastema).
  • Gap between upper and lower front teeth when closing mouth.
  • Upper jaw becomes narrow and does not fit properly with the lower jaw.
  • Speech problems may also occur like difficulty in pronouncing ‘S’.
  • Physical problems like nail infections, sore digit skin etc.
  • Incompetent lips closure.
  • Hyperactive lower lip due to increased movement of facial muscle (Orbicularis Oris).

Digit-sucking starts as a natural part of the development process. It makes babies feel satisfied and may also help them to feel secure and fall asleep.

Miscellaneous causes can be:

  • Insecurity and stress.
  • Child-abuse.
  • Peer relationship and poor performance in school.
  • Deprivation of love and care by care takers.

Stages of Digit-Sucking

As per Moyers, there are three stages of digit-sucking:

Stage 1- Develops as a part of natural growth process.

Stage 2- Clinically significant and continues up to seven years of age. There may also be need of corrective program.

Stage 3- This causes malocclusion in child and orthodontic treatment may also be required.

History- Frequency, duration and intensity of the digit-sucking is inquired from parents.

Along with this child’s emotional status is also considered.

Extra-oral examination- Redness of digit, short nails, cleaner digit as compared to other digits, shorter upper lip, mouth breathing, enlarged nostrils, rough and deformed digit.

Intra-oral examination- All the clinical features discussed previously are examined.

Psychological therapy-

It consists of counselling of parents to give adequate love, care and affection. Giving rewards and praising child in return of a good behavior.

Child should be motivated by care givers and dentist, if needed.

Child is made conscious about the habit like make the child sit in front of a mirror while exercising digit-sucking habit. Give the child some activity that he/she enjoys which conflicts with the habit of digit-sucking. This way child may learn to stop the habit when done on repetitive basis.

Reminder therapy-

This therapy is best when child is willing to stop and is more than seven years of age, but cannot do so as the habit is now performed subconsciously. A reminder like,

  • Taping the digit may act as first reminder.
  • Tightening the bandage on elbow so that child feels it while bending the elbow.
  • An appliance (removable or fixed, for example, crib) can help a child to get rid of the habit.

Chemical therapy-

Covering the digit with a distasteful preparation like pepper solution, quinine and asafoetida will not allow child to put thumb or finger in the mouth.

Mechanical therapy-

Mechanical restraints applied to the hand and digits like splints, adhesives, tapes.

Appliance therapy-

Various orthodontic appliances are employed to break the habit.

  • Removable appliances- Tongue spikes, Tongue guards, Spurs.

Fixed appliances-  -Quad helix, Hay rakes, Maxillary lingual arch with palatal crib.

Prevention of thumb sucking is based on:

  1. Motive based approach: Prevention should be directed towards the motive behind the habit. The etiology of thumb sucking focuses mainly on a psychological background.
  2. Child engagement in various activities: Parents should be counseled on keeping the child engaged.
  3. Parents involved in prevention: Parents should be advised to spend ample time with the child so that they feel secure.
  4. Duration of breast feeding: Duration of feeding should be adequate so that the child feels completely satisfied.
  5. Mother’s presence and attention during bottle feeding: Enough attention should be paid by mother, similar to that in breast feeding, if child is on bottle feeding.

 

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745967/.

https://epdf.pub/queue/textbook-of-orthodontics.html (gurkeerat singh)

https://www.webmd.com/baby/features/breaking-thumb-sucking-habit#2

https://orthodonticsaustralia.org.au/thumb-sucking-concerns/

https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/thumb-sucking/art-20047038

https://www.mouthhealthy.org/en/az-topics/t/thumbsucking

  • PUBLISHED DATE : Sep 04, 2019
  • PUBLISHED BY : NHP Admin
  • CREATED / VALIDATED BY : NHP Admin
  • LAST UPDATED ON : Sep 04, 2019

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