m



m


is defined as placement of the
thumb or one or more fingers in varying depths into
the mouth. Thumb and digit sucking is one of the
commonly seen habits that most children indulge in.
Recent studies have shown that 



may be practiced even during intra uterine life. The

presence of this habit is considered quite normal till
the age of 3-
3-4 years. Persistence of the habit
beyond this age can lead to various malocclusions.
 |tiology

A number of theories have been put

forward to explain why 



occurs. The following are some of the

more accepted ones:
—reudian theory: This theory was proposed by
Sigmond —reud in the early part of this century.
He suggested that a child passes through
various distinct phases of psychological
development of which the oral and the anal
phases are seen in the first three year of life. In
the oral phase, the mouth is believed to be an
oro--erotic & zone. The child has the tendency to
oro
place his fingers or any other object into the oral
cavity. Prevention of such an act is believed to
result in emotional insecurity and poses the risk
of the child diversifying into other habits.
ral drive theory of Sears and wise: Sears
and wise in 1950 proposed that prolonged
suckling can lead to 


.



.
ðenjamin¶s theory: ðenjamin has
suggested that 


arises
from the rooting or placing reflex seen in
all mammalin infant. Rooting reflex is the
movement of the infant¶s head and tongue
towards an object touching his cheek. The
object is usually the mother¶s breast but
may also be a finger or a pacifier. This
rooting reflex disappears in normal infants
around 7 - 8 months of age.
Psychological aspects: Children deprived
of parental love, care and affection are
believed to resort to this habit due to a
feeling of insecurity.
Learned pattern: According to some
authors, 


is merely a
learned pattern with no underlying cause
or psychological bearing.
 Phases of development
Phase I: (Normal and Sub-
Sub-clinically significant). The first
phase is seen during the first three years of life. The
presence of 


during this phase is
considered quite normal and usually terminates at the
end of phase one.
Phase II: (Clinically Significant Sucking): The second
phase extends between 3- 3-6 years of age. The presence
of 


during this period is an indication that
the child is under great anxiety. Treatment to solve the
dental problems should be initiated during this Phase.
Phase III: (Intractable Sucking) : Any 



persisting beyond the fourth or fifth year of life should

alert the dentist to the underlying psychological aspects
of the habit. A psychologist might have to be consulted
during this phase.
 |ffects of thumb sucking
Thumb and digit sucking are believed to
cause a number of changes in the dental
arch and the supporting structures. The
severity of the malocclusion caused by



depends on the trident of
factors. They are:
a. Duration: The amount of time spent
indulging in the habit.
b. —requency: The number of times the
habit is activated in a day.
c. Intensity: The vigor with which the habit
is performed

The following are some of the effects

of 
 

:
Labial tipping of the maxillary anterior teeth resulting in
proclination of maxillary anteriors.
b. The overjet increases due to proclination of the
maxillary anteriors.
Some children rest their hand on the mandibular anterior
during the 


act. In such children lingual
tipping of the mandibular incisors can be expected which
further increases the overjet.
d. Anterior open bite can occur as a result of restriction
of incisor eruption and supraeruption of the buccal teeth.
e. The cheek muscles contract during 



resulting in a narrow maxillary arch which predisposes to

posterior cross bites.
f. The child may develop tongue thrust habit as a result
of the open bite.
g. The upper lip is generally hypnotic while the
lower part of the face exhibits hyperactive
mentalis activity.
The parents should be questioned on the
frequency and duration of the habit. The child¶s
emotional status should be assessed by
enquring into such things as:
a. —eeding habits
b. Parental care of the child
c. Whether the parents are working
An intra-
intra-oral clinical examination should record
all the features seen such as proclination, open
bite etc. The child¶s fingers should be examined.
Presence of clean nails and callus on the finger
is commonly associated with 


.



.
anagement of 



  
 

  
  
   
  m
   


   

  m   

      

 
   
m 
    


  
  


  

  
 



 m
     
 
  
echanical aids: They are basically reminding
aliances that assist the child who is willing to quit
the habit but is not able to do so as the habit has
entered a subconscious level. These appliances
usually consist of a crib placed palatal to the
maxillary incisors. Habit breakers can be of two
types:
a) Removable habit breakers : They are passive
removable appliances that consist of a crib and
is anchored to the oral cavity by means of clasps
on the posterior teeth.
b) —ixed habit breakers : Heavy gauge stainless
steel wire can be designed to form a frame that
is soldered to bands on the molars.
ther aids that can be used to intercept the



habit include bandaging
the thumb, and bandaging of the elbow.
Chemical approach: Use of bitter tasting or
foul smelling preparation placed on the
thumb that is sucked can make the 



habit distasteful. The
medicaments that can be used include:
a. Pepper dissolved in a volatile medium.
b. Quinine
c. Asfetida
 O
m  m mO
!"
#  



 

Parents usually start to worry too early, about how to stop thumb
sucking habit of their children. It is advised that you do not try to
make a child to stop thumb sucking before the age of four (unless
you notice a problem to teeth due to vigorous thumbsucking)
because it might have the opposite results.

Usually children stop the habit on their own, by that age. If they don't,
here are some easy ways to get kids to stop thumbsucking :
Öeep the child's hands occupied with a toy,
puzzle or other activity.

Carefully remove your child's thumb from his or

her mouth during sleep

Give the example of his friends that have

managed to stop thumbsucking.
Don't put the child in a state of anxiety or fear. If
the child has any emotional problems, or is
under stress and needs comforting, you may
need to resolve those issues first before your
child can succesfully stop thumb-
thumb-sucking.

Talk about the 'bad' germs that are on our hands

and how the child puts them in his or her mouth
while thumb sucking.
Avoid punishing or shaming the child.

Reward the child for not thumbsucking for a

progressively increasing time period.

Ask the advice of a pediatric dentist. He will

explain to your kid what will happen to the teeth
if the child does not stop sucking its thumb.
Use a thumb sucking guard. - In difficult
cases, your dentist might suggest the use
of special devices to stop thumb sucking,
called thumb guards. A 


 is a
device with a plastic cover of the thumb
that is attached to a child's wrist. The
thumb sucking guard interrupts the
process by breaking the vacuum created
by sucking, thus removing the child's
pleasure. Treatment with thumb guards
usually lasts four weeks and helps children
to stop thumb sucking succesfully.
 How to Stop Thumb Sucking

Thumb sucking is one of the first

coordinated acts a baby can do that brings
comfort and pleasure. ost kids outgrow
the behavior by their preschool years and
up until that point it's relatively harmless.
Though beyond preschool it can be a
problem once permanent teeth start
coming in. The best way to get your child
to stop sucking her thumb is to find ways
to help her do it on her own.
Give your child extra attention and
observe if conflicts or anxiety provoke
thumb sucking. If so, help him find more
healthful ways to deal with stress.

Reward your child for progress made

towards her goal. Don't think of it as a
bribe because it's something she earned
through effort.
Paint something that taste bad on his
thumb, like vinegar or pickle juice. Don't do
it forcefully or without his permission, but
as a way of helping him achieve his goal.
Then when he's engaged in television and
sticks his thumb in his mouth out of habit,
the bad taste will quickly remind him of
what he's trying to accomplish.
Distract your child when you see her
putting her thumb in her mouth. If you
engage her in an activity that requires both
hands, she'll have to take her thumb out of
her mouth to do the task.
Invite friends over that don't suck their
thumbs for frequent play dates. Peer
pressure is a powerful motivator and if he
surrounds himself with kids who don't suck
their thumbs, it will be easier for him to not
suck his.