Thumb sucking

DR NIKITHA SREE K
MALABAR DENTAL COLLEGE

1. THUMB SUCKING Dr. Nikitha Sree . K Lecturer Malabar Dental College and Research Centre

2. CONTENTS Habit definition and classifications Thump sucking definition and classifications Theories of thump-sucking Etiology Clinical findings Diagnosis Management Journals  

3. habit Habit is defined as a tendency towards an act or an act that has become a repeated performance, relatively fixed, consistent, easy to perform and almost automatic. – Boucher OC

4. CLASSIFICATIONS OF HABITS USEFUL AND HARMFUL HABITS (JAMES-1923) Useful habits- all those habits of normal function such as correct tongue position proper respiration and deglutition. Harmful habits- all those that exert perverted stress against the teeth and dental arches. eg : mouth breathing, tongue thrusting.

5. COMPULSIVE AND NON-COMPULSIVE HABITS (FINN- 1987) Compulsive habits- acquired as a fixation in the child to the extent that he treats to the practice whenever his security is threatened. Non- compulsive- children appear to undergo continuing behavior modification,which permit them to release certain undesirable habit patterns and form new ones which are socially accepted.

6. MEANINGFUL AND EMPTY HABITS (KLEIN-1971) Meaningful habit- habit with a deep rooted psychological problem, Empty habit- meaningless habit that can be treated easily by a dentist using reminder therapy. KINGSLEY-1958 Functional oral habits Muscular habits Combined ones

7. MORRIS AND BOHANNA- 1969 Non- pressure habits- eg . Mouth breathing Pressure habits- eg -a)sucking habits : lip sucking, thump and digit sucking b)biting habit : nail biting/needle holding Postural habits- chin rest Miscellaneous- bruxism

8. DEFINITION Thumb sucking can be defind as placement of the thumb at various depth in the mouth

9. CLASSIFICATION 1.NORMAL THUMB SUCKING Normal during the first and second years of life.such habit is usually seem to disappear as the child mature. 2.ABNORMAL THUMB SUCKING When thumb sucking persist beyond the preschool period. a.Psychological b.Habitual

10. PSHYCHOLOGICAL Habit have a deep-rooted emotional factors involved and may associated with insecurities,neglect or loneliness. HABITUAL Does not have a psychological bearing; however,the child performs the act out of habit Sucking habits can be classufied as: NUTRITIVE SUCKING HABIT ,e,g., breast-feeding,bottle feeding NON-NUTRITIVE SUCKING HABITS ,e,g.,thumb or finger sucking,pacifier sucking

11. ACCORDING TO SUBTELNY(1973 ) TYPE A :Seen in almost 50%,wherein whole digit is placed inside the mouth with the pad of thumb pressing over the palate,while at the same time maxillary and mandibular oral contact is present TYPE B :Seen in almost 13-24%,where in the thumb is placed into the oral cavity and at the same time maxillary and mandibular contact is maintained.

12. TYPE C :Seen in almost 18%,thumb is placed into the oral cavity and just beyond the first joint and contacts hard palate and maxillary incisors,but there is no contact with mandibular teeth TYPE D :Seen almost 6%,only a little portion of the thumb is placed in to the mouth

13. SUCKING REFLEX The process of sucking is a reflex occuring in the oral stage of development and is seen even at 29 week of IUL, and may disappear during normal growth between ages of 1 and 31/2 years.It is the first coordinated muscular activity of the infant.

14. THEORIES OF THUMB SUCKING Classical freudian theory Oral drive theory Sucking reflex Learning theory Rooting reflex

15. CLASSICAL FREUDIAN THEORY Digit sucking is a pleasurable erotic stimulation of the lips and mouth. O ne of the concepts of thumb sucking brought about by this theory is that human posses a biological sucking drive. Any kind of the deprivation of this activity will probably cause an emotionally insecure individual. ORAL DRIVE THEORY S uggest that the strenght of the oral drive is in part a function of how long a child continues to feed by sucking. It is not the frustration of weaning that produces thumb sucking but in fact it is the prolonged nursing that causes it.

16. SUCKING REFLEX THEORY The process of sucking is a reflex occuring in the oral stage of development and is seen even at 29 week of intrauterine life and may disappear during normal growth between the age of 1-31/2 years. B abies who are restricted from sucking due to disease or other factors become restless and irritable. This motivate the infant to suck the thumb. LEARNING THEORY Non-nutritive sucking stems from an adaptive response. The infant associated with feeling like pleasure and hunger and recalls the events.

17. ETIOLOGICAL FACTORS Working mother Order of birth of child Feeding Practices Social adjustment and stress Age of the child Number of siblings Parents occupation

18. ETIOLOGY PARENT'S OCCUPATION Related to socioeconomic status of family. Baby with high socioeconomic status has less sucking urge. WORKING MOTHER Sucking habit commonly seen in children with working mother. They feels insecurity so use their thumb to obtain a secure feeling . NUMBER OR SIBLINGS As the number increases the attention meted by the parents are divided ,neglected by the parent may attempt to compensate by this habit.

19. ORDER OF BIRTH OF THE CHILD Later the sibling rank of a child , the greater the chance for of having an oral habit. SOCIAL ADJUSTMENT AND STRESS It is an emotion based behavior related to difficulty with social adjustment or stress. In older children associated with abnormal psychological devolepment . AGE OF THE CHILD In neonate : insecurities related to primitive demand as hunger. First few weeks of life : related to feeding problem. During the eruption of primary molar : it may be used as a teething device.

20. CLINICAL FINDING EFFECTS ON MAXILLA Increased proclination of the maxillary incisors Increased maxillary arch length. Increased anterior placement of apical base of maxilla. Increased clinical crown of maxilla. Decreased palatal arch width Increased atypical root resorption in primary central incisor. Increased trauma to maxillary cenrtal incisor

21. EFFECTS ON MANDIBLE EFFECTS ON MANDIBLE EFFECTS ON INTERARCH RELATIONSHIP EFFECTS ON LIP PLACEMENT & FUNCTION Retroclination of mandibular incisors. Retruded mandible Increased overjet Decreased overbite Increased posterior crossbite Increased lip incompetence Increased lower lip function under maxillary incisors

22. EFFECTS ON TONGUE PLACEMENT AND FUNCTION OTHER EFFECTS Increased tongue thrust. Increased lip to tongue resting position. Increased lower tongue position Risk to psychologic health Increased risk of poisoning Increased deformation of digits Increased risk of speech defects.

23. DIAGNOSIS HISTORY Determine the psychological component involved. Question regarding the frequency , intensity ,and duration of the habit. Enquire the feeding pattern , parental care of the child.

24. INTRA ORAL EXAMINATION TONGUE Examine for correct size& position of the tongue at rest ,tongue action during swallowing . DENTOALVEOLAR STRUCTURES Flared and proclined maxillary anteriors with diastemas and retroclined mandibular anteriors . Chances of buccal crossbite .

25. EXTRA ORAL EXAMINATION DIGITS Digit-reddened , cleaned chapped and with short finger nail- clean dishpan thumb. Fibrous callus on superior aspect of finger. LIPS Upper lip-short and hypotonic Note the position of lip at rest and during swallowing –together or appart .

26. FACIAL FORM ANALYSIS Check for profile ,maxillary protrusion , mandibular retrusion . Facial profile is either straight or convex. OTHER FEATURES Associated other habits like mouth breathing ,tongue thrust swallow. Chances of middle ear infection.

27. Oral habits and melvin moss concept of growth

28. MANAGMENT PREVENTIVE TREATMENT Feed the child whenever he is hungry Feed the child in natural way-breast feeding. Never let the habit to be started the practice must be discontinued at its inception.

29. PSYCHOLOGICAL THERAPY Nagging , scolding or frightening the child cause negativism and tend to make him restore the habit. Beta –hypothesis or Dunlops hypothesis : if a subject can be forced to concentrate on the performance of the act at time of practices it ,he learn to stop performing the act.

30. CHEMICAL METHOD It is the least effective method. Bitter and sour chemicals has been used. E.g ; quinine, pepper, caster oil. Nowadays new anti-thumb sucking solutions like femite , thumb-up ,anti- thumb are marketed.

31. MECHANICAL THERAPY/ REMINDER THERAPY EXTRA ORAL APPROACH Mechanical retainers –splints ,adhesive taps. Thumb guard INTRA ORAL APPROCH Optimum time for appliance placement is between the ages of 3 and 4 ½ years.

32. Removable or fixed palatal crib It breaks the suction forces of the digit on the anterior segment Oral screen Redirecting the pressure of the muscular and soft tissue curtain of cheeks & lips Hay rakes Designed with series of fence like lines Children over 3 ½ years .

33. Blue grass appliance Between 7 & 13 years Using a teflon roller Roll the roller instead of sucking the thumb Quad helix Fixed appliance used to expand the arch Helix serve remind not place finger in mouth Modified blue grass appliance Have 2 rollers of different color

34. CURRENT STRATEGIES -Increasing the arm length of the night suit -Thumb–home concept : small bag given to child to tie around wrist during sleep -Use of hand puppets

35. -Thumb sucking books -My special shirt : it provide a number of tools . This keep the child busy avoiding the habit .

36. 1.JOURNAL-thump sucking revisited -FROM THE SCHOOL OF DENTISTRY, DEPARTMENT OF BEHAVIOUR SCIENCE,STATE UNIVERSITY OF NEWYORK , USA (ELLIOT N.GALE,Ph.D , WILLIAM A. AYER) -Abstract The present article has traced the development of thumpsucking from a rooting and placing reflex through the learning and habituation of response. On the basis of the research presented, it is concluded that thump sucking may be unrelated to the emotionality of the child. In addition , it appears that the response can be consolidated by giving the child the oppurtunity to suck his thump and fingers continually. The habit is harmful in the psychological point of view, but there is evidence that it is not harmful from a dental standpoint.

37. It is indicated that punitive measures are not harmful to the child and can be used successfully in the correction of habit. However , they believe that positive reinforcement is better method of dealing with it.( ie , giving attention when the child is not sucking thump and points out to him. Unfortunately, it is apparent that this is a rather difficult approach, the so-called ‘punitive’ measure, such as ‘gloving’ the hands or utilizing dental appliances, will most likely be more convenient and reliable and will lead to rapid extinction of this undesirable and dentally destructive habit.

38. A 5 year old girl presented with a 3 year history of severe trichotillmania and alopecia. This is observed to occur with only in the presence of thump-sucking. Treatment is done to eliminate thump-sucking habit only. Results indicated that along with thump-sucking trichotillmania also eliminated. 2.Elimination of thumpsucking as a treatment for severe trichotillmania - t.steurt watson , kleith d. allen

39. 3.Modified bluegrass appliance-a non punitive therapy.( amish diwanji.preet jain ) It is a non-punitive appliance and esthetic and child can wear it comfortably. It can be given as a supportive therapy as it requires no reminding or bribing,and parents can be freed of anxiety and frustration. It does not interfere with child’s growth and eliminates the habit with limited complications.

40. 4.Thump and finger sucking habits ( nzao -association of orthodontics) Digit sucking habit can result in the development of malocclusion. There are various ways in which these habits may be dicouraged . Almost all harm done to the developing occlusion is reversible,either spontaneously or with a course of orthodontic treatment. For persistent habits past the age of 5 to 6 years, referral to an orthodontist would be recommended.

41. 5.thump-sucking and falling asleep ( mualla ozturk and orhan m. Ozturk ) Study is carried out in Turkey, 50 thumpsuckers , 50 non thumpsuckers , 250 school children and 312 ‘problem’ children were investigated through interviews, questionnaire and other clinical techniques with their mothers. Studies were aspects of feeding, onset and incidence of thumpsucking,strength of sucking drive, sex distribution, educational level and occupation of mothers, parental attitudes toward physical contact with children, mother child relationships, and particular forms of falling asleep. It was found that thumsucking was aetiologically more related to ways of falling asleep than other factors.

42. REFFERENCE Text book of Pediatric dentistry- SHOBHA TANDON Text book of Pediatric dentistry- NIKHIL MARWAH Text book of Pediatric dentistry- DAMLE internet

43. Thank you...