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Habits and its management,thumb sucking /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  • 3. Definitions: William James: An acquired habit, from psychological point of view, is nothing but a new pathway of discharge formed in the brain, by which certain incoming currents ever after tend to escape. Moyers: Habits are learned pattern of muscle contraction, which are complex in nature. Finn: A habit is an act, which is socially
  • 4. Classification of habits According to William James: Useful habits: These habits include the habits of normal function such as correct tongue posture, proper respiration etc. Harmful habits: These are the ones which exert stresses against the teeth and dental arches such as mouth breathing, lip sucking, thumb sucking.
  • 5. According to Finn and Sim: Compulsive habits: When the habit has acquired a fixation in the child to the extent that he retreats to the practice of this habit whenever his security is threatened.This is his safety valve when emotional pressures become too much to cope with. Non-compulsive habits: Habits which are easily dropped or added from the child behaviour pattern as he matures.
  • 6. Various habits are: Thumb sucking/finger sucking Tongue thrusting Mouth breathing Lip biting and lip sucking Postural habits Nail biting Masochistic habits Bobby pin opening Frenum thrusting Bruxism Cheek biting/sucking
  • 7. Thumb sucking/finger sucking Gellin: Defines digit sucking as placement of thumb or one or more fingers in various depths into mouth. Moyers: Repeated and forceful sucking of thumb with associated strong buccal and lip contractions.
  • 8. Psychology of thumb sucking Freudian theory: He suggests that orality in the infants is related to pregenital organization and thus, the object of thumb sucking is nursing. He believes that abrupt interference in such basic mechanism will likely lead to substitution of such antisocial tendency such as stuttering. Oral drive theory (Sears and Wise): He suggests that the strength of oral drive is in part a function of how long a child continuous to feed by sucking. Thus it is not the frustration of weaning but, rather oral drive which has been strengthened by the prolongation of nursing.
  • 9. Benjamins theory: He proposed two theories1. 2. Thumb sucking is an expression of a need to suck that arises because of association of sucking with primary reinforcing aspects of feeding. Thumb sucking arises from the rooting and placing reflexes common to all mammalian infants. A multidisciplinary research team at the university of Alberta support the theory that digital sucking habits in humans are simple learned response.
  • 10. Clinical aspects of digital sucking: Prenatal/ antenatal: Shortly before the child passes through the birth canal, the fetus shows increased muscular activity and the thumb may find its way into the mouth, thus initiating thumb sucking habit before birth. The fetus seeks a ‘position of comfort’ which occasionally interferes with post natal dentofacial development.
  • 11. Postnatal: A: Finger sucking from birth to 4 yrs of age: Infants generally start sucking habit in the first three months of life, which may be due to feeding problems, emotional stress with which they are unable to cope, insecurity and desire to attract attention. For the 1st 4yrs of life damage to occlusion is confined largely to the anterior segment. The damage is temporary, provided the child starts with normal occlusion. An exerciser or pacifier was developed which is hoped to greatly reduce the need and desire of the infant for thumb sucking between meals and at bed time. e.g Nuk sauger nipple. Edwall functional nursing nipple. Nuk sauger nipple Conventional nipple
  • 12. B Active finger sucking after 4 yrs of age: The permanence of malocclusion increases if the habit persists beyond 4 yrs of life. Trident of habit factors: DURATION FREQUENCY INTENSITY Duration: duration of sucking i.e hours per day of sucking, plays a major role in tooth displacement. Frequency: frequency of habit during day and night affects the end result. Intensity: more the intensity of sucking more the perioral muscles function and more is the damage.
  • 13. Effect of thumb sucking The of effect of sucking habit depends on: Position of thumb in mouth Leverage effect the child gains against the other teeth and the alveolus. Apposition of sucking finger on the maxilla: In case the finger rests on the lower incisors as a fulcrum Promotes the development of class I, class II div I malocclusion. Anterior open bite. Protraction of maxillary anterior teeth. Labial tipping of mandibular anterior teeth.
  • 14. In case the finger rests on the lower anteriors then lingual displacement of lower anteriors will occur. Vertical equilibrium is altered on the posterior teeth leading to more eruption of posterior teeth causing open bite. Arch form is affected due to alteration in balance between cheek and tongue pressures i.e maxillary arch tends to become vshaped. Thumb sucking is associated with tongue thrust to maintain the anterior seal.
  • 15. Narrower nasal floor and high palatal vault Maxillary lip hypotonic and mandibular lip hyperactive Hyperactive mentalis muscle In case the child bites on both its index fingers, it leads to protrusion and open bite corresponding with the side in which the finger is being held
  • 16. Bilateral posterior crossbite as the posterior teeth are forced palatally by the buccal musculature. Apposition of finger sucking on the mandible: In case the fingers are pressed on the lingual side of the mandibular alveolar process and lower anterior teethlabial tipping of upper and lower incisors is due to forward and downward displacement of tongue.
  • 17. Can lead to class III malocclusion in which mandible jaw is pulled forward by fingers Facial asymmetry may be caused Line of occlusion is changed Callus formation and low virus infection on fingers which is continuously been sucked.
  • 18. Management Most of the children discontinue their habit at the age of 4yrs or by 5 yrs No treatment is recommended as the malocclusion,if present, corrects itself as the habit ceases Adult approach: As the time of eruption of the permanent incisors approach, a straight forward discussion with a dentist is recommended Reminder therapy: a simple method is to secure an adhesive bandage with waterproof tape on the finger that is being sucked.
  • 19. • Reward system: if the reminder therapy fails then reward system is used in which small tangible reward daily for not engaging in the habit. If this fails then elastic bandage loosely wrapped around the elbow prevents the arm from flexing and finger from being sucked. If this fails then the reminder appliance is fitted to actively impede finger sucking. eg ,crib, maxillary lingual arch with crib etc.
  • 20. Psychological approach: Dunlop theory (beta hypothesis)-This theory states that by practicing a bad habit with the intent to stop it, one learns not to perform the undesirable act. The child will not derive any satisfaction from purposeful repetition of the habit but will experience a painful reaction in its performance and will gradually abandon the habit. This is applicable to older children whose cooperation can be obtained. Chemical approach: In this a hot flavored, bitter tasting or foul smelling preparations can be applied on the finger that is being sucked. e.g red pepper, quinine, asafetide.
  • 21. Appliances used Removable appliances: Tongue spikes Tongue crib Rake appliance Vestibular screen Fixed appliances Hay rake Maxillary lingual arch with palatal crib
  • 22. A crib is a habit retraining appliance which utilizes a blunt wire ‘reminder’ which prevents the child from indulging into the habit. It serves the following functions: To break the suction and force on anterior segment. As a reminder. Make the habit non pleasurable. Forces the tongue backward, changing the shape during rest position from an elongated mass to a more wider position, nearly like a normal tongue.
  • 23. A rake may be removable or fixed. It discourages not only thumb sucking but tongue thrusting and abnormal swallowing also. Another appliance by Haskell and Mink called the blue grass appliance was used to stop thumb sucking. In this a modified six sided roller machine from teflon was used.
  • 24. Time of therapy Check up appointments are made at 3-4 wk interval. Appliance to be worn for 4-6 months. A period of 3 months of total absence of finger sucking is good insurance for relapse. The appliance is removed in parts i.e after 3 months of habit free interval the spurs are cut off,3 wks later posterior loop extension is cut and 3 wks later palatal bar and crown may be removed.
  • 25. Thank you Leader in continuing dental education