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Habits and its management,thumb sucking 1 /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.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Habits and its management,thumb sucking 1 /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

  • 1. HABITS ANDHABITS AND ITSITS MANAGEMENMANAGEMEN TTINDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  • 2. William James: An acquired habit, fromWilliam James: An acquired habit, from psychological point of view, is nothing butpsychological point of view, is nothing but a new pathway of discharge formed in thea new pathway of discharge formed in the brain, by which certain incoming currentsbrain, by which certain incoming currents ever after tend to escape.ever after tend to escape. Moyers: Habits are learned pattern ofMoyers: Habits are learned pattern of muscle contraction, which are complex inmuscle contraction, which are complex in nature.nature. Finn: A habit is an act, which is sociallyFinn: A habit is an act, which is socially DefinitionsDefinitions:: www.indiandentalacademy.comwww.indiandentalacademy.com
  • 3. According to William James:According to William James: Useful habits:Useful habits: These habits include the habits of normal functionThese habits include the habits of normal function such as correct tongue posture, proper respirationsuch as correct tongue posture, proper respiration etc.etc. Harmful habits:Harmful habits: These are the ones which exert stresses againstThese are the ones which exert stresses against the teeth and dental arches such as mouththe teeth and dental arches such as mouth breathing, lip sucking, thumbbreathing, lip sucking, thumb sucking.sucking. Classification of habits www.indiandentalacademy.comwww.indiandentalacademy.com
  • 4. According to Finn and Sim:According to Finn and Sim: Compulsive habitsCompulsive habits:: When the habit has acquired a fixation in theWhen the habit has acquired a fixation in the child to the extent that he retreats to the practicechild to the extent that he retreats to the practice of this habit whenever his security isof this habit whenever his security is threatened.This is his safety valve whenthreatened.This is his safety valve when emotional pressures become too much to copeemotional pressures become too much to cope with.with. Non-compulsive habitsNon-compulsive habits:: Habits which are easily dropped or addedHabits which are easily dropped or added from the child behaviour pattern as he matures.from the child behaviour pattern as he matures. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 5. Various habits are:Various habits are: Thumb sucking/finger suckingThumb sucking/finger sucking Tongue thrustingTongue thrusting Mouth breathingMouth breathing Lip biting and lip suckingLip biting and lip sucking Postural habitsPostural habits Nail bitingNail biting Masochistic habitsMasochistic habits Bobby pin openingBobby pin opening Frenum thrustingFrenum thrusting BruxismBruxism Cheek biting/suckingCheek biting/sucking www.indiandentalacademy.comwww.indiandentalacademy.com
  • 6. Gellin: Defines digit suckingGellin: Defines digit sucking as placement of thumb or oneas placement of thumb or one or more fingers in variousor more fingers in various depths into mouth.depths into mouth. Moyers: Repeated andMoyers: Repeated and forceful sucking of thumb withforceful sucking of thumb with associated strong buccal andassociated strong buccal and lip contractions.lip contractions. Thumb sucking/finger sucking www.indiandentalacademy.comwww.indiandentalacademy.com
  • 7. Psychology of thumb suckingPsychology of thumb sucking Freudian theoryFreudian theory:: He suggests that orality in the infantsHe suggests that orality in the infants is related to pregenital organization and thus, the objectis related to pregenital organization and thus, the object of thumb sucking is nursing. He believes that abruptof thumb sucking is nursing. He believes that abrupt interference in such basic mechanism will likely lead tointerference in such basic mechanism will likely lead to substitution of such antisocial tendency such assubstitution of such antisocial tendency such as stuttering.stuttering. Oral drive theory (Sears and Wise):Oral drive theory (Sears and Wise): He suggestsHe suggests that the strength of oral drive is in part a function of howthat the strength of oral drive is in part a function of how long a child continuous to feed by sucking. Thus it is notlong a child continuous to feed by sucking. Thus it is not the frustration of weaning but, rather oral drive which hasthe frustration of weaning but, rather oral drive which has been strengthened by the prolongation of nursing.been strengthened by the prolongation of nursing. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 8. Benjamins theoryBenjamins theory:: He proposed two theories-He proposed two theories- 1.1. Thumb sucking is an expression of a need to suck thatThumb sucking is an expression of a need to suck that arises because of association of sucking with primaryarises because of association of sucking with primary reinforcing aspects of feeding.reinforcing aspects of feeding. 2.2. Thumb sucking arises from the rooting and placingThumb sucking arises from the rooting and placing reflexes common to all mammalian infants.reflexes common to all mammalian infants. A multidisciplinary research teamA multidisciplinary research team at theat the university of Alberta support the theory that digitaluniversity of Alberta support the theory that digital sucking habits in humans are simple learnedsucking habits in humans are simple learned response.response. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 9. Clinical aspects of digital sucking:Clinical aspects of digital sucking: Prenatal/ antenatalPrenatal/ antenatal:: Shortly before the child passes throughShortly before the child passes through the birth canal, the fetus shows increasedthe birth canal, the fetus shows increased muscular activity and the thumb may findmuscular activity and the thumb may find its way into the mouth, thus initiatingits way into the mouth, thus initiating thumb sucking habit before birth. Thethumb sucking habit before birth. The fetus seeks a ‘position of comfort’ whichfetus seeks a ‘position of comfort’ which occasionally interferes with post nataloccasionally interferes with post natal dentofacial development.dentofacial development. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 10. Postnatal:Postnatal: AA:: Finger sucking from birth to 4 yrs ofFinger sucking from birth to 4 yrs of age:age: Infants generally start sucking habit in theInfants generally start sucking habit in the first three months of life, which may be duefirst three months of life, which may be due to feeding problems, emotional stress withto feeding problems, emotional stress with which they are unable to cope, insecuritywhich they are unable to cope, insecurity and desire to attract attention.and desire to attract attention. For the 1For the 1stst 4yrs of life damage to occlusion is4yrs of life damage to occlusion is confined largely to the anterior segment.confined largely to the anterior segment. The damage is temporary, provided theThe damage is temporary, provided the child starts with normal occlusion.child starts with normal occlusion. An exerciser or pacifier was developedAn exerciser or pacifier was developed which is hoped to greatly reduce the needwhich is hoped to greatly reduce the need and desire of the infant for thumb suckingand desire of the infant for thumb sucking between meals and at bed time.between meals and at bed time. e.g Nuk sauger nipple.e.g Nuk sauger nipple. Edwall functional nursing nipple.Edwall functional nursing nipple. Nuk sauger nipple Conventional nipplewww.indiandentalacademy.comwww.indiandentalacademy.com
  • 11. B Active finger sucking after 4 yrs of ageB Active finger sucking after 4 yrs of age:: The permanence of malocclusion increases if the habitThe permanence of malocclusion increases if the habit persists beyond 4 yrs of life.persists beyond 4 yrs of life. Trident of habit factors:Trident of habit factors: DURATIONDURATION FREQUENCYFREQUENCY INTENSITYINTENSITY Duration: duration of sucking i.e hours per day of sucking,Duration: duration of sucking i.e hours per day of sucking, plays a major role in tooth displacement.plays a major role in tooth displacement. Frequency: frequency of habit during day and night affectsFrequency: frequency of habit during day and night affects the end result.the end result. Intensity: more the intensity of sucking more the perioralIntensity: more the intensity of sucking more the perioral muscles function and more is the damage.muscles function and more is the damage. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 12. Effect of thumb suckingEffect of thumb sucking The of effect of sucking habitThe of effect of sucking habit depends on:depends on: Position of thumb in mouthPosition of thumb in mouth Leverage effect the child gainsLeverage effect the child gains against the other teeth and theagainst the other teeth and the alveolus.alveolus. Apposition of sucking finger onApposition of sucking finger on the maxilla:the maxilla: In case the finger rests on theIn case the finger rests on the lower incisors as a fulcrumlower incisors as a fulcrum Promotes the development ofPromotes the development of class I, class II div Iclass I, class II div I malocclusion.malocclusion. Anterior open bite.Anterior open bite. Protraction of maxillary anteriorProtraction of maxillary anterior teeth.teeth. Labial tipping of mandibularLabial tipping of mandibular anterior teeth.anterior teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 13. In case the finger rests on theIn case the finger rests on the lower anteriors then linguallower anteriors then lingual displacement of lower anteriors willdisplacement of lower anteriors will occur.occur. Vertical equilibrium is altered onVertical equilibrium is altered on the posterior teeth leading to morethe posterior teeth leading to more eruption of posterior teeth causingeruption of posterior teeth causing open bite.open bite. Arch form is affected due toArch form is affected due to alteration in balance betweenalteration in balance between cheek and tongue pressures i.echeek and tongue pressures i.e maxillary arch tends to become v-maxillary arch tends to become v- shaped.shaped. Thumb sucking is associated withThumb sucking is associated with tongue thrust to maintain thetongue thrust to maintain the anterior seal.anterior seal. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 14. Narrower nasal floor and high palatal vaultNarrower nasal floor and high palatal vault Maxillary lip hypotonic and mandibular lipMaxillary lip hypotonic and mandibular lip hyperactivehyperactive Hyperactive mentalis muscleHyperactive mentalis muscle In case the child bites on both its index fingers, itIn case the child bites on both its index fingers, it leads to protrusion and open bite correspondingleads to protrusion and open bite corresponding with the side in which the finger is being heldwith the side in which the finger is being held www.indiandentalacademy.comwww.indiandentalacademy.com
  • 15. Bilateral posterior crossbite as the posterior teeth areBilateral posterior crossbite as the posterior teeth are forced palatally by the buccal musculature.forced palatally by the buccal musculature. Apposition of finger sucking on the mandible:Apposition of finger sucking on the mandible: In case the fingers are pressed on the lingual side of theIn case the fingers are pressed on the lingual side of the mandibular alveolar process and lower anterior teeth-mandibular alveolar process and lower anterior teeth- labial tipping of upper and lower incisors is due to forwardlabial tipping of upper and lower incisors is due to forward and downward displacement of tongue.and downward displacement of tongue. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 16. Can lead to class III malocclusion in which mandible jawCan lead to class III malocclusion in which mandible jaw is pulled forward by fingersis pulled forward by fingers Facial asymmetry may be causedFacial asymmetry may be caused Line of occlusion is changedLine of occlusion is changed Callus formation and low virus infection on fingers whichCallus formation and low virus infection on fingers which is continuously been sucked.is continuously been sucked. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 17. ManagementManagement Most of the children discontinue their habit at the age ofMost of the children discontinue their habit at the age of 4yrs or by 5 yrs4yrs or by 5 yrs No treatment is recommended as the malocclusion,ifNo treatment is recommended as the malocclusion,if present, corrects itself as the habit ceasespresent, corrects itself as the habit ceases Adult approach: As the time of eruption of the permanentAdult approach: As the time of eruption of the permanent incisors approach, a straight forward discussion with aincisors approach, a straight forward discussion with a dentist is recommendeddentist is recommended Reminder therapy: a simple method is to secure anReminder therapy: a simple method is to secure an adhesive bandage with waterproof tape on the finger that isadhesive bandage with waterproof tape on the finger that is being sucked.being sucked. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 18. If this fails then elastic bandage loosely wrapped around theIf this fails then elastic bandage loosely wrapped around the elbow prevents the arm from flexing and finger from beingelbow prevents the arm from flexing and finger from being sucked.sucked. If this fails then the reminder appliance is fitted to activelyIf this fails then the reminder appliance is fitted to actively impede finger sucking. eg ,crib, maxillary lingual arch withimpede finger sucking. eg ,crib, maxillary lingual arch with crib etc.crib etc. • Reward system: if the reminder therapy fails then reward system is used in which small tangible reward daily for not engaging in the habit. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 19. Psychological approachPsychological approach:: Dunlop theory (betaDunlop theory (beta hypothesis)-This theory states that by practicinghypothesis)-This theory states that by practicing a bad habit with the intent to stop it, one learnsa bad habit with the intent to stop it, one learns not to perform the undesirable act. The child willnot to perform the undesirable act. The child will not derive any satisfaction from purposefulnot derive any satisfaction from purposeful repetition of the habit but will experience arepetition of the habit but will experience a painful reaction in its performance and willpainful reaction in its performance and will gradually abandon the habit. This is applicablegradually abandon the habit. This is applicable to older children whose cooperation can beto older children whose cooperation can be obtained.obtained. Chemical approachChemical approach: In this a hot flavored, bitter: In this a hot flavored, bitter tasting or foul smelling preparations can betasting or foul smelling preparations can be applied on the finger that is being sucked. e.gapplied on the finger that is being sucked. e.g red pepper, quinine, asafetide.red pepper, quinine, asafetide. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 20. Appliances usedAppliances used Removable appliancesRemovable appliances:: Tongue spikesTongue spikes Tongue cribTongue crib Rake applianceRake appliance Vestibular screenVestibular screen Fixed appliancesFixed appliances Hay rakeHay rake Maxillary lingual archMaxillary lingual arch with palatal cribwith palatal crib www.indiandentalacademy.comwww.indiandentalacademy.com
  • 21. A crib is a habit retrainingA crib is a habit retraining appliance which utilizes a bluntappliance which utilizes a blunt wire ‘reminder’ which preventswire ‘reminder’ which prevents the child from indulging into thethe child from indulging into the habit. It serves the followinghabit. It serves the following functions:functions: To break the suction and forceTo break the suction and force on anterior segment.on anterior segment. As a reminder.As a reminder. Make the habit non pleasurable.Make the habit non pleasurable. Forces the tongue backward,Forces the tongue backward, changing the shape during restchanging the shape during rest position from an elongatedposition from an elongated mass to a more wider position,mass to a more wider position, nearly like a normal tongue.nearly like a normal tongue. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 22. A rake may be removableA rake may be removable or fixed. It discourages notor fixed. It discourages not only thumb sucking butonly thumb sucking but tongue thrusting andtongue thrusting and abnormal swallowing also.abnormal swallowing also. Another appliance byAnother appliance by Haskell and Mink called theHaskell and Mink called the blue grass appliance wasblue grass appliance was used to stop thumb sucking.used to stop thumb sucking. In this a modified six sidedIn this a modified six sided roller machine from teflonroller machine from teflon was used.was used. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 23. Time of therapyTime of therapy Check up appointments are made at 3-4 wkCheck up appointments are made at 3-4 wk interval.interval. Appliance to be worn for 4-6 months.Appliance to be worn for 4-6 months. A period of 3 months of total absence ofA period of 3 months of total absence of finger sucking is good insurance for relapse.finger sucking is good insurance for relapse. The appliance is removed in parts i.e after 3The appliance is removed in parts i.e after 3 months of habit free interval the spurs aremonths of habit free interval the spurs are cut off,3 wks later posterior loop extensioncut off,3 wks later posterior loop extension is cut and 3 wks later palatal bar and crownis cut and 3 wks later palatal bar and crown may be removed.may be removed. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 24. www.indiandentalacademy.comwww.indiandentalacademy.com Thank youThank you For more details please visitFor more details please visit www.indiandentalacademy.comwww.indiandentalacademy.com