Thumb sucking habit is a Placement of the thumb or one or more fingers in varying depths into the mouth. – Gellin- 1978.

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Thumb and Finger
Habits
Jumana Almaghrabi, Dental Intern at KAUFD

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Outlines:
 Introduction
 Definition
 Clinical Findings
 Treatment
 Appliances
 Case presentation
 conclusion

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Introduction:
 On clinical examination of a 3- to 6-year-old child the presence of an
oral habit is an important finding.
 Permeant teeth may be effected If a habit is not eliminated or
spontaneously discontinued before their eruption.
 If the habit is stopped during the mixed-dentition years, the adverse
dental changes will begin to reverse naturally.
 Efforts to discourage the habit may involve as little as a conversation
between the dentist and the child, or they may involve more complex
appliance therapy.
 The most important point to remember is that the child must want to
discontinue the habit for treatment to be successful.
introduction

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 One study has shown
that school-aged
children consider
thumb suckers
significantly less
intelligent, less
attractive, and less
desirable as friends.
introduction

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Definition:
 Placement of the thumb or one or more fingers in varying depths into the
mouth. – Gellin- 1978.
 Thumb and finger habits make up the majority of oral habits.
 About 2/3 of such habits are ended by 5 years old.
 Clinical experience suggests that 4 to 6 hours of force per day is probably
the minimum necessary to cause tooth movement
 As little as 35 grams of force can tip a tooth.
 The prevalence of thumb sucking in Saudi population 21.10%.
 It is more common in male.
Definition

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Clinical Finding:
 The most frequently reported
dental signs of an active habit
are the following:
 1. Anterior open bite
Clinical Findings

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Clinical Finding:
 2. Facial position of the
upper incisors and
lingual position of the
lower incisors leading to
increased overjet
 3. Maxillary constriction
Clinical Findings

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Treatment:
 If parents or the child do not want to engage in treatment, it
should not be attempted.
 The child should be given an opportunity to stop the habit
spontaneously before the permanent teeth erupt.
 If treatment is selected as an alternative, it is generally
undertaken between the ages of 4 and 6 years.
 The dentist should evaluate the child for psychological
overtones before embarking on habit elimination.
treatment

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Types of
Treatment
COUNSELING
REMINDER
THERAPY
REWARD
SYSTEM
ADJUNCTIVE
THERAPY
treatment

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COUNSELING
 Its adult like discussions
focus on the changes that
have occurred because of
the sucking and their impact
on aesthetics.
 This approach is best aimed
at older children who can
conceptually grasp the issue
and who may be feeling
social pressure to stop the
habit.
treatment

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REMINDER THERAPY
 The second approach, reminder
therapy works by changing the
sucking sensation enjoyed by the
child.
 An adhesive bandage secured
with waterproof tape on the
offending finger can serve as a
constant reminder not to place the
finger in the mouth.
treatment

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REWARD SYSTEM
 Third treatment for oral
habits is a reward system. A
contract is drawn up between
the child and the parent or
between the child and the
dentist.
 The reward system is less
successful if the child uses
the habit to fall asleep.
treatment

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ADJUNCTIVE THERAPY
 physically interrupt the habit and remind the patient can be used.
 involves restraining the patient’s arm in an elastic bandage or
some equivalent so it cannot be flexed and the hand brought to
the mouth
 Adjunctive habit discouragement appliances should be left in the
mouth for 6 to 12 months.
Appliances

14. zAppliances:
The quad helix palatal crib Bluegrass appliance
Appliances

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Case
A fixed Haas-type appliancePretreatment intraoral photographs
A 6-year-old female patient, in mixed dentition, presented class II division 1
malocclusion, overjet of 9.0 mm, and AOB of 4.0 mm. Constricted maxillary arch,
slight diastema between the maxillary incisors and between the lower central
incisors, and a slight midline deviation to the left were also present
Case presentation

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Nine months after removal
of the palatal expander
and no thumb sucking
habit
18 months after removal of
palatal expander appliance.
Relapse of the anterior
open bite due to relapse of
the thumb sucking habit.
Case presentation
Callus on the right
thumb observed.

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Conclusion:
 The interception of the malocclusion at an early stage with the
Haas-type fixed appliance was effective and worked as an
effective tool for stopping the thumb sucking habit and
normalization of overjet and overbite. However, there was the
recurrence of the habit with the relapse of the AOB.
 the need of a multidisciplinary approach, consent, and
cooperation as the keys to a good prognosis.
conclusion

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References:
 Friman PC, McPherson KM, Warzak WJ et al: Inluence of thumb sucking on peer
social acceptance in irst-grade children, Pediatrics 91:784–786, 1993.
 Helle A, Haavikko K: Prevalence of earlier sucking habits revealed by anamnestic data
and their consequences for occlusion at the age of eleven, Proc Finn Dent Soc
70:191–196, 1974.
 Profit WR, Fields HW, Sarver DM: Contemporary orthodontics, ed 5, St Louis, 2012,
Mosby–Year Book.
 Profit WR: Equilibrium theory revisited: factors inluencing position of the teeth, Angle
Orthod 48(3):175–186, 1978.
 Adair SM: The Ace Bandage approach to digit-sucking habits, Pediatr Dent 21:451–
452, 1999.
 Greenleaf S, Mink, JR: A retrospective study of the use of the bluegrass appliance in
the cessation of thumb habits, Pediatr Dent 25(6):587–590, 2003.
 Haskell BS, Mink JR: An aid to stop thumb sucking: the “Bluegrass” appliance, Pediatr
Dent 13(2):83–85, 1991.
 Levine RS. Briefing paper: oral aspect of dummy and digit sucking. Br Dent J. 1999; 186(3):108.
 Abbasi AA, Alkadhi OH, AlHobail SQ, AlYami AS, Tareq M, et al. (2017) Prevalence of
Parafunctional Oral Habits in 7 to 15 Years Old Schoolchildren in Saudi Arabia. J Orthod Endod.
3:11. doi: 10.21767/2469-2980.100045