1. UNIVERSITY OF GLASGOW
Digit sucking & dummy-sucking habit
Personal notes
Mohammed Almuzian
1/1/2013
.

2. Mohammed Almuzian, University of Glasgow Page 1
Table of Contents
Prevalence of digit sucking habits................................................................... 2
Aetiology ...................................................................................................... 2
Factors important in habit............................................................................... 2
There are two types of sucking habit............................................................... 2
Types of finger-sucking.................................................................................. 3
Effects of the digit sucking habits ................................................................... 3
A. Dental and skeletal effect.......................................................................... 3
3. Transverse effects. ................................................................................... 4
4. Functional effect ...................................................................................... 4
B. Effect on the digit..................................................................................... 4
C. Oral health effects.................................................................................... 4
Management of digit-sucking habits ............................................................... 5
Prevention of digit-sucking habits, BOS guidelines 2000................................. 5
Treatment of digit-sucking habits, BOS guidelines 2000.................................. 5
Correction of Problems Caused by Habit......................................................... 6
Dummy-sucking habit.................................................................................... 6
Prevalence..................................................................................................... 6
The effect of dummy-sucking on the occlusion ............................................... 6
Advantages of the pacifier.............................................................................. 8
Summary of evidences ................................................................................... 8

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Digit sucking & dummy-sucking habit
Prevalence ofdigit sucking habits
1. 20 years ago, 50% suck their thumb but now but this number reduced to 30%
because patients start sucking the dummy.
2. Nowadays, the incidence of digit sucking is around 30% at 1 year of age,
reducing to 12% at 9 years and 2% by 12 years. (Brenchely, 1992).
3. Most persistent suckers are female (Brenchely, 1992).
4. Prevalence of dummy-sucking habit: 75-85 in Westeren society use pacifiers
and more in low socioeconomic gp
Aetiology
1. Habit is a learned behaviour. Infants have a natural sucking that encourages
eating. Sometimes this persists after enough food has been eaten.
2. Habit is a sign of underlying emotional disturbance
Factors important in habit
1. Age
2. Intensity
3. Duration
4. Frequency
There are two types of sucking habit
1. Rooting habit where the infants try to turn the head toward anything touch the
check and this continue tile the age of 7 months
2. Sucking reflex which remain tile the age of 12 months. If the sucking continues
after that it is considered as abnormal habit. Larsson 1987

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Types of finger-sucking
1. The ordinary thumb sucking or sucking with the ventral side of the fingers
facing the palate and the maxillary incisors;
2. sucking with the dorsalside of the fingers upwards. In this case the finger or
fingers lie passive and the effect should be similar to that of dummy-sucking.
Effects of the digit sucking habits
A. Dental and skeletaleffect
Larsson 1987
1. Vertical effects.
The asymmetrical anterior open bite is mainly caused by reduced alveolar
growth and it is self-corrected if the habit is cessed before 9 year.
2. Antero-posterior effects
 Convex profile
 Lip incompetent
 The maxillary incisors becomeproclined. When the sucking habit stops, the
proclination of the upper incisors will diminish as a result of the lip pressure if
the lip function is normal
 Spacing in the incisor region because the maxillary dental arch becomes
lengthened
 Retroclined and crowded LLS but it could be proclined or upright depending on
the type of sucking habit. In some cases in the lower jaw, the incisors are
normally somewhat proclined in finger-suckers. A reason for this may be that
the tongue is forced against the lingual surfaces of the lower incisors when
sucking and this anteriorly directed force exceeds the opposite force caused by
the finger
 Increased overjet

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 Cl2 MR and CR.
3. Transverse effects.
 The main reason why a sucking habit causes a crossbiteis probably due to the
effect of the finger on the tongue . They occupythe upper/ anterior part of the
oral cavity, thus forcing the tongue to a lower position. This will leave the upper
canine region without lingual support during sucking.
 Perhaps also the low position of the tongue can widen the lower arch and in this
way contribute to a posterior crossbitein the deciduous dentition.
 Contraction of the upper arch in the canine region and/or expansion of the lower
arch will create interfering occlusal contacts mainly on the deciduous canines.
These interferences will result in a forced lateral guidance of the mandible to
producea unilateral crossbiteand probably ML deviation..
4. Functional effect
Atypical swallowing pattern because the child with an anterior openbite usually
thrusts the tongue through the open bite
B. Effecton the digit
1. Eczema can result from repeated wetting and drying
2. It may also be a means of spread of infectious diseases, herpetic
gingivostomatitis or staphylococcalimpertigo.
C. Oral health effects
This include increase prevelance of caries, oral infection and TMD (Turner
2013)

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Managementof digit-sucking habits
Prevention of digit-sucking habits, BOS guidelines 2000
1. If a dummy is provided, there appear to be fewer problems in the long-term,
because the majority of dummy sucking habits are self-limiting and stop before
eruption of the permanent teeth. Any persistent dummy sucking habit is easily
broken by removal of the dummy.
2. It has been suggested that if a digit-sucking habit is noticed, a dummy should be
given to the child.
3. If a dummy is used it must not be sweetened. After the age of 2, to prevent
problems with speech development, it should be used as little as possible during
the day
Treatment of digit-sucking habits, BOS guidelines 2000
1. The child must want to stop otherwise any approachis likely to be unsuccessful.
2. A child who is undergoing severe psychological trauma is unlikely to respond to
habit breaking. A psychologist’s input may be required
3. The use of orthodontic pacifiers which is oval shape and has a vent to reduce
the effect of dummies
4. The following methods for breaking the habit are listed in the order in which
they should be used:
A. Non-physicalmethods
 Explanation
 Reward
 Habit reversal
Teach the child to carry out alternative activities when they have the urge to
suck the digit
B. Physical methods

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Reminder therapy like finger bandage, finger paint, boxing gloves or
thermoplastic finger post
C. Intra-oral appliances
These deterrent appliances have been shown to be effective within 10 months
and should be used after 7 months on unsuccessfulness of previous methods.
They must be fitted with the full understanding and co-operation of the child
and must not compromise compliance with any future orthodontic treatment.
Intraoral appliance
1. Removable appliance
2. Fixed appliance like palatal appliance with crib or Blue grass appliance
3. Functional appliance can stop habit
Correctionof Problems Causedby Habit
1. Active orthodontic treatment should not be attempted until the habit is broken
2. Fortunately, most of the problems created by the habit are reversible once the
habit is eliminated
3. It has been suggested that digit-sucking beyond the age of 7 has been associated
with an increased risk of root resorption during orthodontic treatment
Dummy-sucking habit
Larsson, 1987
Prevalence
1. 80-90% of children before age of 4
2. only 1% still suck at the age of six
The effectof dummy-sucking on the occlusion
Larsson 1987

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A. In children with active habit
1. Ap: no effects
2. Vertically: AOB
3. Transversely:
 PostXbite which will disappear if the habit stopped beforeage of 4. It was
found that even the tendency of postXbite in the previous dummy sucker
patient is less than normal. Where dummy-sucking continues after the first
molars erupt, the effect on their transverse position does not seem to be
significant. The reason may be that the dummy does not reach further into the
mouth than the level of the second deciduous molars. This means that the
tongue occupies the rear of the mouth, thus providing palatal supportto the
permanent molars against
 Function: Atypical swallowing pattern becausethe child with an anterior
openbite usually thrusts the tongue through the openbite.
B. After cessionofthe habit at age of 16 years:
1. Clinically
 Normal OB compared to normal
 Normal transverse buccalrelationship
 less crowding this caused by dummy sucking during early childhood could be of
some beneficial influence on the development of the arches, as well as
promoting the slight anterior rotation of the maxilla and mandible
2. Cephalometric measurements:
 Decreased AFH
 Decreased MMPA!!!
 Anterior mand rotation!!!
C. Other side effects of pacifiers
 Early weaning of breast feeding
 Otitis media

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 Oral health effects : This include increase prevelance of caries, oral infection
and TMD (Turner 2013) this is why the pacifier should be kept hygienic
without sugar dipping to reduce its risk and should be used for less than 6 hours
a day. Orthodontic pacifier is recommended.
Advantages of the pacifier
1. Pain relief during certain surgery like catheterization or circumcision
(Cochrane review Steven 2002)
2. Reduce the risk of sudden infant death syndrome Hauk et al 2005. (The real
cause of SIDS is sleeping next to adults after consuming alcohol, or infant
sleeping alone, or suffocation by the pillow,). The theory behind the effect of
dummies in reducing the SIDS is
 Keeping the tongue high during sleeping
 Muscle exercise
 Keeping the child from turning to one side
 Reducing the risk of GIT reflux
 Increase the paternal and maternal awareness bec the child will cry if the
pacifier lost
3. Reduce the likehood of digit sucking habit
Summary of evidences
 Nowadays, the incidence of digit sucking is around 30% at 1 year of age,
reducing to 12% at 9 years and 2% by 12 years. (Brenchely, 1992).
 Most persistent suckers are female (Brenchely, 1992).
 Effects of the digit sucking habits, Larsson 1987
 This include increase prevelance of caries, oral infection and TMD (Turner
2013)
 Prevention of digit-sucking habits, BOS guidelines 2000

10. Mohammed Almuzian, University of Glasgow Page 9
 The effect of dummy-sucking on the occlusion, Larsson 1987
 Oral health effects : This include increase prevelance of caries, oral infection
and TMD (Turner 2013) this is why the pacifier should be kept hygienic
without sugar dipping to reduce its risk and should be used for less than 6 hours
a day. Orthodontic pacifier is recommended.
 1. Pain relief during certain surgery like catherterization or circumcision
(Cochrane review Steven 2002)
Bishara 2004
Introduction: The purposes of the study were to determine prospectively the duration of nonnutritive
sucking behaviors of children between 1 and 8 years of age and the effect of persistent habits on
selected occlusal characteristics in the late deciduous dentition. Methods: Sucking behavior data
were initially collected from 797 children who were followed longitudinally from birth; the data came
from periodic questionnaires completed by the parents. In addition, study models were obtained for
372 children at 4 to 5 years of age and assessed for posterior crossbite, anterior open bite, and
overjet. The subjects were grouped according to the duration and type of habit (pacifier or digit, for
less than 12 months or more than 48 months). Children with nonnutritive sucking of less than 12
months were further grouped according to the duration of breast-feeding. The McNemar
nonparametric test was used to compare the changes in the incidence and effect of the habits with
time. Results: There was a significant (P = .001) decrease in the incidence of pacifier habits between
1 and 5 years of age, from 40% to 1%. There was a significant (P = .01) decrease in the incidence of
digit habits between 1 and 4 years of age, from 31% to 12%. Between 4 and 7 years of age, the
decrease in the incidence reached a plateau—ie, the decrease continued but at a slower rate. Between
7 and 8 years of age, there was an additional significant (P = .008) decrease in the incidence of digit
habits, but 4% of the children were, to various extents, still sucking fingers. Children who had pacifier
or digit habits lasting less than 12 months did not have significantly different occlusal characteristics
than children who were breast-fed for 6 to 12 months. Prolonged pacifier and digit habits caused
significant changes in the occlusal characteristics in the late deciduous dentition, and the effects of
pacifier habits were different from those of digit sucking.
Conclusions
From these findings, the following conclusions can be made.
1

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There were no significant differences in the prevalence of digit and pacifier habits between
boys and girls between 1 and 8 years of age.
2
Children who had pacifier or digit habits lasting less than 12 months did not have significantly
different occlusal characteristics than children who were breast-fed for 6 to 12 months.
3
Prolonged habits (>48 months), with either pacifier or digit, have detrimental effects on the
occlusion in the late deciduous dentition (5 years of age).
4
When changes in the prevalence of pacifier and digit habits were compared, more children
with digit habits had difficulty in stopping the habits after 4 years of age. As a result, it might
be useful to attempt to substitute the digit habit with a pacifier habit as soon as possible.
Parents should also be instructed to reduce the pacifier’s in-the-mouth time.
5
So that clinicians can intercept the development of crossbites and functional shifts, it is
prudent to observe the developing occlusion in children with prolonged digit or pacifier habits
in the deciduous dentition. The transverse occlusal relationship, particularly in pacifier-sucking
children, should be evaluated between 2 and 3 years of age. If there are interfering contacts
of the deciduous canines, the parents should be instructed to reduce pacifier-sucking time
and obtain appropriate treatment if needed.