- The document discusses the thumb sucking habit in children. It defines thumb sucking and provides a classification system. Theories on the development of thumb sucking habits include the Freudian oral drive theory and learning theory. - Etiological factors that may contribute to thumb sucking include socioeconomic status, number of siblings, feeding habits and age of the child. Diagnosis involves examining the child's digits, lips, facial form and examining intraorally. - Clinical findings of thumb sucking can include effects on the maxilla like proclined incisors, increased arch length and anterior placement of the maxilla. Effects on the mandible may include retrusion. Prolonged thumb

2. THUMB SUCKING HABIT
PREPARED BY,
ALPHY AUGUSTINE,

3. DEFINITION OF HABIT
CLASSIFICATION OF HABIT
DEVELOPMENT OF HABIT
ETIOLOGICAL AGENTS IN ORAL HABIT
 THUMB SUCKING HABIT
DEFINITION
CLASSIFICATION
THEORIES AND CONCEPT OF THUMB SUCKING
ETIOLOGICAL FACTORS ASSOCIATED WITH THUMB
SUCKING
DIAGNOSIS OF THUMB SUCKING
CLINICAL FINDINGS
DENTOFACIAL CHANGES
PREVENTION
TREATMENT CONSIDERATION
MANAGEMENT
HABIT BREAKING APPLIANCE FOR HABBIT CORRECTION
REFERENCES

4. Oral habits in children are prime concern for the dentist, be it an orthodontist ,
pedodontist or a general practitioner.
Finn says that habits cause concern because they cause
Oral structure changes
Behavioral problems
Socially unacceptable act
DEFINITIONS OF HABITS
1. DORLAND (1963): Fixed or Constant practice establishment by frequent
repetition.
2. WILLIAM JAMES: A new pathway of discharge formed in the brain by which
certain in coming currents lead to escape.
3. MASLOW (1949): A habit is a formed reaction that is resistant to change, whether
useful or harmful, depending on the degree to which it interferes with the child’s
physical , emotional and social functions.
4. MOYERS: Habits are learned patterns of muscle contraction, which are complex
in nature.
Habit is an automatic response to a situation acquired normally as the result of
repetition and learning, strictly applicable only to motor responses. At each
repetition the act becomes less conscious and can lead on to an unconscious habit.
CLASSIFICATION OF HABITS:
USEFUL AND HARMFUL HABITS(JAMES IN 1923)
1. USEFUL HABITS
These include habits that are considered essential for normal function such
as proper positioning of the tongue, respiration and normal deglutition.
2. HARMFUL HABITS
These include habits that have a deleterious effect on the teeth and their
supporting structures such as thumb sucking, tongue thrusting etc

5. MEANINGFUL AND EMPTY HABITS(KLEIN 1971)
1. MEANINGFUL HABITS
They are habits that have a psychological bearing
.
2. EMPTY HABITS
They are simple habits without a detectable cause.
PRESSURE, NON-PRESSURE AND BITING HABITS(MORRIS AND BOHANA
1969)
1. PRESSURE HABITS
These include sucking habits such as thumb sucking, lip sucking, finger
sucking and also tongue thrusting.
2. NON-PRESSURE HABITS
Habits which do not apply a direct force on the teeth or supporting structures
are termed non-pressure habits. Example: mouth breathing.
3 .BITING HABITS
These include habits such as nail biting, pencil biting and lip biting.
FUNCTIONAL ORAL HABITS AND MUSCULAR HABITS(KINGSLEY 1958)
1 .FUNCTIONAL ORAL HABITS
Eg :Mouth breathing
2 .MUSCULAR HABITS
Individual habit eg.lip sucking
Habits in which there is combined activity of the muscles of the mouth and
jaws of the thumb/finger inserted into the mouth .eg:.thumb sucking.
3. COMBINED HABITS
COMPULSIVE AND NON-COMPULSIVE HABITS(FINN 1987)
1. COMPULSIVE HABITS
These are deep rooted habits that have acquired a fixation in the child to the
extend that the child retreats to the habit whenever his security is threatened
by events which occur around him.The child tends to suffer increased
anxiety when attempts are made to correct the habits.

6. 2
.NON-COMPULSIVE HABITS
Children appear to undergo continuing behavior modification, which permit
them to release certain undesirable habit patterns and form new ones which
are socially accepted.
NORMAL AND ABNORMAL HABITS
1. NORMAL HABITS
Those habits that are deemed normal by children of a particular age group.
2. ABNORMAL HABITS
Those habits that are pursed after their physiological period of cessation.
PHYSIOLOGICAL AND PATHOLOGICAL HABITS
1. PHYSIOLOGICAL HABITS
Physiological habits are those that are required for normal physiologic
fractioning eg:Nasal respiration, sucking during sucking.
2 .PATHOLOGICAL HABITS
Habits that are pursued due to pathological reasons such as adenoids and
nasal septal defects that may lead to mouth breathing.
BASED ON THE EXTRINSIC OR INTRINSIC FACTORS(GRABER 1972)
1 .Thumb or finger sucking
2. Tongue thrusting or sucking
3. Lip or nail biting
4. Speech defects
5 .Mouth breathing
6. Bruxism
7 .Postural defects
8. Defective occlusal habits
RETAINED AND CULTIVATED HABITS
1. RETAINED HABITS
Those habits that carried overhood from childhood into adult.
2. CULTIVATED HABITS
Those cultivated during the socio-active life of an individual.

7. DEVELOPMENT OF HABIT
A new born instinctively develops certain habits essential for his survival in the
state of neuromuscular immaturity.
There are five sources of conscious mental patterns in childhood which lead to the
development of habit:
Instinct
Insufficient outlet for surgery
Pain /discomfort or insecurity
Abnormal physical size of parts
Limitations /imposition by parents or others
ETIOLOGICAL AGENTS IN THE DEVELOPMENT OF ORAL
HABIT
1. ANATOMICAL
For example posture of tongue. Infantile swallow occurs due to the
large tongue in a small oral cavity coupled with anterior open bites of
gum pads.
2. MECHANICAL INFERENCES
Mechanical inferences lead to undesirable oral habits, example in a
child with normal breathing and swallowing, if permanent incisors
erupt ectopically, then to achieve a proper anterior seal/vacuum when
swallowing, the child must thrust the tongue and resultant mouth
breathing occurs due to loss of lip seal. Again if the succedaneous
teeth are missing, an abnormal habit can develop.
3. PATHOLOGICAL
Certain conditions of oral and perioral structures can cause an
undesirable oral habit, example tonsillitis, DNS, hypertrophy of
inferior nasal turbinates (can cause mouth breathing).
4. EMOTIONAL
Upset children regress towards infancy, assume infantile postures,
example digit sucking which gives the child a feeling of security
5. IMITATION
Young children are extremely observant and sensitive to environment
and highly affected by parents and siblings.The child may imitate jaw
positions/speech disorders of parents.

8. THUMB SUCKING (DIGIT SUCKING(FINGER SUCKING) HABIT
DEFINITION:
 Placement of thumb or one or more fingers in various depths into the mouth
or oral cavity (Gellin).
 Repeated and forceful sucking of thumb with associated strong buccal and
lip contractions(Moyers)
(Gessell and Lig)
 Finger sucking is perfectly normal at one stage of development.
 Finger sucking may be considered normal for the first year and a half of life
and will disappear spontaneously by the end of the second year with proper
attention to nursing.
CLASSIFICATION:


NORMAL THUMB SUCKING
ABNORMAL THUMB SUCKING
-Psychological –deep rooted emotional factor
-Habitual –performs the act out of habit.
Sucking habits classified as
Nutritive
- Breast feeding, bottle feeding
Non-nutritive sucking habits(NNS)
-Thumb or finger sucking, pacifier sucking.

9. Subtelny (1973): graded thumb sucking into 4 types
TYPE A
Seen in almost 50% of children, where in the whole digit is placed inside
the mouth, with the pad of thumb pressing over the palate, while at the same
time maxilla and mandible anteriors contact is present.
TYPE B
Seen in almost 13-24% of children where in the thumb is placed in oral
cavity without touching the vault of the palate, while at the same maxillary
and mandibular anteriors contact is maintained.
TYPE C
Seen in almost 18% of children where, the thumb is placed in the mouth
first,and contacts the hard palate and maxillary incisors but there is no
contact with mandibular incisors.
TYPE D Seen in almost 6%of children where very little portion of thumb is
placed into the mouth.
Cook (1958) 3 Patterns of thumb sucking.
Pushed palate in a vertical direction and displayed only little buccal
wall contractions.
Registered strong buccal wall contractions and a negative pressure in
the oral cavity show posterior cross bite.
Alternate positive and negative pressure, least effect on anterior
occlusion
.

10. CLASIFICATION OF NNS HABITS (JOHNSON 1993)
LEVEL
I(+/-)
II(+/-)
DESCRIPTION
Boys or girls of any chronological age with a habit that occurs during
sleep
Boys below age 8years with a habit that occurs at one setting during
waking hours
III(+/-)
Boys under age of 8 with a habit that occurs at multiple settings
during waking hours
IV(+/-)
Girls below age of 8 years or boy over 8 years with a habit that occur
at one setting during waking hours
V(+/-)
Girls below age of 8 years or boy over 8 years with a habit that occur
multiple setting during waking hours
VI(+/-)
Girls over 8 years with a habit during waking hours
(+/-) designates willingness of parents to participate in treatment

11. THEORIES AND CONCEPTS OF THUMB SUCKING
1.CLASSICAL FREUDIAN THEORY (SIGMUND FREUD-1919)
The psychoanalytic theory has proposed that a child goes through various
distinct phases of psychological development. In oral phase, it is believed that
the mouth is erogenous zone. During this phase child takes anything and
everything to the oral cavity. It is believed that any kind of deprivation of this
activity will cause an emotionally insecure individual
2.ORAL DRIVE THEORY(SEARS AND WISE-1982)
They suggest the strength of oral drive is in part of a function of how long a
child continues to feed by sucking. It is not the frustration of weaning that
produces the thumb sucking but in fact it is the prolonged nursing that causes it.
3.ROOTING REFLEX (BENJAMIN-1962)
The rooting reflex is movement of the infant’s head and tongue towards an object
touching its cheeks. He suggested that the thumb sucking arises from the rooting
and placing reflexes common to all mammalian infants during the first 3 months of
life.
4.SUCKING REFLEX(ERGEL-1962)
The process of sucking is a reflex occurring in the oral stage of development and is
seen even at 29 weeks of intrauterine life and may disappear during normal growth
between the ages of 1-3and half years. It is the first coordinated muscular activity
of the infant. Babies who restricted from sucking due to disease or other factor
become restless and irritable. This deprivation may motivate the infant to suck the
thumb and finger for additional gratification.
5 .LEARNING THEORY(DAVIDSON-1967)
This theory advocates that non-nutritive sucking stems from an adaptive
response. The infant associates sucking with feelings like pleasure and hunger
and recalls these events by sucking the suitable objects available, which is
mainly thumb or finger.

12. ETIOLOGICAL FACTORS ASSOCIATED WITH THUMB SUCKING
SOCIO-ECONOMIC STATUS
In high socio-economic status the mother is in a better position to feed the
baby and in a short time the baby’s hunger is satisfied. Whereas in the low
socio-economic group mother is unable to provide sufficient breast milk to
infants, hence in the process the infants suckles intensively for a long time
thereby exhausting the sucking urge. This theory explains the increased
incidence of thumb sucking in industrialized areas when compared to rural
areas.
WORKING MOTHER
The sucking habits is commonly observed to be present in children with
working parents because such children are brought up in hands of caretaker
and develop feeling of insecurity.
NUMBER OF SIBLINGS
The development of habit can be related to the number of siblings because
more the number increases the attention meted out by the parents to the child
gets divided. A child who feels neglected by the parents may attempt to
compensate his feelings of insecurity by means of this habit.
ORDER OF BIRTH OF THE CHILD
Later the sibling ranks in the family, greater is the chance of having an oral
habit.
FEEDING HABITS
Thumb sucking is seen to be more frequent in among breast –fed children.
Yet abrupt weaning from the bottle or breast has also been hypothesized to
contribute to acquiring an oral habit. A negative relation is also seen
between breast feeding and the development of dummy or finger sucking.

13. SOCIAL ADJUSTMENT AND STRESS
Digit sucking has also been proposed as or emotionally based behavior.
AGE OF THE CHILD
The time of appearance of digit sucking habit has significance.
 In the neonates: Insecurities are related to primitive demands as
hunger.
 During the first few weeks of life: Related to feeding problems.
 During eruption of primary teeth: It may be used to relieve teething.
 Still later: Children use the habit for the releases of emotional
tensions with they are unable to cope, taking refuge in regressing to an
infantile behavior pattern
 DIAGNOSIS OF THUMB SUCKING HABIT
Clinical aspects of thumb sucking given by Moyers in 1995
PHASE
PHASE I
PHASE II
CLINICAL
STAGE
Normal or sub
clinically significant
sucking
AGE OF
CHILD
Pre-school
infant
Clinically
significant sucking
Grade school
PHASE III Intractable sucking
Teenage child
INFERENCE
This phase extends from
childbirth to about 3yrs of age
depending on the child’s social
development. Most infants
display a certain amount of
thumb sucking during this
period, particularly at time of
weaning.
This phase extends from 3 to
6years.Continued, purposeful
digit sucking during this time
deserves more serious attention
because the possibility indicates
a clinically significant anxiety
and it is the time to solve dental
problems related to digit
sucking.
Any thumb sucking persisting
after the child’s fourth year
presents the dentists with a
problem. A thumb sucking habit
seen during this phase may
require psychological therapy
and an integrated approach by
the dentist.

14. HISTORY
Once the positive history of habit is determined the question regarding the
frequency, intensity and duration of the habit is determined. The remedies that
have been tried at the home, the feeding patterns, parental care of the child is also
ascertained.
EMOTIONAL STATUS
It is essential to determine if the habit is meaningful or empty. This requires an
insight into the emotional security and familial well being of the child.
EXTRA ORAL EXAMINATION
Digits that are involved in the habit will appear reddened, exceptionally clear,
chapped and a short fingernail i.e. a clean dishpan thumb. Fibrous roughened callus
may be present on the superior aspect finger
Lips:The position of the lips at rest or during swallowing should be observed. A
short, hypotonic upper lip frequently characterizes chronic thumb suckers. Lower
lip is hyperactive and this leads to further proclination of upper anterior teeth.

15. Facial form analysis:
Check for mandibular retrusion, maxillary protrusion, high mandibular plane angle
and profile.
When swallowing, the patient is observed for presence of a facial grimace or an
excessive mentalis muscle contraction, a normal placement of the tongue against
the teeth and palate and whether the pattern of speech of the child is essentially
normal. Facial profile is either straight or convex.
Other features include Associated symptoms hat should be watched for during the
initial examination are habitual mouth breathers and tongue thrust swallow,
particularly in children with anterior open bite. Active thumb suckers also have a
higher incidence of middle ear infection and frequently have enlarged tonsils
accompanied by mouth breathing.
INTRAORAL EXAMINATION-
TONGUE- Examine for tongue position at rest, tongue action during swallowing.
GINGIVA- Look for evidence of mouth breathing; gum line etching, decay or
excessive staining on the labial surface of upper central and lateral incisors.

16. CLINICAL FINDINGS
The type of malocclusion produced by digit sucking is dependent on a
number of variables (NANDA 1989)
 Position of digit
 Associated orofacial muscle contraction
 Mandibular position during sucking
 Facial skeletal pattern
 Intensity, frequency and duration of force applied
DENTOFACIAL CHANGES ASSOCIATED WITH THUMB SUCKING
(JOHNSON & LARSON 1993)

17. EFFECTS ON
MAXILLA
EFFECTS ON THE
MANDIBLE
•Increased proclination of maxillary anteriors with diastema
•Increased maxillary arch length
•Increased anterior placement of apical base of maxilla
•increased SNA
•increased clinical crown length of maxillary incisors
•increased counterclockwise rotation of the occlusal plane.
•Decreased SN to ANS-PNS angle.
•Decreased palatal arch width.
•Increased atypical root resorption in primary central incisors.
•Increased trauma to maxillary central incisors
•Increased proclination of mandibular incisors
•Increased mandibular intermolar distance
•Increased distal position of B point
•Decreased maxillary and mandibular incisal angle
•Increased overjet
•Decreased oerbite
•Increased posterior crossbite
• Increased unilateral and bilateral Class II occlusion
EFFECTS ON THE
INTERARCH
RELATIONSHIP
EFFECTS ON LIP
PLACEMENT AND
FUNCTION
•Increased lip incompetence
•Increased lower-lip function under hte maxillary incisors
EFFECTS ON TONGUE
PLACEMENT & FUNCTION
•Increased tongue thrust
•Increased lip to tongue resting postion
•Increased lower tongue position
•Risk to psycologic health
OTHER EFFECTS
•Increased risk of poisoning
•Increased deformation of digits
•Increased risk of speech defects,especially
lisping

20. PREVENTION OF THUMB SUCKING
1)
Motive based approach
The etiology of thumb sucking focuses on a predominant psychological
background. Its prevention should be directed towards the motive behind the
habit. History serves as an important tool for diagnosing the etiology.
2)
Child’s engagement in various activities
Parents when questioned may reveal that the child practices the habit when bored
and left to himself, or it could be just before he goes to sleep. In such cases,
the parents can be counseled on keeping the child engaged in various
activities. This gives little chance for child to practice the habit.
3)
Parents involved in prevention
When parents are at home they should be advised to spend ample time with the
child so as to put away his feeling of insecurity.
4)
Duration of breast feeding
Care should be taken when feeding infants in that the duration of feeding should
adequate so as to enable the child to exhaust his sucking urge and feel
completely satisfied.
5)
Mother’s presence and attention during bottle feeding
Bottle fed babies should be held by the mother and enough attention should be
given in the process. This will promote a close emotional union between the
mother and baby similar to that in breast feeding.
6)
Use of physiological nipple
A physiological nipple should be used for bottle feeding and size and number of
holes should be standardized to regulate a slow and steady flow of milk.

21. 7)
Use of dummy or pacifier
Acquiring a digit sucking habit can be prevented by encouraging the baby to suck a
dummy instead. If the child already has thumb sucking habit, it will not be
easy to introduce a dummy. It is necessary to offer a dummy to a child
whose behavior indicates an urgent desire to suck a digit or dummy.
TREATMENT CONSIDERATIONS
 Psychological status of the child
Diagnosis and management of any psychological problem should be planned
before the treatment of any potential or present dental problem. The frequency,
duration and intensity of the oral habit are important in evaluating the
psychological status of the child. If the oral habit was associated with an emotional
problem this would suggest the need for psychological consultation.
 Age factor
If the child desists with finger sucking habit within the first three years of life, the
damage incurred such as open bite, is temporary provided the child’s occlusion is
normal. No treatment is provided in this age group. If a malocclusion is caused by
digit sucking and the habit is discontinued between the age of 4-5 years, self
correction of habit can be exempted. When digit sucking continues after 6 years or
into mixed dentition, the malocclusion will not be self corrected.
 Motivation of the child to stop the habit
It is also important to assess the maturity of the child in response to new situations
and to observe the child’s reactions to any suggestion. The treatment approach for
the digit sucking habit should deal directly with the child.

22.  Parental concern regarding the habit
If the parent is unable to cope with the situation positively then both the parents
and the child should be dealt with during the treatment. It is important that the
child should not be embarrassed or criticized, rather help should be offered to deal
with this difficult habit.
 Other factors
Self –correction again depends on the severity of the malocclusion, anatomic
variation in the peri oral soft tissue, and the presence of other oral habits such as
tongue thrusting, mouth breathing and lip biting.
MANAGEMENT OF THUMB SUCKING
The treatment can be broadly divided into the following (according to PINKHAM)
i.
ii.
iii.
iv.
i.
PREVENTIVE THERAPY
PSYCHOLOGICAL THERAPY
REMINDER THERAPY- a) chemical
APPLIANCE THERAPY
b) mechanical
PREVENTIVE THERAPY (Hughes 1941)
Firstly, feed the child whenever he is hungry and let him eat as much as he wants.
Secondly feed the child the natural way. Thirdly never let the habit to be started the
practice must be discontinued at its inception.
ii.
PSYCOLOGICAL THERAPY
Screen the patient for underlying psychological disturbances that sustain a thumb
sucking habit. Once psychological dependence is suspected, the child referred to
professionals for counseling.
β-HYPOTHESIS OR DUNLOP’S HYPOTHESIS. He believed that if a
subject can be forced to concentrate on the performance of the act at the time
he practices it, he could learn to stop performing the act. Forced purposeful
repetition of habit eventually associates with unpleasant reactions and the

23. habit is abandoned. The child should be asked to sit in front of the mirror
and asked to observe himself as he indulges in the habit.
THUMB SUCKING BOOK-“The Little Bear who Sucked His Thumb”
is a book directed at children, for children. The
book has been written and illustrated by DR.Dragan Antolos, an experienced
dentist with a special interest in thumb sucking habits in children. The book
and chart are a non-invasive and effective strategy for stopping thumb
sucking, and have received positive support from psychiatrists, speech
pathologists and pedodontic societies. DR.Dragan Antolos,”It is important to
balance the psychological benefits of thumb sucking with the negative
impact it has on developing, permanent teeth.”The Little Bear who Sucked
His Thumb” is a book that the child will relate to the story and it will
deliver a positive message without pressure.

24. iii.
REMINDER THERAPY
CHEMICAL THERAPY
Recommends the use of hot flavoured,bitter and sour tasting or foul smelling
preparations, placed on the thumb or fingers that are sucked. The chemical therapy
uses Cayenne (red) pepper dissolved in a volatile liquid medium. Quinine and
Asafoetida, castor oil which have bitter taste and an offensive odor respectively,
also may be used. This should be done only when the patient has a positive attitude
and wants treatment to break the habit.A commercially available product FEMITE
(Denatonium benzoate) is also used for prevention of digit sucking.
MECHANICAL THERAPY
Mechanical restraints applied to the hand and digits like splints, adhesives
tapes. Thumb guard is the most effective extra oral appliance for control of
the habit.

25. a. THERMOPLASTIC THUMB POST was devised by Allen in 1991 where
a thermoplastic material was placed on the offending digit. A total of 6
weeks of treatment time was required for elimination of habit.
b. ACE BANDAGE APPROACH: other approach include the use of ace
bandage which is an at home program to assist children with nocturnal
digit sucking habits. The program involves nightly use of an elastic
bandage wrapped across the elbow. Pressure exerted by the bandage
removes the digit from the mouth as the child tires and fall asleep.
c. NORTAN AND GELLIN(1968)- proposed a 3 alarm system often
effective in children between 3-7 years
 Offending digit is taped and when the child feels the tape in te
mouth it serves as the first alarm.
 Bandage tied on the elbow of the arm with the offending digit,
a safety pin is placed lengthwise. When the child flexes the
elbow, the closed pin mildly jabs indicating a second alarm

26.  Bandage tightens if the child persists serving as a third
alarm
d. USE OF LONG SLEEVE NIGHTGOWN-This is useful in children who
sincerely want to discontinue the habit and only perform during their
sleep. The arms of their night suit are lengthened so that they cannot
reach their thumb during night.
e. THUMB-HOME CONCEPT-This is the most recent concept. In this
method a small bag is tied around the wrist of the child during sleep. It is
explained to the child that just as the child sleeps in his home, the thumb
also sleeps in its house. Thus the child is restrained from thumb sucking
during night.

27. f. USE OF HAND PUPPETS-Currently the use of hand puppets is gaining
popularity. These help in eliminating thumb sucking.
g. MY SPECIAL SHIRT-This helps in minimizing the damage of the finger
sucking by providing a number of tools to address the habit in a phased
manner.

28. iv.
APPLIANCE THERAPY
Various orthodontic appliances are employed to attenuate and eventually break
the habit. Removable appliances used may be palatal crib, rakes, palatal arch,
lingual spurs, and Hawley’s retainer with and without spurs. Fixed appliances
such as upper lingual tongue screens appear to be more effective in breaking
these habits.
Removable or fixed palatal crib-It breaks the suction force of the digit on
the anterior segment, reminds the patient of his habit and makes the habit
a non-pleasurable one.
Oral Screen-Oral screen is a functional appliance introduced by Newell
in 1912.It produces its effects by redirecting the pressure of the muscular
and soft tissue curtain of the cheeks and lips. It prevents the from placing
the thumb or finger into the oral cavity during sleeping hours.

29. Hay Rakes-Mack (1951) advocated the use of dental appliance in
children over 3 1/2 years of age who persistent thumb suckers. The
device was called hay rake as it was designed with a series of fence like
lines that prevented sucking.
Blue Grass appliance-Developed by Bruce S Haskell (1991).It is a fixed
appliance using a Teflon roller, together with positive reinforcement. Used
to manage thumb sucking habit in children between 7 and 13 years of age.
The patient believes that he has acquired a new toy to play with. Instructions
are given to them to roller instead of sucking the digit.
Quad helix-The quad helix is fixed appliance used to expand the constricted
maxillary arch. The helixes of the appliance serve to remind the child not to
place the finger in the mouth.

30. Modified Blue Grass appliance-This is a modification of the original
appliance with the difference being that this has two rollers of different
colors and material instead of one. If the patient tries to suck on his
thumb the suction will not be created and his thumb will slip from the
rollers thus breaking the act.
GRABER explained the working of these appliances
 Render finger habit meaningless by breaking suction
 Prevents finger pressure from displacing maxillary central incisors thus
avoids/labially from creating worse a malocclusion.
 Forces the tongue backwards changing its postural rest position, thus
exerting more lateral pressures

31. 
HABIT BREAKING APPLIANCE DESIGN FOR
HABIT CORRECTION

32. REFERENCES









TEXT BOOK OF PEDODONYICS-SHOBHA TANDON
TEXT BOOK OF PEDIATRIC DENTISTRY-NIKHIL MARWA
TEXT BOOK OF PEDIATRIC DENTISTRY- S G DAMLE
PRINCIPLES AND PRACTICE OF PEDODONTICS-AARTHI RAO
PEDIATRIC DENTISTRY(INFANCY THROUGH
ADOLESCENCE)-JIMMY PINKHAM;HENRY FIELDS
HANDBOOK OF PEDIATRIC DENTISTRY-AGNUS C CAMERON
DENTISTRY FOR CHILD AND ADOLESCENTDEAN,McDONALD,AVERY
CLINICAL PEDODONTICS-SIDNEY B. FINN
GOOGLE SEARCH ENGINE