This document discusses thumb sucking habits in children. It begins by defining habits and classifying different types of oral habits. It then defines thumb sucking and classifications for normal versus abnormal thumb sucking. Various theories for the etiology of thumb sucking are presented, including classical Freudian theory, oral drive theory, sucking reflex theory, and learning theory. Clinical findings, diagnosis, and management strategies are outlined. Finally, several journal articles on topics related to thumb sucking are summarized in 1-3 sentences each.

1. THUMB
SUCKING
Dr. Nikitha Sree. K
Lecturer
Malabar Dental College and
Research Centre

2. CONTENTS
 Habit definition and classifications
 Thump sucking definition and classifications
 Theories of thump-sucking
 Etiology
 Clinical findings
 Diagnosis
 Management
 Journals

3. HABIT
Habit is defined as a tendency
towards an act or an act that has
become a repeated performance,
relatively fixed, consistent, easy to
perform and almost automatic. –
Boucher OC

4. CLASSIFICATIONS OF HABITS
USEFUL AND HARMFUL HABITS
(JAMES-1923)
Useful habits- all those habits of normal
function such as correct tongue position
proper respiration and deglutition.
Harmful habits- all those that exert
perverted stress against the teeth and
dental arches. eg: mouth breathing,
tongue thrusting.

5. COMPULSIVE AND NON-COMPULSIVE
HABITS (FINN- 1987)
Compulsive habits- acquired as a fixation in
the child to the extent that he treats to the
practice whenever his security is threatened.
Non- compulsive- children appear to undergo
continuing behavior modification,which permit
them to release certain undesirable habit
patterns and form new ones which are socially
accepted.

6. MEANINGFUL AND EMPTY HABITS (KLEIN-1971)
Meaningful habit- habit with a deep rooted
psychological problem,
Empty habit- meaningless habit that can be treated
easily by a dentist using reminder therapy.
KINGSLEY-1958
Functional oral habits
Muscular habits
Combined ones

7. MORRIS AND BOHANNA- 1969
Non- pressure habits- eg. Mouth breathing
Pressure habits- eg-a)sucking habits : lip
sucking, thump and digit sucking
b)biting habit : nail biting/needle holding
Postural habits- chin rest
Miscellaneous-bruxism

8. DEFINITION
Thumb sucking can be defind as
placement of the thumb at various
depth in the mouth

9. CLASSIFICATION
1.NORMAL THUMB SUCKING
Normal during the first and second years of
life.such habit is usually seem to disappear as
the child mature.
2.ABNORMAL THUMB SUCKING
When thumb sucking persist beyond the
preschool period.
a.Psychological
b.Habitual

10. PSHYCHOLOGICAL
Habit have a deep-rooted emotional factors
involved and may associated with
insecurities,neglect or loneliness.
HABITUAL
Does not have a psychological
bearing; however,the child performs
the act out of habit
Sucking habits can be classufied as:
NUTRITIVE SUCKING HABIT,e,g.,breast-feeding,bottle
feeding
NON-NUTRITIVE SUCKING HABITS,e,g.,thumb or
finger sucking,pacifier sucking

11. ACCORDING TO SUBTELNY(1973)
TYPE A:Seen in almost
50%,wherein whole digit
is placed inside the
mouth with the pad of
thumb pressing over the
palate,while at the same
time maxillary and
mandibular oral contact
is present
TYPE B:Seen in almost
13-24%,where in the
thumb is placed into the
oral cavity and at the
same time maxillary and
mandibular contact is
maintained.

12. TYPE C:Seen in almost 18%,thumb is
placed into the oral cavity and just
beyond the first joint and contacts hard
palate and maxillary incisors,but there is
no contact with mandibular teeth
TYPE D:Seen almost
6%,only a little portion of the
thumb is placed in to the
mouth

13. SUCKING REFLEX
The process of sucking is a reflex
occuring in the oral stage of development
and is seen even at 29 week of IUL, and
may disappear during normal growth
between ages of 1 and 31/2 years.It is the
first coordinated muscular activity of the
infant.

14. THEORIES OF THUMB SUCKING
Classical freudian theory
Oral drive theory
Sucking reflex
Learning theory
Rooting reflex

15. CLASSICAL FREUDIAN THEORY
 Digit sucking is a pleasurable erotic stimulation of the lips and
mouth.
 One of the concepts of thumb sucking brought about by this
theory is that human posses a biological sucking drive.
 Any kind of the deprivation of this activity will probably cause
an emotionally insecure individual.
ORAL DRIVE THEORY
 Suggest that the strenght of the oral drive is in part a function of
how long a child continues to feed by sucking.
 It is not the frustration of weaning that produces thumb sucking
but in fact it is the prolonged nursing that causes it.

16. SUCKING REFLEX THEORY
 The process of sucking is a reflex occuring in the oral stage of
development and is seen even at 29 week of intrauterine life and
may disappear during normal growth between the age of 1-31/2
years.
 Babies who are restricted from sucking due to disease or other
factors become restless and irritable.
 This motivate the infant to suck the thumb.
LEARNING THEORY
 Non-nutritive sucking stems from an adaptive response.
 The infant associated with feeling like pleasure and hunger and
recalls the events.

17. ETIOLOGICAL FACTORS
Working mother
Order of birth of child
Feeding Practices
Social adjustment
and stress
Age of the child
Number of siblings
Parents occupation

18. ETIOLOGY
PARENT'S OCCUPATION
 Related to socioeconomic status of family.
 Baby with high socioeconomic status has less sucking urge.
WORKING MOTHER
 Sucking habit commonly seen in children with working
mother.
 They feels insecurity so use their thumb to obtain a secure
feeling.
NUMBER OR SIBLINGS
 As the number increases the attention meted by the parents
are divided ,neglected by the parent may attempt to compensate by
this habit.

19. ORDER OF BIRTH OF THE CHILD
Later the sibling rank of a child , the greater the chance for
of having an oral habit.
SOCIAL ADJUSTMENT AND STRESS
It is an emotion based behavior related to difficulty with
social adjustment or stress.
In older children associated with abnormal psychological
devolepment.
AGE OF THE CHILD
In neonate : insecurities related to primitive demand as
hunger.
First few weeks of life : related to feeding problem.
During the eruption of primary molar : it may be used as a
teething device.

20. CLINICAL FINDING
EFFECTS ON MAXILLA
oIncreased proclination of the maxillary
incisors
oIncreased maxillary arch length.
oIncreased anterior placement of apical base
of maxilla.
oIncreased clinical crown of maxilla.
oDecreased palatal arch width
oIncreased atypical root resorption in primary
central incisor.
oIncreased trauma to maxillary cenrtal incisor

21. EFFEC
TS ON
MANDI
BLE
EFFECTS ON MANDIBLE
EFFECTS ON INTERARCH RELATIONSHIP
EFFECTS ON LIP PLACEMENT & FUNCTION
oRetroclination of mandibular incisors.
oRetruded mandible
oIncreased overjet
oDecreased overbite
oIncreased posterior crossbite
oIncreased lip incompetence
oIncreased lower lip function under maxillary
incisors

22. EFFECTS ON TONGUE
PLACEMENT AND FUNCTION
OTHER EFFECTS
oIncreased tongue thrust.
oIncreased lip to tongue resting position.
oIncreased lower tongue position
oRisk to psychologic health
oIncreased risk of poisoning
oIncreased deformation of digits
oIncreased risk of speech defects.

23. DIAGNOSIS
HISTORY
o Determine the psychological component
involved.
o Question regarding the frequency , intensity
,and duration of the habit.
o Enquire the feeding pattern , parental care of
the child.

24. INTRA ORAL EXAMINATION
TONGUE
o Examine for correct size& position of the
tongue at rest ,tongue action
during swallowing.
DENTOALVEOLAR STRUCTURES
o Flared and proclined maxillary anteriors with
diastemas and retroclined mandibular
anteriors.
o Chances of buccal crossbite.

25. EXTRA ORAL EXAMINATION
DIGITS
o Digit-reddened , cleaned chapped and with short
finger nail- clean dishpan thumb.
o Fibrous callus on superior aspect of finger.
LIPS
o Upper lip-short and hypotonic
o Note the position of lip at rest and during swallowing
–together or appart.

26. FACIAL FORM ANALYSIS
o Check for profile ,maxillary protrusion
,mandibular retrusion.
o Facial profile is either straight or convex.
OTHER FEATURES
o Associated other habits like mouth
breathing ,tongue thrust swallow.
o Chances of middle ear infection.

27. ORAL HABITS AND MELVIN MOSS CONCEPT OF GROWTH

28. MANAGMENT
PREVENTIVE TREATMENT
 Feed the child whenever he is
hungry
 Feed the child in natural way-breast
feeding.
 Never let the habit to be started the
practice must be discontinued at its
inception.

29. PSYCHOLOGICAL THERAPY
 Nagging , scolding or frightening the child cause
negativism and tend to make him restore the habit.
 Beta –hypothesis or Dunlops hypothesis: if a
subject can be forced to concentrate on the
performance of the act at time of practices it ,he
learn to stop performing the act.

30. CHEMICAL METHOD
 It is the least effective method.
 Bitter and sour chemicals has been used.
 E.g ; quinine, pepper, caster oil.
 Nowadays new anti-thumb sucking
solutions like femite , thumb-up ,anti- thumb
are marketed.

31. MECHANICAL THERAPY/ REMINDER THERAPY
EXTRA ORAL APPROACH
 Mechanical retainers –splints ,adhesive taps.
 Thumb guard
INTRA ORAL APPROCH
 Optimum time for appliance placement is between the
ages of 3 and 4 ½ years.

32. Removable or fixed palatal crib
It breaks the suction forces of the digit on the
anterior segment
Oral screen
Redirecting the pressure of the muscular and
soft tissue curtain of cheeks & lips
Hay rakes
Designed with series of fence like lines
Children over 3 ½ years.

33. Blue grass appliance
Between 7 & 13 years
Using a teflon roller
Roll the roller instead of sucking the
thumb
Quad helix
Fixed appliance used to expand the arch
Helix serve remind not place finger in
mouth
Modified blue grass appliance
Have 2 rollers of different color

34. CURRENT STRATEGIES
-Increasing the arm length of the night suit
-Thumb–home concept : small bag given to
child to tie around wrist during sleep
-Use of hand puppets

35. -Thumb sucking books
-My special shirt : it provide a number of
tools .
This keep the child busy avoiding the
habit.

36. 1.JOURNAL-THUMP SUCKING REVISITED
-FROM THE SCHOOL OF DENTISTRY, DEPARTMENT OF
BEHAVIOUR SCIENCE,STATE UNIVERSITY OF NEWYORK , USA
(ELLIOT N.GALE,Ph.D, WILLIAM A. AYER)
-Abstract
 The present article has traced the development of thumpsucking from
a rooting and placing reflex through the learning and habituation of
response.
 On the basis of the research presented, it is concluded that thump
sucking may be unrelated to the emotionality of the child. In addition ,
it appears that the response can be consolidated by giving the child
the oppurtunity to suck his thump and fingers continually.
 The habit is harmful in the psychological point of view, but there is
evidence that it is not harmful from a dental standpoint.

37.  It is indicated that punitive measures are not harmful to the
child and can be used successfully in the correction of habit.
 However , they believe that positive reinforcement is better
method of dealing with it.(ie, giving attention when the child
is not sucking thump and points out to him.
 Unfortunately, it is apparent that this is a rather difficult
approach, the so-called ‘punitive’ measure, such as ‘gloving’
the hands or utilizing dental appliances, will most likely be
more convenient and reliable and will lead to rapid extinction
of this undesirable and dentally destructive habit.

38.  A 5 year old girl presented with a 3 year history of
severe trichotillmania and alopecia.
 This is observed to occur with only in the presence
of thump-sucking.
 Treatment is done to eliminate thump-sucking habit
only.
 Results indicated that along with thump-sucking
trichotillmania also eliminated.
2.ELIMINATION OF THUMPSUCKING AS A TREATMENT
FOR SEVERE TRICHOTILLMANIA
-T.STEURT WATSON ,KLEITH D. ALLEN

39. 3.MODIFIED BLUEGRASS APPLIANCE-A NON PUNITIVE
THERAPY.(AMISH DIWANJI.PREET JAIN)
 It is a non-punitive appliance and esthetic and child
can wear it comfortably.
 It can be given as a supportive therapy as it requires
no reminding or bribing,and parents can be freed of
anxiety and frustration.
 It does not interfere with child’s growth and
eliminates the habit with limited complications.

40. 4.THUMP AND FINGER SUCKING HABITS
(NZAO-ASSOCIATION OF ORTHODONTICS)
 Digit sucking habit can result in the development of
malocclusion.
 There are various ways in which these habits may
be dicouraged.
 Almost all harm done to the developing occlusion is
reversible,either spontaneously or with a course of
orthodontic treatment.
 For persistent habits past the age of 5 to 6 years,
referral to an orthodontist would be recommended.

41. 5.THUMP-SUCKING AND FALLING ASLEEP
(MUALLA OZTURK AND ORHAN M. OZTURK)
 Study is carried out in Turkey, 50 thumpsuckers, 50 non
thumpsuckers, 250 school children and 312 ‘problem’
children were investigated through interviews,
questionnaire and other clinical techniques with their
mothers.
 Studies were aspects of feeding, onset and incidence of
thumpsucking,strength of sucking drive, sex distribution,
educational level and occupation of mothers, parental
attitudes toward physical contact with children, mother
child relationships, and particular forms of falling asleep.
 It was found that thumsucking was aetiologically more
related to ways of falling asleep than other factors.

42. REFFERENCE
 Text book of Pediatric dentistry-
SHOBHA TANDON
 Text book of Pediatric dentistry-
NIKHIL MARWAH
 Text book of Pediatric dentistry-
DAMLE
 internet

43. THANK YOU...