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Introduction :
Oral habits may be a part of normal development,
a symptom with a deep rooted psychological basis or may
be the result of abnormal facial growth1. Thumb and finger
habits are considered to be the most prevalent of oral
habits, ranges from 13% to 100% at the time of infancy. The
prevalence of digit habits decreases with age, by 3.5 to 4
years but some may continue into adulthood. When these
habits persist, a number of factors like the frequency,
duration, intensity, relationship of the dental arches, and
the childs state of health affect the development of oral
structures.2
Classification :
Based on clinical observation thumb sucking is
considered normal during 1st and 2nd year of life then it
disappears as child matures, and does not generate any
malocclusion. When the habit persist beyond the preschool
period it is considered as abnormal habit and if ignored may
cause deleterious effects on dentofacial structures. This is
again divided in to psychological and habitual.
Habit with deep rooted emotional factors is called
psychological and is associated with insecurities, neglect, and
loneliness. Habitual cause is when there is no psychological
bearing and child performs the act out of habit3.
Phases of Development of Thumb Sucking (moyers)
Phase I Normal and sub clinically significant. It is
seen during first three years of life. The habit is considered
ABSTRACT:
Thumb sucking is a natural reflex in infants that usually starts
in intrauterine life. It is the first co-ordinated muscular activity in
humans. Few children accommodate with the habit if they use it to
comfort themselves for deep rooted psychological reasons. The
examination of a Pediatric dental patient with an oral habit, the
practitioner requires to make a series of relatively complex evaluations
before arriving at a diagnosis or making any recommendations for care
.The assessment of these behaviors must be coupled with a sensitive
assessment of the physical and emotional status of the child and the
relationship of the parent or caregiver. Treating and intercepting the
habit with psychological counseling is more important and effective
than mechanotherapy that usually we do.
Keywords:
Thumb sucking, psychology, psychosocial, counseling
I. Remainder therapy:
Painting something that tastes yucky on the thumbs
can make them less satisfying. Physical barriers like band
aids, gloves etc can also be used.
J. Thumb guard:
It is an appliance that is worn when the child is
tempted to suck. Once the guard is worn they cannot
generate vacuum and so sucking is not much satisfying.
Another approach is long sleeve gown by doubling the
length of the sleeve. It makes difficulty for the child to suck.
While providing remainder therapy the child should be
instructed that these are just to remind them to take the
thumb out and it is not a punishment1.
K. Parent counseling:
A different approach that can be practiced when its
known that the child, wants to discontinue the habit, it requires
the cooperation of the parent and their consent to disregard
the habit and not mention it to the child. In private
conversation with the child, the problem and its effect must be
elicited. The parents' role in correction is very significant. Over
anxiety and the resulting nagging approach or punishment
often creates greater tension and intensification of the habit.
Thus a change in the home environment and routine help the
child to overcome the habit.
Nagging, scolding or frightening the child should
be avoided since this could cause negativism and tend to
make him resort to the habit.
From a psychological point of view the child should
make the decision that he doesn't want to do it anymore.
Parents should not force the preschoolers to break the
habit since they only know the pleasure derived from the
habit but they cannot understand why the habit to be
stopped. Some children practice the habit while watching
T.V especially when there is no other person to take care of
them during day time. So in such case, parents should
spend more time with children during day time10.
Other Possible Approaches:
I. Mechanotherapy:
Removable or fixed palatal crib
It breaks the suction force of the digit on the
anterior segment, makes the habit a non-pleasurable one.
Hay Rakes
Mack (1951) advocated the use of dental
appliance in children over 3 years of age who are
persistent thumb suckers. The device was called hay rake as
it was designed with a series of fence like lines that
prevented sucking1.
Conclusion:
To conclude, the essence of this extract is that, this
habit has more psychological factors involved and can be
best managed through counseling and psychological
approach than the usual mechanotherapy, thereby
preventing a full-blown stage of malocclusion that the habit
may cause. The management of the habit is accessible to
all practioners as it does not demand any special or
technique sensitive procedures. Awareness must be created
at a community level so that early interception of the habit
can be achieved.
References:
1. Nikhil Marwah, Textbook of Pediatric Dentistry 2nd edition 2009.page 281 - 89.
2. John A Maguire., The Evaluation and treatment of Pediatric oral habits,
Dental Clinics of North America. Volume 44, No.3, July 2000.
3. Shobha Tandon, Textbook of Pedodontics 2nd edition 2008.page 492 504.
4. Arathi Rao, Principles and Practice of Pedodontics, 2nd edition 2008.page
115 126.
5. Eric D.Johnson, Brent E.Larson., Thumb sucking: Literature review. Journal
of Dentistry for Children ,Nov - Dec 1993.page 385 391.
6. Singh S.P., Utreja A.,Chawla H.S., Distribution of malocclusion types
among thumb suckers seeking orthodontic treatment. J Indian Soc Pedo Prev
Dent Supplement 2008.page s114 s117.
7. Amitha M Hegde, Arun M Xavier., Childhood Habits: Ignorance is not bliss
A Prevalence Study. International journal of clinical pediatric dentistry, Jan
April 2009;2 (1):26-29.
8. Johnson ED, Larson BE, Thumb sucking: classification and treatment,
ASDC J.Dent Child, 1993 Nov-Dec 60(4) : 392-398.