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  • Breaking Your Child's Thumb Sucking Habit

    IMAGE Thumb sucking in young children is a very normal response to anxiety and stress. Still, this behavior should decrease by ages 2-4 and stop by age five. Many children are slow to break the habit, which can lead to anxiety for parents. Is it worth the stress to break the thumb sucking habit? Yes, because long-term thumb sucking can cause problems with chewing, speech, and facial appearance.

    Effects on the Jawbone

    The longer and harder a child sucks his thumb the more harm is done to the teeth and jaws. Regular, strong thumb sucking makes front teeth move and can even reshape the jaw bone. Upper front teeth flare out and tip upward while lower front teeth move back and inward. But, how can something as small as a child's thumb or finger actually move bone?
    Children’s jaws are rich in blood supply and fairly low in mineral content like calcium. This makes jaws of children under age eight especially soft and flexible. As a result, prolonged thumb or finger sucking easily deforms the bone around the upper and lower front teeth. The deformity produces a hole or gap when teeth are brought together, known as an open bite.
    If a child stops thumb sucking before loss of baby front teeth and arrival of adult front teeth, most or all of the damage may disappear. However, if the habit persists, there may be lasting damage. Flared upper teeth, delayed arrival of front teeth, and open bites are all common problems. This can result in chewing difficulties, speech abnormalities, and an unattractive smile.

    Do Home Remedies Work?

    Some parents try home remedies to break the habit. Common methods include:
    • Placing gloves on their children before bedtime
    • Painting thumbs and fingers with various foul-tasting substances
    • Wrapping bandages around the offending digits
    Thumb sucking is also a deep-rooted behavior and may need more than these remedies offer. The child's desire to stop will determine the success of any intervention.

    The Dental Solution: A Crib That's Not for Sleeping

    One answer to thumb sucking is a simple device called a "crib." The crib is placed on the child's upper teeth by an orthodontist, dentist, or pediatric dentist. It usually stops the habit the first day of use.
    The crib’s technical name is a "fixed palatal crib.” It is a type of brace that sits full-time on the upper teeth and roof of the mouth. The crib consists of half circle of wires connected to supporting bands or rings. The half-circle of flared wires fit behind the child's upper front teeth. It is barely visible in normal view. The bands are fastened to the baby molars.
    The first step for parents is to make an appointment for their child with an orthodontist or dentist.
    At the first visit, the dentist will ask about the child’s thumb sucking habits and examine the child for problems with tooth position and bite. If the teeth and jaws show change from long-term thumb sucking, the dentist may recommend a crib to stop the habit.
    A second appointment is then arranged. Dental records such as clay impressions, facial and dental photographs, and jaw x-rays are taken.
    The dentist begins crib construction at the third visit. The crib is cemented at the fourth appointment.
    The child will experience soreness of upper back teeth for a few hours. You may also notice altered speech for 1-2 days. It will be necessary to avoid chewing gum, hard and sticky candy, popcorn, peanuts, and other brace-destroying foods. Thorough tooth brushing after each meal is stressed to prevent food and plaque build-up, gum infections, and cavities.
    Parents should know that a child with a newly placed crib may initially have trouble sleeping. The device is not painful, but it takes away a comfort that may have helped her to fall asleep. Be sure to offer lots of tender loving care, words of support, and praise to provide a smooth transition.
    After crib placement, the patient is checked in 2-4 weeks, and then seen every 1-2 months until the appliance is removed. These visits are short, and not painful. In cases where hard or sticky foods have loosened the bands, re-cementation may be necessary. Avoidance of the offending foods should eliminate this problem.

    Effectiveness of the Crib

    Once the crib is cemented, there is nothing to adjust and no moving or removable parts. It is one of the simplest, yet most effective dental devices. Why is the crib so effective in stopping thumb sucking? It takes away the habit's pleasure. Crib wires prevent the thumb or finger from touching the gums behind the front teeth and on the roof of the mouth, turning a pleasant experience into an unpleasant one. With no satisfaction, the child has no incentive to continue.
    As a rule, the front tooth position is better within two weeks after crib placement. It takes 4-6 months for an open bite to close and the front teeth to straighten. The brace is left on 9-12 months, plenty of time for the habit to fade away.
    What is a good age to begin crib treatment? The ideal time is when upper front baby teeth become loose and before the adult teeth have pushed out. This usually occurs just before or after age six. Ending the habit allows adult teeth to have better positioning. Dental health is certainly important to a child's well-being, as is parental peace of mind. For the thumb sucking patient, the orthodontic crib provides the answer to both.

    What About Thumb Sucking in Older Children?

    Sucking on a thumb, finger, or blanket may be noted in preteens, teenagers, and even adults. The initial orthodontic treatment is the same for all, placement of a crib to break the habit. For teens and adults, counseling may be suggested to deal with any underlying psychological problems.

    RESOURCES

    American Academy of Pediatric Dentistry http://www.aapd.org

    American Dental Association http://www.ada.org

    CANADIAN RESOURCES

    Canadian Dental Association http://www.cda-adc.ca/

    Canadian Family Physician http://www.cfpc.ca/

    References

    Adair The Ace Bandage approach to digit-sucking habits. Pediatr Dent . 1999 Nov-Dec;21(7):451-3.

    American Dental Association. Thumbsucking. American Dental Association website. Available at: http://www.ada.org/2977.aspx . Accessed June 11, 2012.

    Bergersen EO. Preventive eruption guidance in the 5- to 7- year old. Journal Clinical Orthodontics . 1995;29:382-85.

    Gawlik JA, Oh NW, Mathieu GP. Modifications of the palatal crib habit breaker appliance to prevent palatal soft tissue embedment." ASCD Journal Dentistry Children . 1995; 62:409-11.

    Josell SD. Habits affecting dental and maxillofacial growth and development. Dental Clinics North America . 1995;39:851-60.

    Maguire JA. The evaluation and treatment of pediatric oral habits. Dent Clin North Am . 2000 Jul;44(3):659-69.

    Rosenberg MD. Thumb sucking. Pediatrics in Review . 1995;16:73-91.

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