“We are what we repeatedly do. Excellence, then, is not an act, but a habit”
The seminar is tailor made for students with an intent to help understand the subject, hope this makes up my little contribution in simplifying the topic.
2. “We are what we repeatedly do.
Excellence, then, is not an act, but a
habit”
3. Introduction
Definitions
Classifications
Prevalence of oral
habits
Thumb sucking
habit
Tongue thrusting
habit
Contents Part I
4. • Habit can be defined as a fixed or
constant practice established by
frequent repetition.
Dorland (1957):
• Habit is a frequent or constant practice
or acquired tendency, which has been
fixed by frequent repetition.
Buthersworth (1961):
5. • “ a tendency towards an act or as act
that has become a repeated
performance relatively fixed,
consistent, easy to perform and almost
automatic”.
Boucher(1963) defined habit as
• “an act, which is socially
unacceptable”.
Finn(1987)defined habit as
6. Oral Habits
• Frequent or constant practice or
acquired tendency, which has been fixed
by frequent repetition.
Buttersworth(1961)
• Oral habits are learned patterns of
muscular contractions, which are
complex in nature
Moyers( 1982)
9. 1.JAMES W. (1923)
Include the habits of
normal function such as:
a)correct tongue position,
b)proper respiration,
c)proper deglutition and
d)normal usage of lips in
speaking.
USEFUL HARMFUL
11. III MORRIS AND BOHANNA (1969)
A)Pressure habits
Eg: Thumb sucking
Tongue thrusting
Non pressure habit
Eg: Mouth breathing
B) Biting habits
Eg: Pencil biting
12. IV KLEIN E(1971)
Meaning habits :
suggests the existence of a direct psychological
cause and effect relationship.
Empty habits :
are simple habits without a detectable cause
13. Klein classified abnormal pressure habits
into intrinsic and extrinsic
a) Intrinsic pressure habits (within the mouth)
sucking
THUMB
FINGER
TONGUE
LIP
CHEEK
biting
NAIL
TONGUE
LIP
MOUTH
BREATHIN
G
MOUTH
BREAT
HING INCORRECT
SWALLOWIN
G
TONGUE
THRUSTIN
G
20. Easily dropped from the child’s behaviours pattern as
he matures.
Naturally modified or eliminated through the
maturation process.
More consistent behaviour
Increased level of maturity and responsibility.
Non compulsive oral acts –
21. GRABER
Thumb and finger sucking
Tongue thrust and tongue sucking
Lip and nail biting
Mouth breathing
Abnormal swallowing habit
Speech defects
Postural defects
Psychogenic Bruxism or Occlusal neurosis
Defective occlusal habits.
22. PREVALENCE of Oral Habits
Kharbanda et al 2003
5-13 yr old children, Delhi -25.5%
Tongue thrusting – most common (18.1%)
followed by mouth breathing (6.6%)
Thumb sucking (0.7%) and lip biting (0.04%)- relatively less
common
There was no significant difference between boys and girls
23. PREVALENCE of Oral Habits
Shetty SR, Munish AK
Mangalore - 29.7% of children.
Digit sucking(3.1%), Pencil biting-(9.8%) and Tongue thrust-
(3.02%) Highly prevalent among 3-6 yrs.
Mouth breathing(4.6% )and bruxism (3.1%) - significant in 7-
12 yrs
Lip/cheek biting(6%)and nail biting (12.7%) - more common
in 13-16 yrs.
Digit sucking, tongue thrust, mouth breathing and bruxism -
more prevalent among boys
Lip/cheek biting, nail biting and pencil biting -more prevalent
among girls.
25. Development of a habit
The newborn develops some instincts, which
are composed of elementary reflexes.
Instinct : pattern and order are inherited,
Habit: pattern and order are acquired,
if constantly repeated during the lifetime of
an individual.
26. At the beginning,
the infant makes an effort by
frequent learning and
practice,
later on the muscles start
responding more readily.
At the onset it takes a long
time for the impulses to pass
along the efferent nerves to
muscle involved
27. It has been stated that unconscious mental pattern of
childhood develops from five sources namely
Instinct,
Insufficient or in correct outlet of energy,
Pain or discomfort,
Abnormal physical size of parts,
Imitation of or imposition of others
29. BUCCINATOR, SUPERIOR
CONSTRICTOR, PTERYG
PMANDIBULAR RAPHE
HARMONIOUS
PRESSURE
BALANCE
ORAL
HABIT
S
NORMAL
DENTOFACIAL AND
SKLETAL GROWTH
TONGUE
LIPS
ABNORMAL SOFT TISSUE
PRESSURE, ALTERED
MUSCULAR CONTRACTION
ALTERED DENTOFACIAL AND
SKLETAL GROWTH
30. Acc to Freud
Personality develops through a series of
childhood stages during which the pleasure-
seeking energies of the id become focused on
certain erogenous areas.
This psychosexual energy, or libido, was
described as the driving force behind behavior.
Psychological development of child from birth
to adolescence is divided into five stages
31. Stages successfully completed: Healthy
personality
Unsuccessful @ appropriate age: Fixation
The Oral Stage:
first year of human life
erotic pleasure oral stimulation (Char’)
During the oral stage,
primary source of interaction : mouth,
Rooting and Suckling reflex is especially
important.
32. Mouth: Vital for eating
the infant also develops a sense of trust and
comfort through this oral stimulation
the infant is entirely dependent upon caretakers,.
Infant derives pleasure from oral stimulation
gratifying activities such as tasting and suckling.
33. Issues with dependency or
aggression.
Oral fixation can result in habits
like:
nail biting, thumb or finger
PRIMARY
CONFLICT
WEANING
PROCESS
IF, FIXATION OCCURS @ THIS STAGE,
35. Thumb/Finger sucking
Definition:
Placement of the thumb or
one or more fingers in
varying depths into the
mouth.
– Gellin- 1978
Repeated and forceful
sucking of thumb with
associated strong buccal and
lip contractions
- Moyers
36. I.U Life
First 2 yrs.
Disappears with maturation.
No: malocclusion
Abnormal IF, persists
IF not controlled at this age: May cause deleterious
effects on dentofacial structures.
37.
38. Significance: new born infant
FEELING OF
euphoria,
sense of security,
warmth and being wanted.
41. O’BRIEN(1996)
A)Nutritive sucking habits:
Provides essential nutrients
Ex- Breast feeding , Bottle feeding.
B)Non nutritive sucking habits:
Ensures a feeling of well-being, warmth and a sense of
security.
Ex- Thumb/ finger sucking, Pacifier sucking
42. Classification of NNS habits
Johnson and Larson 1993 (JDC )
Level Description
Level 1 (+/-) Boys or girls of any chronological age with a habit that
occurs during sleep.
Level II (+/-) Boys below age 8yr with a habit that occurs at one
setting during waking hours
Level III (+/-) Boys below age 8yr with a habit that occurs at multiple
sittings during waking hours
Level IV (+/-) Girls below age 8yr or a boy over 8 yrs with a habit that
occurs at one setting during waking hours
Level V (+/-) Girls under age 8 yr or a boy over age 8 yrs with a habit
that occurs at multiple sittings during waking hours
Level VI (+/-) Girls over age 8 yrs with a habit during waking hours
46. Sucking reflex- Engel 1962
Seen even at 29 week of I.U. life
First coordinated neuromuscular activity of infant
Disappears during normal growth btw 1-3 ½ yrs
Purpose:
Nutritional/Physiological gratification
Emotional gratification
Also experience pleasurable stimuli from lips, tongue
and oral mucosa & learn assct’ enjoyable sensations
such as closeness of a parent.
47. Babies restricted from suckling due to disease or other
factors become restless and irritable.
This deprivation motivates the infant to suck the thumb
or finger for additional gratification
48. SUCKLIN
G SUCKING
SEEN WITH BREAST
FEEDING
BREAST NIPPLE FORMS A
PERFECT ANTERIOR SEAL NO
NEED FOR ADDITIONAL NEGATIVE
PRESSURE
HARMONIOUS, FEELING OF
LOVE, WARMTH, AFFECTION
AND BETTER NOURSMENT OF
THE CHILD
SEEN WITH BOTTLE
FEEDING
NEGATIVE PRESSURE CREATED IN
THE ORAL CAVITY BY THE ACTION OF
BUCCINATOR AND ORBICULARIS
ORIS
DELETERIOUS
(FEELINGS OF DETACHMENT FROM
MOTHER AND INADEQUATE
NOURISHMENT)
49. INFANTILE OR VISCERAL
SWALLOW
Characteristic of the infantile or
visceral swallow as listed by
Moyer’s:
The jaws are apart, with the tongue
between the gum pads.
The mandible is stabilized primarily by
contraction of the muscles of the VIIth
cranial nerve and the interposed
tongue.
The swallow is guided, and to a great
extent controlled by sensory
interchange between the lips and the
50. MATURE SWALLOW
By 18 months of age the mature swallow characteristics listed
by Moyers are observable.
The teeth are together
The mandible is stabilized by contraction of the mandibular
elevators, which are primarily 5th cranial nerve muscles.
The tongue tip is held against the palate about and behind
the incisors and peripheral portions flow between opposing
posterior segments.
There are minimal contractions of the lips during the mature
swallow.
53. Buccinator mechanism
When the child places the thumb between teeth
Negative pressure is created within Mouth
and tongue gets lowered down
Pressure against upper anteriors
Cheek pressure against the upper
posteriors
Increased activity of Buccinator
mechanism, and the absence of
opposing tongue muscle force
V shaped maxillary arch with high vault
palate
54. Variables affecting malocclusion
Sorokohit and Nanda (1989)
1) Position of the digit
2) Associated orofacial muscle contraction
3) Mandibular position during sucking
4) Facial skeletal pattern
5) Intensity, frequency and duration of force applied.
55. THEORIES: Psychology of Non Nutritive digit
sucking
Theories to explain the cause of occurrence
of this habit
• Freudian theory (1905)
• Learning theory (Davidson, 1967)
• Oral drive theory (Sears and Wise, 1982)
• Johnson and Larson (1993)
56. FREUDIAN THEORY(1905)
Distinct phases of psychological
development
Oral and anal phases seen in first 3
years of life.
Oral phase- mouth believed to be
Oro-erotic zone.
The child has tendency to place his
finger or any object into the oral
cavity.
57. Prevention of such an act : results in emotional insecurity
and passes the risk of the child diversifying into other
habits.
Thumb sucking considered as manifestation of insecurity,
maladjustment , internal conflicts
58. The Learning Theory: Davidson 1967
• Non-nutritive sucking stems from adaptive response
• Infant associates sucking with hunger, satiety & being held.
• These events are recalled by finger or thumb.
• i.e habit stems from an adaptive response and assumes no underlying
psychological cause as a result of learning
59. BENJAMIN’S THEORY (1962):
Thumb sucking arises from “ROOTING
REFLEX”, common to all mammilian infants.
It is max’ during first 3months of life.
If it persists, may lead to abnormal habit.
60. ORAL DRIVE THEORY
Sears and wise(1950)
Acc to this, theory prolongation of nursing strengthens
the oral drive.
(i.e prolonged sucking can lead to thumb sucking)
61. PREVALENCE
Birth to 2years of age: - 50-67%
2 to 5 years of age:- 24-43%
6 to 10 years of age:- 17%
Above 10 years :- 10%
Brahm and Morris
62. INCIDENCE:
Popovich and Thompson-1973, Kelley et al 1973:
• Higher incidence in girls than boys :11.7% girls and
8.3% boys.
• Subtenly and Subtenly 1973: Equal distribution
• Race: Low incidence in Negroid races.
(Brenchley 1992)
64. The trident Factors affecting thumb
sucking : Graber and Swain (1985)
Intensity:
Implies how vigorously the habit is pursued.
The digit may rest passively in the mouth or
may be sucked with much enthusiasm.
Frequency: Indicates how often during the
day the habit is Practiced.
Duration: Indicates the number of years the
habit is continued
65. 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 normal during this phase and
unusually terminates at the end of phase one.
66. Phase II
Clinically significant sucking:
The 2 phase extends between 3- 6 years of age. The
presence of sucking during this period is an indication
that the child is under great anxiety.
Treatment should be initiated during this phase.
67. Phase III
Intractable sucking:
Any thumb sucking persisting beyond 4 and 5 year of
life should alert the dentist to the psychological aspect of
approach.
68. VARIABLES INFLUENCING
Age
Sex
RACE :negroids, eskimo :1969 Owen (MUNN)
Pacifier : Ravn 1967 (Am J Ortho)
Feeding methods : Levy 1928
Siblings : Larsson 1993 (JDC)
Parental status :Calisti 1960 (JDR)
Working mother
69. DIAGNOSIS
• History of the digit sucking activity
• Evaluation of the child’s emotional status
• Extra oral examinations
• Intra oral examinations
70. HISTORY: Mathewson, Forrestor
• Parents
• Feeding patterns
• Three major questions: (Graber 1972)
Frequency
Duration (most imp)
Intensity
Direction, type
71. EMOTIONAL STATUS
• Essential to determine meaningful or empty habit.
• Identify the child who wants to stop but just needs some
help
73. DIGITS
Reddened
Exceptionally clean and chapped
Short clean finger/ thumb nail (dish
pan thumb)
Fibrous roughened callus on superior
aspect of finger nail
Grooves on thumb
74. LIPS
Upper lip :
Short and hypotonic
Passive or incompetent during swallowing
Lower lip :
Hyperactive
75. FACIAL FORM ANALYSIS
Maxilla protrusion
Mandibular retrusion
High mandibular plane
angle
Facial profile- straight
/ convex
Saddle nose (due to
pressure of index
finger)
76. Dentofacial changes associated with prolonged non
nutritive sucking habits - Johnson and Larson 1993
Effects on Maxilla:
Proclined maxillary incisors
trauma to maxillary central incisors
Maxillary arch length
Clinical crown length of maxillary
anteriors
palatal arch width ie High palatal arch
Increased atypical root resorption in
primary central incisors
77. Effects on Mandible:
Retroclination / proclination of mandibular
incisors
Retroclination : direct apical & lingual force
from digit
Proclination: indirect force from tongue
beneath digit
Decreased clinical crown length of
mandibular anteriors
Increased mandibular inter molar
distance:Uncontained arch
Retrusion of mandible
81. Lip incompetence
Lower lip function under the maxillary
incisors
Effect on tongue placement and function:
Tongue thrust
Lip to tongue resting position (oral seal)
Lower & lateral tongue position
Effect on lip placement and
function:
82. Other features
Other habits- habitual mouth breathing, tongue thrust
swallow
Middle ear infections
Enlarged tonsils
GI disturbances
Speech defects (lisping)
83. TREATMENT CONSIDERATIONS:
FINN
Psychological status of the child
Age factor
Motivation of child
Parental cooperation
Friendly rapport
Other factors (goal orientation for time limit)
85. Emotional significance
Diagnosis and management of any psychological
problem should be planned before 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.
86. The events that precede the habit such as the use of a
security blanket, the dependency on a favorite
toy, problems with sleep, nightmares, nervousness and
anxiousness will yield information concerning the
possible psychological stimuli of the habit.
If the oral habit is associated with an emotional problem
this would suggest the need for psychological
consultation.
87. Age factor :1) Younger than 3 years
No active intervention :general emotional immaturity.
Most children will outgrow the habit by 5
Most class 1 open bite malocclusion will be self
correcting when the permanent incisors erupt if the habit
doesn’t cease prior to their eruption.
88. The parents should be advised generally to ignore the
active habit, and give the child as much attention as
possible when he is not thumb sucking.
They should also be advised,
For class II children: further orthodontic treatment will
be necessary when the child is older.
89. 3- to 7 year olds
Caution : Depending on the type of the habit and
whether he is actively pulling his maxilla anteriorly or just
sucking his digit with buccal constriction.
Finger suckers : concern then thumb suckers because
anterior orthopedic force vectors associated with finger
sucking leverage.
It is advised counseling the child with good molar
intercuspation with little anterior pull. i.e passive sucking
child.
90. Older then 7 years
Anterior open bite that is usually not closed by itself
because of functional patterns that have been
established.
They will require active orthodontic treatment.
The appliances delivered should not be punitive,
Should be multipurpose
Should help the child to control his habits by giving him
a reminder
91. Motivation of the child to stop the habit:
Important to assess : the maturity : 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.
The first ingredient needed to stop the habit is
the child’s desire to stop.
92. Parental concern regarding the habit:
If the parent is unable to cope with the situation
positively then both the parent and the child should be
dealt with during treatment.
Parents : silent partners.
Important : child should not be offered to deal with this
difficult habit.
Negative reinforcements : threats, nagging and ridicule
would only entrench the habit.
93. Other factors:
Self-correction again depends on the severity of the
malocclusion, anatomic variation in the perioral soft
tissue and the presence of other oral habits, such as
tongue thrusting,
mouth breathing and
lip biting habits.
96. TREATMENT MODALITIES
Once the decision for treatment has been made, one
must next determine what intervention is appropriate.
The treatment considerations are
psychological status, age factor, maturity of the
patient, and patient co-operation.
The combinations of explanations with consideration of
physical appearance and social acceptance may be
sufficient for the child to give up the behavior.
97. In addition to their own intention some children may
require additional help.
Another tool that is helpful for this type of child is the use
of positive reinforcement.
Rewards for progress in diminishing the habit should
include praise and something special that is agreeable
to patient and parent.
98. Psychological Therapy :
A. Dunlop's hypothesis
If a subject is forced to concentrate on the performance
of the act and 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 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
99. B. Six steps in cessation of habit (Larson &
Johnson)
Step 1: Screening for psychological component.
Step 2: Habit awareness.
Step 3: Habit reversal with a competing response.
Step 4: Response attention.
100. Step 5: Escalated DRO (differential reinforcement of other
behaviors)
Step 6: Escalated DRO with reprimands.
(Consists of holding the child, establishing eye contact
and firmly admonishing the child to stop the habit
101. C. Three alarm system: (Norton & Gellin-
1968)
A chart is designed with days of the week and blank
spaces.
When the child engage in his habit he is told to
wrap the digit he sucks with coarse adhesive tapes.
The child feels the tape in his mouth it is the first alarm
and this reminds him to stop the habit.
102. D. Reward system
Children should be encouraged and rewarded for not
practicing the habit. “contingency contracting” is a
contract made between the child and dentist or child and
parent.
103. E. ACE BANDAGE APPROACH
In this approach,
Bandage should be wrapped around
the finger and stars should be
entered into the calendar.
Reminds the parent and child
Every 20 stars: REWARD
104. F. THUMB BUDDY TO LOVE
This is commercially available and is a positive teaching tool and
chemical free method.
It contains thumb puppet that is inserted into the child's thumb and a
calendar at the back of the book.
By having the thumb puppet, the child stays motivated to stop the
habit.
105. G. THUMB - HOME CONCEPT : Skinaz
2000
This is the most recent concept.
Eliminating chronic thumb sucking by preventing a co-
varying response: “The behavior is believed to lose its
appeal by being reframed as a duty.
106. Thus, make the child to suck all the ten finger the same
length of time so that it produce unpleasant reaction and
gradually it quits the habit”.
Forced repetition of the habit will eventually associate it
with unpleasant reaction.
107. H. CHEMICAL TREATMENT
Bitter and sour
Very minimal success e.g.
quinine, asafetida, pepper, caster oil etc.
NEWER anti-thumb sucking solutions
Femite
Thumb-up
Anti-thumb
108. 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.
109. 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.
110. 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 punishment.
111. 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.
112. 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.
113. 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.
114. “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 time
116. INTRAORAL APPROACHES :
• Mink and Haskell 1991 : Blue
grass appliance
• Pediatric clinics of University
of Kentucky and University of
Louisville
• Six sided roller made of
Telfon attached with 0.045
stainless steel wire soldered
to molar orthodontic bands.
117. • Patient instructed to turn the roller instead of sucking the
digit.
• Patient got a new toy to play with tongue & got
distracted
• Time : 3- 6 months
118. Location of roller: most superior aspect of palate
Not in contact with palate
No obstruction in eating or speech
Not used in preschool children
7 – 13 yr age
119. Chris Baker 2000 : Modified blue grass
appliance
4mm acrylic beads
Adv: reduced bulk
Less obstruction, attractive for children
Used in age group 1 ½ - 12 years
Modification:
Attachment with quad helix
Removal time: 6 months after habit cessation
Oral habits are habits that frequently children acquire that may either temporarily or permanently be harmful to dental occlusion and to the supporting structures.When habit causes defect in orofacial structure, it is termed as pernicious oral habit.
Include the habits of normal function such as:correct tongue position, proper respiration, proper deglutition and normal usage of lips in speaking.Include all that exert perverted stresses against the teeth and dental arches such as:Tongue thrusting,Thumb-sucking, Mouth breathing, Lip biting, Nail biting, Lip sucking etc.
Comb’n activity of the muscles + jaws and of the thumb/finger inserted into the mouth.Eg. Thumb sucking.Muscular action combined with the introduction of passive objects into the mouth. Eg. Pencil bitingMuscles: No active role: Caused due to effects on the position of dentition being extraneous pressures. eg: abnormal pillowing, face leaning on hand, etc.
Am J Ortho 1978
A consultation with a pediatrician/psychologist may be necessary before any treatment.
Chin propping,Face leaning on hand,Abnormal pillowing positions,Leaning on forearm or handHabitually sleeping on the right side of the face may cause the nose to turn leftward or vice versa, a deviated septum may also result from this sleeping habit.
Malocclusion developed in musicians from pressure exerted on their teeth or face.
1) Chin propping 2)Face leaning on hand 3)Abnormal pillowing position 4) Habitual sleeping on one side of the face.
Habit that has acquired fixation in the child to the extent that he reverts to the practice of this habit whenever his security is threatened by events, which occur around him. They have deep seated emotional need and is possibly the only safety value when emotional pressure become too much to cope with
Are those habits that are Children appear to undergo continuing behaviour modification, which permits them to release certain undesirable habit patterns and form new and more socially acceptable ones.
Many authors like Mitchell, Nelson, Swinehart, Mc Coy, Saltzman, Graber, Finn, Hogeboom and others have divided the harmful (deleterious) oral habits in various ways. But among them Graber gave a good and simple classification. He summed up extrinsic and intrinsic factors -
An instinct is one where the pattern and order are inherited, while in a habit the pattern and order are acquired if constantly repeated during the lifetime of an individual.
Until this conflict is resolved, the individual will remain "stuck" in this stage.During the oral stage, the infant's primary source of interaction occurs through the mouth, so the rooting and suckling reflex is especially important. The mouth is vital for eating, and the infant derives pleasure from oral stimulation through gratifying activities such as tasting and suckling. Because
Caretakers(who are responsible for feeding the child)
Individual would have issues
The habit of thumb sucking is primarily a psychological principle. In efforts to discontinue the habit the responsibilities of the parent is no longer less than that of the doctor or the patient himself.
Am J Ortho
N: first 2 yrs of life.Disappears as child matures.Doesnt generate any malocclusionIF habit persts beyond preschool age,: then abnormal, IF ntcontrollddis age: May cause deletarious effects on dentofacial str.
Observed in intra uterine life
N: TS cons’ normal in first 2 yrs of life.Usualy disappears as child matures.Habit doesn generate any malocclusionIF habit perstsbeyong preschool age,: then abnormal, IF ntcontrolld @dis age: May cause deletarious effects on dentofacial str.
Has a deep rooted psycological bearingNone; Child performs act out of habit: CAUSE fr concern due to potential to develop malocc.
(+/-Depending Upon willingness of patient to participate in treatment levelIncreased level: Increased habit severity)
- 50% of the children - Whole digit is placed inside the mouth with the pad of the thumb pressing the palate. -Maxillary and mandibularanteriors contact is maintained.Ortho1973
- 13 – 15% of children -Thumb is placed into the oral cavity without touching the vault of the palate. -Max and mandanteriors contact is maintained
- 18 % of the children Thumb/fingers, placed into the mouth just behind the first joint and contacts hard palate and only maxillary incisors. - 6 % of the children - very little portion of the thumb is placed in the mouth
SUCKLING action is exerted by Masseter, Orbicularisoris, Mentalis, Buccinator, Sup Phary’ constr’, Ptymraphe
The development of various reflexES - INTRAUTERINE life By 14th week of intra uterine life- stimulation of lips causes the tongue to moveAt about the same time stimulation of upper lip causes mouth closure and even deglutitionGag reflex develops by about 18 ½ weeks Respiration by about 25 weeksSucking by 25 weeksSucking and swallowing by 32 weeks.
Nutritive Suction Physiology NS process includes three closely related phases: expression/suction (E/S),7,13-15 swallow (S) and breathing (B).
munn
JDC 1967
* Rooting reflex: Movement of an infant’s head and tongue towards a stimulus touching infant’s cheek
Forrestor 1981
Prader-Willi syndrome.
Anterior placement of apical base of maxilla
Increased retroclination
Most children will outgrow the habit by the time they are 5 years old\
Mainly characterized by:
Parents should become silent partners. Negative reinforcements in the form of threats
Counselling: Explain about habitsill effects• Show photographs, video• Dunlop hypothesis• Card to score• Discuss with parents
The elbow of the arm with offending thumb : firmly wrapped in two inch elastic bandage safety pins are placed at proximal & distal ends of bandage and one safety pin is placed lengthwise at the mesial end of the elbow and when the child sucks the thumb again, the closed pin on the medial end of elbow, mildly jabbing the elbow indicates second alarm. If the habit persist, the bandage is tightened this is the final or third alarm, which will definitely remind the child of the habit.
The contract simply states that the child should not suck their thumb for specific period of time. The child should be rewarded if the requirement of the contract is met.
Reminds the parents to wrap the bandage the previous day and also the child for not sucking their thumb. For every twenty stars entered in the calendar, the child should be rewarded.
In this a small bag is given to the child to tie around his wrist during sleep and it is explained to the child that just as the child sleeps in his home, the thumb will also sleep in its house and so the child is restrained from thumb sucking during night.
Chemicals have been used over the thumb causally to terminate the practice but withare also being marketed but they have also had a very moderate success