Having difficulty coaxing your child away from his thumb? A noted dentist explains a foolproof method to stop the thumb sucking habit.
Thumb sucking in young children is a very normal response to anxiety and stress. Still, this behavior should decrease by ages 3-4 and stop by age five. Many children are slow to break the habit which can lead to parental anxiety. Is it worth the stress to break the thumb sucking habit?
You may have heard that long term sucking of thumbs or fingers does not cause serious dental problems. Unfortunately, that’s wrong. In fact, 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 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 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. Although, it may take up to 6 months for the changes to occur. However, there can be lasting damage if the habit persists. 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
Children can easily overcome these measures. Thumb sucking is also a deep-rooted behavior and may need more than these remedies offer.
Parents who are willing to try a highly planned method can read the advice in
Little People: Guidelines for Common Sense Child Rearing. This book carefully spells out a series of steps using nail painting. The steps have been shown to be helpful in stopping thumb sucking. This approach requires hard work and consistency from both the parent and child. For many busy families with limited time, these home methods are difficult to apply.
The Dental Solution: A Crib That's Not for Sleeping
One answer to this parental problem is a simple device called a "crib." The crib is placed on the child's upper teeth by an orthodontists. 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 wires fits 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.
First Visit
At the first visit, the doctor 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 orthodontist will usually recommend a crib to stop the habit.
Second Visit
A second appointment is then arranged. Dental records such as clay impressions, facial and dental photographs, and jaw x-rays are taken.
Crib Placement
The orthodontist begins crib construction at the third visit. The crib is cemented in at the fourth appointment.
The child experiences 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 the child with a newly placed crib may at first 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.
Follow-up
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, before the adult teeth have pushed out. This usually occurs just before or after age six. Prompt thumb removal allows adult teeth to have a much better positioning. Dental health is certainly important to a child's wellbeing. So is parental peace of mind. For the thumb sucking patient, the orthodontic crib provides the answer to both.
Dental health is certainly important to a child's wellbeing. So 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.
For the thumb sucking patient, the orthodontic crib provides a solution. Talk to your child's dentist to learn more about this device.
RESOURCES:
American Academy of Pediatrics
http://www.aap.org
American Academy of Pediatric Dentistry http://www.aapd.org
CANADIAN RESOURCES:
AboutKidsHealth
http://www.aboutkidshealth.ca/
Canadian Family Physician
http://www.cfpc.ca/cfp/
REFERENCES
Adair The Ace Bandage approach to digit-sucking habits.
Pediatr Dent. 1999 Nov-Dec;21(7):451-3.
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.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
