At The Child Dental Center (CDC) we are passionate about educating you about the effect of orofacial habits, so that you can take proactive steps to address these habits before they affect your child’s orofacial development. As parents, most of you are not aware that non-nutritive sucking habits (e.g. thumb sucking, finger sucking, dummy sucking and tongue sucking) can affect the facial growth, oral cavity and facial aesthetics. We offer information to illustrate the effects of oral habits (when they are chronic or prolonged), to help you make informed decisions about your child’s health and wellbeing before these habits lead to more serious problems requiring medical or orthodontic intervention.
The effects of non-nutritive sucking habits on developing teeth are minor in infants and children under age 3 and are limited to changes in the incisor position. Some upper incisors become tipped toward the lips, whereas others are prevented from erupting. The teeth change as a result of non-nutritive sucking habits vary with the intensity (how strong), duration (how long), and frequency (how often) of the habit as well as with the manner in which the thumb or fingers are placed in the mouth.
In most cases, tooth movement resulting from non-nutritive sucking habits will resolve by itself if the habit is discontinued before the permanent teeth erupt. Post the eruption of permanent teeth the continuation of non-nutritive sucking habit needs appropriate interventions to prevent or intercept possible malocclusion (improper alignment of the jaws and teeth) or skeletal dysplasia from occurring.
Persistent non-nutritive sucking habits will affect your child’s developing teeth and occlusion (or bite). Three factors which determine how much your child’s oral habit will affect their bite frequency, duration, and intensity. Duration is the most important. Because of this, children who engage in oral habits for longer periods of time will be at the highest risk for negative effects on their developing bite. A professional evaluation has been recommended at CDC for children beyond the age of 3 years, with subsequent intervention to cease the above mentioned habits when initiated by your child.
Oral habits cause muscles around the mouth as well as the tongue to move and contract. These muscle movements apply forces to the neighboring teeth and jaw bones. This constant force on the teeth can lead to tooth movement away from their natural position. In addition the forces can actually cause the underlying jaw bones to become reshaped and affect proper growth and development. Some of the most common changes we see at CDC are that with prolonged oral habits are:
CDC recommends that children stop their non-nutritive oral habits by three years of age. Early cessation of these habits gives the mouth a greater chance of “re-aligning” itself before the permanent teeth erupt. In many cases, once the child has stopped the habit many of the problems with the bite resolves on their own. While some children require orthodontic treatment later in life if bite problems persist. If the habit continues as the permanent teeth erupt into the mouth, then many of these permanent teeth will display the same problems seen in primary teeth (or baby teeth).
It is important that parents identify oral habits early so preventative action can be taken to discontinue the habits before adverse effects take form and adversely affect a child’s orofacial function. These habits include:
Non-nutritive sucking behaviors (eg, finger or pacifier sucking etc) are considered normal (infants and young children) and associated with their need to satisfy the urge for contact and security.
Sucking is a natural reflex for infants. Most infants and young children require some amount of additional sucking beyond that needed for nourishment. This type of sucking, known as non-nutritive sucking, provides emotional benefits, enabling the infant or child to calm himself and focus attention. Non-nutritive sucking can be an important first step in the infant’s development of self-regulation and ability to control emotion. Pacifiers are usually an easier habit to break because the parent can regulate when and for how long the child gets to use one.
Thumb and finger sucking habit comprise a majority of all oral habits. 4 to 6 hours of force used daily causes tooth movement. A child who sucks intermittently with high intensity may not produce much tooth movement at all, whereas a child who sucks continuously (for more than 6 hours) can cause significant dental change. Thumb habits can be more difficult to address but some simple tricks include placing a band aid on the thumb to help remind your child not to suck it, or placing a sock or glove on the hand when the child goes to bed.
Tongue thrusting, an abnormal tongue position and deviation from the normal swallowing pattern, and mouth breathing may be associated with anterior open bite, abnormal speech, and anterior protrusion of the maxillary incisors. Management may consist of simple habit control, myofunctional therapy, habit appliances, orthodontics, and possible surgery.
Mouth breathing and non-nutritive sucking habits can also lead to retraction of the lower jaw, which means the lower jaw sits back from its natural resting position. This means the base of the tongue (which attaches to the lower jaw) also sits back in the throat more than it should. This can predispose children to snoring and sleep apnoea, especially in a supine position i.e. when resting on the back. A retracted lower jaw may also create problems for the temporomandibular joint, which joins the upper and lower jaws near the ear. This can lead to impingement of the Eustachian tubes, which extend from the oral cavity to the inner ears causing hearing problems.
The upper jaw becomes V-shaped (rather than being U-shaped), this can cause the roof of the mouth (palatal arch) to become high and narrow. The roof of the mouth also forms the base of the nasal cavity, and when the roof of the mouth becomes high and narrow this can affect the size and shape of the nasal cavity, which can lead to problems with sinus drainage and airflow, making nasal breathing more difficult and causing or reinforcing mouth breathing.
These changes can also lead to poor lip seal, and may compromise the proper, natural movement of the tongue leading to difficulty eating, chewing and swallowing food or liquid. Speech and articulation can also be affected by poor control of the shape and movement of the tongue.
Bruxism, defined as the habitual non-functional forceful contact between occlusal tooth surfaces, can occur while awake or asleep. The etiology is multifactorial and has been reported to include central factors (eg, emotional stress, parasomnias, traumatic brain injury, neurologic disabilities) and morphologic factors (eg, malocclusion, muscle recruitment). Complications include dental attrition, headaches, temporomandibular joint dysfunction, and soreness of the masticatory muscles. Preliminary evidence suggests that juvenile bruxism is a self- limiting condition that does not progress to adult bruxism. The spectrum of bruxism management ranges from patient/ parent education, occlusal splints, and psychological techniques to medications.
These oral habits have a strong psychological component to them as the child uses these habits for self-soothing so it may be difficult for them to initially give them up. It is important to give encouragement and positive reinforcement to wean your little one from their habit. Positive reinforcement has more success than negative reinforcement. When you begin the process of trying to break an oral habit remember that it takes at least 30 consecutive days of avoiding the habit to help prevent relapse.
Talk with the child. The dentist can provide the child with information regarding consequences of a habit. Sometimes this alone is enough to make the child stop sucking.
Use reminder therapy. This approach is appropriate for children who want to stop sucking but need some help. An adhesive bandage secured with waterproof tape on the finger or thumb can remind the child not to suck. A mitten or sock placed on the hand at night can also be effective. Stress to the child that this is a reminder, not a punishment.
Use a reward system. Under this system, the child, a parent, and the dentist agree that the child will discontinue the habit within a specified time period and will then receive a reward. The reward must be motivating to the child.
Treatment modalities offered at CDC to control habits may include patient/ parent counseling, behavior modification techniques, myo-functional therapy, and appliance therapy.
Physically interrupt the habit. If none of the preceding methods are successful, and the child truly wants to stop the habit, two other methods can be tried: (1) The child’s arm can be loosely wrapped in an elastic bandage during the night to prevent flexing the arm and inserting the thumb or fingers into the mouth. Stress to the parent that the bandage should not be wrapped tightly. (2) A dentist can place an intraoral appliance in the mouth that interferes with sucking.
Dentist at CDC can help children stop their non-nutritive sucking habit. However, it is important to remember that the child must want to discontinue the habit for the intervention to be successful
