Phase I Correction of Thumbsucking

As an orthodontist, everyday I work with children, adolescents, and adults to help overcome prolonged thumbsucking habits. A thumbsucking habit (which may manifest in adulthood to a thumbnail biting habit) often results in significant skeletal deformities such as maxillary arch constriction (narrow upper jaw), aperto-gnathia (skeletal openbite or upward sloping palate), anterior dental openbite, and bilateral posterior crossbite.

Etiology:
The behavior has been historically associated as either (1) an innate desire (pyscho-analytical theory) or (2) a learned response (behavioristic theory). However, research has been unable provide consistent support for either theory. After all, we know from research that chronic thumbsuckers suffer no more neurotic or emotional disorders than other children (contradictory to the psychoanalytical position), and furthermore, thumbsucking can be found in a fetus (which contradicts the behavioristic theory).

We do know that habitual thumbsucking appears to be a means of relief from tension (i.e. the child is tired, hungry, or sad) and associated with pleasure and comfort. Research also shows a direct correlation between the probability of thumbsucking with the degree of introversion (shy children may have a greater likelihood of prolonged thumbsucking).

The following is an excerpt from orthodontist Arthur C. Hawkins, on the psychological need for thumbsucking: "Every person has feelings of apprehension and insecurity at times, even though he may not be in touch with them. Grown people have at their disposal a wide variety of ways to vent these feelings. They can eat, drink, smoke or work in excess. They can vent feelings while driving, attending sports events, playing games, socializing or working . . . but what options does the infant or small child have for venting feelings of apprehension or insecurity? There are few available; one of them is [thumb]sucking."

Constructive Correction of a Thumb Habit
*It is critical to remember that a constructive, positive approach in which the patient can gain self confidence and take pride in accomplishment is always better than a destructive approach of nagging or belittling.

In our office, openbite correction and cessation of prolonged thumbsucking is a treatment that I take great pride in performing. The first photo of our patient James with a severe skeletal openbite with bilateral dental crossbite and incisor intrusion). In addition to Phase I orthodontic treatment, I choose to prescribe by Dr. Hawkin's constructive model with a few additions:

1. I always begin the appointment by complimenting the patient about his appearance (which can be the color or shape of his teeth)
2. **I assure the patient that everything will be fine and that we will work together to create a beautiful smile and help control the thumb.
3. It is important to emphasize with the patient. "Sometimes the thumb just goes in the mouth." But also, "they are in control, not the thumb."
4. After emphasizing, also explain that the retained habit is having an adverse effect on his teeth and bite, and if we can control our thumb (I like using the word "our" rather than "your") the bite will turn out perfect.
5. Offer some suggestions that aid correction of the thumb habit. I say something, like: "Johnny, I know sometimes the thumb just goes in the mouth after a tough day at school, or if you get hungry, or tired. We have a few suggestions that may help. We can also help too."
6. In addition to positive reinforcement, suggestions to help with thumbsucking may include:
a) Phase I orthodontic treatment (which may include a maxillary expander, a thumb guard, or simply upper and lower braces on the incisors)
b) Use of band-aids or Mavala (nail biting varnish) on the thumbs
c) Sleeping with an oversized sweater with the sleeves sewn or teaching the child to sleep on their hands
d) For girls, painting of finger nails
e) Development of a reward system (working toward recognition and goals)
f) Lastly, and this is the hardest: often thumbsucking is associated with a secondary habit (i.e use of a security blanket, a teddy bear, twirling the hair, rubbing the tummy) which parents should consider correcting. Often, the moment the child is given the blanket, the thumb goes in the mouth. As such, without the blanket or teddy, the thumb habit quickly corrects.

Early correction of thumbsucking may prevent against the development of a skeletal or dental malocclusion, and the associated speech and masticatory difficulties. I suggest parents attempt to correct a thumb habit no later than 7 years of age, prior to the eruption of the permanent incisors. The second photo below is of an adult patient with a prolonged childhood thumb habit which resulted in developing tongue thrust, causing a challenging openbite with dental asymmetry. Her dramatic improvement was achieved with 18 months of braces (upper braces are behind the teeth, known as Incognito braces).

I hope this has provided some helpful information on thumbsucking. Please feel free to respond with any questions or comments or requests for additional information.

Respectfully,
Dr. Kravitz
South Riding, Virginia
www.kravitzorthodontics.com