Habit Elimination – Non-Nutritive Sucking Habits
Oral habits such as digit sucking can be normal for infants and toddlers. This tendency for sucking should diminish by age 3. After age 5 it becomes a habit. Long-term sucking habits can interfere with optimal orofacial growth and development. The American Dental Association and the American Academy of Pediatrics recommend children should discontinue sucking habits by 4 years or younger. (Pacifiers are recommended for infants, although the habit should be eliminated by age 12-24 months). “Habits of sufficient duration, frequency and intensity may be associated with dentoalveolar or skeletal deformations such as an increased overjet decreased overbite, posterior crossbite or long facial height”. S.D. Josell, discusses the potential for “altered oral functions or rest position” that may have “a significant influence on the developing orofacial region”. Many times after a long-term sucking habit has been eliminated, the muscular and swallowing problems remain. This is because the oral muscles, tongue, teeth and jaws have formed and learned to function with the thumb, finger or pacifier in the mouth. Trained myofunctional therapists may provide guidance, support and a positive approach for digit sucking elimination and other non-nutritive habits such as pacifiers.
Marge Foran, RDH, COM provides a program for thumb sucking elimination using positive behavior modification techniques. She has had many hours of formal training with a leading expert in this field, “The Thumblady” Shari Green, RDH, COM from Chicago.
Research by S. Green (population of 441 subjects) and R. Van Norman (population of 441 subjects) show that 90-95% alter or quite the habit within 1-3 days. This type of program inspires self confidence in children which can have lifelong consequences.
Montana Parent Magazine – article published by Marge Foran on pacifier and thumbsucking habits – January, 2014, page 48. http://digital.turn-page.com/i/233634
Thumb sucking may cause an open bite such as in the photo below…..
30 days after successfully not sucking…..
References: The American Academy of Pediatric Dentistry (AAPD) Guidelines on Management of the Developing Dentition and Occlusion in Pediatric Dentistry 2009 Green, S. (2010) Conformational study: a positive-based thumb and finger sucking elimination program, IJOM, 2010, V36 Josell, SD (1995) Habits affecting dental and maxillofacial growth and development, Dental Clinics of North America, 1995 October; 39(4): 851-60
Two studies which show that pacifiers may have more effects on the orofacial growth and development.
Effects of oral habits’ duration on dental characteristics in the primary dentition
Warren, J., Bishara, S., Steinbock, K., Yonezu, T., Nowak, A. (2001), J Am Dent Assoc, 2001 Dec, 132(12): 1685-93.
Studies have shown the that long-term non-nutritive habits may lead to open bites and posterior cross bites, but there is less research on habits of shorter duration. This study evaluated children 4 to 5 years of age.
Results: Children with non-nutritive sucking habits that continued to 48 months of age or beyond demonstrated many significant differences from children with habits of shorter durations: narrower maxillary arch widths, greater overjet and greater prevalence of open bite and posterior crossbite. In addition, compared with those who ceased their habit by 12 months of age, those with habits at 36 months of age had significantly greater mandibular canine arch widths, maxillary canine arch depths and overjet, while those with habits at 24 months and 36 months had significantly smaller palatal depths. Prevalence of anterior open bite, posterior crossbite and excessive overjet (> 4 millimeters) increased with duration of habits. CONCLUSIONS: While continuous nonnutritive sucking habits of 48 months or longer produced the greatest changes in dental arch and occlusal characteristics, children with shorter sucking durations also had detectable differences from those with minimal habit durations. CLINICAL IMPLICATIONS: It may be prudent to revisit suggestions that sucking habits continued to as late as 5 to 8 years of age are of little concern.
Sucking, chewing and feeding habits and the development of crossbite: a longitudinal study of girls from birth to 3 years of age
Larsson, E. (2001), Angle Orthod, 2001 Apr;71(2):116-9.
This study included 60 girls from birth to 3 years of age. Results showed that girls without sucking habits breast feed longer than girls with non-nutritive sucking habits – 11 months vs 5 months. A posterior crossbite was seen in 2 of the 39 of the girls. One girl stopped the habit at 2 ½ years old and at the next visit the “crossbite had corrected itself spontaneously”. One of the 2 girls with crossbite at 3 years of age developed a prenormal occlusion with both anterior and posterior crossbites. For 12 more pacifier suckers, an interfering contact was noted with a forced guidance of the mandible and a midline shift. In all 12 cases, the interfering teeth were primary canines. We conclude that parents should be instructed to reduce the “in the mouth time” of the pacifier. The transverse occlusal relationship in pacifier-sucking children should be evaluated between 2 and 3 years of age. If interfering contacts of the primary canines exist, the parents should be instructed to reduce the pacifier-sucking time.