Dental Problems

Treatment Plan for Thumb Sucking Habit

DenturesThumb sucking can also be avoided by following a treatment plan. The treatment plan for thumb sucking habit includes psychological therapy, reminder therapy and mechanotherapy, which is discussed below in this article. Read on to know more.

Treatment plan for thumb sucking habit

The treatment plan can be broadly divided into the following:

  1. Psychological therapy:

    • Screen the patient for the underlying psychological disturbances that sustain a thumb sucking habit. Once psychological dependence is suspected, the child is referred to professionals for counseling.
    • Thumb sucking children between the ages of 4 and 8 years of age need only reassurance, positive reinforcement and friendly reminders.
    • Awareness of the habit can be accomplished by emphasizing the positive aspects of habit cessation. Various aids are employed to bring the habit under the notice of the child such as study models, mirrors, etc.
    • Children and parents are informed about existing dento-facial deformities and the long-term risks of a sustained habit. Patients should be presented with positive mental and visual images of the dentofacial ideals expected from habit cessation and subsequent orthodontic treatment.
    • During the treatment adequate emotional support and concern should be provided to the child by the parents.
    • Destructive approaches in the form of nagging, shamming and belittling ought to be strictly avoided.
    • Constant reassurance and encouragement should be provided to the patient to gain his confidence.
    • The use of positive behavior modification techniques and even hypnosis has been effective in digit habit therapy. When the habit is discontinued, the child can be rewarded with a favorite new toy or special outing.
    • Dunlop’s beta hypothesis: He believed that if a subject can be forced to concentrate on the performance o the act at the time he practices it, he can learn to stop performing the act. Forced purposeful repetition of a habit eventually associated it with unpleasant reactions and the habit is abandoned. The child should be asked to sit in form of a mirror and asked to suck his thumb, observing himself as he indulges in the habit.
  2. Reminder therapy:

    This can be divided into the following:

    • Extra oral approaches:

      It employs hot tasting, bitter flavored preparations or distasteful agents that are applied to finger or thumbs. For example, Cayenne pepper, quinine, asafoetida. This is effective only when the habit is not firmly entrenched.

      Thermoplastic thumb post was devised by Allen in 1991 where a thermoplastic material was placed on the offending digit. A total of 6 weeks of treatment time was required for elimination of habit.

    • Intraoral approaches:

      Various orthodontic appliances are employed to attenuate and eventually break the habit. Removable appliances used may be palatal crib, rakes, palatal arch, lingual spurs, Hawley’s retainer with and without spurs. Fixed appliances such as upper lingual tongue screens appear to be more effective in breaking these habits. If the child has made appreciable changes in his habit by 3 months, the appliances can be safely removed for a testing period. If gross signs of anxiety are aroused e.g, bed wetting, bad dreams, etc. the appliance should be removed.

  3. Mechanotherapy:

    • Fixed intra-oral anti thumb sucking appliance:

      Most effective mechanical deterrent to thumb sucking is an intraoral appliance attached to the upper teeth by means of bands fitted to the primary second molars or the first permanent molar. A lingual arch forms the base of the appliance to which are added interlacing wires in the anterior portion in the area of the anterior part of the hard palate. It works by preventing the patient from putting the palmer surface of the thumb in contact with the palatal gingiva, thereby robbing the pleasure of sucking.

    • Blue grass appliance:

      Haskell (1991) introduced this appliance, for children with a continued thumb sucking habit, which is affecting the mixed or permanent dentition. It consists of a modified six sided roller machined from Teflon to permit purchase of the tongue. This is slipped over a 0.045 stainless steel wire soldered to molar orthodontic bands. This appliance is placed for 3-6 months. Instructions are given to turn the roller instead of sucking the digit. Digit sucking is often seen to stop immediately.

    • Quad helix:

      This appliance prevents the thumb from being inserted and also corrects the malocclusion by expanding the arch.

The above article discusses about the

treatment plan for thumb sucking habit


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