Download Advice on Dummy and Digit-Sucking Habits

Advice on Dummy and Digit-Sucking Habits
These guidelines are intended to provide advice for health professionals involved in the care of children with
dummy (pacifier) or digit-sucking habits. They are based on the current evidence available, which is
predominantly observational in nature, as there are no controlled clinical trials at present.
Background
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Racial factors
80-90 % of children in the Western world have sucking habits1
These habits are not universal across the world, for example they are non-existent in Eskimos2
Gender
Sucking habits are equivalent for males and females until the age of 1 year3,4
After this they are more common in females, because males give up the habit earlier.
Socio-economic factors
Dummy sucking is more common in the lower socio-economic groups5
Digit sucking is more common in the higher groups5
Age
Most habits begin in the first 3 months and are so common as to be considered normal3
Dummy-sucking declines rapidly after this and is almost non-existent after the age of 7 years6
Digit-sucking tends to decline at a slower rate, and more habits persist into the permanent dentition6
Frequency of habit
It is thought that significant effects on the teeth are only likely to occur if the habit exceeds about 6 hours
a day7
Type of feeding (breast or bottle-fed)
The method of feeding has no effect on the prevalence or type of habit3, 8
Aetiology (2 theories)
1. Habit is a sign of underlying emotional disturbance1
2. Habit is a learned behaviour. Infants have a natural sucking urge that encourages eating. Sometimes this
urge persists after enough food has been eaten.9 This surplus urge is satisfied with dummy or digitsucking, and may last from a few minutes to a few hours.10
Current opinion favours this second theory.
Effects of Habits
Dummy-sucking
• Effects are primarily in the deciduous dentition, as the habit usually stops before the permanent teeth
erupt1
• Reduction in overbite, producing an anterior open bite.11, 12 This effect is minimised using “orthodontic”
dummies, whose teats are flatter in cross-section and collapse in the mouth1
• Reduction in maxillary arch width, which may cause a posterior cross-bite11, 13
• Long-term effects (i.e. in the permanent dentition) are negligible14
Digit-sucking
The effects are determined by the nature and intensity of the habit.
• Reduced overbite or anterior open-bite, which is often asymmetrical1
• Upper incisors are proclined,14 lower incisor may be retroclined15
• Maxillary arch may be narrowed, producing a cross-bite and displacement1
• Effects are often seen in the permanent dentition due to the continuation of the habit
• Small but probably clinically insignificant effects on the underlying skeletal pattern14
Effect on the digit
• Eczema can result from repeated wetting and drying and in extreme cases angular deformities can occur
(although most self-correct on elimination of the habit).16
• It may also be a means of acquisition and spread of infectious diseases, such as roundworm, herpetic
gingivostomatitis or staphylococcal impertigo.16
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Prevention of Habits
If a dummy is provided, there appear to be fewer problems in the long-term, because the majority of dummysucking habits are self-limiting and stop before eruption of the permanent teeth.1 Any persistent dummysucking habit is easily broken by removal of the dummy.
It has been suggested that if a digit-sucking habit is noticed, a dummy should be given to the child.1, 17
If a dummy is used it must not be sweetened.1 After the age of 2, to prevent problems with speech
development, it should be used as little as possible during the day.
Breaking the Habit
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The child must want to stop otherwise any approach is likely to be unsuccessful.
It is advisable to start discouraging habits when the permanent incisors are beginning to erupt, to prevent
effects on the permanent dentition
A child who is undergoing severe psychological trauma is unlikely to respond to habit breaking. A
psychologist’s input may be required
The following methods for breaking the habit are listed in the order in which they should be used:
Non-physical methods
• Explanation1
Explain the effects of digit-sucking and the need for stopping.
This is often all that is required to break the habit.
• Reward18
Introduce a simple system to monitor and reward stopping the habit
• Habit reversal15
Teach the child to carry out alternative activities when they have the urge to suck the digit
Physical methods
• Digit1
Examples include a sticking plaster on the digit, or wearing a glove sewn to the pyjama top at night
• Intra-oral appliances19-21
These deterrent appliances have been shown to be effective within 10 months.
They must be fitted with the full understanding and co-operation of the child and must not compromise
compliance with any future orthodontic treatment.
Correction of Problems Caused by Habit
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Active orthodontic treatment should not be attempted until the habit is broken1
Fortunately, most of the problems created by the habit are reversible once the habit is eliminated22
It has been suggested that digit-sucking beyond the age of 7 has been associated with an increased risk of
root resorption during orthodontic treatment.23
Produced by the Development and Standards Committee, BOS
4 July 2000
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References for “Advice on Dummy and Digit-sucking Habits”
1.
Moore M.B. Digits, Dummies and Malocclusions. Dental Update 1996, 23, 415-422
2.
Curzon M.E.J. Dental implications of thumb sucking. Pediatrics 1974, 54, 196-200
3.
Traisman A.S. and Traisman H.S. Thumb and finger-sucking: a Study of 2650 infants and children
Journal of Pediatrics 1958, 52, 566-672
4.
Zadik D., Stern N. and Litner M. Thumb and pacifier sucking habits. American Journal of Orthodontics 1977,
71, 197-207
5.
Jenkins P.M., Feldman B.S. and Stirrups D.R. The effect of social class and dental features on referral for
orthodontic advice and treatment. British Journal of Orthodontics 1985, 11, 185-188
6.
Larsson E. Dummy and fingersucking habits with special attention to their significance for facial growth and
occlusion. 1 Incidence study. Swedish Dental Journal 1971, 64, 667-672
7.
Proffit W.R. Contemperary Orthodontics.2nd ed. pp 126-127. St Louis, Missouri: Mosby-Year Book, 1993
8.
Meyers A. and Herzberg J. Bottle feeding and malocclusion. Is there an association? American Journal of
Orthodontics and Dentofacial Orthopaedics 1988, 93, 149-152
9.
Larsson E. and Dahlin K.G. The prevalence and the aetiology of the initial dummy- and finger-sucking habit.
American Journal of Orthodontics 1985, 87, 432-435
10.
Jacobson A. Psychology and early orthodontic treatment. American Journal Orthodontics 1979, 76, 511-529
11.
Lidner A. and Modeer T. Relation between sucking habits and dental characteristics in preschool children
with unilateral crossbites. Scandinavian Journal of Dental Research 1989, 97, 278-283
12.
Adair S.M., Milano M. and Dushku J.C. Evaluation of the effects of orthodontic pacifiers on the primary
dentitions of 24- to 59-month old children: preliminary study. Pediatric Dentistry 1992, 14, 13-18
13.
Lidner A. and Hellsing E. Cheek and lip pressure against maxillary dental arch during summy sucking
European Journal of Orthodontics 1991, 13, 362-366
14.
Larsson E. Dummy and finger sucking habits with special attention to their significance for facial growth and
occlusion. 4 Effects of facial growth and occlusion. Swedish Dental Journal 1972, 65, 605-634
15.
Martinez N.P. and Hunkler R.J. Jr. Managing digital habits in children. International Journal of Orthodontics
1986, 24, 5-8
16.
Vogel L.D. When children put their fingers in their mouths. Should parents and dentists care?
New York State Dental Journal 1998, 64, 48-53
17.
Levine R.S. Briefing paper: Oral aspects of dummy and digit sucking. British Dental Journal 1999, 186, 108
18.
Morley K.R. and McIntyre T. Management of non-nutritive or digit-sucking habits in children – a practical
approach. Canadian Dental Association 1994, 60, 969-71
19.
Haryett R.D., Davidson P.O. Sandilands M.L. Chronic thumbsucking: the psychologic effects and the
effectiveness of various methods of treatment. American Journal of Othodontics 1967, 53, 569-585
20.
Haryett R.D., Hansen F.C. and Davidson P.O. Chronic thumbsucking: A second report on treatment and its
psychologic effects. American Journal of Orthodontics 1970, 57, 164-178
21.
Da Silva Filo O.G., Gomes Gloncalves R.J. and Maia F.A. Sucking habits: clinical management in dentistry
Journal of Pediatric Dentistry 1991, 15, 137-56
22.
Larsson E. Dummy and finger sucking habits with special attention to their significance for facial growth and
occlusion. 7 The effect of earlier dummy and finger sucking habit in 16 year old children compared to children
without earlier habits. Swedish Dental Journal 1978, 2, 23-33
23.
Linge L. and Linge B.O. Patient characteristics and treatment variables associated with apical root resorption
during orthodontic treatment. American Journal of Orthodontics and Dentofacial Orthopaedics 1991, 99,
35-43
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