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Thumb and Finger Sucking -- Is It Really A Problem?

Thumb-sucking and/or finger-sucking are practiced by many children for a variety of reasons. These habits usually start very early in life, and children frequently outgrow them by 3 or 4 years of age. Thumb-sucking is one of the mot common concerns that parents have, particularly if the habit continues beyond 5 of 6 years of age. However, parents should take comfort in the fact that not all thumb-sucking is damaging to the growth and development of teeth and jaws. Thumb and finger sucking can change tooth positions only if the forces created during the activity are of appropriate magnitude and duration. In other words, a child who only places his thumb in his mouth at night to help him fall asleep and whose thumb falls out when he is sleeping is unlikely to cause any ill effects on his teeth. On the other hand, a child who sucks her thumb or finger constantly all day or all night is highly likely to damage the natural harmony among the face, bones, and teeth. Vigorous sucking combined with lengthy duration are the elements needed to displace teeth and/or deform growing bone.

What To Look For In Your Thumb- or Finger-Sucking Child

The types of changes that may develop in the thumb-sucker are dependent on a number of variables.

The most common effects seen are:

• anterior open bite (where there is a gap between the upper and lower front teeth, into which the thumb or finger fits very nicely!)
• protrusion of the upper front teeth (where the upper front teeth are pushed out and up by the force of the thumb)
• retrusion of the lower front teeth (where the lower front teeth are pushed inward by the force of the thumb)
• narrow high-arched palate

You should bring your child for an orthodontic consultation if any or all of these effects are evident in your child's mouth. The key is prevention. Early intervention by your orthodontist is the ideal treatment to prevent the deformity from developing further and causing a more severe problem as your child grows and develops. In addition, early treatment of a serious thumb-sucking habit is easier than treatment after years of an ingrained habit.

What Treatment Is Required?

Sometimes no active orthodontic treatment is required. It is important that we define at the very beginning that which is to be treated. Sometimes it is indeed an open bite, sometimes a psychological problem, sometimes a neuromuscular reflex. There are three distinct phases of development when considering thumb-suckers.

Most infants display a certain amount of thumb and finger sucking during this period particularly at the time of tooth eruption and weaning. Ordinarily, this is naturally resolved toward the end of this phase.

A firm and definite program of correction is indicated at this time. There are many different orthodontic appliances used, some of which are so large and cumbersome that they provide nothing but frustration for the child; and thumb-suckers usually have that in abundance anyway. My own favorite is a type of retainer used in the lower arch with small attachments to remind the thumb to keep out. Using this type of appliance encourages the child to help conquer the problem and is not merely a mechanical interference to the thumb.

Persistent thumb-sucking at this age may be indicative of problems other than dental. I always begin with a discussion of the problem with the child alone before inserting a corrective appliance. I emphasize to the parents that no one should discuss the problem with the child nor should it be a subject for family discussion, since the child and I will take care of the problem between ourselves. Above all else, no disparaging comments should be made by anyone concerning the habit. I find that most children benefit greatly by removing the family focus on their thumb-sucking, thus preparing the child to work with the orthodontist in a more mature way. This type of psychology, along with an active appliance to remind the child to keep his or her thumb out, is a kinder and more gradual approach. It allows the child to become more involved in the therapy than the more traditional (large mechanical "rake") appliance and gives the child the opportunity to be a key player in successfully managing the habit. Children who overcome thumb-sucking themselves in this fashion are grateful and appreciative patients and greatly mature psychosocially during the treatment.

Copyright © 1997, 2005 by Mairead M O'Reilly. All rights reserved. No reproduction without written permission.

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About the author: Dr. O'Reilly practices orthodontics and dentofacial orthopaedics in Annapolis, Maryland. Dr. O'Reilly's unique expertise includes early interceptive orthodontic treatment for children ages 6 to 10, adolescent and adult orthodontic treatment, employing growth modification techniques, traditional metal braces, ceramic (tooth-colored) braces, and the latest in orthodontic technology: self-ligating braces. She is also a certified provider of Invisalign, the invisible way to straighten teeth.

She has worked extensively with children with craniofacial deformities in London, England; Rochester, New York; Washington, D.C.; and Baltimore and Annapolis, Maryland. Dr. O'Reilly's emphasis is on people and the difference her profession can make in their lives. Good orthodontic care can greatly enhance the way people feel about themselves. The changes are more than cosmetic, however. Orthodontics can substantially prolong tooth longevity, prevent periodontal (gum) problems, and successfully treat TMJ problems, jaw deformities, and those related symptoms such as chronic headaches, clicking and grinding. In addition the improved appearance one enjoys from treatment also dramatically affects self-esteem. Dr. O'Reilly sees her patients as partners in treatment and brings sincere concern for each individual.

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