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Habits

Thumb Sucking / Pacifier Use / Nail Biting / Lip SuckingGrinding

Thumb Sucking

Along with favorite blankets, teddy bears, and nap time, thumb sucking can be one of the most comforting activities of childhood. According to a recent report, between 75% and 95% of infants suck their thumbs, so chances are there’s a thumb sucker (or a former thumb sucker) in your family. Is this cause for worry?

In most cases, the answer is no. However, it’s worthwhile to pay attention to your little one’s habits in case his or her behavior has the potential to affect overall oral health.

What is normal thumb-sucking behavior?

Most children begin sucking their thumbs or fingers from a very young age; many even start inside the womb. Sucking is a natural reflex for an infant, and it serves an important purpose. Sucking often provides a sense of security and contentment for a young one. It can also be relaxing, which is why many children suck their thumbs as they fall asleep.

According to the American Dental Association, most children stop thumb sucking on their own between the ages of two and four. They simply grow out of a habit that is no longer useful to them. However, some continue sucking beyond the preschool years (although studies show that the older a child gets, the lower the chances are of continuing the habit).

Ideally, thumb sucking should be stopped before it can have ill effects on the dentition. This is different for every child because there are many variables involved (i.e., duration of habit, frequency of habit, and force of the habit). There are also genetic components that make some individuals prone to the ill-effects of thumb sucking. A general rule of thumb (pun intended) is that if your child is still sucking when his or her permanent teeth start to erupt, it is time to take immediate action to break the habit.

What signs should I watch for?

First, take note of how your child sucks his or her thumb. If the sucking is passive, with the thumb gently resting inside the mouth, it is less likely to cause damage. If, on the other hand, the thumb sucking is aggressive, and places pressure on the mouth or teeth, the habit may cause problems with tooth alignment and proper mouth growth. Extended sucking affects both the teeth and the shape of the face and may lead to a need for early-stage orthodontic treatment in the future.

If at any time you suspect your son or daughter’s thumb sucking may be affecting oral health, please give us a call and schedule a visit. We can help you assess the situation.

How can I help my child quit thumb sucking?

There are two types of thumb sucking: conscious and unconscious. If your child sucks a thumb purposefully with no desire to quit, it will be more difficult to break the habit. Unconscious thumb sucking is easier to stop because simple interventions are effective in reminding children to stop sucking.

Should you need to help your youngster end the habit, follow these guidelines:

  1. Always be supportive and positive. Instead of punishing your child for thumb sucking, give praise when he or she shows progress.
  2. Put a Band-Aid on your little one’s thumb or a glove or sock over the hand at night. Let your son or daughter know this is not a punishment, but a way to help remember to avoid sucking. Sometimes children will unconsciously take off gloves and socks to make the thumb accessible again. If this happens, I’d recommend having your child sleep in one of mom or dad’s old long-sleeved shirts with the sleeves sewn shut. This will prevent him or her from being able to access a thumb without purposefully doing so.
  3. Start a progress chart and let your child put a sticker up every day he or she doesn’t suck. If your child makes it through a week without sucking, he or she gets to choose a prize. When the whole month is full, reward your youngster with something great (a toy or new video game); by then the habit should be over. Making your child an active participant in the treatment will increase the willingness to break the habit.
  4. If you notice your child sucking when he or she is anxious, work on alleviating the anxiety rather than focusing on the thumb sucking.
  5. Take note of the times your child tends to suck (such as long car rides, while watching movies) and create diversions during these occasions.
  6. Explain clearly what might happen to the teeth if he or she keeps thumb sucking.

Whatever your method, always remember that your child needs your support and understanding during the process of breaking the habit of thumb sucking.


Pacifier Use

Closely related to thumb sucking is pacifier use. As you can imagine, pacifiers have the ability to alter the dentition similar to thumb sucking but usually in a much less pronounced way.

Contrary to popular belief, pediatric dentists are NOT opposed to pacifier use. In fact, here at South Hills Pediatric Dentistry we encourage families to utilize the pacifier in the hope that it will prevent development of a thumb habit. Pacifier use is preferable for two reasons:

  1. The effects on the dentition are less severe
  2. A pacifier can be taken away at the discretion of the parent ... unlike a thumb. :)  

Why are pacifiers bad for the teeth?

When teeth come into the mouth, they erupt until they come in contact with opposition; typically, the teeth on the opposing arch. When a child sucks his or her thumb or uses a pacifier, the thumb or pacifier acts as an artificial stop that opposes further eruption of the teeth. This creates what is called an Anterior Open bite.  

Also, the process of sucking causing excessive force from the muscles of the face to put forces on the developing upper jaw, which can result in a constricted upper arch. This can lead to what is referred to as a Posterior Cross bite.

An Anterior Open bite and a Posterior Cross bite are hallmark signs of a thumb or pacifier habit. Thumb sucking causes a more severe open bite and more significant posterior cross bite.

What pacifier should my child use?

Not all pacifiers are created equally. The type of pacifier has a great impact on the dentition. The two most popular pacifier brands are the Avent Soothie Pacifier and the Nuk Orthodontic Pacifier. As the name implies, the Nuk Orthodontic Pacifier is approved by pediatric dentists and orthodontists alike because it has far fewer deleterious effects on the teeth.

The low profile of the Nuk allows the front teeth to come together normally. The Avent Soothie Pacifiers are the type given by most hospitals to newborns because the nipple more closely resembles the human breast. Unfortunately, it is far WORSE on the teeth. At South Hills Pediatric Dentistry, we recommend using an orthodontically approved pacifier.

When should a pacifier habit be stopped?

Studies show that if the pacifier is taken away too early, the child is much more likely to convert to a thumb-sucking habit. Because of this, at South Hills Pediatric Dentistry we encourage families to allow pacifier use until AT LEAST 18 months of age. On the other hand, the longer a child uses the pacifier, the more likely it is that there will be effects on the teeth. We recommend cessation between ages 18 months and 3 years.  

How can I help my child stop using the pacifier?

There are two typical methods to stop pacifier use:

  1. “Cold turkey”
  2. Gradual cessation of the habit

There is no right or wrong way to break the habit. Whichever method you try will likely result in a couple of sleepless nights for both parent and child. The important thing is NEVER to revert back. That lengthens the process and makes it more difficult for your child. Here are a few methods that have been successful for families that Dr. Bart has worked with:

Cold turkey:

  • Sew the pacifier into a “Build-a-Bear” stuffed animal. This way, when your child is sad, he or she may not have the pacifier anymore, but can at least cuddle the “Pacifier Bear.”
  • Tell your child that the hospital needs pacifiers for the new babies being born. Have your child give the pacifier to a nurse or a doctor.

Gradual cessation:

  • Gradually cut the tip off the pacifier. Eventually the child will become uninterested because he or she can’t produce the intended suck.
  • Reduce the amount of time your child gets the pacifier each day. If he or she typically has the pacifier all the time, limit it to naps and bedtime. Once that is established, you can restrict pacifier use to bedtime only and train your son or daughter to fall asleep at naptime without it. Once your child can nap without it, you can take the pacifier away completely. 
  • Start a progress chart and let your little one put a sticker up every day that he or she doesn’t use the pacifier. If your youngster makes it through a week without sucking, he or she gets to choose a prize.

Stopping any habit is difficult, but your child will be better off once the pacifier is removed.  


Nail Biting

Nail Biting is a parafunctional habit that can produce oral problems.  The most common oral complications from nail biting are:

  1. Tooth chipping
  2. Gingival injury
  3. Bacterial transfer

Tooth chipping usually occurs gradually. The tip of the tooth can become traumatized over time and its edge can become roughened, sharp, and worn down. Occasionally, large sections of tooth structure can fracture, and result in a cosmetically unpleasing appearance.  

Gingival injury can occur when children participate in fingernail biting/chewing. The foreign nail can imbed in the gingiva, which can cause pain and irritation.  

Bacterial transfer happens because bacteria from the environment (including, dirt, feces, etc.) live beneath the fingernails. When an individual bites a fingernail, he or she is introducing these microorganisms into the oral cavity.


Lip Sucking

Lip sucking is not uncommon in children.  Some children suck their lips because of certain personality traits. Others may suck their lips because of perpetual lip dryness. The results of chronic lip sucking are:

  • Excess overjet
  • Swollen/dry/irritated perioral tissues
  • Lip incompetence

Chronic sucking of the lower lip will put backward force on the lower front teeth while placing forward force on the upper front teeth. This results in an undesirable tooth relationship in which the upper teeth are flared forward. Often this can be even more exaggerated if a child has a retrognathic (underdeveloped) lower jaw. Children with this tooth relationship often get teased for being “Buck Toothed.”

Lip sucking also has ill effects on the tissues around the mouth. The chronic lip sucking will dry and irritate the tissues to the point where swelling and redness occur. Often, children will complain that they can’t eat spicy foods because it burns their lips. Some parents will conclude that the child must have a food allergy, which is not the case.

Lip incompetence is the inability of the lips to come in contact at rest.  This occurs because the flared upper incisors prevent the lips from coming together. Incompetence of the lips can also result in mouth breathing, which also has ill effects on the dentition. 


Teeth Grinding

Teeth grinding, or bruxism, refers to excessive grinding of the teeth and/or excessive clenching of the jaw, and is common in children. The first indication is the noise created by your child grinding on the teeth during sleep. Or you may notice wear (teeth getting flatter) to your son or daughter’s dentition.

Although teeth grinding is often the result of stress in adults, the same is not always true of children. If your child’s teeth grinding is not the result of stress, other possible causes include irritation in the mouth, inner ear pressure, allergies, and misaligned teeth.

The good news is that, because your child’s teeth and jaws change and grow so quickly, teeth grinding is not usually a damaging habit that requires treatment, and most outgrow it by adolescence. However, if excessive wearing of the teeth is present, our office may recommend wearing a night guard.

If you’re concerned about your child’s teeth grinding, ask the dentist about the potential causes and, if necessary, the possible solutions.

American Academy of Pediatric Dentistry American Dental Association
American Association of Orthodontists Invisalign Preferred Provider
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