Oral habits like thumb-sucking and using a pacifier use can be normal, soothing reflexes from birth to one year of age. The majority of children naturally outgrow their habit easily on their own. However, habits that persist after the age of three or four risk oral complications:
- Crooked teeth
- Narrow arches
- Proclined teeth (AKA buck teeth)
- Longer and more complicated orthodontic treatment, possibly including surgery or extractions
- Posterior crossbites (the upper arch fits inside the lower arch)
- Anterior open bite
- Smaller airways
- Impacted teeth
- Long facial height by changing the growth pattern
The first step to eliminating habits is to examine the patient and take limited, orthodontic records. Panos, cephs, and uncomfortable intraoral photos aren’t needed at age 3-5 but may be needed in older children. For children ages 3 and 4, I recommend making the exam fun by having the child use his own fingers to retract his teeth and make a “funny” face while biting his teeth together like an alligator. I used to save a few of these photos to show the child how other kids did it and offer a copy of the photo home as a souvenir.
I also recommend getting a baseline SDB/Habit Questionnaire for documentation. Many pediatric oral trainer companies have their own version of this form, or you can purchase one from our store.
For kids under age 5, often all you need to do to correct the malocclusion is to eliminate the habit. Positive reinforcement is the best step to start:
- Children may suck their thumbs when they feel insecure. Work on correcting the cause of anxiety, instead of the thumb-sucking habit. Stress in the home often needs to be corrected before you can address the habit.
- Reward children when they refrain from sucking. Use a Sticker Chart on a calendar.
- Give verbal praise to the child. Encouragement from siblings also helps. Success with habit cessation is a win for the whole family, and the siblings should also get a reward or a family celebration, like a trip to the ice cream parlor!
- If these methods fail, remind the children of their habit by bandaging the thumb or putting a sock on the hand at night. One of my favorite tricks is to take a large, men’s, long-sleeve T-Shirt and tie knots in the ends of the arms. You can let the child decorate it with fabric pens or tie-die it so that it’s less like a punishment and more like a fun adventure!
If that method isn’t successful, I recommend a soft, removable habit correction appliance which I call a “Tooth Pillow”. These are stock (not custom), so taking an impression isn’t necessary. Fees start at $50 and go up depending on what company you use. Some companies do require you to take a certification course to order these appliances.
For kids, older than age 5, often more aggressive treatment might be necessary beyond the removable appliances, including fixed or removable palatal cribs and/or palatal expanders. These will require full orthodontic records and an impression or scan.
These custom appliances usually stop thumb sucking immediately. They are used for 6-12 months, at least.