Project Overview

Non-Nutritive Sucking
Habits

Definition of habit

Phases of thumb
Classification of habitssucking
NNS & NS habits
Types of thumb
sucking

Effects of thumb
sucking
Diagnosis

Causative factors

Control

Theories of aetiology

Treatment

Habit..
It is the tendency towards an act
that
has
become
repeated
performance,
relatively
fixed,
consistent & easy to perform by an
individual.

Classification Of Oral
Habits.
Oral habits
Obsessive Non-obsessive

Obsessive
(deep rooted)
Intentional or
Masochistic or SelfMeaningful
e.g.:
nail biting
digit sucking
lip biting

Inflicting Injurious Habit

e.g. :
gingival stripping

Non-obsessive
(easily learned and drooped)
Unintentional or
Empty
e.g.:
abnormal
pillowing
chin

propping

Functional habits
e.g. :
Mouth Breathing
Tongue Thrusting

Bruxism

Thumb Sucking
It can be defined as the placement of the
thumb into the various depth into the mouth.

Classification of thumb
sucking
(A) Clinical classification
Normal Thumb Sucking

Abnormal Thumb
Sucking
psychological habitua
l

B) Sucking habits can be classified as

Nutritive
Sucking Habits

Non-Nutritive
Sucking Habits

e.g.:

e.g.:

Breast
Feeding

Thumb or
Finger
Sucking

Bottle
Feeding

Pacifier
Sucking

Non-nutritive sucking habits

Thumb Sucking

Pacifier Sucking

Classification of NonNutritive Sucking

Level

Description

Level I
(+/-)

Boys or Girls of any chronological age

with a habit that occurs during sleep.
Boys below age 8 with a habit that occurs
at one setting during waking hours.
Boys under age 8 Yrs. with a habit that
occurs had a multiple settings during
waking hours.
Girls below age 8 or a boy over 8 yrs.
with a habit that occurs at one setting
during waking hours.
Girls under age 8 or a boy over 8 yrs.
with a habit that occurs across multiple

Level II
(+/-)
Level III
(+/-)
Level IV
(+/-)

Causative Factors

Parents Occupation
Working Mother
Number of Siblings
Order of birth of the child
Social adjustment &
Stress
Feeding Practices
Age of the Child

1. Parents Occupation : It related to the socioeconomic status of the family. Families living
in a high socio-economic status are blessed
with ample sources of nourishment. Mothers
belonging to low socio-economic group is
unable to provide the infant with sufficient
breast milk.
2. Working Mother : Sucking habits is commonly
observes to be present in a children with
working parents. Such children brought up in
the hands of Care taker may have feelings of
insecurity.
3. Number of Siblings : The development of the
habit can be indirectly related to the number
of siblings.
4. Order of the Birth of Child : It has been

5. Social Adjustment & Stress : Digit sucking

has also been proposed as an emotion based
behavior related to the difficulty with the
social adjustment or with stress.
6. Feeding Practices : Thumb sucking is seen to
be more frequent among the breast-fed
children. A negative relation is also seen
between the breast feeding & the
development of dummy or finger sucking.
7. Age of the Child :
-In the Neonate
-During the first week of life
-During the eruption of the primary molar
-Still Later

Theories of NNS

Classical Freudian
Theory
(1905) Psychoanalytical theory holds that this
original response arises from an inherent
Psychosexual drive suggesting hat digit sucking
is Pleasurable erotic stimulation of the Lips and
mouth. One of the concepts of thumb sucking
brought about by this theory is that human
posses a biological sucking drive.
An infant associates sucking with pleasurable
feeling such as hunger, satiety and being held.
These events will be replaced in later life by

Theories of NNS

The learning theory :

Davidson (1967) This theory advocates that non

nutritive sucking stems for an adaptive
response.
The infants associates sucking with such
pleasurable feeling such as huger. These events
are recalled by sucking the suitable objects
available mainly thumb or finger.

Oral drive theory :

Sears and Wise (1982) They suggested that the
strength of the oral drive is in part of a function

Theories of NNS
and not frustration of weaning. This theory
agree with Freuds that sucking increases the
erotogenesis of the mouth.

Johnson and Larson :

(1993) They believed that it is a combination
psychoanalytic and learning theories which
explains that all children posses and inherent
biologic drive for sucking.
Environmental factors also may contribute to
this sucking drive to non nutritive sources such
as thumb or finger.

Sucking reflex
The process of sucking is a reflex occurring in
the oral stage of development and is seen even
at 29 weeks of i.u.,and may disappear during
normal growth between the ages one and three
and half.It is the first co-ordinated muscular
activity of the infant .
Finger & tongue thrusting habits
are normal for the first year and half of life and
will disappear spontaneously by the second year
with proper attention to nursing.If it continues
beyond three years,malocclusion will result.

Phases of development of thumb

sucking
Phase I : Normal / subclinically significant sucking
seen during first three year of life
considered normal during this phase

B. Phase II : Clinically
significant sucking
seen during three to six and half year of age

Phases of development of thumb

sucking
Phase III : Intractable
sucking
any thumb sucking that persists beyond
fourth or fifth year of life

Effects of non-nutritive thumb

sucking
Effects of non-nutritive thumb sucking habits on
developing teeth are minor in infants or
children under age three.

Effects of thumb sucking

Duration (How Long)
depends on
Intensity (How strong)

Frequency (How Often)

Effects of non-nutritive thumb

sucking
I. Proclination & protrusion of upper
incisor teeth
Proclination of the
upper anterior teeth
& anterior openbite

Effects of non-nutritive thumb

sucking

Increased overjet due

maxillary
anterior teeth

Lingual tipping of mandibular anterior

teeth

to

proclined

Supraeruption of buccal teeth

Posterior crossbite due to overactivity of
buccinator compressing the maxilla
Narrow & high palatal vault.
Hypotonic upper lip with the lower part of the
face
exhibiting hyper active mentalis activity

Effects of non-nutritive thumb

sucking
VIII. Retrognathic mandible.
IX. Retrusion of lower anterior and
supraeruption of buccal teeth may cause
tongue thrusting.

Anterior openbite in
the primary dentition
caused by dummy
sucking habit.

Diagnosis of digit sucking

History: It determine the psychological
component involvedQuestion regarding the
frequency, intensity and duration of habit.
Enquire the feeding patterns, and parental care
of the child.
Presence of other habits should be evaluated.
Extra Oral Examination :
Various key areas to be noted include the
following
The Digit:

Diagnosis of digit sucking

Callus formation on the thumb as a result of

thumb sucking.

Diagnosis of digit sucking

Lip:
Chronic thumb sucker are having short,
hypotonic upper lip.
Upper lip passive or incompetent during
swallowing and lower lips hyper active and
this leads to a further increase in the
proclination of the upper anteriors due to
its thrust on these teeth.
Facial form analysis: Check for the mandibular
retrusion, maxillary protrusion, high
mandibular plane angle and profile.

Diagnosis of digit sucking

Other Features :
Features caused due to presence of other habits
along with thumb sucking.
Active thumb sucker also habit higher incidence
of middle ear infections.
Intra Oral Examination :
Tongue : Examine the oral cavity for correct size
and position of tongue at rest, tongue action
during swallowing.
Dento Alveolar Structure :
Individuals with severe finger or thumb sucking
habit, where the digit applied and anterior

Diagnosis of digit sucking

the upper dentition and palate, will have flared
and proclined maxillary antetriors with
diastemas and retroclined mandibular
antetriors.
Other Symptoms are constriction of buccal
musculature and tendency to narrow palates.

Forces acting on the

teeth while thumb
sucking.

Diagnosis of digit sucking

Gingiva : Look for the evidence of mouth
breathing, gum line etching, decayed or
excessive staining on labial surface of upper
central and lateral incisors.

Control of thumb sucking

Prevention
I.

Motive based approach: Its prevention

should be directed towards the motive
behind the habit.

II. Childs Engagement in various activities :

Parents can be consult on keeping the child
engage in various activities.
III. Parents involvement in prevention : When
the parents are at home they should be
advised to ample time with the child so as to
put away his feelings of insecurity.

Control of thumb sucking

V. Mothers presence and attention during bottle
feeding: It will promote close emotional
union between the mother and the baby.
VI. Use of psychological nipple : Size and
number of hole should be standardized to
regulate a slow and steady flow of milk.
VII. Use of dummy or pacifier : Thumb sucking
can be prevented by encouraging the baby
to suck a dummy instead.

Treatment Consideration
I.

Psychological status of the child : Frequency,

duration and intensity of oral habit are
important in evaluating the psychological
status of the child.

II. Age factor : The child having thumb sucking

habit at
a. 3 Years of age :
Effect Damage incurred such as
openbite, temporary provided childs
normal occlusion. No treatment provided
in this age group.
b. 4 to 5 years of age :
Effect- Self correction can be expected.

Treatment Consideration
III . Motivation of the child to stop the habit : It
is also important to assess the maturity of child
in response to new situation and to observe the
childs reaction to any suggestion.
IV. Parental concern regarding the habit :
Negative reinforcements in the form of threats,
nagging and ridicule would only entrench the
habit.
V. Other factors : Self correction again depends
on severity of malocclusion, anatomic variation
in the perioral soft tissue, and presence of other
oral habits such as tongue thrusting, mouth

Management
I.

Psychological approach : The parents should

be consulted to provide the child with
adequate love and affection. They should be
advised to divert the childs attention to the
other things such as play and toys.
Dunlops beta hypothesis : This hypothesis is
the best way to break a habit bites
conscious, purpose full repetition.
Child should be asked to sit in front of a
mirror and to suck his thumb, observing
himself as he indulges in the habit.

II. Reminder therapy :

a. Extra oral approaches :
It employs hot tasting, bitter flavoured

Management
applied to thumb example cayenne, pepper,
quinine, as afoetida. This is the effective only
when the habit is not formally entrenched.
b. Intra oral approaches : Removable
appliances- These are palatal crib, rakes,
palatal arch, lingual spurs. Hawleys retainer
with or without spur.
Fixed appliances Upper lingual tongue screens
appear to be more effective in breaking these
habits.

Management

Habit crib & retainer appliance

Habit crib appliance

Management

Hawleys
Retainer

Management
Mechanotherapy
First fixed intra-oral anti-thumb sucking
appliances
-Bands fitted to the primary second molar
or first permanent molar. A lingual arch forms
the base of the appliances to which are added
interlacing wires in the anterior portion in the
area of the anterior part of hard palate.
-This preventing the patient from putting
the palmer surface of the thumb in contact with
palatal gingiva.

Management
Blue Grass Appliances :
Haskell introduce this appliance. It consist
of a modify six sided roller machined from teflon
to permit purchase of tongue. This is slipped
over .045 stainless steel wire soldered to a
molar orthodontic bands. This appliance is
placed for three to six months. Instructions are
given to turn instead of sucking.
Quad helix :
It prevent the thumb from being inserted
and also corrects malocclusion by expanding the
arch.

Management
Quad Helix to correct
posterior cross bite in
mixed dentition. These
appliances are simple to
construct, are well
tolerated by patient and
are efficient. They have
advantage that they
have fixed an will also
act as retainer once the
malocclusion is
corrected

Quad Helix

Tongue guard appliance incorporating a mid

palatal screw expander.