Project Overview

Non-Nutritive Sucking
Habits
Definition of habit
Phases of thumb
Classification of habitssucking
NNS & NS habits Effects of thumb
sucking
Types of thumb
sucking Diagnosis
Causative factors Control
Theories of aetiology Treatment
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Habit……..
It is the tendency towards an act
that has become repeated
performance, relatively fixed,
consistent & easy to perform by an
individual.

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Classification Of Oral
Habits…….
Oral habits

Obsessive Non-obsessive

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 Obsessive(deep rooted)
Intentional or Masochistic or Self-
Meaningful Inflicting Injurious Habit
e.g.: e.g. :
nail biting
gingival stripping
digit sucking
lip biting

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 Non-obsessive
(easily learned and drooped)
Unintentional or Functional habits
Empty
e.g. :
e.g.:
Mouth Breathing
Tongue
abnormal Thrusting
pillowing
Bruxism
chin
propping
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Thumb Sucking……
It can be defined as the placement of the
thumb into the various depth into the mouth.

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Classification of thumb
sucking
(A) Clinical classification

Normal Thumb Sucking

Abnormal Thumb
Sucking

psychological habitua
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l
B) Sucking habits can be classified as

Nutritive Non-Nutritive
Sucking Habits Sucking Habits
e.g.: e.g.:
Breast Thumb or
Feeding Finger
Sucking
Bottle
Feeding Pacifier
Sucking
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 Non-nutritive sucking habits

Thumb Sucking

Pacifier Sucking www.FourthMolar.com

 Classification of Non-
Nutritive Sucking
Level Description
Level I (+/-) Boys or Girls of any chronological age with
a habit that occurs during sleep.
Level II (+/-) Boys below age 8 with a habit that occurs
at one setting during waking hours.
Level III Boys under age 8 Yrs. with a habit that
(+/-) occurs had a multiple settings during
waking hours.
Level IV 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
Level V (+/-)a habit that occurs across multiple
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settings during waking hours.
Causative Factors
 Parent’s Occupation
 Working Mother
 Number of Siblings
 Order of birth of the child
 Social adjustment & Stress
 Feeding Practices
 Age of the Child

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1. Parents Occupation : It related to the socio-
economic 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.
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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
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-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.
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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 www.FourthMolar.com
drive is in part of a function
 Theories of NNS
and not frustration of weaning. This theory
agree with Freud’s 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. www.FourthMolar.com
 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.
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 Phases of development of thumb
sucking
Phase I : Normal / sub-
clinically 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
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 Phases of development of thumb
sucking

Phase III : Intractable

sucking
any thumb sucking that persists beyond
fourth or fifth year of life

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 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

depends on
Duration (How Long)

Intensity (How strong) Frequency (How Often)

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 Effects of non-nutritive thumb
sucking
I. Proclination & protrusion of upper
incisor teeth

Proclination of the
upper anterior teeth
& anterior openbite

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 Effects of non-nutritive thumb
sucking
 Increased overjet due to proclined
maxillary anterior teeth
 Lingual tipping of mandibular anterior
teeth
 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
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 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.

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 Diagnosis of digit sucking
History: It determine the psychological
component involved—Question 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: www.FourthMolar.com
Diagnosis of digit sucking

Callus formation on the thumb as a result of

thumb sucking.
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 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.
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 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
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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.

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 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.

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 Control of thumb sucking
Prevention
I. Motive based approach: Its prevention
should be directed towards the motive
behind the habit.
II. Child’s Engagement in various activities :
Parents can be consult on keeping the child
engage in various activities.
III. Parent’s 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.
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 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.

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 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 child’s
normal occlusion. No treatment provided
in this age group.
b. 4 to 5 years of age :
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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
child’s 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
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 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 child’s attention to the
other things such as play and toys.
Dunlop’s 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 :
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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. Hawley’s retainer
with or without spur.
Fixed appliances – Upper lingual tongue screens
appear to be more effective in breaking these
habits.

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 Management

Habit crib & retainer appliance

www.FourthMolar.com Habit crib appliance
 Management

Hawley’s
Retainer
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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. www.FourthMolar.com
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. www.FourthMolar.com
 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
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Quad Helix
Tongue guard appliance incorporating a mid
palatal screw expander.
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