Malocclusion caused by sucking behaviors

Thumb-sucking, finger-sucking, and pacifier use can cause malocclusion (poor bite) in young children. However, when a child stops the sucking habit, the teeth naturally begin moving back to their normal positions.

Infants are born with a natural sucking reflex, and it's common for this reflex to evolve into a comforting behavior. However, thumb- and finger-sucking and pacifier use for more than 4 to 6 hours per 24 hours can eventually:

• Push the upper front teeth (incisors) outward and the lower incisors inward (overjet).
• Prevent the incisors from coming in (erupting) completely (open bite).
• Cause the top molars to bite inside the lower molars (crossbite). This may be due to the cheek muscles pressing the upper molars inward during strong sucking.¹

The sooner a child stops sucking on a finger, thumb, or pacifier, the better for incoming permanent teeth. If the sucking habit continues past age 5 to 7, the permanent incisors probably won't come in straight. Once the sucking habit stops, the permanent teeth will naturally begin to return to their proper positions. Orthodontic treatment may help with this process.

Helping your child quit a sucking habit

Treating sucking habits in children isn't usually necessary. Most children stop on their own sometime between ages 3 and 6. Pacifier use tends to end earlier than thumb- or finger-sucking. Most parents find it easier to wean a child from pacifier use than from thumb- or finger-sucking. Children who continue to suck their thumbs till early school age may feel pressure from their peers and may decide to stop then.

Treatment for thumb-sucking is a controversial topic. Some children are not ready or able to stop their sucking habit, despite their dentists' or parents' decision that they must. Some parents and professionals believe that when a child won't cooperate, the treatment won't be effective. It could even be traumatic and may prolong the habit. Others believe that it's sometimes necessary to try to stop the habit without the child's cooperation.

Treatment to stop a sucking habit works best if your child is involved in the treatment and agrees to try to stop. By educating your child, staying neutral, and not being critical, you can help your child get ready for sacrificing a long-held habit. Consider these tips when helping your child quit thumb-sucking or related habits.

• Pick a low-stress period of time. Avoid a time of change or challenge, such as a move, divorce, the start of the school year, or even a new sports activity.
• Enlist your child's dentist for providing some education about the effects of thumb-sucking.
• Help your child put away any attachment objects that may trigger the sucking habit, such as a baby blanket or toy.
• With your child, develop a reminder for not sucking the thumb, such as putting a mitten, a sock, an adhesive bandage, or a bitter-tasting substance on the thumb, especially at night. A bulky elastic bandage, loosely wrapped around the mid-arm, can make it difficult for the hand to reach the mouth while your child sleeps.
• Use positive reinforcement. Compliment your child for the smallest of gains as well as the big successes.
• Develop a reward system, such as putting a star on the calendar for each successful day. After an agreed-upon number of days, have a celebration for your child.

For more information, see the topic Thumb-Sucking.

Citations

1. Christensen JR, et al. (2005). Oral habits. In JR Pinkham et al., eds., Pediatric Dentistry: Infancy Through Adolescence, 4th ed., pp. 431–439. St. Louis: Elsevier Saunders.