WHAT ABOUT THUMB SUCKING?
Two questions that have been asked and answered over and over by experts and are still the most frequently asked questions today, “Does thumb sucking do damage to the teeth?” “Does this child need to stop thumb/finger sucking?”
The answer seems to be different depending on the professional you ask. Some pediatricians say, “Leave the thumb sucker alone.” “They will outgrow the pattern.” Progressive pediatricians understand that chronic thumb/finger sucking needs to be addressed. Some dentists wait until the child is ready to see the orthodontist and then they let the orthodontist deal with the problem. The preventive dentist wants the thumb sucking to cease so growth and development of the oro-facial structure is not interrupted. Many orthodontists feel it is crucial to deal with the thumb/finger sucking problem to promote dental equilibrium. (Dental equilibrium allows the teeth to maintain their position.)
If a thumb/finger exerts a force, and if the duration of that force is long enough, there will be movement of the teeth. The most common damage to the dentition includes crossbite, overjet, and anterior open bite. The direction of jaw growth may also be affected. Constant pressure of the thumb/finger against the roof of the mouth can also contribute to a high narrow arched palate.
What other thumb complications are possible? The thumb/finger anchors the tongue down and forward instead of allowing the tongue to rest in the proper position on the roof of the mouth. Thumb sucking contributes to abnormal tongue patterns, altered respiratory patterns, and to open mouth rest posture of the lips. The chronic thumb/finger sucking can cause skin or cuticle infections and or calluses on the thumb/finger from the pressure being exerted.
The facial muscles which are utilized in chewing, swallowing, and speech constitute the foundation upon which speech is constructed. When the thumb anchors the tongue down and forward causing the incorrect rest posture of the tongue an inaccurate and inappropriate spring off point for articulation occurs causing the initiation of the sounds to be misarticulated. When the tongue is resting low and forward the production of a frontal /t/,/d/,/n/,/l/, or interdental /s/ lisp may occur. When the chronic (which means taking place in two or more settings) thumb/finger sucker sucks in the school setting he/she tends to tune out what is occurring around them making it difficult to focus on a subject. Sometimes reduction of peer acceptance and or bullying may occur. And how many thumb/finger suckers do you know wash their hands before initiating the thumb/finger sucking action? This repetitive sucking frequently exposes them to germs.
Every profession, let alone every professional will have their own philosophy as to if and when a thumb/finger sucking habit needs to be addressed. However, if the right questions are not asked the chronic thumb/finger sucker slips through the cracks and is not helped or help comes late with many complications attached. What professional has the opportunity to positively influence these patients, has the desire and expertise to look at the overall health picture, evaluate and determine if the thumb/finger sucking habit need to be eliminated, and then approach the thumb/finger sucking parent and child and then provide them with educated information about the complications of thumb/finger sucking and provide guidance for treatment? The answer is the DENTAL HYGIENIST professional. The dental hygienist routinely does assessments, screening, education, referral, and treatment planning. Incorporating assessment of a chronic thumb/finger habit, then educating the parent and child of the complications that may be occurring and provide treatment education can be within the scope of their expertise.
It is important to note what the thumb/finger sucking habit compromises when it is a chronic problem. When the thumb/finger sucking persists, as we know dental equilibrium is interrupted. According to William R. Proffitt D.D.S., PhD ( University of North Carolina at Chapel Hill and author of Contemporary Orthodontics, 1978), “all clinical orthodontics is based on moving teeth by deliberately altering the force applied by the orthodontist to alter the previous equilibrium causing tooth movement.” He feels “the duration of a force, because of the biologic response, is more important that its magnitude.” The time line for duration to affect the dentition is estimated between 4 and 8 hours.
This premise would also apply to thumb/finger sucking. When you preface the formula frequency + intensity + duration = damage to the concept of thumb sucking and if there is a great deal of thumb/finger sucking daily and or nightly, with a very strong sucking action, and this pattern continues for an extended length of time, damage to the dentition and interference with the freeway space will occur. With the thumb/finger anchoring the tongue down and forward the freeway space is opened and with constant sucking and the tongue remaining low and forward the freeway is opened for a considerable amount of time disrupting the dental equilibrium which leads to many possible complications such as, changes in the oro-facial structure, malocclusions, speech problems, abnormal tongue patterns.
As we know there is an expert for every part of the body. Why should the thumb be any different? You have the dental and orthodontic professionals specializing in maintaining oral health, you have the pediatrician specializing in care and development of children and the prevention and treatment of children’s diseases. However; most people have not heard about a professional specializing in treatment of thumb/finger/digit sucking problems. This professional is called an Oro-Facial Myologist. An IAOM board certified oro-facial mycologist is a trained professional that diagnoses and provides treatment for abnormal tongue patterns, open mouth rest posture of the lips and low forward rest posture of the tongue referred to as Rest Posture Therapy. Before an IAOM professional can begin treating any of these problems the thumb/finger/digit sucking pattern has to be eliminated or the other therapy regimes will not be successful. The IAOM (International Association of Oro-Facial Myology ) is a professional organization devoted to educating, training, and verifying qualified Oro-Facial Myologists. There dedication and professional standards have established them as experts throughout the world. If you do not know of a qualified IAOM therapist in your area the www.@iaom.com website will provide a list of qualified therapists close to you.
In conclusion it is important to ascertain the What, When, Where, and Why of your thumb sucking patient to determine if elimination of the habit needs to be addressed. Then think about “Who” the professional is with the expertise to treat your patient with understanding and compassion utilizing a concise, individualized, and positive approach to eliminating his or her thumb/finger/digit sucking problem. For more information on thumb/finger/digit sucking go to www.@Two-ThumbsUp.com The dental hygienist can then discuss treatment possibilities within the office setting and determine the appropriate course of action providing the patient with guidance for their overall health and well being.