Advice on Dummy and Digit-Sucking Habits

These guidelines are intended to provide advice for health professionals involved in the care of children with dummy (pacifier) or digit-sucking habits. They are based on the current evidence available, which is predominantly observational in nature, as there are no controlled clinical trials at present. Background Racial factors 80-90 % of children in the Western world have sucking habits1 These habits are not universal across the world, for example they are non-existent in Eskimos2 Gender Sucking habits are equivalent for males and females until the age of 1 year3,4 After this they are more common in females, because males give up the habit earlier. Socio-economic factors Dummy sucking is more common in the lower socio-economic groups5 Digit sucking is more common in the higher groups5 Age Most habits begin in the first 3 months and are so common as to be considered normal3 Dummy-sucking declines rapidly after this and is almost non-existent after the age of 7 years6 Digit-sucking tends to decline at a slower rate, and more habits persist into the permanent dentition6 Frequency of habit It is thought that significant effects on the teeth are only likely to occur if the habit exceeds about 6 hours a day7 Type of feeding (breast or bottle-fed) The method of feeding has no effect on the prevalence or type of habit3, 8

Aetiology (2 theories) 1. Habit is a sign of underlying emotional disturbance1 2. Habit is a learned behaviour. Infants have a natural sucking urge that encourages eating. Sometimes this urge persists after enough food has been eaten.9 This surplus urge is satisfied with dummy or digitsucking, and may last from a few minutes to a few hours.10 Current opinion favours this second theory. Effects of Habits Dummy-sucking Effects are primarily in the deciduous dentition, as the habit usually stops before the permanent teeth erupt1 Reduction in overbite, producing an anterior open bite.11, 12 This effect is minimised using orthodontic dummies, whose teats are flatter in cross-section and collapse in the mouth1 Reduction in maxillary arch width, which may cause a posterior cross-bite11, 13 Long-term effects (i.e. in the permanent dentition) are negligible14 Digit-sucking The effects are determined by the nature and intensity of the habit. Reduced overbite or anterior open-bite, which is often asymmetrical1 Upper incisors are proclined,14 lower incisor may be retroclined15 Maxillary arch may be narrowed, producing a cross-bite and displacement1 Effects are often seen in the permanent dentition due to the continuation of the habit Small but probably clinically insignificant effects on the underlying skeletal pattern14 Effect on the digit Eczema can result from repeated wetting and drying and in extreme cases angular deformities can occur (although most self-correct on elimination of the habit).16 It may also be a means of acquisition and spread of infectious diseases, such as roundworm, herpetic gingivostomatitis or staphylococcal impertigo.16
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Prevention of Habits If a dummy is provided, there appear to be fewer problems in the long-term, because the majority of dummysucking habits are self-limiting and stop before eruption of the permanent teeth.1 Any persistent dummysucking habit is easily broken by removal of the dummy. It has been suggested that if a digit-sucking habit is noticed, a dummy should be given to the child.1, 17 If a dummy is used it must not be sweetened.1 After the age of 2, to prevent problems with speech development, it should be used as little as possible during the day.

Breaking the Habit The child must want to stop otherwise any approach is likely to be unsuccessful. It is advisable to start discouraging habits when the permanent incisors are beginning to erupt, to prevent effects on the permanent dentition A child who is undergoing severe psychological trauma is unlikely to respond to habit breaking. A psychologists input may be required

The following methods for breaking the habit are listed in the order in which they should be used: Non-physical methods Explanation1 Explain the effects of digit-sucking and the need for stopping. This is often all that is required to break the habit. Reward18 Introduce a simple system to monitor and reward stopping the habit Habit reversal15 Teach the child to carry out alternative activities when they have the urge to suck the digit Physical methods Digit1 Examples include a sticking plaster on the digit, or wearing a glove sewn to the pyjama top at night Intra-oral appliances19-21 These deterrent appliances have been shown to be effective within 10 months. They must be fitted with the full understanding and co-operation of the child and must not compromise compliance with any future orthodontic treatment.

Correction of Problems Caused by Habit Active orthodontic treatment should not be attempted until the habit is broken1 Fortunately, most of the problems created by the habit are reversible once the habit is eliminated22 It has been suggested that digit-sucking beyond the age of 7 has been associated with an increased risk of root resorption during orthodontic treatment.23

Produced by the Development and Standards Committee, BOS 4 July 2000

References for Advice on Dummy and Digit-sucking Habits

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Moore M.B. Digits, Dummies and Malocclusions. Dental Update 1996, 23, 415-422 Curzon M.E.J. Dental implications of thumb sucking. Pediatrics 1974, 54, 196-200 Traisman A.S. and Traisman H.S. Thumb and finger-sucking: a Study of 2650 infants and children Journal of Pediatrics 1958, 52, 566-672 Zadik D., Stern N. and Litner M. Thumb and pacifier sucking habits. American Journal of Orthodontics 1977, 71, 197-207 Jenkins P.M., Feldman B.S. and Stirrups D.R. The effect of social class and dental features on referral for orthodontic advice and treatment. British Journal of Orthodontics 1985, 11, 185-188 Larsson E. Dummy and fingersucking habits with special attention to their significance for facial growth and occlusion. 1 Incidence study. Swedish Dental Journal 1971, 64, 667-672 Proffit W.R. Contemperary Orthodontics.2nd ed. pp 126-127. St Louis, Missouri: Mosby-Year Book, 1993 Meyers A. and Herzberg J. Bottle feeding and malocclusion. Is there an association? American Journal of Orthodontics and Dentofacial Orthopaedics 1988, 93, 149-152 Larsson E. and Dahlin K.G. The prevalence and the aetiology of the initial dummy- and finger-sucking habit. American Journal of Orthodontics 1985, 87, 432-435 Jacobson A. Psychology and early orthodontic treatment. American Journal Orthodontics 1979, 76, 511-529 Lidner A. and Modeer T. Relation between sucking habits and dental characteristics in preschool children with unilateral crossbites. Scandinavian Journal of Dental Research 1989, 97, 278-283 Adair S.M., Milano M. and Dushku J.C. Evaluation of the effects of orthodontic pacifiers on the primary dentitions of 24- to 59-month old children: preliminary study. Pediatric Dentistry 1992, 14, 13-18 Lidner A. and Hellsing E. Cheek and lip pressure against maxillary dental arch during summy sucking European Journal of Orthodontics 1991, 13, 362-366 Larsson E. Dummy and finger sucking habits with special attention to their significance for facial growth and occlusion. 4 Effects of facial growth and occlusion. Swedish Dental Journal 1972, 65, 605-634 Martinez N.P. and Hunkler R.J. Jr. Managing digital habits in children. International Journal of Orthodontics 1986, 24, 5-8 Vogel L.D. When children put their fingers in their mouths. Should parents and dentists care? New York State Dental Journal 1998, 64, 48-53 Levine R.S. Briefing paper: Oral aspects of dummy and digit sucking. British Dental Journal 1999, 186, 108 Morley K.R. and McIntyre T. Management of non-nutritive or digit-sucking habits in children a practical approach. Canadian Dental Association 1994, 60, 969-71 Haryett R.D., Davidson P.O. Sandilands M.L. Chronic thumbsucking: the psychologic effects and the effectiveness of various methods of treatment. American Journal of Othodontics 1967, 53, 569-585 Haryett R.D., Hansen F.C. and Davidson P.O. Chronic thumbsucking: A second report on treatment and its psychologic effects. American Journal of Orthodontics 1970, 57, 164-178 Da Silva Filo O.G., Gomes Gloncalves R.J. and Maia F.A. Sucking habits: clinical management in dentistry Journal of Pediatric Dentistry 1991, 15, 137-56 Larsson E. Dummy and finger sucking habits with special attention to their significance for facial growth and occlusion. 7 The effect of earlier dummy and finger sucking habit in 16 year old children compared to children without earlier habits. Swedish Dental Journal 1978, 2, 23-33 Linge L. and Linge B.O. Patient characteristics and treatment variables associated with apical root resorption during orthodontic treatment. American Journal of Orthodontics and Dentofacial Orthopaedics 1991, 99, 35-43 3

15. 16. 17. 18. 19. 20. 21. 22.

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