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Non-Nutritive Habits Pedo
Non-Nutritive Habits Pedo
Non-Nutritive Habits Pedo
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
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
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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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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
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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.
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
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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
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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