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A single appliance for the correction of Digit-sucking, Tongue-thrust, and Posterior Cross bite
Gajanan v. kulkarni, D. Lau. Pediatr Dent 2010; 32: 61-3.

K. Raj vardan Post graduate student

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Thumb sucking:

The habit of sucking the thumb for oral gratification. . PleasurePleasure-seeking or comforting device, especially when the child is hungry or tired. Peak when the child is between 18 and 20 months of age, and it normally disappears as the child develops and matures.

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The types of changes in the dentition that an oral habit may cause vary, depending on the intensity, duration, and frequency of the habit Thumb sucking beyond 4 to 6 years of age may lead to malocclusion of the teeth and deformation of the bony tissue of the thumb. Age 3: 50% Age 6: 6 % Age 12: 1%

  

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CLINICAL FEATURES:

Anterior open bite

Posterior cross bite

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the upper incisors and lingual movement of the lower incisors

Proclination of

Increased over jet

Maxillary constriction.

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Upper lip becomes hypotonic Lower part of the face exhibits hyperactive mentalis activity

Consideration for Oral Habit Therapy :



Age of the patient Maturity of the patient Parent cooperation Assessment of deformity Degree and the presence/absence of other complexities
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Treatment: Treatment:


Depending on the willingness of the child to stop the habit, three different approaches to treatment have been advocated. They are:

Reminder Therapy Reward Therapy Appliance Therapy

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Timing of treatment is critical. Treatment is usually undertaken by age 6 years The child should be given every opportunity to stop the habit spontaneously before the eruption of the permanent teeth.

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Reminder Therapy:


Reminder therapy is appropriate for those who want to stop the habit but need some help to stop completely. An adhesive bandage taped to the offending finger can serve as a constant reminder

Reward Therapy

Ace bandage

Thumb cap

A contract is agreed upon between the child and parent or between the child and dentist.
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Appliance Therapy:


Used when reminder and reward therapy have failed. There are two major categories of commonly used appliances: Removable

Modified Hawley
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Fixed Appliance
Examples: Hay rake Appliance Palatal Crib

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Disadvantages:


Multiple appliance Time Cost

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A single appliance for the correction of Digit-sucking, Tongue-thrust, and Posterior Cross bite
Gajanan v. kulkarni, D. Lau. Pediatr Dent 2010; 32:61-3.

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Appliance design:


.036 inch blue elgiloy stainless steel wire arch. Teflon roller Tongue crib/rake Molar bands Fixed-removable appliance. Molar bands on Permanent first/Primary second molar.
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Beveled on 3 sides 5/8 inch in length inch in diameter

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Accurate pretreatment patient records should be made, including radiographic survey, study models, and photographs. Ideal time for treatment late primary/early mixed dentition.

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Placement &clinical management:



Appliance should be placed in mouth for 1 month before expansion. Molar separation with orthodontic separators, followed by try in to ensure the fit is optimal. Cemented with Glass ionomer. Crib is removed once the tongue thrusting habit is corrected.
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Posterior cross bite is corrected by incremental activation of the wire arch. Only wire portion is removed. Appliance is reactivated until overcorrection is achieved.

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Results:


Treatment period is from 6-8 months to 1 year. Anterior open bite is corrected spontaneously following cessation of the habit. Over correction of Posterior cross bite is attained in 2-3 months after insertion.

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Pre treatment

Post treatment

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limitations
      

Tongue irritation Temporary discomfort Speech and eating difficulties. Breakage Oral hygiene. Careful monitoring of the dentist Patient & parent cooperation

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Discussion:


Conventional strategies towards sucking behavior requires multiple appliances. Sucking habit is stopped by the rake/crib and the blue grass portions. Rake/crib is removed once the tongue thrust habit is stopped. Alteration of the tongue posture is maintained by the remaining blue grass portion.
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Retroclination of the max anteriors is usually followed by the cessation of the habit. Posterior cross bite is corrected by activating W arch laterally. Giuntini et al recently introduced a single appliance consisting of quad-helix with crib, which was proved to be effective in producing favorable dental effects and patient compliance. The earlier the single appliance is used, the more ideal the results and shorter the treatment time.

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Conclusion:

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References:


A single appliance for the correction of Digit-sucking, Tongue-thrust, and Posterior Cross bite Gajanan v. kulkarni, D. Lau. Pediatr Dent2010; 32:61-3. Declann M, Richard Welbury. Clinical problem solving in Orthodontics and Paediatric dentistry, 1st ed, chapter 11. St Louis: Elsevier; 2005:48-51. Haskell, Bruce S and Mink, John R. An Aid to Stop Thumb-Sucking: The Bluegrass Appliance, Pediatr Dent1991;13:83-5. John J. Warren et al. Effects of oral habits duration on dental characteristics in the primary dentition. J Am Dent Assoc 2001;13:1685-93;quiz 1726. Proffit, William R. Contemporary Orthodontics, 2nd edition, Chapter 25, 1993.

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Paola Cozza et al. transverse features of subjects with sucking habits and facial hyperdivergency in the mixed dentition. Am J Orthod Dentofacial Orthop. 2007;132:226-9.

Paola Cozza et al. Sucking habits and facial hyperdivergency as risk factors for anterior open bite in the mixed dentition. Am J Orthod Dentofacial Orthop 2005;128:517-9.

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Thank you

Thank you
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