When do you give the boot to thumb-sucking & paci-addictions?

By Guest Blogger, Dr. Grant Coleman, DMD, MS
http://www.bracesincharlotte.com/

My 3-year old son loves his pacifier. It’s pretty much a requirement for him to have a successful nap or bedtime, and given that my wife and I like sleep, we gladly give it to him. The paci has also given him what we in orthodontics call an “anterior open bite,” which in means that even when he’s biting down on his back teeth, his top and bottom front teeth don’t overlap at all. In fact there’s now a hole in the front that you could probably fit a McNugget in without him even opening his mouth if you tried….

Some of the most common questions that we get in our orthodontic practice from parents of younger children relate to oral habits. Parents are often scared that their child is doomed to a decade in braces because of a thumb-sucking habit, but a little bit of information may put those fears to rest.

First of all, sucking habits in young children are completely normal. It’s a comfort thing, and if it helps your kids sleep better or calm down, then you usually let it continue. When a child has a persistent habit with a thumb or pacifier, you’ll likely see some effects on their teeth from the habit. Orthodontics is nothing more than the process of putting pressure on the teeth to move them-it doesn’t matter where that pressure comes from. So, a persistent habit tends to push the upper teeth up and the lower teeth down, which leaves a hole or “open bite” in the front where the thumb or pacifier fits.

So when should you try to get your child to stop the sucking habit? Ideally before the first adult teeth erupt, which is typically around age 5 or 6. The side effects of sucking habits that are seen in the baby teeth are typically temporary, but once the adult teeth begin to erupt the orthodontic effects of habits can create more involved problems. Difficulty eating or biting through certain foods and speech problems are a couple of things you might encounter if the habit continues.

Getting your child to stop this kind of habit isn’t necessarily hard to do, and I usually recommend starting with the most conservative/least expensive method possible:
1) Begin with a simple, positive reward system at home. Create a “reward jar” that gets $1 put in it for each day your child doesn’t suck his thumb or pacifier; each time he falters and does the habit, you take out 50 cents. At the end of the week, he gets a fun trip to Target where he gets to spend the money he earned in the jar from stopping his habit. This is usually really effective but takes some time to work. It’s also relatively cheap!
2) Use a removable orthodontic thumbguard. You can get this from your dentist or orthodontist, and it is really designed for finger/thumb habits. It is a plastic sleeve that fits over the thumb or finger, held by a wrist strap that the parent snaps on. This can be quite effective because the child can’t take it off by himself-the parent has to actually cut the disposable strap to get it off.
3) Have your orthodontist make a custom “thumb guard” or “thumb crib.” This is a lab-fabricated, metal appliance that is cemented to the upper teeth, and it has a metal mesh just behind the front teeth. It doesn’t hurt, and basically all it does is block the finger/thumb/pacifier from fitting in the mouth like it normally does, taking away the pleasure from the habit. Although more expensive, these appliances almost always work because they are cemented in the mouth and aren’t removable.

Above all, the most important thing is to keep the experience of stopping the habit a positive one! It doesn’t help to call your child a baby or to embarrass him for what he’s doing. You have to create in your child the desire to stop, and positive reinforcement is the best way to do that. Even trips to the dentist or orthodontist can be framed in a positive light to help your child see how he’s growing up.

So, here are the take-home points: if you have a younger child (below age 6) with an oral sucking habit, don’t worry! It’s normal and can provide a lot of comfort, and the dental side effects are typically temporary in the baby teeth. Once the adult teeth start to come in, try the above methods to help your child stop. Stay positive and make it a rewarding experience, not a punishment. And if you’re not having any luck with your at-home methods, talk with an orthodontist about taking the next steps to help your child quit. You and your child will be glad you did.

Thanks, Dr. Coleman, for your Smarty tips:-)