Many people may not be aware that thumb or finger sucking, as well as prolonged pacifier use, can eventually lead to dental problems. Some sources claim that it is safe for children to suck their thumb or use a pacifier up to age 3 or 4 without causing any permanent dental problems. In my eleven years of clinical experience I find that it is best to stop the habit by age two. I have seen many 2 and 3 year olds who have already developed irreversible orthodontic problems.

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Thumb sucking or pacifier use will eventually push the upper teeth out and the lower teeth in, thus creating a large space between the front teeth. Even though it is only the baby teeth that are initially affected, the bone structure around the teeth will also be affected. When the child turns 6 or 7 years old and the adult teeth begin to come in, the child's adult teeth will also have the large gap between the front teeth and thus necessitate future orthodontic treatment. The pacifier habit is easily broken by simply taking away the pacifier. The child will usually be upset and cry for 2 to 4 days. It is much harder to break the thumb sucking habit so I am providing the following information for those in need of advice.

There are three basic categories of treatment.

  • Behavioral therapy helps a child avoid thumb-sucking through various techniques such as reminder therapy and reward systems. Reminder therapy is useful for children who are ready to discontinue the habit. Nagging a child about a habit will most likely prolong it. Reward systems usually involve the use of a calendar, on which is star is placed for every day in which no thumb habit is observed. A reward is given to the child after a certain number of stars have been earned. Behavioral therapy works best if all people involved in the child's care follow the treatment plan. The biggest problem with behavioral therapy alone is that children will thumb suck at night to comfort themselves, especially when tired, and so children will often continue the habit at night subconsciously. Placing an Ace Bandage around the elbow at night can help with this. In the Ace Bandage technique, an elastic bandage is wrapped around the elbow at bedtime. As the child falls asleep, the pressure from the bandage removes the thumb from the mouth. The disadvantages of this last technique are: possible decreased blood flow to the arm so care must be taken to ensure the bandage is not too tight, and a lower success rate than compared to appliance therapy.

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    Thumb devices, such as the one made by Kid Giddy can be used for children with severe thumb-sucking problems. A thumb device is usually made of nontoxic material and is worn over the child's thumb. It is held in place with straps that go around the wrist. A thumb device prevents a child from being able to suck his or her thumb and is worn all day. It is removed after the child has gone 48 hours without trying to suck a thumb. The device is put back if the child starts to suck his or her thumb again. Placing tape or a bandage over the thumb is another method. Unfortunately, most older kids will be able to remove the tape or bandages themselves. MAVALA Stop is another innovative product that has been shown to be very effective. MAVALA Stop is a harmless, transparent nail polish that has a distinct bitter taste. It needs to be reapplied every couple of days.

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    Oral devices (such as a palatal arch or crib that fits into the roof of the mouth) interfere with the pleasure a child gets from thumb-sucking. It may take several months for the child to stop sucking the thumb when these devices are used. When the child stops sucking, parents may choose to continue using the device for several months. This may prevent the child from starting the habit again. Oral devices need to be fitted by a dentist. Even though these appliances are the most effective method to stop thumb sucking, in my opinion, they should be the last choice once we have exhausted all other options. It is the most expensive option and can be difficult to place in young or uncooperative children.