Clinical Insights

If you are parent to a child who has a thumb or finger habit, you are in good company. One study indicated that 15-20% of children under age 6 engage in thumb or finger sucking habits. Even orthodontists' children suck their thumbs! (See cover photo to see my daughter in action).

Below are 4 considerations for parents with a child who engages in thumb sucking. All of the following are evidence-based and established by clinical research, to help your child avoid dental health problems while building self-confidence associated with overcoming a challenging task.

Impact on Dental and Facial Growth and Development

After age 6 and with the corresponding eruption of the first permanent teeth, sucking habits will begin to have an irreversible negative effect on the development of the jaws, bite relationship, and positioning of teeth. In most cases, the habit will contribute specifically to a narrow upper jaw (causing crossbite), protruded upper teeth (overbite), and a failure of the front teeth to bite together properly (open bite).

Stopping By Age 6 or 7 Will Minimize Most Long Term Effects

In my experience as an orthodontist, I find that most children begin to establish social awareness of thumb sucking around age 5-6 and develop an internal motivation to cease the habit when it is observed that peers at school are not engaged in the habit. Fortunately for children and parents, this period coincides with the time in development at which irreversible negative effects can by prevented. Research has shown that cessation of thumb and finger habits prior to the eruption of the permanent incisors (central teeth) at age 6 or 7 will prevent lasting negative impacts on the development of the upper jaw and permanent teeth. This key age to stop also aligns with the American Association of Orthodontists' (AAO) recommended age for the initial evaluation of your child (age 7) by an orthodontic specialist.

Techniques for Stopping Thumb and Finger Sucking

The single most important aspect in helping a child to stop sucking a finger or thumb is to determine self-motivation. In the clinical setting, I typically begin by simply asking the child if he or she would like to stop the sucking habit. If your child is not ready and motivated, then it is not time to attempt to stop the habit. It will only lead to frustration and negativity. The focus, instead, should be on education. Explaining to your child how it would be helpful to them to stop and pointing out that others in their social group or class at school may be in the process of stopping. Acknowledging the difficulty in stopping is also very important. For example, if either parent had a sucking habit as a child, explain to your child how you recall how hard it was to stop, but how rewarded you felt once you were able to tackle the  difficult challenge.

Once established that the child is motivated, I recommend the following techniques to positively reinforce stopping the habit:

1. Continuously reaffirm the child's self-motivation and goal to stop. Examples: "That is so great that you set this goal." and "You can do this, we are so proud of you."
2. Set up a reminder system to help the child stop when the body may be unconsciously initiating the habit during sleep. This can include sleeping with glove or bandaid on the sucking hand and using nail polish on the sucking finger (Mavala Stop is one brand name).  The goal is not to physically prevent your child from performing the habit, but helping to provide reminders so they can willfully stop the habit in a positive, supportive environment. Positive reinforcement is the key.
3. Use a reward calendar on the refrigerator. Every full day/night your child goes without engaging in the habit, place a star on the calendar. Arrange for a reward after 14 consecutive days are achieved without the habit. After 14 consecutive days, the chance of relapse of the habit is very small. (Link: I Can Do It Reward Chart)
4. In many cases, early orthodontic intervention will help your child if he or she is actively engaged in a sucking habit over age 7. Most often, a constricted (narrow) upper arch and possible associated crossbite will indicate the need for a maxillary expander to orthopedically widen the upper jaw. In this case, this very common appliance will change the dynamics of the thumb habit just enough to serve as a reminder and aid the child in stopping the habit.

Consider the BIG PICTURE

Your child will overcome this habit. Your role as a parent is to educate, to motivate, and to provide a positive and supportive environment. Keep in mind that this may be the very first conscious, difficult sacrifice your child makes to improve his or her health and well-being. It must be our goal as adults (parents and healthcare providers alike) to foster self-motivation, encourage that little girl or boy that they are up to the challenge, and celebrate with them when they achieve what they set out to do. Comments like "how am I going to get him to stop" or  "she will never stop this" do little to motivate and will undermine the child's self-expectations. This habit should be looked at as a profound opportunity that can be used as a very important confidence builder for a young child. We adults must create an environment that encourages children in our sphere of influence to learn, to set goals, and to succeed- in thumb-sucking and beyond!!

The DCO Team is here to help you. Please email me at any time (info@dco-ortho.com) if I can provide any additional information to help you or your child.

"Everybody has a plan until they get punched in the mouth." -Mike Tyson

(Montgomery County, PA)- Many parents ask whether their child in braces or Invisalign needs to wear a mouthguard while playing sports. Below are some guidelines to help you ensure your child's teeth are protected while playing sports.

Advantages of Mouthguards

1. Cushion any forceful contact to the face, lips, or jaws to prevent injury
2. Prevent teeth from being chipped, broken, or injured when heavy contact is sustained
3. Evenly distribute force when contact is sustained to the mouth, lips, or teeth

Types of Mouthguards

1. Custom Fit Mouthguards (the cream of the crop, best fitting and performing, made by your dentist or orthodontist)
2. Orthodontic Mouthguards (designed to fit around braces, expanders, and other orthodontic appliances and to give teeth the freedom to move while still providing great protection)
3. Boil and Bite Mouthguards (DIY at-home customization, gets the job done but may not fit as well and will be more bulky when compared to a custom fit mouthguard)

When should my child wear a mouthguard?

1. Any sport or activity where forceful contact to the face could be sustained
2. More obvious sports are: football, hockey, lacrosse, field hockey, boxing, martial arts
3. Less obvious sports where facial injuries can occur but mouthguard wear is typically inconsistent and/or not required to be worn amongst players are: basketball, soccer, baseball, softball. In my practice, I have seen the highest amount of significant dental trauma stemming from basketball in instances where a mouthguard was not being worn
4. If there is any chance for contact to the face or teeth, then a mouthguard = your best friend

If you have any questions about mouth protection or prevention of trauma while playing sports, please feel free to email me at info@dco-ortho.com. We are committed to helping you! I hope you found this short article helpful!

TMJ pain (Temporomandibular Joint Dysfunction or TMD) affects over 3 million people each year in the United States. It consists of pain in the jaw joint and/or surrounding muscles and associated difficulty opening. Some patients experience mild pain and discomfort, while others can experience severe pain that drastically interferes with normal function and quality of life. Individual patients may experience a wide range of severity at different times. TMD is highly correlated with stress. The majority of those who experience TMD are over the age of 20, however, it can occur in children and teenagers.

What is the cause of TMJ Pain (Temporomandibular Joint Dysfunction- TMD)?

1. The majority (almost 70% according to most research) of TMJ Pain is caused by overuse and inflammation of the muscles around the jaw joint.  TMJ pain can also less commonly be caused by functional problems within the joint itself.
2. TMJ pain is often caused by muscle overactivity that occurs during times of stress, and as a result of clenching and/or grinding.
3. A significant portion of the population will experience TMJ pain at some time throughout life and symptoms tend to improve with time through conservative measures (see below):

Seven Simple Solutions for Relief of TMJ Pain:

1. DIET: Soft foods (prevents over activity of chewing muscles)
2. MOTRIN: Motrin/Advil (doses as indicated on bottle) periodically when pain is at its worst (reduces both pain and muscle inflammation)
3. HEAT: Use a heating pad to apply heat to the side of the face near the TMJ for 15 minutes on both sides each night before bed.
4. STRETCH: Stretching exercises to open your mouth as wide as you can without pain to stretch muscles around the jaw and facilitate muscle lengthening and relaxation (2x/day for 5 min each)
5. NIGHTGUARD/RETAINER: A clear nightguard or retainer on upper and/or lower teeth to be worn while sleeping to help to keep your teeth apart and relax the muscles around the TMJ. This should be made and adjusted by an orthodontist or dentist.
6. HABITS: Avoid repetitive chewing habits that cause your muscles to function continuously like chewing on pen caps, chewing on nails, or chewing gum all day long (chewing gum for a few minutes several times per day is ok).
7. RELAXATION: Studies show that TMJ pain and muscle overuse is highly correlated with general life stress. Exercise, good sleep habits, and finding time during the day to mentally and physically relax helps to improve symptoms significantly.

**All therapies above should be monitored by your orthodontist or dentist.

We are committed to help you feel better! This protocol is effective in providing significant relief for a large percentage of patients. If these conservative methods are not effective, we can refer you to a facial pain center for more advanced diagnosis and treatment.

We are here to help you!  Call us at DCO (610-615-3166) with any questions- we would love to assist you!