Stop Thumb Sucking

Thumb sucking appliances

Overview

Thumb sucking appliances use stiff wires installed into the child’s mouth to obstruct the thumb and should be a last resort.  Thumb Sucking is a habit that develops early in age and comforts babies and toddlers. Typically, children stop thumb sucking as they transition to becoming a toddler around the age of two and up to four years old. Thumb sucking that persists beyond the eruption of primary teeth can, and usually does, cause improper growth of the mouth and misalignment of the teeth. Also, thumb sucking that persists past two years old can cause speech problems, and soars, which is why pediatric dentists recommend as early as two years old that parents get their child to stop the habit.  A high percentage of children stop thumb sucking when the permanent front teeth are ready to erupt. If you notice prolonged and/or vigorous thumb sucking behavior in your child, talk to your dentist/orthodontist about quitting through motivation and thumb sucking products, and secondly using one of the many thumb sucking appliance options.

This habit breaking thumb sucking appliance is used on the upper arch to restrain the tongue from excessive anterior movement A .040” support arch wire is soldered to bands on the first molars. A vertical cage is extended just behind the lower anteriors to prevent the patient from tongue thrust. A pearl is added in the vault of the palate to retrain the tongue.

This habit breaking thumb sucking appliance is used on the upper arch to restrain the tongue from excessive anterior movement A .040” support arch wire is soldered to bands on the first molars. A vertical cage is extended just behind the lower anteriors to prevent the patient from tongue thrust. A pearl is added in the vault of the palate to retrain the tongue.

Throughout this article you will find many appliance images.  This article is intended to show you the many options of mouth appliances available – talk to your pediatric dentist or orthodontist to see what is best for your situation.

The Rake thumb sucking appliance

The Rake thumb sucking appliance is used on the patients that seem to get around all the other designs. A .040” support arch wire is soldered to bands on the first molars and a vertical rake is extended just behind the lower anteriors. The rake can be made as long or wide as the clinician desires.

Several thumb sucking products or thumb sucking appliances are available that are specifically designed to break the early childhood habit that exists in about 10% of children over the age of four.  Using the appliance the dentist will attach a mechanical device by wires to rear molars, extending to the front of the mouth. These devices work behind the upper front teeth at the roof of the mouth to either block or cause a firm pressure/slight pain when sucking of the thumb is attempted. One of these appliances, the hay rake, has short “spikes” or prongs in the middle, just behind the front teeth, intended to cause discomfort when the thumb is inserted.  The sharp prongs literally hurt the thumb.

The Roller thumb sucking appliance

This rolling thumb sucking appliance is designed specifically to correct thumb sucking habits. A Teflon roller spins on a wire and prevents the comfort and thumbsucking action. The palatal lingual wire holding the roller is soldered to bands on the first molars.

A very similar device is the intraoral crib (also called palatal crib), and it uses metal rings instead of spikes behind the upper front teeth, which also to disrupt the comforting sensation a child receives from sucking the thumb. Once the palatal crib is inserted, a dentist may leave it there for several months, so a child may have to live with these kinds of devices for long periods. The blue grass appliance is slightly less painful appearing device compared to the hay rake. It is similar in the method of attachment. The bluegrass appliance contains either beads or a short Teflon roller, which can be rotated with the tongue. With this device, the child is expected to roll the tongue on the beads or roller instead of thumb sucking, in this way replacing one habit for another, until the device is removed.

The Flat Crib thumb sucking appliance

The Flat Crib thumb sucking appliance is used to restrain the patient from sucking their thumb. A .040” support arch wire first is soldered to bands on the first molars. Wires are placed across the palate parallel to the occlusal plane to prevent the thumb from contacting the rugae. This appliance is also less noticeable than a vertical Habit appliance.

Other appliances

There are so many different dental appliances, other than the thumb sucking appliance, for so many different applications.  Below are a few described so that you can just get a sample of the variety.  There is also a teeth grinding appliance available, that can replace a retainer and ensure it is worn at night.  Talk to your dentist who knows best!

Lip Bumpers

We like to avoid pulling teeth as often as possible, so we use lip bumpers on our patients who need to create more room for their crowded teeth. The lip bumper is a wire on the lower jaw that extends from one molar to another and keeps lips and cheeks from touching your teeth. When you move your mouth or speak, your lips and cheeks push on the bumper, and the bumper applies pressure to the teeth. This pressure pushes the molars back, creating more space for overcrowded teeth.

If you have a lip bumper, please remember to leave it in while eating, but do not eat hard or sticky foods. Proper, thorough brushing should remove any food that gets stuck in your lip bumper.

Tongue Thrusting Appliance

Tongue thrusting can be corrected by installing a tongue thrusting appliance. This appliance, similar to a mouth guard, is usually worn at night.  Tongue thrusting occurs when the patient presses his or her tongue against the front teeth, usually when swallowing, speaking or resting the tongue. If thrusting is constant, this can cause problems with teeth alignment and must be fixed.

Mandibular Anterior Repositioning Appliance

The Mandibular Anterior Repositioning Appliance (MARA) treats malocclusions of class 2 that are characterized by the upper front teeth protrusion or such that the upper jaw and/or teeth are in front of the lower teeth. Using this appliance malocclusions can be treated. The MARA is reliable and reduces treatment time.

MARA is generally worn between 15 to 18 months, and improvements will be noticed immediately.

This mouth appliance is secured to the first molars using crowns that are made of stainless steel.  It is easy to fit on, and retains more compared to bands. This appliance does not have removable components so that the patient compliance is not an issue. Also, the orthodontist can more accurately predict the length of treatment.  Also, the upper “elbows” can be removed; which facilitates comfort and advanced adjustments. The appliance can be advanced on one side or both sides.

Development of sore spots in the mouth are minimal. Although initially it may feel strange to hold your jaw forward while eating, but in less than one or two weeks maximum chewing food will become feel natural. Eating soft foods initially will ease the transition. The patient should be careful not to chew on the elbows, and definitely staying away from hard foods and hard candy throughout the treatment plan in order to protect the appliance investment.

Lower Lingual Arch

A Lower Lingual Arch (LLA) essentially is a spacer that prevents the molars from drifting forward over time and prevents them from blocking the space where permanent teeth will eventually erupt. This LLA is most commonly employed where premature loss of baby teeth occurs or when a growing kid’s lower teeth become crowded and while permanent teeth are not extracted to fix the issue.

After the appliance is installed there will be soreness the first day or two, and it may hurt to chew.  Again, avoid hard foods or hard candy during this time and stick with a soft diet initially.

The duration of wear varies by patient. Monitor the eruption of new teeth, and at the first sign of a new tooth emerging see the orthodontist for an adjustment. The LLA is removed following the eruption of all the permanent teeth.

Brushing and flossing daily is especially important when wearing this appliance. Be sure to clean around the bands that are connected to the molars and the wire on the tongue side thoroughly in order to prevent the formation of cavities or infection of the gums.  During the initial soar period you may want to avoid high sugar as brushing may be shortened because of soarness.

Nance Appliance

The Nance Appliance (NA) is used to prevent upper molars from moving or shifting forward after it is worn with a headgear. Some patients wear the NA while they are awaiting their bicuspids to grow into place. Patients should always brush around the bands daily. Avoid sticky, or hard foods or candy as it can loosen or damage the appliance.

This teeth appliance is made of two bands that are cemented onto the first molars and a wire spans the roof of the mouth from one molar to the other. An acrylic pad or “button” covers the wire that touches the roof of your mouth directly behind your front teeth.

Distal Jet Appliance

The Distal Jet Appliance (DJA) corrects class II problems, and is a permanent (non-removable) lingual appliance that is used to move upper teeth backward faster and more predictably than headgear. The Distal Jet corrects teeth that have rotated and distalizes molars.

The DJA uses 2 sets of screws that lock on both sides, and a solid track wire. By engineering design, the appliance is self-limiting as it has a distal stop attached to the tracking wire. For further visualization, the Distal Jet Appliance can be converted to a Nance Appliance by tightening the distal and anterior locks against the track wire and adding a Nance holding arch.

Pendulum Appliance

The Pendulum Appliance is used to correct the patient’s bite on the side of their mouth.  The Pendulum Appliance is used to correct class 2 malocclusions by distalizing upper molars.

The roof of the mouth is used to anchor the appliance and to move the molars back into their correct positions. Patients usually wear this appliance for several month to half a year.  The Pendulum Appliance consists of a plastic “button” that touches the roof of the mouth and resilient wire springs that act in a broad swinging arc to move the molars back.

Rapid Palatal Expander

Attached to the upper molars through bonding or by cemented bands, the Rapid Palatal Expander is an orthodontic device used to create a wider space in the upper jaw. It is typically used when the upper jaw is too narrow for the lower jaw or when the upper teeth are crowded or blocked out of the dental arch.

When patients are still growing, their connective tissue between the left and right halves of their upper jaw is very responsive to expansion. By simply activating the expander through turning a screw in the center, with a special key that we provide, gradual outward pressure is placed on the left and right halves of the upper jaw. This pressure causes an increased amount of bone to grow between the right and left halves of the jaw, ultimately resulting in an increased width.

Summary

If simple motivation, or a thumb sucking device worn on the arm or hand does not work, then a dental appliance for thumb sucking may be the right solution.  There are so many different mouth appliances available so speak with your pediatric dentist or orthodontist to understand the options and what is best for you!

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