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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 8  |  Issue : 3  |  Page : 197-201

Sudipta Kar's cribbed thumb guard: An innovative inexpensive way to treat thumb sucking


Department of Pedodontics and Preventive Dentistry, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India

Date of Submission28-Jul-2018
Date of Acceptance07-Jun-2019
Date of Web Publication05-Aug-2019

Correspondence Address:
Dr. Sudipta Kar
21F, Charakdanga Road, Uttarpara, Hooghly - 712 258, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_63_18

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  Abstract 


Active thumb sucking often causes malocclusion and/or facial deformity. Thumb sucking is such a detrimental habit when found in children above 6 years of age causing open bite formation, speech distortion, maxillary prognathism, posterior crossbite, mandibular retrognathism, and midline diastema. On the other hand, abnormal tongue thrusting may also cause growth disturbances of the orofacial structures and malocclusion. The present article has discussed on the management of such detrimental habits with an innovative yet a simple approach never been used before.

Keywords: Appliance, habit, thumb sucking


How to cite this article:
Kar S, Pal A. Sudipta Kar's cribbed thumb guard: An innovative inexpensive way to treat thumb sucking. Int J Health Allied Sci 2019;8:197-201

How to cite this URL:
Kar S, Pal A. Sudipta Kar's cribbed thumb guard: An innovative inexpensive way to treat thumb sucking. Int J Health Allied Sci [serial online] 2019 [cited 2019 Aug 20];8:197-201. Available from: http://www.ijhas.in/text.asp?2019/8/3/197/263951




  Introduction Top


According to Subtelny (1973), when thumb is inserted into the mouth considerably beyond the first joint, it is called Type A, and it is found almost 50% cases. When the thumb is extended into mouth around the first joint or just anterior to it, and no palatal contact is observed it is called Type B (found almost 24%). Thumb is often placed fully into the mouth in contact with the palate without any contact with the mandibular Incisors it is nomenclatured as Type C (18%) and when the lower incisor contacts approximately at the level of thumbnail then it is Type D (8%). According to the American Dental Association and the American Academy of Pediatrics, thumb sucking is considered as a normal phenomenon up to the age of 4 years. Warren and Bishara had a difference of opinion. They elevated the age limit up to 6 years of age.[1] Various unwanted effects of thumb sucking are briefly described underneath [Table 1].
Table 1: Various unwanted effects of thumb sucking

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On the other hand, tongue thrusting is a habit of putting the tongue forward against the teeth or in between during swallowing. It is also known as an infantile or reverse swallow pattern. It may cause open bite formation. According to profit, in case of a child who is having open-bite, tongue posture may be a causative factor, but the tongue activity during swallowing may not be responsible for the development of open bite.[2]


  Case Report Top


A 12-year-old girl accompanied by her parent reported to the Department of Pedodontics and Preventive Dentistry with a chief complaint of thumb sucking during her leisure time and before as well as during sleeping for the past 4–5 years. Child's parent also reported that she was unable to restrict her thumb even after repeated education and motivation from their part. Extraoral soft-tissue examination revealed short upper lip and digit examination revealed roughened callus formation on outer aspect of the thumb and dishpan thumb deformity [Figure 1]. The girl had convex profile and mesomorphic facial pattern with bilaterally nearly symmetrical face. Intraoral examination of the girl revealed normal shape, size, and position of the tongue. The child was counseled in the next visit regarding the deleterious effect of tongue thrusting as well as thumb sucking habit on facial esthetics soft tissue profile and orodental structures. However, the treatment modality was failed. She expressed her inability to stop the habits. Then, it was planned to fabricate one fixed habit breaking appliance with tongue crib to control her habits [Figure 2], [Figure 3], [Figure 4]. Again the treatment failed. The patient was too intelligent and she somehow managed to maintain her thumb sucking habit reported by her parent. The patient distorted the fixed habit breaking appliance in quick succession probably due to the severe urge for thumb sucking. Then, an innovative designed thumb guard with crib was fabricated and given to the patient. The innovative crib inclusion actually showed a miraculous result [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]. Thumb sucking habit was completely stopped, and the orofacial condition was improved [Figure 12] and [Figure 13].
Figure 1: Preoperative photograph showing incompetent upper lip, median diastema, and proclined anteriors

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Figure 2: Tongue-thrusting habit

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Figure 3: Fabricated fixed habit breaking appliance with palatal crib on cast

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Figure 4: Habit-breaking appliance fixed intraorally

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Figure 5: Keratinization and callus formation on the left thumb

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Figure 6: Customized impression tray made up of wax sheet

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Figure 7: Making of the left thumb impression

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Figure 8: Removed alginate left thumb impression

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Figure 9: Duplication of the left thumb

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Figure 10: Fabricated innovative thumb guard with 3 crib and soft elastics inserted into posterior holes

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Figure 11: Placement of the thumb guard

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Figure 12: Cribs interfering the placement of thumb

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Figure 13: Postoperative photograph

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  Discussion Top


Basic treatment modality of deleterious oral habit depends upon the severity of the problem and the need of the patient. Four factors are responsible for the outcome of deleterious oral habits– force duration intensity and frequency.[3] Emotional disturbances are one of the causes of the development of deleterious oral habits.[4] Hence, counseling of a child plays an important role in controlling habits. When it fails, dental surgeon may take help of reward and reminder therapy for the breaking of the habit like inserting thumb wraps or gloves on child's hands. Appliance therapy may be used when reminder and the reward therapy fails removable and fixed cribs appliance, thumb guard, etc. Thumb sucking may be developed due to the gratification of pleasure derived from sucking.[5] Hunger, restlessness, boredom, and fear may cause the development of thumb sucking habit.[1],[6],[7] In the present appliance, the inclusion of metal crib makes the appliance more effective. It resists the intrusion of thumb into the mouth at various levels. Three cribs are incorporated in this design horizontally to prevent the habitual placement of thumb in different thumb joint levels. The advantage of this appliance is, it is easy to fabricate and cost-effective. Two holes are made in the opposite side of the cribs to incorporate one smooth elastic band into the appliance. This elastic actually helps in retention of the appliance on the patient's thumb. The drawback of this appliance is, it is removable in nature. The patient has to be motivated properly to wear the appliance.


  Conclusion Top


As deleterious oral habit have multidirectional ill effects on intra- and extra-oral structures. Time has come to combat it through multidirectional therapy and appliances. Newer innovations and effective patient management may help us to serve our patients in a better way.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Warren JJ, Bishara SE. Duration of nutritive and nonnutritive sucking behaviors and their effects on the dental arches in the primary dentition. Am J Orthod Dentofacial Orthop 2002;121:347-56.  Back to cited text no. 1
    
2.
Proffit WR. Contemporary Orthodontics. 1st ed. Mosby-Year Book, Inc.; 1986. p. 110-2.  Back to cited text no. 2
    
3.
Proffit WR, Mason RM. Myofunctional therapy for tongue-thrusting: Background and recommendations. J Am Dent Assoc 1975;90:403-11.  Back to cited text no. 3
    
4.
Nanda RS, Khan I, Anand R. Effect of oral habits on the occlusion in preschool children. ASDC J Dent Child 1972;39:449-52.  Back to cited text no. 4
    
5.
Helle A, Haavikko K. Prevalence of earlier sucking habits revealed by anamnestic data and their consequences for occlusion at the age of eleven. Proc Finn Dent Soc 1974;70:191-6.  Back to cited text no. 5
    
6.
Farsi NM, Salama FS. Sucking habits in Saudi children: Prevalence, contributing factors and effects on the primary dentition. Pediatr Dent 1997;19:28-33.  Back to cited text no. 6
    
7.
Yemitan TA, daCosta OO, Sanu OO, Isiekwe MC. Effects of digit sucking on dental arch dimensions in the primary dentition. Afr J Med Med Sci 2010;39:55-61.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13]
 
 
    Tables

  [Table 1]



 

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