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What Can Be Done About Thumb Sucking Habits?
The survival of a newborn baby depends on instinctive nutritive sucking, which allows for essential nourishment. Infants also engage in nonnutritive sucking of their fingers and thumbs, which provides them with a sense of well-being, comfort, and security. Thumb sucking, however, can also have negative influences on both dental development and speech. After the age of four, correction of a thumb habit may involve using psychological and/or physical preventive measures. The ultimate goal, however, should be to correct the cause of the habit, rather than the habit itself.

The mouth provides a baby's first contact with the external world, and sucking is an infant's first coordinated muscular activity. Babies even suck their thumb before they are born. Prolonged thumb sucking can deform a child's upper dental arch, cause a crossbite, protrude teeth, and create an open bite. The extent of these negative consequences are affected by the duration of the habit, the daily frequency of the habit, and the manner in which the thumb is placed into the mouth.

Children tend to suck their thumb when they are tired, bored, under stress, or in need of comfort. Taking away the soothing effects of a thumb habit may result in poor conduct by the child. Preventing a thumb habit, against the wishes of a child, may result in learning problems, bed wetting, sleep disorders, initiation of a new habit, or persistence of the old habit. Evaluation by a psychologist, pediatrician, and pediatric dentist may be necessary for the eventual resolution of the problem.

Psychological techniques for correcting a thumb habit include: reminder therapy, distraction 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. Distraction therapy can involve providing a long hug, or offering a comfort object to the child - such as a blanket, favorite toy, or even a pacifier. It is important to note that pacifiers do less damage to the oral structures than a thumb habit. Reward systems usually involve the use of a calendar, on which is star is placed for ever day in which no thumb habit is observed. A reward is given to the child after a certain number of stars have been earned.

Physical preventive measures should be used only in children who want to stop the habit, and in whom there are no psychological contraindications. These preventive measure include dental appliance therapy, as well as an assortment of nondental measures. Dental appliance therapy is usually the last resort, and involves wearing an appliance in the mouth, which decreases the pleasure provided by thumb sucking. These dental options include: the palatal crib, the Bluegrass appliance, the vertical crib, as well as other appliances. These intraoral appliances are also the most expensive option for the parents. They are worn for two to six months.

Nondental preventive measure include: placing a bandage around the thumb, placing a mitten on the hand, or placing an Ace Bandage around the elbow at night. 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, and a lower success rate than with appliance therapy.
A recent dental journal article discusses the Ace Bandage technique of managing night time digit habits:
Adair, SM: The Ace Bandage approach to digit-sucking habits. Pediatric Dentistry 21:451-454, 1999.

Treatment For Displaced Baby Teeth Due To Trauma
Trauma to a child's teeth is one of the most distressing events which can befall a youngster. Such an incident may be even more distressing to the child's parents and other family members. Many of these misadventures occur during the first three years of life, since it is during this time that a child is learning how to be independent and mobile.

Due to the soft and resilient nature of the bone which supports the primary (baby) teeth, it is common for young children to have their teeth displaced and loosened after a traumatic fall - as apposed to having teeth fractured. Luxations (displacement) of primary teeth account for up to 91% of all dental injuries in young children.

Luxation injuries of primary teeth affect the supporting alveolar bone, periodontal ligaments, and structural fibers in the gingiva - as well as the health of the pulp tissue inside of the teeth. Under the right circumstances, dental splinting of the displaced baby teeth for two weeks, antibiotic therapy, baby root canal treatment, and good oral hygiene - may preserve the health of these luxated teeth until it is time for them to exfoliate (fall out) naturally.

Root canal treatment (pulpectomy) may be necessary in order to preserve the health of the luxated teeth. A pulpectomy is needed when inflammation, infection, or degenerative changes have progressed into the root canal portion of the teeth. In this procedure, the diseased tissue is completely removed from the inside of the crown and root. Then, the root canal is cleansed, enlarged, disinfected, and filled with a resorbable material.

Parents should take the following steps when baby teeth have been displaced:
1. First, in a situation involving head or facial injury, take your child to a physician to rule out neurologic damage or airway obstruction. The physician will provide a tetanus toxoid booster or antitoxin injection, if necessary.
2. Next, take your child to a pediatric dentist for an evaluation. He/she may need to use gentle restraint to examine your child's teeth and oral structures. Your child may need to sit on your lap when dental radiographs are taken. You may also be called upon to provide gentle restraint during the examination and x-ray procedures. The dentist may need to take an "occlusal" radiograph of the teeth.
3. The dentist may elect to preserve or extract the displaced baby incisors, depending on clinical findings.
4. Parents should always request periodic dental re-evaluations for a child who has had a traumatic dental injury.
5. Parents should brush and clean their child's teeth every day, especially around the displaced teeth.

A recent dental journal article discusses a conservative method of treating displaced primary teeth:
Holan G: Conservative treatment of severely luxated maxillary primary central incisors. Pediatric Dentistry. 21:459-462, 1999.

Gastroesophageal Reflux Disease: How It Could Affect Your Child's Teeth
Gastroesophageal reflux disease (GERD) is one of the most common disorders affecting the gastrointestinal tract of infants and children. Gastroesophageal reflux (GER) is the involuntary passage of gastric contents into the esophagus and mouth. Dental erosion, and acid-induced loss of dental enamel, may be one of the first signs of GERD in young children. Medical treatment for GERD may be pharmacologic or surgical.

GERD can be caused by inappropriate relaxation of the lower esophageal sphincter (LES), increased abdominal pressure, or increased acid production by the stomach. Transient lower esophageal sphincter relaxation (TLESR) is a common problem with childhood GERD. The LES is a muscular sphincter (band of muscle tissue) which allows food and nourishment to pass down the esophagus, and into the stomach. When this sphincter does not remain tightly closed, the acidic stomach contents travel back up the esophagus and into the mouth. During this pathologic reflux, the lining of the esophagus is irritated, and the dental enamel is chemically eroded.

Childhood symptoms of GERD include: sleep problems, failure to gain weight, abdominal discomfort, recurrent pneumonia, sleep apnea, bruxism, bad breath, a baby who sits up all of the time, or an infant who cries constantly.

Diagnosis of childhood GERD can be accomplished with the 24-hour esophageal pH monitoring study. This procedure uses a flexible indwelling esophageal probe, and is 100% accurate in diagnosing gastric reflux when the esophagus pH is less than 4.0 for at least 6 hours during the 24-hour testing period. Endoscopy is also useful for diagnosing GERD, because it allows visual examination of the lining of the esophagus (mucosa). Evidence of esophageal inflammation such as bleeding, ulceration, or exudate, may be seen. The endoscope is a thin, flexible tube which is placed into the child's mouth, and is passed down into the esophagus. A tiny camera in the endoscope allows a physician to view the esophagus for indications of gastric reflux.

Dental problems related to GERD are caused by the acidic gastric (stomach) contents which travel back up into the oral cavity. Both primary and permanent teeth can be affected by dental erosion. Dental erosion is the demineralization of enamel and dentin caused by chemicals, such as gastric acid. During a child's dental examination the dentist will see "dished-out" areas of lost enamel on the front of the incisors and eye teeth, near the gum line. These are also called cervical lesions of the labial surfaces, caused by chemical erosion. A flattening of the cusp tips of the primary molars may also be seen.

Dental management of GERD includes: avoiding meals within 3 hours of bedtime, avoiding sleeping in the prone position, applying topical fluoride to the teeth daily, and rinsing frequently with plain water. In case of extreme dental erosion, a soft night guard may be worn by a child to protect the teeth.

A dental journal article discusses the dental implications of GERD:
Dodds A, King D. Gastroesophageal reflux and dental erosion: case report. Pediatric Dentistry. 19:409-412, 1997

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