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ORIGINAL ARTICLE
Year : 2008  |  Volume : 26  |  Issue : 7  |  Page : 114-117
 

Distribution of malocclusion types among thumb suckers seeking orthodontic treatment


Oral Health Sciences Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
S P Singh
Oral Health Sciences Center, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


PMID: 19127028

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   Abstract 

The present study was conducted to evaluate the influence of thumb sucking and its duration on the type of malocclusion. A total of 410 North Indian individuals between ages 12-30 years, 161 males and 249 females were examined. A specially designed proforma was used to record the detailed history of the individual. Among the etiological factors it was found that history of thumb sucking was present in 13.9% and significantly related to Class II div 1 malocclusion. When thumb sucking exceeded 18 months, it was found statistically significant (P < 0.1) in Class II skeletal malocclusion, in open bite (P < 0.1) and in extreme overjet
(P < 0.5).
Conclusion: If thumb sucking is not treated early, it can cause skeletal Class II malocclusion, anterior open bite and excessive overjet.


Keywords: Class II div 1 malocclusion, skeletal Class II malocclusion and open bite, thumb sucking


How to cite this article:
Singh S P, Utreja A, Chawla H S. Distribution of malocclusion types among thumb suckers seeking orthodontic treatment. J Indian Soc Pedod Prev Dent 2008;26, Suppl S3:114-7

How to cite this URL:
Singh S P, Utreja A, Chawla H S. Distribution of malocclusion types among thumb suckers seeking orthodontic treatment. J Indian Soc Pedod Prev Dent [serial online] 2008 [cited 2019 Aug 25];26, Suppl S3:114-7. Available from: http://www.jisppd.com/text.asp?2008/26/7/114/44840



   Introduction Top


The implication of digital sucking in young children as a cause of malocclusion continues to be a controversy in dental literature.[1] Similarly early intervention of thumb sucking is a controversial issue.[2] Sucking habits during primary dentition are reported to have little deleterious effect. However when a child engages in non-nutritive, prolonged sucking habit, it often leads to malocclusion. [3],[4],[5],[6],[7],[8] If thumb/ finger sucking habit persists beyond the time that the permanent teeth begin to erupt, malocclusion develops. The resultant malocclusion is characterized by spaced and proclined maxillary anterior, retroclination of lower anterior teeth, anterior open bite, and a narrow maxillary arch.[9],[10][11],[12],[13] Nearly all children who suck their thumb, have an anterior open bite but the reverse is not true. The varying presentation probably is related to the duration more than the intensity of the habit. This is also associated with sucking, which arises from a combination of direct pressure on the teeth and alteration in the pattern of resting cheek and lip pressure.[9],[10],[11],[12],[13]

Tewari[14] conducted a study on the relationship of abnormal oral habits with malocclusion and their influence on anterior teeth in a sample of 2,124 school children in the age range of 6-12 years. She reported that protrusion was observed in 306 children, out of these 213 (69.61%) had the habit of thumb sucking. Open bite was found in 105 children, out of which 84 (80%) had the habit of thumb sucking.

The role of thumb and finger sucking and its relation to malocclusion was investigated by Popovich and Thompson[15] in 1,258 children between 3 to 12 years of age. They found that 462 (36.72%) children had sucking habit. With increase of age the percentage of Class II malocclusion increased from 21.5 to 41.9% in children with sucking habit.

Melson et al.[16] studied the relationship between sucking habit, swallowing pattern and the prevalence of different types of malocclusion in 723 children between 10 to 11 years of age. The abnormal swallowing pattern tendency was reported to increase in children with finger and thumb sucking, who exhibited high frequency of tongue thrust leading to higher frequency of open bite, which also led to development of unilateral or bilateral disto-occlusion and extreme maxillary overjet.

Linder and Modeer[17] studied the relationship between sucking habit and dental characteristics in pre-school children with unilateral cross bite in 68 children with a mean age of 51 months. They reported that unilateral cross bite on the right side was in 58% and on left side was in 42% children. In 85% of children three or more pairs of teeth were involved in malocclusion.

Bowden[18] conducted a study on longitudinal study of the effects of digit and dummy sucking in 116 children between the ages of 2 and 8 years and reported that children in whom digit sucking persisted, revealed a statistically significant increase of skeletal Class II dental base relationship, tongue-thrust and open bite tendencies.

The present study investigated the effect of thumb and finger sucking among adolescents and young adults in the city of Chandigarh. This city is a major centre of trade and education for North Indian states, having people from all socio-economic strata. The prevalence of thumb and finger sucking was investigated among those who sought orthodontic treatment.


   Materials and Methods Top


The study was carried out in the Unit of Orthodontics, Oral Health Sciences Center, Post Graduate Institute of Medical Education and Research, Chandigarh. The sample was drawn from amongst the patients reporting for the treatment of malocclusion. A total of 410 adolescent and young adults were examined. Age was recorded as number of years completed from the date of birth with years rounded off [Table 1].

Criteria for selection

The following criteria were strictly adhered to, while choosing the sample:

  1. Only those patients reporting with the chief complaint of malocclusion to the Unit of Orthodontics for seeking orthodontic treatment.
  2. Only those patients in the age range of 12-30 years, computed through their date of birth, as confirmed from the patient and/or parents.
  3. Only those individuals belonging to North India were included in the study. For this following states were included: Jammu and Kashmir, Punjab, Haryana, Himachal Pradesh, Chandigarh (U.T.), Delhi and Uttar Pradesh.


Examination Procedure

Relevant history and other details were obtained from the parents as well as the patient and recorded in the proforma. Oral examination was conducted with the patient in recumbent position on a dental chair using a mouth mirror and explorer under good artificial light. The information was recorded on a specially designed pro forma. The pro forma was divided into three parts.

Part I: Personal Background

This included age, sex, religion, residential status, family background, marital status, occupation of self/parents as well as socioeconomic status of the family.

Part II: Type of malocclusion

Sagittal:
Class I, Class II division 1, Class II division 2, Class III, skeletal and dental

Vertical: Bite depth (percentage): open bite (mm): overjet (mm)

Transverse: Cross bite

Others: Spacing, crowding and rotations.

Description of the second part of the proforma has been previously described in detail[19]

Part III: Etiological Factor

Thumb and Finger Sucking

A history was obtained from the parents as they observed the child throughout the day and sleeping hours and are usually acutely aware of sucking habit and give a detailed account of thumb or finger sucking. Its duration was recorded in months and cases were grouped into two, thumb sucking habit of less than 18 months and more than 18 months. Confirmation of digital sucking was also done as described by Norton and Gellin.[20]


   Results Top


The distribution of malocclusion cases with a positive history of thumb and finger sucking habit (n = 57) is presented in [Table 2]. Thirty-one individuals had Class I type of malocclusion, 11 of these with less than 18 months and 20 with more than 18 months of thumb/finger sucking habit. Similarly, there were 25 and 1 case respectively of class II division 1 and class II division 2 malocclusion. No thumb sucker was found to have Class III malocclusion. Most of the cases of Class II division 1 (n = 22) had a history of more than 18 months of thumb sucking, which was statistically significant (P < 0.01). The distribution of skeletal and dental malocclusion was 33 cases (less than 18 months = 5; >18 months = 28) in the former and 24 cases (less than 18 months = 9; >18 months = 15) in the latter group. The difference in the duration of the thumb sucking was statistically significant (P < 0.01) for skeletal malocclusion. Open bite was present only in one case, who had sucked thumb for less than 18 months and in 12 cases with a history of more than 18 months. As the thumb sucking habit exceeded more than 18 months, it increased the frequency of open bite, which was significant (P < 0.01).

The distribution of overjet according to severity, that is, 3-5 mm and more than 6 mm, were present in 11 and 26 cases respectively. In the former group only 2 cases had sucked their thumb for less than 18 months and 9 cases for more than 18 months and in the latter group 6 cases had sucked the thumb for less than 18 months and 20 cases for more than 18 months. In both cases the differences were found statistically significant (P < 0.05). Seven cases had unilateral posterior cross bite (less than 18 months = 2; more than 18 months = 5) and 6 had bilateral cross bite (0-18 months = 1; more than 18 months = 5). These differences were statistically insignificant.

The distribution of spacing in maxillary teeth according to the severity, that is, 3-5 mm and more than 6 mm was present in 9 cases in the former group (0-18 = 1; more than 18 months = 8) and the difference was found significant (p < 0.01) and 6 cases (less than 18 months = 1; more than 18 months = 5) due to duration of thumb sucking was found insignificant. Moderate type of crowding (3-5 mm) in mandibular arch was present in 16 cases (less than 18 months = 5; more than 18 months = 11) and severe type of crowding in 8 cases (less than 18 months = 4; more than 18 months = 4) with a positive history of thumb sucking.


   Discussion Top


The damage which may be caused by thumb sucking includes: anterior open bite, posterior cross bite, exaggerated overjet, temporo-mandibular joint problems, diastema, and retrusive position of the mandible. [21],[22],[23],[24],[25],[26],[27],[28] Houston[29] and Melsen et al.[16] also reported a positive correlation between the distal occlusion and cross bite due to finger sucking habit. Larsson[9],[10],[11],[12],[13] reported in his studies anteriorly placed maxilla and protrusion of upper anteriors. In the present study, a positive correlation was found between Class II division 1 and thumb and finger sucking habit (p < 0.01) thus indicating that thumb sucking causes more Class II division 1 types of malocclusion. In this study, it was observed that when thumb sucking exceeded more than 18 months it caused skeletal type of malocclusion (p < 0.01). Thumb/finger sucking beyond 18 months was further related to development of open bite (p < 0.01) and extreme maxillary overjet (p < 0.05). The data on Class II division 1 malocclusion was similar to those reported by Popovich and Thompson[15] and Humphreys and Leighton.[8] Mylarniemi[30] examined children at the age of six and also reported that frequency of distal occlusion increases with age in thumb suckers. Effect of thumb sucking on posterior cross bite was not found to be significant in the present study. When the thumb sucking exceeded more than 18 months it was found that moderate (3-5 mm) type of spacing was present (p < 0.05). Effect of thumb sucking on crowding of mandibular teeth was insignificant. Many authors[31],[32],[33],[34],[35] reported that prolonged thumb sucking caused proclination of upper anterior teeth and retroclination of lower anterior teeth, but made no mention of mandibular incisor crowding.

The present study limited the history to duration of thumb sucking, and the history did not expose the age at which this habit was discontinued, which would have some effect on the observations in terms of development of habit, its relation to malocclusion and its self-correction or deterioration. All these factors need to be studied using a larger sample, of younger age group, preferably longitudinally and with well-structured epidemiological parameters.


   Summary and Conclusions Top


When thumb sucking habit exceeded more than 18 months, it was found to cause statistically significant occurrence of Class II division 1 of malocclusion, protrusion of upper anterior teeth, skeletal type of malocclusion and anterior open bite.

 
   References Top

1.Gellin ME. Digital sucking and tongue thrusting in children. Dent Clin North Am 1978;22:603-19.  Back to cited text no. 1  [PUBMED]  
2.Curzon ME. Dental implication of thumb sucking. Pediatrics 1974;54:196-200.  Back to cited text no. 2  [PUBMED]  
3.Backlund E. Facial growth and the significance of oral habits, mouth breathing and soft tissues for malocclusion. Acta Odontol Scand 1963;21:55-73.  Back to cited text no. 3    
4.Gale E. Thumb sucking reconsidered. Am J Orthod 1969;55:161-70.  Back to cited text no. 4    
5.GraberTM. Orthodontics principles and practice. Philadelphia: W.B. Saunders Company;   Back to cited text no. 5    
6.Grover TD. Thumb sucking and its management. J Indian Dent Assoc 1959;31:61.  Back to cited text no. 6    
7.Hellman H. A study of some etiological factors of malocclusion. Dent Cosmos 1914;56:1017-31.  Back to cited text no. 7    
8.Humphreys HF, Leighton BC. A survey of antero-posterior abnormalities of the jaws in children between the ages of two and five and a half year of age. Br Dent J 1950;88:3-15.   Back to cited text no. 8  [PUBMED]  
9.Larson E. Dummy-and finger sucking habits with special attention to their significance for facial growth and occlusion, 6: Age changes between 9 and 12 years for cases with a finger sucking habit at 9 but not at 12 years compared with corresponding changes for control cases. Sven Tandlak Tidskr 1978;68:55-9.  Back to cited text no. 9    
10.Larsson E. Dummy and finger sucking habits with special attention to their significance of facial growth and occlusion. 4: Effect on facial growth and occlusion. Sven Tandlak Tidskr 1972;65:605-34.  Back to cited text no. 10    
11.Larsson E. Dummy-and finger sucking in 4-year olds. Sven Tandlak Tidskr 1975;78:219-24.  Back to cited text no. 11    
12.Larsson E. Dummy-and finger sucking habits with special attention to their significance for facial growth and occlusion, 7: The effect of earlier dummy-and finger sucking in 16-year old children compared with children without earlier sucking habit. Swed Dent J 1978;1:23-33.  Back to cited text no. 12    
13.Larsson E. The effect of finger sucking on occlusion: A review. Eur J Orthod 1987;9:279-82.   Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.Tewari A. Abnormal oral habits: Relationship with malocclusion and influence on anterior teeth. J Indian Dent Assoc 1970;42:81-4.  Back to cited text no. 14  [PUBMED]  
15.Popovich F, Thompson GW. Analysis of factors associated with persisting maxillary diastema. J Dent Res 1974;53:272.  Back to cited text no. 15    
16.Melson B, Stensgaard K, Pedersen J. Sucking habits and their influence on swallowing pattern and prevalence of malocclusion. Eur J Orthod 1979;1:271-80.  Back to cited text no. 16    
17.Lindner A, Modeer T. Relationship between sucking habits and dental characteristics in preschool children with unilateral posterior crossbite. Scand J Dent Res 1989;97:278-83.  Back to cited text no. 17    
18.Bowden BD. A longitudinal study of the effects of digit and dummy-sucking. Am J Orthod 1966;52:887-901.   Back to cited text no. 18  [PUBMED]  
19.Singh SP, Utreja A, Chawla HS. A study of distribution of malocclusion among North Indians seeking Orthodontics treatment. JIOS 1993;24:47-53.   Back to cited text no. 19    
20.Norton LA, Gellin ME. Management of digital sucking and tongue thrusting in children. Dent Clin North Am 1968;12:363-83.   Back to cited text no. 20    
21.Louis JP, Cohen MM, Fales MH. Correlation between malocclusion, oral habits and socio-economic level of pre-school children. J Dent Res 1960; 39:450.  Back to cited text no. 21    
22.Moss JP, Picton DC. The problems of dental development among the children on a Greek Island. Dent Pract Dent Rec 1968;18:442-8.  Back to cited text no. 22  [PUBMED]  
23.Moyers RE. Hand Book of Orthodontics. 2nd ed. Chicago: Year Book Medical Publishers. Inc; 1963. p. 18.   Back to cited text no. 23    
24.Moyers RE. Hand Book of Orthodontics. Chicago: The Year Book Medical Publisher Inc; 1969.   Back to cited text no. 24    
25.Proffit WR, Field HW, Ackerman JL, Thomas. Contemporary Orthodontics. St Louis Toronto, Canada: The C.V. Mosby Co; 1986.  Back to cited text no. 25    
26.Straub WJ. Malfunction of the tongue. Am J Orthod 1960;46:404-24.  Back to cited text no. 26    
27.Sweet CA. Thumb and Finger sucking by children. Am J orthod 1948;34:1017-8.  Back to cited text no. 27  [PUBMED]  
28.Swinehart EW. Structural and nervous effects of thumb sucking. J Am Dent Assoc 1938;25:736-43.  Back to cited text no. 28    
29.Houston WJ. Mandibular growth rotations-their mechanisms and importance. Eur J Orthod 1988;10:369-73.  Back to cited text no. 29  [PUBMED]  [FULLTEXT]
30.Myllδrniemi S. Oraland dental state in Helsinki Pre-school children III. Prevalence of dummy and finger sucking habit and V oral habits and occlusion. Proc Finnish Dent Soc 1973;69:47-51.  Back to cited text no. 30    
31.Traisman AS, Traisman HS. Thumb and finger-sucking: A study of 2650 infants and children. J Pediatr 1958;52:566-72.  Back to cited text no. 31  [PUBMED]  
32.Zadik D, Stern N, Litner M. Thumb and pacifier-sucking habits. Am J Orthod 1967;71:197-201.  Back to cited text no. 32    
33.Schneider PE, Peterson JE. Oral habits: Consideration in management. Pediatr Clin North Am 1982;29:523-546.  Back to cited text no. 33    
34.Peterson JE and Schneider PE. Oral habits: A behavioral approach. Pediatr Clin North Am 1991;38:1289-307.  Back to cited text no. 34    
35.Baalack IB, First AK. Finger sucking children: A study of incidence and occlusion condition. Acta Odontol Scan 1971;29:499-512.  Back to cited text no. 35    



 
 
    Tables

  [Table 1], [Table 2]


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