|Year : 2009 | Volume
| Issue : 4 | Page : 260-262
An unusual type of sucking habit in a patient with cleft lip and palate
Department of Pedodontics & Preventive Dentistry, K.V.G Dental College, Sullia, India
|Date of Web Publication||14-Nov-2009|
Department of Pedodontics & Preventive Dentistry, K.V.G Dental College, Sullia
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Digit sucking, a form of non-nutritive sucking, is a habit of concern to specialist in various fields such as psychiatrist, psychologist, pediatricians, pediatric dentists, orthodontist, speech pathologist and plastic surgeon. The habits have harmful unbalanced pressures to be born by the immature highly malleable alveolar ridges. Sucking behaviors have long been recognized to affect occlusion and dental arch characteristics. As early as 1870s, Campbell and Chandler recognized that prolonged finger or thumb sucking habits had deleterious effects on certain occlusal traits including anterior open bite, increased over jet and class II canine and molar relationships. However, little is known about digit sucking habit and its effect in a cleft lip and palate child as there is no literature till now reported on the digit sucking in a cleft lip patient.
Keywords: Digit sucking in cleft lip and palate patient, finger sucking in handicapped child
|How to cite this article:|
Satyaprasad S. An unusual type of sucking habit in a patient with cleft lip and palate. J Indian Soc Pedod Prev Dent 2009;27:260-2
|How to cite this URL:|
Satyaprasad S. An unusual type of sucking habit in a patient with cleft lip and palate. J Indian Soc Pedod Prev Dent [serial online] 2009 [cited 2020 Feb 18];27:260-2. Available from: http://www.jisppd.com/text.asp?2009/27/4/260/57664
| Introduction|| |
Habits are learned patterns of muscular contraction and it may be a part of normal development, or a symptom with a deep-rooted psychological basis or a result of abnormal facial growth. Prolonged non-nutritive sucking was reported to cause changes in certain dental arch measurements such as decreased maxillary arch width and increased lower arch width, with correspondingly higher prevalence of posterior cross bite.  While continued non-nutritive sucking of 48 months or longer produced the greatest changes in dental arch and occlusal characteristics, children with shorter sucking duration also had detectible differences.  So it is prudent to revisit suggestions that sucking habit of shorter duration is of little concern. 
Even though digit sucking is one of the common habits, there are not any reports in the literature on any type of digit sucking in cleft lip and palate patients nor is it included in the classification of oral habit. In the following paragraph, we report a special case of digit sucking in a child with a handicapping condition of unilateral cleft lip and palate. [Figure 1]
| Case Report|| |
A female child of 8 months was reported to the Department of Pedodontics and Preventive Dentistry, KVG Dental College and Hospital, Sullia, with unilateral cleft lip and palate. There was no previous history of treatment or surgeries. The patient had difficulty in feeding with regurgitation and respiratory infections. The child weighed 6.2 kg and showed no signs of malnutrition. Intraoral examination revealed a unilateral cleft lip and palate with a wide gap between the alveolar segments. Further examination and history revealed that the child had the tendency to place her fingers into the oral cavity and suck. The finger sucking habit was present since birth and the child used to place the middle and ring fingers into the oral cavity and index finger on the nose while sucking the digits [Figure 2].
To improve the esthetic result of lip repair, the pre-surgical orthopedics of cleft molding was planed, so that a more coalesced cleft with an ideally shaped alveolar ridge, which in turn diminishes the tension after the lip surgery, is gained. Also that a significant decrease in the alveolar cleft size results in diminished need for bone grafting in the mixed dentition stage. This deformity is characterized by flattened nasal alar cartilage on the side of the cleft that is splayed out by the alveolar gap.
A Naso Alveolar Molding (NAM) was planed to reduce the gap between the cleft and to mould the nasal deformity before the lip surgery that was already delayed. A primary impression of the defect was made using greenstick compound [Figure 3] and a cast was poured. The cast showed the defect to be 17 mm wide. NAM appliance was given.
The NAM was continued for two months at the end of which the size of the defect had reduced to 14 mm. The nasal stent, which consisted of an orthodontic wire bent to raise a small triad ball to mirror the nostril shape was fabricated and adjusted once a week by raising the wire and the nasal ala was slightly lifted [Figure 4]. However the habit still persisted on removal of the appliance, which demanded a strict parental vigilance as the gap that had closed may widen on placing her tongue or finger.
The patient was operated for lip closure using the Millard's procedure and the healing was uneventful. And patient was recalled to notice that there was no evidence of the habit after the surgery [Figure 5].
| Discussion|| |
The process of sucking is seen even at 29 weeks of intrauterine life and it is the first coordinated muscular activity of the infant. It is important to meet the psychological and nutritional needs during feeding and apart from nutritional satisfaction child associates the pleasure from lips, tongue and oral mucosa with fondling. He usually suckles for a long time intensively to get required nourishment thereby exhausting the sucking urge. The etiology of finger sucking habit is said to be due to lack of psychological and nutritive needs during feeding and so child sucks the finger for additional gratification. 
This patient was devoid of breast feeding due to lack of milk in mother and the discomfort of feeding due to regurgitation and dis-satisfaction of sucking urge could have added or precipitated the child towards the digit sucking habit. So habit could be a result of re-channeling the frustration of satisfying surplus sucking urge and the fingers acted as an artificial palate.
Relationship between non-nutritive sucking and occlusal abnormalities have been extensively studied and found to produce certain malocclusions in primary dentitions including anterior open bite, increased over jet and class II canine and molar relationships. ,, The prevalence increased with duration. Although many studies document the consequences of prolonged non-nutritive sucking on primary dentition, most of them relied on cross sectional designs. The relationship between the two is difficult to prove.
Even though finger sucking is very common during infancy and continues through the second year of life, it needs an immediate intervention as these habits have a devastating influence on the treatment outcome of the cleft lip and palate. The results of several electromyography studies indicate that circumoral muscles were especially active during digit sucking in addition to the cheek pressure in the canine region.  In this patient additional to the pressure exerted by these muscles during sucking habit, repair of cleft lip and palate may also attenuate the cross bite, which may alter the treatment outcome. So these cases need special attention because of the implications on the reparative treatment modalities.
Electromyography studies done on masticatory muscles in operated unilateral cleft lip and palate has shown different muscle function as compared to non-operated patients.  Operated cleft lip and palate patients showed highest value of EMG activity of superior orbicular oris with abnormal lip seal.  Hence this habit after the surgery must have stopped because of the difference in adaptability and functions of muscles.
| References|| |
|1.||Warren JJ, Bishara SE. Duration of nutritive and non nutritive sucking behaviors and their effects on the dental arches in the primary dentition. Am J Orthod Dentofacial Orthop 2002;121:347-56. [PUBMED] [FULLTEXT] |
|2.||Warren JJ, Bishara SE, Steinbock KL, Yonezu T, Nowak AJ. Effects of oral habits duration on dental characteristics in the primary dentition. J Am Dent Assoc 2001; 132:1685-93. [PUBMED] [FULLTEXT] |
|3.||Singh SP, Utreja A, Chawla HS. Distribution of malocclusion types among thumb suckers seeking orthodontic treatment. J Indian Soc Pedod Prevent Dent 2008; 26:114-8. |
|4.||Text book of Pedodontics-- Shobha Tandon. 2 nd ed. Paras publishers; p. 428. |
|5.||Adair SM, Milano M, Lorenzo I, Russell C. Effects of current and former pacifier use on the dentition of 24-- to 59--month--old children. Pediatr Dent 1995;17: 437--44. [PUBMED] [FULLTEXT] |
|6.||Fukata O, Braham RL, Yokoi K, Kurosu K. Damage to the primary dentition from thumb and finger (digit) sucking. ASDC J Dent Child 1996;63:403-7. |
|7.||Farsi NM, Salama FS. Sucking habits in Saudi children: prevalence, contributing factors and effects on the primary dentition. Pediatr Dent 1997; 19:28-33. [PUBMED] [FULLTEXT] |
|8.||Lindner A, Hellsing E. Department of Orthodontics, Karolinska Institute University Hospital of Huddinge, Sweden. Cheek and lip pressure against maxillary dental arch during dummy sucking |
|9.||Li W, Lin J, Fu M. Electromyographic investigation of masticatory muscles in unilateral cleft lip and palate patients with anterior cross bite. Cleft Palate Craniofac J 1998;35:415-8. [PUBMED] [FULLTEXT] |
|10.||Carvajal R, Miralles R, Cauvi D, Berger B, Carvajal A, Bull R. Superior orbicularis oris muscle activity in children with and without cleft lip and palate. Cleft Palate Craniofac J 1992;29:32-6. [PUBMED] [FULLTEXT] |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
|This article has been cited by|
||Prevalence of Oral Habits in Children with Cleft Lip and Palate
| ||Paula Caroline Barsi,Thaieny Ribeiro da Silva,Beatriz Costa,Gisele da Silva Dalben |
| ||Plastic Surgery International. 2013; 2013: 1 |
|[Pubmed] | [DOI]|