Health promotion is the ability of adental professional to inform and motivate their patients to adopt betterhealth behaviors. It is extremely important to understand the generationaldifferences amongst the patient population. We must understand all the levelsof the “age totem pole”-starting as young as preschool-aged children, throughadolescents and teens, and even into late adulthood geriatric patients. Eachgeneration coming with their own healthcare customs, beliefs, and routines. Asdental professionals, we must be able to listen, recognize, and evaluate thedental practices performed by patients so that we are able to implement thebest outcome for the patient.
We want to be able to identify conditions and/orillnesses that would affect the patient both positively and negatively. We wantto reassure and applaud the patient when performing adequate oral hygiene, andshow alternatives in areas that need improvement. Although not with all disease comesdeath, there are certain conditions that would require lifetime maintenance andresult in more disorder.
With the geriatric population, cognitive and musculoskeletaldisorders are common, while in the pediatric population, early childhood caries(ECC) and bottle-feeding are common conditions that aren’t detrimental to theiroverall health, but could cause dental changes that could negatively affecttheir overall wellbeing. Finger sucking is another commonoral habit that is present in the pediatric population. It is considered normaland a developmental process for infants. Children utilize this habit as meansof comfort, if they are bored, and even if they are beginning to get hungry.Sometimes, there are cases where the infant sucks their finger, but a pacifieris another means of getting that same soothing effect. Finger sucking hasbecome normalized and many more families are becoming numb to the age at whichit started and at which it ends, if it ever is stopped.
Sucking on their fingeror pacifier is normal up to four years of age. Not known, if this oral habitcontinues age four or even age five, it begins to create problems for thechild, such as dental malocclusion. Stress is another main culprit for fingersucking, just as nail biting or pen chewing effects the adulthood population;more stress, means more sucking and less stress, means less sucking. So thisbrings into effect the psychological aspect of it as well. Although it is afeeling of comfort and soothing feelings, it is extremely important to breakthis habit young because of the physical changes and abnormalities it causes inthe oral cavity. It is essential for the infant’s parents to understand theenvironmental, social, and psychological characteristics of finger sucking are,understand ways to prevent it from continuing into toddlerhood to prevent themalformations it can cause in the child’s oral cavity.
Like mentioned before, fingersucking is considered to be a normal developmental process for infants. Thisinstinctual habit allows newborns to adequately breastfeed without havingguidelines; they are able to perform the skill and learn on their own, which isa detrimental skill that is necessary for developing babies. The sucking habit beginswith the mother’s breast then to nearby objects to familiarize the newborn withits surroundings. This is where pacifiers or “binkies” come into play as well,they are utilized to comfort anxious children, soothe their appetite, as wellas soothe them to sleep. “When a pacifier isn’t available, the infant cansubconsciously resort to their fingers, typically the thumb” (Diwanki, n.d.
) Jason Stricker, RaymondMiltenberger, and fellow associates conducted a study on three children, eachdiagnosed with Attention Deficient Hyperactive Disorder (ADHD), one being sixyears old, one being seven, and one being fourteen. They participated in astudy monitoring their finger sucking habits, during which the observant viewedtheir normal routines from 3 pm-8 pm. There was finger sucking evident when theparticipants did countless activities, such as eating dinner, playing videogames, or sitting and watching television. The study concluded that the suckingwas retained by automatic reinforcement, or a favorable result without anyoneelse being involved.
No matter how strong the habit was, the children wouldusually stop thumb sucking when their parents or caregivers were present in theroom, “possibly because of a learned response of punishment associated withtheir oral habit” (Stricker, 2002). Initiative versus guilt is thedevelopmental stage at which theorist Erik Erikson believed preschoolers wereexperiencing psychologically. They are very eager and active in trying newthings, however, it is during this period, these children are extremely vulnerableand if excessive negative reinforcement is used, the child doesn’t learn andfails to exhume that feeling of self power and sense of self. They become guiltyand an inadequacy on being on their own. They may become more depressed andstressed, and it could be the causative agent of the thumb or finger suckinghabit acquired. The parents should be educated about positive reinforcement,rewarding the child, praising and actively listening to the child when they aretalking with them. It can teach the child that not sucking their finger isgood, instead of focusing on the negative qualities.
Consequently, the childwill be motivated to not want to suck their finger and this enthusiasm willhelp to quit the habit quicker and sooner. If the positive reinforcement and talkingwith the child isn’t succeeding, the parents can resort to orthodonticappliances designed to inhibit the child from finger sucking. If negative versus positive reinforcementisn’t working, the finger sucking habit of the child is a very strongdependence that they are struggling with. With this, comes a challenge for boththe parent and child. Because of this age in their lives, finger sucking andthumb sucking are a habit that may cost for the child to not have as manyfriends in school. Their peers look down upon them and often tease children forit.
This rejection from friends at school can lead to more emotional problemsfor the child, and most likely the need for orthodontics to correct the oralfixation (Bokony & Patrick, n.d.). An anterior open bite, which is a spacebetween the child’s top (maxillary) front teeth, and the bottom (mandibular)front teeth, is a common malocclusion that occurs from thumb sucking. This canalso be seen from continuous use of a pacifier in the space where the mouthoccludes. Other dental issues that may result from finger sucking includedoverbite, posterior crossbite, and narrowing of the hard palate. Overbites arewhen the top teeth don’t occlude or meet the bottom teeth at the correct angle,they overlap the bottom.
This malocclusion will resolve itself if the childquits the finger sucking by age six, when the first permanent teeth erupt inthe mouth. “The open bite, posterior crossbite, and narrowing of the hardpalate all tend to need orthodontic appliances to correct them” (Brandon,2012). Speech impairments may develop in these children if the anterior teeth,the most affected teeth, continue shifting. With proper aesthetics and speaking,the anterior teeth help to enunciate specific syllables and sounds whentalking.
“In addition to the dental malformations and speech impediments,bacteria, accidental poisoning, and herpetic whitlow are other negative aspectsof this oral para-functional habit” (Stricker, 2012). There are specific orthodonticappliances that are fabricated to prevent or reverse finger sucking. The threeappliances available are the “Hay Rake”, the “Palatal Crib”, and the “Bluegrass”. With each appliance having its owndesign and style, they are all constructed for the same purpose, to end orreverse the oral habit of the child. The “Hay Rake” is the harshest of the three appliances. It is a palatal wireattached to the posterior molars, and it has prongs that face downward towardthe tongue. So if the child wants to put their thumb in their mouth to suck, thedownward facing prongs poke the child’s finger. The “Palatal Crib” is similarin that it is a wire placed, however, it does not have prongs on the appliance,there is a metal bar or ring.
If the child wants to suck their thumb, they caninsert the finger into their mouth, but they won’t get the same favorableeffect when they hit the metal bar or ring fixated at their palate. The “Bluegrass”appliance has acrylic beads or even a roller in place of the prongs or metalring, which allows the child to roll their tongue over the beads instead of placingtheir finger in their mouth. It allows for more stimulation and musclemovements in the tongue and normal positioning of the teeth and tonguequickest.
These appliances are not cheap, they are rather expensive treatment, andso it is important for the parent to recognize the finger sucking habit earlyand talk to a dental professional about alternatives to help prevent the habit. If the finger sucking is notcorrected prior to permanent teeth eruption and shifting, the child will needorthodontics to undo the damage caused. Traditional braces where metal bracketsare bonded and placed on the child’s full dentition, then connected with ametal wire. The metal wire causes for the teeth to shift into an ideal class Iocclusion, where the top canine is between the bottom canine and premolar andthe front teeth are slightly over the bottom’s incisal edge. If the child hadsucked their finger during the development of their palate, they may need inaddition to the braces, a palatal expander to allow for proper moving andspacing of the teeth. The expander is placed by the orthodontist in the officeand adjusted, based on the diagnosis, once a day with a key.
This allows forthe palate to widen and correct the malocclusion formed. “Individual casesdetermine the time the braces will remain on the teeth” (Hutto, 2013). Alongsidethese orthodontic appliances, it is detrimental for dental professionals toeducate both the parents and the children who are trying to break this oralhabit. Dental hygienists performassessments, screenings, education, referrals, and treatment planning. Theseduties help patients receive and understand the best possible treatment fortheir individual dental needs.
As mentioned before, there are preventativeappliances for children who suck their thumbs passed a suggested age (4). Childrenover the age of five who suck their fingers usually present with specificdental problems. As a dental hygienist, I would first exercise my role as aclinician for those children who suck their fingers. When they come in fortheir dental appointment, the children will receive an oral screening todetermine if the para-functional habit is effecting their permanent dentition.
I would next educate their parentsabout the adverse effects finger sucking could pose on their child. I need toteach and motivate the parents to want to understand about the para-functionalhabit their child is addicted to. By motivational interviewing, the parentswill develop their own solutions to their child’s habit, with me guiding themto the right answer or set of solutions. Once these effects were explained andquestions were answered I would then advise the parents to consider takingtheir children to the orthodontist for corrective treatment. These treatmentscan be expensive and the parents should be advised but I would recommend thatthey do the treatment for their children because if their occlusion isn’tcorrected they can present later in life with jaw problems or suffer fromembarrassment due to the appearance of their smile. This would allow me toexercise my role as an advocate. In conclusion, dental hygienistsplay an important role in patient care. When the hygienist exercises theirroles in the dental office, they can provide and encourage the best care forpatients of all ages.
Those patients who suck their fingers pass therecommended age can develop oral malformations of the teeth and palate. Luckily,preventative and corrective appliances are available to prevent and correctthese problems. As a dental hygienist, it is our job to educate and advocatefor these children and their parents.