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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2016  |  Volume : 34  |  Issue : 3  |  Page : 294-297

New electronic habit reminder for the management of thumb-sucking habit

1 Department of Pediatric Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India
2 Department of Orthodontics, VS Dental College, Bengaluru, Karnataka, India
3 Government Dental College, Bengaluru, Karnataka, India

Date of Web Publication25-Jul-2016

Correspondence Address:
Srinath Krishnappa
Prof and Head, Department of Pediatric Dentistry, Government Dental College and Research Institute, Fort, Bengaluru - 560 002, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-4388.186750

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Methods for intervention of nonnutritive sucking habits include counseling, positive reinforcement, calendar with rewards, adhesive bandage, bitter nail polish, long sleeves, and appliance therapy. All these methods have been reported in the literature with variable success rates. We present a case of an 8-year-old child with thumb-sucking habit successfully managed in a short period of 5 months by a new electronic habit reminder, an extraoral appliance which was designed to overcome the disadvantages associated with intraoral appliances.

Keywords: Appliance, electronic, habit, reminder, sucking

How to cite this article:
Krishnappa S, Rani M S, Aariz S. New electronic habit reminder for the management of thumb-sucking habit. J Indian Soc Pedod Prev Dent 2016;34:294-7

How to cite this URL:
Krishnappa S, Rani M S, Aariz S. New electronic habit reminder for the management of thumb-sucking habit. J Indian Soc Pedod Prev Dent [serial online] 2016 [cited 2023 Feb 1];34:294-7. Available from: http://www.jisppd.com/text.asp?2016/34/3/294/186750

   Introduction Top

Thumb sucking is a form of nonnutritive sucking occurring as early as the 29th week of gestation.[1] Sucking behaviors in infants and young children are mainly derived from the physiologic need for nutrients and are normal in the first 2–3 years of life, however, may cause permanent damage if continued beyond this time.[2] The continuation of oral habits is usually due to physical and emotional stimuli such as boredom, stress, hunger, hyperactivity, sadness, pleasure, and various kinds of disabilities.[1] The current understanding of the child development suggests that sucking behaviors also arise and persist in part because of psychological needs; normally, developed infants have an inherent biological drive for sucking.[2]

Sixty-six percent (n = 50) of mothers in Saudi Arabia had noticed the adverse effect of these habits on their child's occlusion, and this was given as the main reason for their attempts to stop the habit, and although 48% of mothers had sought advice about digit-sucking from dentists and pediatricians (30% and 18%, respectively), 60% of the dentists and all pediatricians had made no suggestions about any solution.[3]

It has been observed that anterior open bite and posterior cross-bite were associated with habits of 36 months or more (n = 630), and sustained pacifier habits, including those of 24–47 months, were associated with anterior open-bite and Class II molar relationships while digit habits were associated with anterior open-bite when sustained for 60 months or longer.[4]

Oral appliances when used should not be painful or interfere with occlusion; instead, it should merely act as a reminder. These appliances, if inserted for several months, usually eliminate the habit in children who want to stop; however, emotional problems, difficulty with speech and eating, and iatrogenically “self-inflicted” wounds can occur and this type of appliance tends to be regarded as a punitive rather than a supportive treatment.[5]

Children-seeking orthodontics had articulatory and oromyofunctional disorders, and significant impact of the occlusion on speech and more articulation disorders for/s, n, l, t/has been found in the cases seeking orthodontic treatment.[6] Several other phenomena were seen more often in this group, namely, more impaired lip positioning during swallowing, impaired tongue function at rest, mouth breathing, open mouth posture, lip sucking/biting, anterior tongue position at rest, and tongue thrust. Moreover, all children with a tongue thrust showed an anterior tongue position at rest.[6]

In the light of these factors, considering some of the drawbacks of intraoral appliances as an alternative, an extraoral electronic habit reminder was designed (Electronic Habit Reminder Patented – Ref: No. 2853/CHE/2014 A, publication date 27/06/2014) and was used to successfully manage thumb-sucking habit in an 8-year-old boy.

   Case Report Top

An 8-year-old male child along with his mother reported to the department with the chief complaint of thumb-sucking habit. History of finger sucking regularly about 4–7 h/day was noted, unconsciously in sleep or when the child was idle since the primary dentition period. On examination, a decrease in normal overbite/open-bite was noted and the maxillary incisors were slightly proclined, [Figure 1] which confirmed the diagnosis of nonnutritive sucking habit.

A nonpunitive reminder therapy was planned using an extraoral appliance. The appliance is a simple device, which gives alarm when the child takes the finger into the mouth as the appliance has to be worn on that finger which is involved in sucking. The alarm part was encased in an attractive wristwatch [Figure 2] so as to make the appliance attractive to the child. The appliance was custom fabricated by measuring the length of the finger and by taking the impression of the involved finger. The appliance was delivered [Figure 3].
Figure 1: Reduced overbite/open-bite in a child with thumb-sucking habit

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Figure 2: Electronic habit reminder (extraoral habit reminder)

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Figure 3: Electronic habit reminder device delivered

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After insertion of the appliance, the parent/child was instructed to wear the appliance as a wrist watch. The cartoon designs were incorporated to motivate the child to wear the appliance. The parents and school teachers were instructed to encourage the child to wear the appliance as much as possible during day and night time, except while having food or other activities such as brushing. Any history of habit-breaking was determined from both the child and his parents to verify success of habit-breaking treatment. Child/parent was given a diary to record the frequency of the habit regularly. The child was being contacted and examined every 3 weeks. Success of a habit-breaking appliance was marked when the habit was completely stopped.

The child was followed for 15 months [Figure 4]. He was very comfortable with the appliance and enjoyed wearing it. The frequency of the habit gradually came down, and by the end of 5 months, the child had discontinued the habit. The child was instructed to continue to wear the appliance for another 6 months so that the habit does not relapse.
Figure 4: Postmanagement view

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   Discussion Top

Thumb sucking is a common phenomenon in pediatric age group that reflects the earliest form of habitual manipulation of body.[7] Many questions arise in the minds of general dentist, pediatricians, pediatric dentists, and psychiatrists regarding impact of sucking habits on developing dentition.[7] The age of the child, intensity, duration and frequency of the habit, child cooperation, and motivation are all important factors to be considered for the success of any intervention, and sufficient time should be given for the child to stop the habit on his/her own.[7]

Methods for habit intervention include counseling, positive reinforcement, calendar with rewards, adhesive bandage, bitter nail polish, long sleeves, and appliance therapy, and all of these methods used to stop the finger-sucking habit have been reported in the literature with variable success rates.[8]

Appliance therapy should be considered after consultation with the parent of the child, and for many years, habit-breaking appliances in the form of palatal cribs, spurs, palatal bars, hay rakes, and cage-type appliances have been used in the pediatric age group; however, emotional disturbances, difficulty in speech and eating, and iatrogenically self-inflicted wounds can occur with such appliances.[9] Addy et al.[10] reported in a cross-sectional study that the prevalence of candidal recovery at some sites and Candida densities at all sites was significantly increased i fixed and removable appliance wearers and suggested that the presence of orthodontic appliances might lead to proliferation of Candida in the oral carriers. It has been reported in a long-term study that the carriers before treatment were 39%; after 9 months, it had increased to 79%; and after treatment, it was reduced to 14%.[11]

Hence, an extraoral appliance with an electronic habit reminder was used in the present study, and the digit-sucking habit was successfully managed in a duration of 5 months. This appliance has mainly two parts: (1) Extraoral appliance and (2) reminder [Figure 2] and [Figure 3]. The extraoral appliance part comprises four contact heads and is fixed to the acrylic ring. The reminder part comprises alarm device and battery, which is connected to the appliance part by wires. These are adapted within the wrist watch that has a cartoon design to make the appliance attractive. The appliance part was adapted to the thumb, and the reminder was worn on a strap around the wrist of the child with digit-sucking habit. When the patient keeps the digit inside the mouth, the alarm starts from the reminder to remind the child, and when the child takes the thumb out of mouth, the alarm stops automatically due to the flexible nature of contact heads. The electronic habit reminder costs about 500 rupees only, and thus, it is highly cost-effective compared to appliances used in the management of nonnutritive sucking habits.

Cessation of the habit was noted in 5 months and the appliance was continued for another 6 months to prevent relapse of the habit. Although removable appliances suffer from patient compliance issues of wearing them, the child did not have any complaint regarding the appliance during the treatment period and was well-accepted. Discomfort in wearing or psychological effects such as teasing have not been noted.

   Conclusion Top

Extraoral electronic habit reminder appliance is a nonpunitive appliance and the child can wear it comfortably. This being an extraoral appliance is effective in managing the nonnutritive sucking habits without any complication and eliminates the habit in a short period.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Rosenberg MD. Thumbsucking. Pediatr Rev 1995;16:73-4.  Back to cited text no. 1
Johnson ED, Larson BE. Thumb-sucking: Literature review. ASDC J Dent Child 1993;60:385-91.  Back to cited text no. 2
Al-Jobair A, Al-Emran SE. Attitudes of Saudi Arabian mothers towards the digit-sucking habit in children. Int J Paediatr Dent 2004;14:347-54.  Back to cited text no. 3
Warren JJ, Slayton RL, Bishara SE, Levy SM, Yonezu T, Kanellis MJ. Effects of nonnutritive sucking habits on occlusal characteristics in the mixed dentition. Pediatr Dent 2005;27:445-50.  Back to cited text no. 4
Massler M, Wood AW. Thumb-sucking. J Dent Child 1949;16:1-9.  Back to cited text no. 5
Van Lierde KM, Luyten A, D'haeseleer E, Van Maele G, Becue L, Fonteyne E, et al. Articulation and oromyofunctional behavior in children seeking orthodontic treatment. Oral Dis 2015;21:483-92.  Back to cited text no. 6
Neeraja R, Kayalvizhi G, Sangeetha PV. Reminder therapy for digit sucking: Use of a nonpunitive appliance – A case report. Virtual J Orthod 2009;8:5-8.  Back to cited text no. 7
Ellingson SA, Miltenberger RG, Stricker JM, Garlinghouse MA, Roberts J, Galensky TL, et al. Analysis and treatment of finger sucking. J Appl Behav Anal 2000;33:41-52.  Back to cited text no. 8
Diwanji A, Jain P, Doshi J, Somani P, Mehta D. Modified bluegrass appliance: A nonpunitive therapy for thumb sucking in pediatric patients – A case report with review of the literature. Case Rep Dent 2013;2013:537120.  Back to cited text no. 9
Addy M, Shaw WC, Hansford P, Hopkins M. The effect of orthodontic appliances on the distribution of Candida and plaque in adolescents. Br J Orthod 1982;9:158-63.  Back to cited text no. 10
Arendorf T, Addy M. Candidal carriage and plaque distribution before, during and after removable orthodontic appliance therapy. J Clin Periodontol 1985;12:360-8.  Back to cited text no. 11


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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