Health the infant sucks their finger, but

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           Health promotion is the ability of a
dental professional to inform and motivate their patients to adopt better
health behaviors. It is extremely important to understand the generational
differences amongst the patient population. We must understand all the levels
of the “age totem pole”-starting as young as preschool-aged children, through
adolescents and teens, and even into late adulthood geriatric patients. Each
generation coming with their own healthcare customs, beliefs, and routines. As
dental professionals, we must be able to listen, recognize, and evaluate the
dental practices performed by patients so that we are able to implement the
best outcome for the patient. We want to be able to identify conditions and/or
illnesses that would affect the patient both positively and negatively. We want
to reassure and applaud the patient when performing adequate oral hygiene, and
show alternatives in areas that need improvement.

            Although not with all disease comes
death, there are certain conditions that would require lifetime maintenance and
result in more disorder. With the geriatric population, cognitive and musculoskeletal
disorders are common, while in the pediatric population, early childhood caries
(ECC) and bottle-feeding are common conditions that aren’t detrimental to their
overall health, but could cause dental changes that could negatively affect
their overall wellbeing.

            Finger sucking is another common
oral habit that is present in the pediatric population. It is considered normal
and a developmental process for infants. Children utilize this habit as means
of 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 pacifier
is another means of getting that same soothing effect. Finger sucking has
become normalized and many more families are becoming numb to the age at which
it started and at which it ends, if it ever is stopped. Sucking on their finger
or pacifier is normal up to four years of age. Not known, if this oral habit
continues age four or even age five, it begins to create problems for the
child, such as dental malocclusion. Stress is another main culprit for finger
sucking, just as nail biting or pen chewing effects the adulthood population;
more stress, means more sucking and less stress, means less sucking. So this
brings into effect the psychological aspect of it as well. Although it is a
feeling of comfort and soothing feelings, it is extremely important to break
this habit young because of the physical changes and abnormalities it causes in
the oral cavity. It is essential for the infant’s parents to understand the
environmental, social, and psychological characteristics of finger sucking are,
understand ways to prevent it from continuing into toddlerhood to prevent the
malformations it can cause in the child’s oral cavity.

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            Like mentioned before, finger
sucking is considered to be a normal developmental process for infants. This
instinctual habit allows newborns to adequately breastfeed without having
guidelines; they are able to perform the skill and learn on their own, which is
a detrimental skill that is necessary for developing babies. The sucking habit begins
with the mother’s breast then to nearby objects to familiarize the newborn with
its surroundings. This is where pacifiers or “binkies” come into play as well,
they are utilized to comfort anxious children, soothe their appetite, as well
as soothe them to sleep. “When a pacifier isn’t available, the infant can
subconsciously resort to their fingers, typically the thumb” (Diwanki, n.d.)

            Jason Stricker, Raymond
Miltenberger, and fellow associates conducted a study on three children, each
diagnosed with Attention Deficient Hyperactive Disorder (ADHD), one being six
years old, one being seven, and one being fourteen. They participated in a
study monitoring their finger sucking habits, during which the observant viewed
their normal routines from 3 pm-8 pm. There was finger sucking evident when the
participants did countless activities, such as eating dinner, playing video
games, or sitting and watching television. The study concluded that the sucking
was retained by automatic reinforcement, or a favorable result without anyone
else being involved. No matter how strong the habit was, the children would
usually stop thumb sucking when their parents or caregivers were present in the
room, “possibly because of a learned response of punishment associated with
their oral habit” (Stricker, 2002). Initiative versus guilt is the
developmental stage at which theorist Erik Erikson believed preschoolers were
experiencing psychologically. They are very eager and active in trying new
things, however, it is during this period, these children are extremely vulnerable
and if excessive negative reinforcement is used, the child doesn’t learn and
fails to exhume that feeling of self power and sense of self. They become guilty
and an inadequacy on being on their own. They may become more depressed and
stressed, and it could be the causative agent of the thumb or finger sucking
habit acquired. The parents should be educated about positive reinforcement,
rewarding the child, praising and actively listening to the child when they are
talking with them. It can teach the child that not sucking their finger is
good, instead of focusing on the negative qualities. Consequently, the child
will be motivated to not want to suck their finger and this enthusiasm will
help to quit the habit quicker and sooner. If the positive reinforcement and talking
with the child isn’t succeeding, the parents can resort to orthodontic
appliances designed to inhibit the child from finger sucking.

             If negative versus positive reinforcement
isn’t working, the finger sucking habit of the child is a very strong
dependence that they are struggling with. With this, comes a challenge for both
the parent and child. Because of this age in their lives, finger sucking and
thumb sucking are a habit that may cost for the child to not have as many
friends in school. Their peers look down upon them and often tease children for
it. This rejection from friends at school can lead to more emotional problems
for the child, and most likely the need for orthodontics to correct the oral
fixation (Bokony & Patrick, n.d.). An anterior open bite, which is a space
between the child’s top (maxillary) front teeth, and the bottom (mandibular)
front teeth, is a common malocclusion that occurs from thumb sucking. This can
also be seen from continuous use of a pacifier in the space where the mouth
occludes. Other dental issues that may result from finger sucking included
overbite, posterior crossbite, and narrowing of the hard palate. Overbites are
when 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 child
quits the finger sucking by age six, when the first permanent teeth erupt in
the mouth. “The open bite, posterior crossbite, and narrowing of the hard
palate 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 when
talking. “In addition to the dental malformations and speech impediments,
bacteria, accidental poisoning, and herpetic whitlow are other negative aspects
of this oral para-functional habit” (Stricker, 2012).    

            There are specific orthodontic
appliances that are fabricated to prevent or reverse finger sucking. The three
appliances available are the “Hay Rake”, the “Palatal Crib”, and the “Bluegrass”. With each appliance having its own
design and style, they are all constructed for the same purpose, to end or
reverse the oral habit of the child. The “Hay Rake” is the harshest of the three appliances. It is a palatal wire
attached to the posterior molars, and it has prongs that face downward toward
the tongue. So if the child wants to put their thumb in their mouth to suck, the
downward facing prongs poke the child’s finger. The “Palatal Crib” is similar
in 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 can
insert the finger into their mouth, but they won’t get the same favorable
effect 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 metal
ring, which allows the child to roll their tongue over the beads instead of placing
their finger in their mouth. It allows for more stimulation and muscle
movements in the tongue and normal positioning of the teeth and tongue
quickest. These appliances are not cheap, they are rather expensive treatment, and
so it is important for the parent to recognize the finger sucking habit early
and talk to a dental professional about alternatives to help prevent the habit.

            If the finger sucking is not
corrected prior to permanent teeth eruption and shifting, the child will need
orthodontics to undo the damage caused. Traditional braces where metal brackets
are bonded and placed on the child’s full dentition, then connected with a
metal wire. The metal wire causes for the teeth to shift into an ideal class I
occlusion, where the top canine is between the bottom canine and premolar and
the front teeth are slightly over the bottom’s incisal edge. If the child had
sucked their finger during the development of their palate, they may need in
addition to the braces, a palatal expander to allow for proper moving and
spacing of the teeth. The expander is placed by the orthodontist in the office
and adjusted, based on the diagnosis, once a day with a key. This allows for
the palate to widen and correct the malocclusion formed. “Individual cases
determine the time the braces will remain on the teeth” (Hutto, 2013). Alongside
these orthodontic appliances, it is detrimental for dental professionals to
educate both the parents and the children who are trying to break this oral

            Dental hygienists perform
assessments, screenings, education, referrals, and treatment planning. These
duties help patients receive and understand the best possible treatment for
their individual dental needs. As mentioned before, there are preventative
appliances for children who suck their thumbs passed a suggested age (4). Children
over the age of five who suck their fingers usually present with specific
dental problems. As a dental hygienist, I would first exercise my role as a
clinician for those children who suck their fingers. When they come in for
their dental appointment, the children will receive an oral screening to
determine if the para-functional habit is effecting their permanent dentition.

            I would next educate their parents
about the adverse effects finger sucking could pose on their child. I need to
teach and motivate the parents to want to understand about the para-functional
habit their child is addicted to. By motivational interviewing, the parents
will develop their own solutions to their child’s habit, with me guiding them
to the right answer or set of solutions. Once these effects were explained and
questions were answered I would then advise the parents to consider taking
their children to the orthodontist for corrective treatment. These treatments
can be expensive and the parents should be advised but I would recommend that
they do the treatment for their children because if their occlusion isn’t
corrected they can present later in life with jaw problems or suffer from
embarrassment due to the appearance of their smile. This would allow me to
exercise my role as an advocate.

            In conclusion, dental hygienists
play an important role in patient care. When the hygienist exercises their
roles in the dental office, they can provide and encourage the best care for
patients of all ages. Those patients who suck their fingers pass the
recommended age can develop oral malformations of the teeth and palate. Luckily,
preventative and corrective appliances are available to prevent and correct
these problems. As a dental hygienist, it is our job to educate and advocate
for these children and their parents.    

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