Sucking for a new born is an instinct, a necessity for survival. Thumb sucking has been viewed during pregnancy by the prospective mother while having an ultrasound. When the thumb sucking persists past age six or becomes chronic defined as occurring in two or more settings (ex. home & school) it may be time to think about eliminating this problem.

 Individuals are referred to this clinic for thumb/finger sucking problems for a variety of reasons. Preventive dentists want the elimination of the thumb sucking to reestablish natural growth and development of the oro-facial structure, the orthodontist wants the pressure the thumb exerts on the teeth eliminated because the thumb exerts a force in the opposite direction the Dr. is trying to move the teeth ,as well as opening the freeway space disrupting dental equilibrium. The speech pathologist refers so the tongue can have the correct spring off point for proper articulation. And a chronic thumb sucking problem can be a contributor to a low forward rest posture of the tongue and a tongue thrust. If the thumb sucking is not eliminated the tongue thrust will remain.

There are many different treatment approaches available to eliminate a thumb problem. Psychodynamic therapy, mechanical devices, and behavior modification to name a few. The empirical data clearly supports the use of behavior strategies, specifically behavior modification. Dental appliance habit breakers tend to open the dental freeway space disrupting dental equilibrium which is not desirable.

• Thumb sucking can contribute to the following:

• Low forward rest posture of the tongue

• Open mouth rest posture of the lips

• Weakness in the midline of the tongue

• This weakness allows lateral margins of the tongue to flare laterally

• Contributes to frontal /t/,/d/,/n/,/l/,/sh/,/j/,/z/, and frontal or interdental /s/ lisp

• Weakness of lateral margins flaring contributes to the lateral/s/ lisp.

• Lack of correct placement, and low tonicity prevents the precision, dexterity, and mobility necessary to achieve transition from isolated sounds to conversational speech

• Malocclusion due to disrupting dental equilibrium

• High narrow arched palate (roof of mouth)

• Peer pressure can make the thumb sucker feel self-conscious and lessen his or her self esteem

• Teasing, harassing, and even bullying can occur

• If thumb sucking occurs in the classroom tuning out pertinent information daily can disrupt the educational process

• And how many thumb sucking children do you know stop and wash their hands before initiating their thumb sucking action. We all know how important it is today to wash our hands and keep our hands away from our face.

 The initial consultation is to ascertain the Who – What – When – Where - Why of their thumb sucking problem and if a program is needed. If elimination of the thumb sucking pattern is advisable the therapy will encompass conscious awareness, motivation, positive reinforcement and a mini reward system. Elimination of the thumb sucking habit generally occurs within ten days and or nights respectively.

The key to a successful thumb sucking program is AWARENESS – DESIRE – EDUCATION = SUCCESS. If the thumb sucker is aware of what problems the thumb sucking is causing, desire to eliminate the thumb sucking can begin, and the education of what complications the thumb is contributing to, provides the combination to successfully working together to eliminate the thumb sucking problem. With a concise, fun, and positive approach the child not only eliminates thumb sucking but may also enhance his/her confidence and self-esteem.

 

Very light resting tongue pressures can influence tooth eruption and contribute to a malocclusion the most common being open bite and excessive overjet. Low forward rest posture of the tongue is a primary concern and needs to be addressed. The forward rest posture of the tongue is continuous and intermittent; with remaining forward disrupt the dental equilibrium by opening the freeway space. In being open for hours a differential dental eruption can occur resulting in malocclusion. This differential eruption and the force of the tongue resting forward is the primary mover of teeth rather than the actual tongue thrusting which is a common mistake.

 

A thorough evaluation is required to determine if there is a low forward rest posture of the tongue and if and what contributors there are for this incorrect rest posture. Some of the possible contributors I look for are as follows; thumb/finger sucking, tongue sucking, enlarged tonsils, high narrow arched palate, shortened frenum (tongue- tie), low tonicity of the muscles. The two main causes of this forward rest posture of the tongue most likely is, prolonged sucking habits and airway problems. Once a determination of contributors is established and or eliminated a regime of exercises would be the course of treatment.

 

Therapy entails working on the rest posture of the tongue, the movement of the tongue, correct chewing, gathering and swallowing of solid foods. After working on the eating pattern moving into correct drinking patterns is addressed. Special attention is focused on nasal breathing and a lips together rest position. If airway issues are suspected to me due to a medical issue such as large tonsils and or adenoids referral to the medical professional is done prior to beginning any therapy. The focus of therapy is dealing with teeth-apart behaviors and postures that can lead to or already have resulted in a malocclusion, and eliminating continuous and intermittent light pressure against the anterior teeth.

 

Incorrect rest posture of the tongue contributes to an incorrect spring off point for articulation, low tone of the midline, and difficulty with transition from isolated sounds to conversational speech.  Abnormal tongue patterns commonly referred to as” tongue thrust” is a secondary concern if a low forward rest posture of the tongue is evident. The tongue thrusting will only contribute to the malocclusion if first there is a low forward rest posture of the tongue. It is very common for a D.D.S., Orthodontist, Speech Pathologist, and or Pediatrician referring an individual to say you are being referred for; “Tongue Thrust therapy.” What they actually are referring you for is “Rest Posture Therapy” to correct oro-facial myo-functional disorders. The tern tongue thrust seems to be more descriptive and is easily understood by the parent and child.

 

A thorough evaluation is required to determine first, if there is a low forward rest posture of the tongue. The tongue thrust is an adaptation to (rather than the cause of) tooth movement and changes. However, a tongue thrust can develop from a forward tongue rest posture. If a forward rest posture of the tongue is present the tongue thrust can then effect dental position by contributing to making the malocclusion worse and therapy for both is needed. Rest Posture Therapy would include treatment of the open mouth rest posture of the lips, low forward rest posture of the tongue, and the tongue thrust. Therapy involves normalizing the abnormal tongue functioning pattern as a way of stabilizing the freeway space.

A thorough evaluation is required to determine whether the lips apart open mouth rest posture is a habit due to past upper respiratory problems or if medical implications are still present. Medical, dental and speech background will be discussed, plus examination of the oro-facial structure, breathing pattern, chewing, gathering, eating and drinking patterns. Some of the medical upper respiratory contributors may be enlarged tonsils and or adenoids, allergies, seasonal sinus, which may be helped with medication or surgery if deemed necessary by the appropriate physician.

 

Once a determination of causes has been established a course of treatment is set forth. Treatment of lips apart open mouth rest posture consists of a series of exercises. Work on correct placement and movement of the tongue, tone the midline and lateral margins of the tongue to prevent flaring laterally, work on habitual nasal breathing and lips together rest posture. Lips apart open mouth rest posture has been linked to a variety of problems. Chapped lips and licking of the lips in the winter can be painful. Malocclusion - open bite, excessive overjet, and crossbite are big concern of Orthodontists. If this open mouth rest posture is not corrected it not only is detrimental to a successful orthodontic treatment plan it may be a contributing factor to orthodontic relapse. The incorrect rest posture of the tongue prevents the correct spring off point for articulation creating a problem achieving transference from isolation into conversational speech which is why the Speech Pathologist is concerned.