Dental Management of the Mentally Handicapped Children

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Dental Management of the Mentally Handicapped Children

There are many definitions of mental retardation. The most commonly used by all the professionals is the one given by American Association of Mental Retardation. Mental retardation or mental handicap refers to a conditio9n that slows down mental and physical growth. A mentally retarded child is slow or lacking in the development of mental function, when compared to those children of his age level. Therefore, a ten year old mentally retarded child may exhibit behavior like that of a three or four year old child depending on his/her level of retardation.

The number of new special schools for the children with mental retardation is increasing with concern for proper transits, planning and preschool programs. Mental retardation is not an illness. It is a state of arrested development of intelligence, originating in the development period and is associated with diminished adaptive behavior.

What are the causes of mental retardation?

Mental retardation can be caused by many factors: accordingly before birth, at birth or child’s early years.

  1. Prenatal: causes that occur before birth
  2. Perinatal: causes that occur during the birth process
  3. Postnatal: causes that happen after birth or during childhood

Prenatal causes exert their effects before birth. Examples include genetic and heredity, toxins taken by the pregnant mother, disease, and neural tube defects. Genetics and heredity include conditions such as fragile X syndrome and Down syndrome, as well as phenylketonuria (PKU). Prenatal toxins include alcohol, tobacco, and drug exposure resulting from the behavior of the mother during pregnancy. Diseases and infection, such as HIV/AIDS, can devastate an unborn baby. Neural tube disorders, such as anencephaly (where most of the child’s brain is missing at birth) and spina bifida (incomplete closure of the spinal column), are also prenatal causes of mental retardation.

Perinatal causes occur during the birthing process. They include birth injuries due to oxygen deprivation (anoxia or asphyxia), umbilical cord accidents, obstetrical trauma, and head trauma. They also include low birth weight.

Postnatal causes occur after birth. The environment is a major factor in many of these situations. Child abuse and neglect, environmental toxins, and accidents are examples of postnatal causes. An additional reason for being identified as having mental retardation is societal biases, particularly toward diverse students.

How to prevent dental problems in mentally handicapped children?

Creating awareness of the importance of oral hygiene is a step to be undertaken, to ensure lower incidence of dental problems in the mentally handicapped. This can be achieved by bringing the prevention of dental disorders to the forefront. Primary prevention is a prophylactic measure to prevent the onset of the illness, while secondary prevention is to prevent the symptoms of illness at its earliest. The former can be achieved by giving training for proper cleaning of teeth; the latter enhances the resistance of the body to prevent co-morbid conditions affecting ear, nose, throat and sinus. It is to be noted that gingival disorders are found to be more common in mentally handicapped with problems like the Downs syndrome. The bigger size of the tongue prevents full closure of the mouth, thereby encouraging mouth breathing resulting in dry gums and increasing chances of infection. Poor vascularity, plaque and calculus enhance permanent damage.

Thus the saying, “prevention is better than cure” is an idea, which needs to be emphasized to the parents so that there is an organized effort on their part to give attention to proper oral hygiene. In case of children, the parents can star by helping them hold the toothbrush and clean their teeth. Subsequently, allow the child to clean the front teeth without support and then help clean the back teeth and the sides. Finally, watch whether the child properly does so; if the child does well, some incentives can be given to make the routine dental care a habit

Dental management of the mentally handicapped children

Patient management in the case of the mentally handicapped might cause problems because of the lack of co-operation and ineffective communication. There are certain requirements, which cannot be overlooked. It is to be understood that those children lacking logical thinking can be non-co-operative and may require special treatment chairs with belts etc, to restrain them. In extreme cases of non-acceptance, partial sedation may also be required.

Therefore, special facilities and dental care within familiar surroundings like school premises could help soothe their apprehensions, which, in turn, help in giving treatment effectively. Based on the facts mentioned above, the IDA believes that a permanent setup for free check-up and treatment for these unfortunate children by dental surgeons at a school or an institution is a matter that requires urgent attention.

Causes and Effect of Lip Sucking Habit in Children

lip sucking

Normal lip structure and function is important for speaking, eating and maintaining the balanced occlusion. The lip habit may involve either of the lips, higher chances towards the lower lip. It is a habit that involves manipulation of lips and perioral structures. Prolonged thumb sucking, lip licking, lip biting, cheek chewing, mouth breathing affect both the oral and perioral tissues. Lip sucking in childhood is not rare, but probably under diagnosed

Classification of Lip habit:-

  1. Lip licking/wetting of lips by the tongue
  2. Lip sucking habit-pulling the lips into the mouth between the teeth

What are the Causes of lip habit?

  • Malocclusion-some children have a problem with occlusion such as an overjet. Because of this overjet, placing the lower lip tissue in the space between the upper and lower jaws becomes much easier to accomplish
  • Emotional stress
  • Lip sucking occurs in children when mental attention and concentration are required in situations such as a new environment or a new task being learned that causes stress for the child

Clinical manifestations of lip habit:-

  • Proclination of upper front teeth
  • Retrusion of lower front teeth
  • Muscular imbalance
  • Lower incisor collapse with lingual crowding
  • Reddened ad chopped lip
  • Mento-labial sulcus becomes accentuated

lip suckingWhat is the treatment for lip sucking/licking?

Lip habit is not self- correcting and may become more deleterious with age because of the muscular force interacting child’s growth. Treatment of lip sucking habit should be directed initially towards the cause followed by appliance therapy like lip protector, oral screen and lip bumper. If the child is older, explain the esthetic importance to discontinue the habit. In some cases, psychological support may be needed depending upon the severity of the problem.

How to Brush Your Teeth Properly | 10 Step Guide

Brushing teeth is something most of the people do every day. It’s an essential part of the morning routine that we must complete adequately. This easy task deserves more attention than we usually give it to be fully favorable. An extra care while brushing and thinking about it seriously will give healthier teeth, and save the cost and pain of a procedure at the dentist’s office. Brushing teeth is a simple process. It doesn’t take much of your time or materials. Things needed for a perfect brush is a sink, a cup, and a toothbrush and toothpaste, which can easily be purchased from any store. When buying toothpaste, find the one that is right for you. There are many options: whitening, tartar control, cavity protection, and many more. The steps for brushing teeth are as follows:

  1. Wetting the toothbrush by holding the bristles under water from the faucet just long enough to moisten it. The toothpaste sticks a little better to the brush when the bristles are wet first.
  2. Squeeze out enough toothpaste to cover half of the bristles and begin the brushing process.
  3. Now place the head of the toothbrush in the mouth in such a way that the bristles are touching the crowns of the bottom teeth.
  4. Brush back and forth gently all along the bottom teeth to remove any small pieces of food or sugars that might have been stuck in the grooves.
  5. Then, move to the inside of the lower teeth. Slowly angle the bristles along the meeting point of the tooth and gum in a way that the brush can completely remove plaque sitting on top of the gum line.
  6. Now move to the outside part, repeating the same brushing technique gently.
  7. Now begin to brush the upper teeth. Brush gently on the surfaces used to chew and switch to the inside and outside enamel.
  8. Focus on the front teeth because those are what others see.
  9. Once the brushing has been done thoroughly for about two minutes, rinse out the toothbrush under the faucet and rinse out your mouth with a cup of water.
  10. Don’t swallow the toothpaste which often happens with children brushing teeth. If you consume a significant amount, consult a doctor immediately.

Brushing should be done twice in a day for healthier teeth. Cavities in the teeth are mainly caused when bacteria eat the food particles and sugars and on the teeth, along with the enamel. Therefore, brushing teeth before bed is especially important since the bacteria and germs could potentially remain on the teeth for a longer time.

how to brush your teeth properlyWhenever a dentist asks, “how do you brush your teeth,” we reply that it is just a simple task, not involving any technique. Brushing is also advised for children who don’t have teeth yet. Parents can clean their gums with just water. This process has to be done gently without causing any bleeding in their mouth. Parents can keep their child from getting gum problems and tooth decay by starting their dental care early. The above-mentioned steps for brushing apply for children also.

Children have to be encouraged for brushing. Photographs of children brushing teeth can be shown to educate them of the procedure. The only care to be taken is that very less amount of toothpaste is to be used and toothbrush with very soft bristles. Brushing should also be done slowly and gently without any trouble or irritation to the child.

Brushing is essential to prevent gum problems and tooth decay as well as to remove the growth of plaque on exposed surfaces of the teeth. No skills or training is required in the proper cleaning of teeth, only following of simple steps of brushing teeth will do. Brushing should occur after waking up, as well as at bedtime. Floss is also recommended after brushing, at least once to clean the plaque between teeth where a brush can’t reach. Visiting a dentist every six months for teeth cleaning is a harmless way to make sure that you have a healthy mouth. Brushing is a simple and quick task that must not be overlooked

Gingival Hyperplasia Causes and Complications in Children

Causes and Complications of Gingival Overgrowth in children

Gingiva or gums surround the teeth and provide a seal around them. Healthy gingiva appears in coral pink color, but may contain melanin pigment. Gingiva is divided into free gingiva, attached gingiva and interdental papilla. Free gingiva is terminal edge of gingiva surrounding the teeth in collar like fashion. Attached gingiva is continuous with free gingiva and it is firm, resilient tightly bound to the underlying alveolar bone. Interdental papilla is in pyramidal shape and it occupies the interproximal space beneath the area of tooth contact.

Gingival overgrowth also called as gingival hyperplasia or gingival hypertrophy or hypertrophic gingivitis. Gingival overgrowth is the enlargement of attached gingiva due to increased number of cells. Gingival overgrowth can be initiated by factors such as mouth breathing, irritations along the neck of the tooth or hormonal changes such as those at puberty. The most prevalent types of gingival overgrowth in children based on the cause are

  • Drug induced gingival hyperplasia
  • Hereditary gingival fibromatosis
  • Neurofibromatosis

gingival enlargement


 Drug induced gingival hyperplasia:-

Certain drugs can cause gingival overgrowth. These drugs are

  • Cyclosporine-it is given to depress the immune system
  • Nifedipine and amlodipine-these are used to treat hyper tension
  • Phenytoin- used to treat epilepsy

Gingival hyperplasia will occur due to increase in the connective tissue extracellular matrix. It is more prevalent in male children and adolescents. Drug induced gingival hyperplasia can cause functional difficulties, disfigurement and delayed permanent teeth eruption.

Hereditary gingival Fibromatosis:-

It is also called as Von recklinghausen disease. It is most common syndromic gingival enlargement in children. It is an autosomal dominant disease. It usually appears at the time of permanent teeth eruption. Histologically it contains highly collagenized connective tissue. It can

cause drifting of teeth, retention of primary teeth, Diastema and poor plaque control.

Neurofibromatosis 1:-

It is an autosomal dominant disease. It is seen more common in mentally handicapped individuals. Gingival overgrowth is caused by the formation of plexiform neurofibromas in the connective tissue of the gingiva. These plexiform neurofibromas consist of hypertrophic nerves arranged as lobules in the connective tissue. Occasional malignant transformation may occur

Gingival Overgrowth associated with Syndromes:-

Gingival overgrowth is seen in syndromes that are

  • Rutherfurd syndrome
  • Cross syndrome
  • Romon syndrome
  • Haband syndrome

What are the complications of gingival overgrowth in children?

  • Retained primary teeth or baby teeth
  • Delayed the eruption of permanent teeth
  • Poor plaque control
  • Drifting of teeth
  • Diastema is a gap between two teeth. It appears most often between the two upper front teeth
  • Increased distal spacing
  • Difficulty with chewing
  • Change in the facial appearance due to lip protrusion
  • Affects the normal closure of the lips
  • Emotional distress
  • Increased risk of caries
  • Malocclusion
  • It can also affects the speech of a child

How to Manage Gingival hyperplasia in children?

Dentist consultation is necessary for the treatment of gingival overgrowth. Mild gingival hyperplasia can be treated by professional scaling. Effective plaque control can reduce and prevent the gingival enlargement. Drug induced gingival enlargement can be treated by changing the drug or decreasing the dose of drug. Severe gingival enlargement can be treated by gingivectomy. It is a surgical procedure in which excess gingival tissue is removed. Mouth breathing, hormonal alterations should be treated. Gingival hyperplasia associated with syndrome needs both systemic and dental treatment. Daily twice brushing, regular flossing and regular dental visits provide good oral hygiene.


Baby Bottle Tooth Decay Causes,Effects and Prevention

Baby Bottle Tooth Decay Causes, Symptoms and Preventive methods

Baby bottle tooth decay also called as nursing bottle caries or early childhood caries. Tooth decay in infants and very young children is often referred to as baby bottle tooth decay. This dental problem develops in infants especially infants that are put to bed with a bottle containing a sweet liquid. Baby bottle tooth decay is commonly seen in upper front teeth, other teeth may also be affected. Baby teeth serve as place holders for the permanent teeth. Decay in the baby teeth can affect the child’s chewing, speaking and smiling. The breast milk or formula that comforts and nourishes your baby can also cause severe tooth decay.

Baby teeth are also called as primary teeth or deciduous teeth. Teething usually begins around 6 months of age. In majority of babies first tooth will erupt between 4 and 7 months. All the set of primary teeth will be seen by his/her third birthday. Don’t neglect the baby teeth because healthy baby teeth will lead to healthy permanent teeth. Decayed primary teeth can disturb the permanent teeth eruption which results in crooked or crowded permanent teeth.

nursing bottle caries

What are the Causes of baby bottle tooth decay?

Bottles containing milk, formula, juices, and sugar water continuously bathe an infant’s mouth with sugar. The bacteria such as streptococcus mutans, lactobacillus use sugar and produce acids. These acids destroy the enamel of baby teeth. Sugars, bacteria and time are the key factors for the cavity formation.

  • Decay happens when sweetened liquids or those with natural sugars like milk, formula and fruit juice cling to infants teeth for a long time. Bacterial reaction on these produces acids. Acids demineralize the enamel leads to tooth decay.
  • Babies whose pacifiers are dipped in sugar or sugar syrup
  • High sugar content drinks at night time increases the risk of decay because saliva production decreases during sleeping

How to Prevent Baby Bottle Tooth Decay?

  • Wipe the baby’s gums with a clean gauze pad or wash cloth after each feeding. Though the baby has no teeth cleaning the gum pads is necessary
  • Clean and massage gums
  • If your child sleeps with a bottle, break the habit now and avoid the risk of decay. Gradually diluting the bottle contents with water over 2 to 3 weeks after that period, fill the bottle only with water
  • Begin brushing your child’s teeth when his\her first tooth come in
  • Finger tooth brushes are also available for proper cleaning of your child oral cavity
  • Don’t fill the bottles with sugar water or soft drinks. Bottles are for milk, infant formula, water, electrolyte containing solutions when the child has diarrhea
  • Never allow your child to fall asleep with a bottle containing anything but water
  • Don’t dip the pacifier in a sweet syrup
  • Reduce the sugar in your child’s diet especially between meals
  • Flossing should be started once all the baby teeth have come in
  • Make sure your child is getting enough fluoride which prevents the decay
  • Schedule regular dental visits by your child’s first birthday
  • Encourage your child to drink from a cup by his\her first birthday. Wean them off the bottle by age 12 to 14 months
  • Ask your dentist for topical fluoride application
  • It is your responsibility to keep your baby’s teeth clean in the earlier years, later teach them brushing techniques.

What are the Symptoms of Baby Bottle Tooth Decay?

Chalky white spots appear on the tooth surface. This is the early sign of tooth decay. If you notice the white spots on the teeth immediately consult your dentist to stop the further progression of the decay. Severe decay appears in dark brown in color. If a tooth is decayed and left untreated pain and infection can occur. Baby bottle tooth decay can leads to pain, infection, crowded permanent teeth and pain while eating. Baby’s smile, chewing and speaking also affected by the baby bottle tooth decay

What is the Treatment plan for Baby Bottle Tooth Decay?

Your dentist will give you the best treatment plan because the type of treatment depends on severity of the decay and the age of child. White spots on the tooth surface can be treated by fluoride treatment or placing fluoride varnish can be used to remineralize the tooth. Severe decay can be treated by pulpectomy, restoration process or tooth extraction.


10 Natural Foods For Children’s Brain Growth

We all know that brain is most important organ in our body. It has many functions like reasoning, planning, orientation, recognition; perception of stimuli, problem solving and it is associated with movement, visual processing, speech, memory, emotions. It is responsible for basic vital life functions such as breathing, heartbeat, blood pressure.

Some foods will help for the growth of the brain. If you add these foods to your child’s diet, your kid become sharp, memory increases and he will do good job in his school. So take care about his/her diet.

brain growth foods

What are the foods that help for brain growth?

1.      Salmon:-

Solmon brain growth foodsSalmon is loaded with proteins and omega 3S. Eating salmon while pregnant and nursing can boost learning capacity and academic performance in children. Salmon contains high levels of omega 3 fatty acids which are important for brain and retina. Feeding salmon to preschool children improves academic performance. It is also an excellent source of vitamin D.

Salmon are very low in Mercury as they are small in size and eat plants. Eating salmon regularly has been shown to reduce the risk and incidence of depression, hostility i9n young adults and cognitive decline in the elderly

2.     Eggs:-

eggs brain growth foodsEggs are good choice as a part6 of healthy and balanced diet. Eggs contain vitamin A, Folate, vitamin B5, B12 B2, phosphorus, selenium. Eggs also contain decent amounts of vitamin D, vitamin E, vitamin K, vitamin B6, calcium and Zinc. Eggs are high in cholesterol.

Eggs contain choline which is an important nutrient that i8s used to build cell membranes and has a role in producing signaling molecules in the brain, along with various other functions. Eggs are less expensive and easy to prepare and. You can prepare simple dishes like cakes, muffins, omelet, egg curries. So add egg to your kid’s diet.

3.      Peanut butter:-

peanut brain growth foodsPeanut butter is a kid’s friendly and nutritious food. Most kids love peanut butter. The health benefits of peanut butter for children include good supply of protein for body development, good supply of essential fatty acids for brain development, supply of vitamins, minerals and antioxidants. Peanut butter contains omega 3 fatty acids. These fatty acids are ideal for brain development for your child. As your child grows he/she needs a regular supply of these fatty acids

Peanut butter is a good source of protein, B vitami9ns, iron, folic acid and fiber. Natural peanut butter that is not made with hydrogenated oil is a healthier choice. Kids also like to dip food, and peanut butter is a healthier option than dressings and some sauces.

4.      Whole grains:-

whole grains brain growth foodsA whole grain possess natural nutrition and a unique rich flavor. Naturally, whole grain provides so many benefits. Your children will gain several healthy benefits from starting to eat whole grains at an early age. Many whole grain products can capture a child’s attention and taste buds.

When you are looking for whole grains, read the labels carefully because food labels on bread, pastas, cereals can say wheat, multi grain and store ground but that doesn’t mean whole grain. Whole grains provide glucose, an energy source the brain needs. Whole grain also contains B vitamins which are good for the nervous system. Whole grain pasta and whole grain cereals are also available in the market. So add whole grains to your child’s diet

5.     Oats/oatmeal:-

oats brain growth foods for kidsProtein and fiber rich oat meal helps keep heart and brain arteries clear. Healthy breakfast consumption is very important to children because critical and complex learni9ng skills are developed at a young age, and these skills are vital to further mental and physical development. High fiber and protein attributes are believed to be some of the primary factors that influence spatial memory performance in young children.

Boosts immune system by helping the immune cells seek out and repair areas or the body that may be fighting a bacterial infection. Oats promotes a slower and prolonged release of glucose into the blood system. Because of all these health benefits, it is the best breakfast for your kid

6.     Berries:-

berries brain growth foodsAll berries are great sources of fiber, vitamins, minerals and antioxidants. Blue berries are packed with antioxidants called anthocyanin, that may help keep memory sharp and raspberries contain ellagic acid, a compound with anticancer properties. Berries enhance your children’s brain power. Children need folic acid for healthy brain development. High levels of this vitamin B promote higher IQ, better memory function and enhance concentration. Berries are excellent source of vitamin C. Blue berries are one of the most potent antioxidant foods in the world.

Children like these fruits because these are juicy fruits and good in taste. These are given as finger foods for toddlers, snacks, fruity topping ice creams for kids. School children are exposed to many viruses and illness. You can boost up their immune system and help them to fight against infections by feeding berries.

7.      Colorful veggies:-

veggies brain growth foodsEating veggies in a variety of colors like red, dark green, yellow, purple, white, orange not only provides eye candy for your kids but mixing things up also gives them a broad range of nutrients. Vegetables with rich deep color are an excellent source of antioxidants to keep the brain cells healthy.

Vegetables provide complex carbohydrates, fiber and nutrients. Different colors indicate different nutrient profiles, so focus on giving a little of each color in your kids diet to maximize the nutritional benefits. Add tomatoes, sweet potatoes, pumpkin, carrot, spinach, purple cauliflower, broccoli to your kid’s diet.

8.      Nuts and seeds:-

nuts and seeds brain growth foodsNuts and seeds are packed with proteins, essential fatty acids, vitamins and minerals. These are essential for brain growth. Walnuts are good source of plant based omega 3 fats, natural phytosterols and antioxidants. Walnuts boost brain function and even promote brain healing. These are served as combined with olive oil and dark leafy greens make a healthy sauce for whole grain pasta

9.      Milk and yogurt:-

milkMilk and milk products are geed source of B vitamins, vitamin D, calcium, potassium. Yogurt can help keep brain cell membranes flexible, helping them to send and receive information. These are good in taste, affordable. These foods increase the immunity.

10. Turmeric:-

turmericThe Curcumin in turmeric powder can actually make the brain grow. Curcumin is an anti-inflammatory agent and strong antioxidant. Turmeric powder is usually added to Indian recipes.

There are plenty of benefits when you have milk with turmeric. Turmeric is a depression fighter as well. Ayurveda and Unani systems of medicines in India have used turmeric in health and wellness since for as long as records even exist.

Effect of Tongue Thrust in Children

Tongue thrust also called as reverse swallow or immature swallow.  In recent years the tongue thrust problems and the resultant oral features have come to the forefront of the progressive, clinical orthodontist’s attention. If the tongue was observed thrusting between and the teeth did not close in centric occlusion during swallowing, it was specified that a tongue thrust was present.

What is Tongue Thrust?

The tongue protrudes through the upper front teeth during swallowing, speech and while the tongue is at rest. Tongue thrust is the habit of sealing the mouth for swallowing by thrusting the top of the tongue forward against the lips.

Tongue thrust is normal in infants until approximately the age of 6 months. The loss of this normal infant behavior is one of the signs that the baby is ready to begin eating baby food. During infantile swallow the tongue is placed between the gum pads.  After 6 months of age, several maturation events occur that alter the functioning of the orofacial muscles.

With the arrival of incisors the tongue assumes a retracted posture if the transition of infantile to mature swallow does not take place with the eruption of teeth then it leads to tongue thrust swallow. In a thrusted swallow the tongue is pushed up and forward and in mature swallow the tongue is pushed up and back. As a child develops a more mature swallow the back and sides of their tongue begin growing stronger and gain more control of movement.

tongue thrustAt what age does a child usually exhibit a tongue thrust swallowing pattern?

A child exhibits a tongue thrust pattern from birth, because it is an infantile swallowing pattern. It is acceptable to have this swallowing pattern up to the age of four years. Most children will outgrow the infantile pattern and develop the mature pattern of swallowing, not developing a problematic tongue thrust. If the child has not naturally outgrow the pattern by age four, the thrust is strengthened becomes an issue, and will require a training program to correct the thrusting pattern.

During a normal swallow, the mid tongue should be placed on the roof of the mouth, not between the teeth. Placing the tongue between the teeth pushes the teeth apart and out.

What is the Effect of Tongue Thrust?

Tongue thrust can adversely affect the teeth and mouth. The affects are depends on intensity, duration, frequency and type of tongue thrust.

  • Many people who tongue thrust have open bite; the force of the tongue against the teeth is an important factor in contributing to bad bite
  • Speech is not frequently affected by the tongue thrust swallowing pattern. The ‘s’ sound is the one most affected an abnormal swallow will move teeth into abnormal positions and cause growth distortions of the face and teeth
  • The tongue moves forward in an exaggerated way during speech and or swallowing. The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech , swallowing and at rest
  • Lip separation
  • More erratic mandibular movements
  • Increase in anterior face height
  • Irregular tongue movements
  • In a thrusted swallow the back and middle of the tongue are pretty non-active
  • Reversal of orthodontic treatment
  • Just like thumb sucking, tongue thrust exerts pressure against the front teeth pushing them out of alignment

What are the Causes of Tongue Thrust?

  • Enlarged tongue(macroglossia)
  • Thumb sucking
  • Large tonsils
  • Hereditary factors
  • Tongue tie(ankyloglossia)
  • Allergies
  • Nasal congestion
  • Certain types of artificial nipples used in feeding infants
  • Upper respiratory tract infections

What are the Different Types of Tongue Thrusting?


Type 1-non deforming

Type2-deforming anterior tongue thrust

  • Sub group1-anterior open bite
  • Subgroup2-anterior proclination
  • Subgroup3-posterior crossbite

Type3-deforming lateral tongue thrust

  • Sub group-posterior open bite
  • Subgroup2-posterior crossbite
  • Subgroup3-deep overbite

Type4-deforming anterior and lateral tongue thrust

  • Subgroup1-anterior and posterior open bite
  • Subgroup2-proclination of anterior teeth
  • Subgroup3-posterior crossbite

Another classification

  1. Simple tongue thrust-normal tooth contact in posterior region, anterior open bite, contraction of lips, mentalis muscle and mandibular elevators
  2. Lateral tongue thrust-posterior open bite with tongue thrusting laterally
  3. Complex tongue thrusting-features are generalized open bite, absence of contraction of lip muscle

What is the Treatment plan for Tongue Thrusting?

The most proven and effective technique to solve the tongue thrust problem is by oral habit training. This is an exercise that reeducates the muscles associated with swallowing by changing the swallowing pattern. This method must be taught by a trained speech therapist.

  • If an associated habit like thumb sucking is present, it must be treated first
  • Speech therapy not indicated before the age of 8 years
  • The patient may place an appliance similar to nightguard in the mouth at night, or may wear a more permanent device that can be removed or adjusted by a dentist
  • Tongue tie should be corrected




Causes of Thumb Sucking | Effects | Treatments for Child

Thumb sucking is usually involves placing the thumb into the mouth and rhythmically repeating sucking contact for a prolonged duration.

At birth, a baby will reflexively suck any object placed in mouth; this is the sucking reflex responsible for breast feeding. from the very first time they engage in nutritive feeding, infants learn that the habit can not only provide valuable nourishment, but also a great deal of pleasure, comfort and the child grows older, and is eventually weaned off the nutritional sucking, they can either develop alternative means for receiving those same feelings by beginning to suck their thumb or finger.

Thumb Sucking Causes:

Thumb sucking is observed when the child is Tired, Screed, and Bored. There are times when child feels sick or sleepy or when trying to adjust at new places such as preschool and day care, Kids will get used to Thumb Sucking.

thumb suckingVarious theories are given by different people to explain thumb sucking habit.

  1. Psychoanalytical theory
  2. Oral drive theory
  3. Learning theory
  4. Root reflex theory

Psychoanalytical theory:

Proposed by S.FREUD.

When kids feel more of insecurity or some underlying disturbances they will addict for Thumb sucking. Even stress can cause the thumb sucking habit to kids.

If we try to break the habit without eliminating the underlying cause then the thumb sucking is substituted by some other antisocial activity.

Oral drive theory:

Proposed by SEARS & WISE

When kids are exposed more to Prolongation of nursing or Strengthens the oral drive Thumb Sucking appears. To satisfy the oral drive child starts with thumb sucking.

Learning theory:

Based on this theory the cause of thumb sucking is adaptive psychological cause. This is acquired as the result of learning.

Root reflex theory:

Proposed by BENJAMEIN.

Root reflex irks the movement of the infants head and tongue towards an object touching his cheek.the object is usually the mother’s breast but may also be a finger or a pacifier. This reflex disappears in normal infants around 7-8 months of age.

Phases of Development:

Phase1:-normal & sub clinically significant seen in first 3 years of life

Phase2:-clinically indicates that the child is under great anxiety.

Phase3:-intractable sucking. Thumb sucking persisting beyond the 4th or 5th year od life.

Effects of thumb sucking:
  • Changes in the dental arch and supporting tissues
  • Severity of malocclusion depends on
  • Duration-the amount of the time spent for thumb sucking
  • Frequency-number of times the habit is activated in a day
  • Intensity-the vigor with which the habit is performed.

Children’s who rest their thumbs passively in their mouths are less likely to have dental                     problems than children who suck aggressively.

  • Labial tipping of upper front teeth results in proclination
  • Increased overjet
  • The cheek muscles contract during thumb sucking resulting in a narrow maxillary arch which can cause posterior cross bite.
  • Child may get tongue thrust habit as a result of the open bite.
  • Thumb becomes red and chopped.

Thumb Sucking Treatment:


The parents should be counseled to provide the child with adequate love and effection.the childs attention should be diverted to other things such as playing with toys.

  • Motivate the child to break the habit
  • Praise the child when he is not sucking his thumb
  • Avoid punishing or shaming the child
  • Distract the child with other activities which requires both hands

Chemical approach:

Use of bitter tasting or foul smelling preparation placed on the thumb that is sucked can make the habit distasteful. ex:asafetida, quinine

Mechanical aids:

A dentist will give the mechanical aids to break the habit.

These are 2 types

  • Removable:-passive removable appliance consists of a crib and is anchored on the posterior teeth by means of clasps
  • Fixed:-heavy gauge stainless steel wire can be designed to form a frame that is soldered to bands on the molars..

Bandaging the thumb and elbow

Thumb guard:-it is a devise with plastic cover of the thumb that is attached to a child’s wrist. this guard interrupt the process by breaking the vacuum created by sucking, thus removing the child’s pleasure.