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Title The Effects Of Thumb Sucking On Malocclusion
Clinical Question Are children who suck their thumb more likely to develop malocclusion compared to children who do not suck their thumbs?
Clinical Bottom Line Children with non-nutritive sucking habits demonstrated narrower maxillary arch widths, greater over-jet and greater prevalence of open bite and posterior cross-bite. By modifying nonnutritive sucking behaviors anterior open bites and posterior cross-bites could be prevented. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 11780987Warren/2001Children 4-5 years old, sample size 372Longitudinal cohort study
Key results372 children were divided into 5 groups by age range. Records of digit sucking, pacifier sucking and both were recorded for a duration of how long the habit existed. All 5 groups had children which had a finger sucking habit. Group number 5 which consisted of children that were 48 months or older, had 46 of the 59 children with a digit sucking habit. These children experienced an anterior open bite and posterior cross-bite, with p-values of less than 0.001. The p-value for their cross-bite was found to be 0.037.
#2) 16532883Warren/2005630 children in mixed dentitionLongitudinal Study
Key resultsThis was a longitudinal study that consisted of 630 school children in the mixed dentition stage. Fifty-five percent of the children had malocclusions. Malocclusions were defined as anterior open bite, posterior cross-bite, bilateral Class II molar relationship, or an over-jet greater than 4 mm. In children 36 months or more, anterior open bite and posterior cross-bites were seen. The conclusion of this study was that malocclusions were quite prevalent in children with digit sucking habits. By modifying nonnutritive sucking behaviors anterior open bites and posterior cross-bites could be prevented.
Evidence Search Limits: Humans, English Search "Malocclusion"[Mesh] malocclusion Search "Finger sucking"[Mesh] Search thumb sucking
Comments on
The Evidence
Evidence from the 2001 Warren study is mediocre. The evidence is good because it was a longitudinal cohort study, but I would have liked to have seen a control/baseline with a comparison of children that did not suck their thumbs. I should have assumed that the probability of a child not sucking on their thumbs or other digits would be highly unlikely, which was proved in the article. The evidence found from the 2005 Warren study reaffirmed the data found in the previous study. It was noted that more than half the children had malocclusions associated with non-nutritive (thumb sucking) habits of 36 months or more.
Applicability The evidence found shows that thumb sucking, especially the persistent habit continuing for a prolonged number of years will lead to a development of malocclusion in children. The results of the study suggest some potential harm in continuing habits beyond 24 months of age, with greater risk of developing occlusal problems with longer sucking habit duration, particularly habits persisting to 36 (2005) to 48 months (2001) of age or beyond.
Specialty/Discipline (Orthodontics) (Pediatric Dentistry) (Behavioral Science)
Keywords Malocclusion, thumb sucking, pacifier, nonnutritive sucking, oral para-functions.
ID# 806
Date of submission: 04/28/2011spacer
E-mail safahieh@livemail.uthscsa.edu
Author Sanam Safahieh
Co-author(s) e-mail
Faculty mentor/Co-author Maria Mendez Cervantes, DDS
Faculty mentor/Co-author e-mail CervantesMen@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
Comments and Evidence-Based Updates on the CAT
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by Aimee Chung, Jeff Adcock (San Antonio, TX) on 10/03/2014
A PubMed search on malocclusion related to thumb sucking was performed September 2014 with the MeSH Terms 'malocclusion', 'open bite', 'thumb sucking', and 'finger sucking'. A more recent publication was found: Urzal 2013, PMID: 24313582, which further supports the conclusion of the published CAT. This cross-sectional study, however, determined that thumb sucking had the smallest odd ratio of 5.6, compared to other oral habits related to malocclusion (pacifier sucking and tongue thrusting).

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