General anxiety, dental anxiety, digit sucking, caries and oral hygiene status of children resident in a semi-urban population in Nigeria.

BACKGROUND: Digit sucking can represent untreated anxiety or other emotional problems. The aim of this study was to determine if digit sucking is a predictor of general anxiety and dental anxiety; and if general and dental anxiety are associated with caries and oral hygiene status of children resident in sub-urban Nigeria. METHODS: This was a secondary data analysis of a household survey conducted in Ile-Ife, Nigeria. The level of general anxiety and dental anxiety of 450 6 to12 year old children were measured using the Revised Child Manifest Anxiety Scale and Dental Subscale of the Child Fear Survey Schedule respectively. Presence of digit sucking habit, caries and oral hygiene status were determined. General anxiety and dental anxiety scores were dichotomized into low and high levels respectively. Logistic regression was conducted to determine if digit sucking was a predictor of general anxiety and dental anxiety; and if general anxiety and dental anxiety were predictors caries and good oral hygiene status. Adjustments were made for age and sex. RESULTS: Digit sucking is not a significant predictor of dental anxiety (p = 0.99) and general anxiety (p = 0.79). Children with high general anxiety (AOR: 5.02; 95% CI: 2.9-9.74; p <  0.001) and high dental anxiety (AOR: 1.74; 95% CI: 1.15-2.65; p = 0.009) had higher odds of having caries and good oral hygiene respectively. CONCLUSION: Digit sucking was not a significant predictor of general anxiety and dental anxiety. General and dental anxiety however, had effects on the likelihood of having caries and good oral hygiene.

Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders.

Habits, such as hair pulling and thumb sucking, have recently been grouped into a category of clinical conditions called body-focused repetitive behavior disorders (BFRBDs). These behaviors are common in children and, at extreme levels, can cause physical and psychological damage. This article reviews the evidence base for psychosocial treatment of pediatric BFRBDs. A review of academic databases and published reviews revealed 60 studies on psychosocial treatments for pediatric BFRBDs, 23 of which were deemed suitable for review. Based on stringent methodological and evidence base criteria, we provided recommendations for each specific BFRBD. Individual behavior therapy proved probably efficacious for thumb sucking, possibly efficacious for several conditions, and experimental for nail biting. Individual and multicomponent cognitive-behavioral therapy was named experimental for trichotillomania and nail biting, respectively. No treatment met criteria for well-established status in the treatment of any BFRBD. Recommendations for clinicians are discussed. Reasons for the limitations of existing research in children and adolescents are explored. Several recommendations are presented for future pediatric treatment research on BFRBDs.

Interventions for the cessation of non-nutritive sucking habits in children.

BACKGROUND: Comforting behaviours, such as the use of pacifiers (dummies, soothers), blankets and finger or thumb sucking, are common in babies and young children. These comforting habits, which can be referred to collectively as 'non-nutritive sucking habits' (NNSHs), tend to stop as children get older, under their own impetus or with support from parents and carers. However, if the habit continues whilst the permanent dentition is becoming established, it can contribute to, or cause, development of a malocclusion (abnormal bite). A diverse variety of approaches has been used to help children with stopping a NNSH. These include advice, removal of the comforting object, fitting an orthodontic appliance to interfere with the habit, application of an aversive taste to the digit or behaviour modification techniques. Some of these interventions are easier to apply than others and less disturbing for the child and their parent; some are more applicable to a particular type of habit.  OBJECTIVES: The primary objective of the review was to evaluate the effects of different interventions for cessation of NNSHs in children. The secondary objectives were to determine which interventions work most quickly and are the most effective in terms of child and parent- or carer-centred outcomes of least discomfort and psychological distress from the intervention, as well as the dental measures of malocclusion (reduction in anterior open bite, overjet and correction of posterior crossbite) and cost-effectiveness. SEARCH METHODS: We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 8 October 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 9), MEDLINE via OVID (1946 to 8 October 2014), EMBASE via OVID (1980 to 8 October 2014), PsycINFO via OVID (1980 to 8 October 2014) and CINAHL via EBSCO (1937 to 8 October 2014), the US National Institutes of Health Trials Register (Clinical Trials.gov) (to 8 October 2014) and the WHO International Clinical Trials Registry Platform (to 8 October 2014). There were no restrictions regarding language or date of publication in the searches of the electronic databases. We screened reference lists from relevant articles and contacted authors of eligible studies for further information where necessary. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials in children with a non-nutritive sucking habit that compared one intervention with another intervention or a no-intervention control group. The primary outcome of interest was cessation of the habit. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration. Three review authors were involved in screening the records identified; two undertook data extraction, two assessed risk of bias and two assessed overall quality of the evidence base. Most of the data could not be combined and only one meta-analysis could be carried out. MAIN RESULTS: We included six trials, which recruited 252 children (aged two and a half to 18 years), but presented follow-up data on only 246 children. Digit sucking was the only NNSH assessed in the studies. Five studies compared single or multiple interventions with a no-intervention or waiting list control group and one study made a head-to-head comparison. All the studies were at high risk of bias due to major limitations in methodology and reporting. There were small numbers of participants in the studies (20 to 38 participants per study) and follow-up times ranged from one to 36 months. Short-term outcomes were observed under one year post intervention and long-term outcomes were observed at one year or more post intervention. Orthodontics appliance (with or without psychological intervention) versus no treatmentTwo trials that assessed this comparison evaluated our primary outcome of cessation of habit. One of the trials evaluated palatal crib and one used a mix of palatal cribs and arches. Both trials were at high risk of bias. The orthodontic appliance was more likely to stop digit sucking than no treatment, whether it was used over the short term (risk ratio (RR) 6.53, 95% confidence interval (CI) 1.67 to 25.53; two trials, 70 participants) or long term (RR 5.81, 95% CI 1.49 to 22.66; one trial, 37 participants) or used in combination with a psychological intervention (RR 6.36, 95% CI 0.97 to 41.96; one trial, 32 participants). Psychological intervention versus no treatmentTwo trials (78 participants) at high risk of bias evaluated positive reinforcement (alone or in combination with gaining the child's co-operation) or negative reinforcement compared with no treatment. Pooling of data showed a statistically significant difference in favour of the psychological interventions in the short term (RR 6.16, 95% CI 1.18 to 32.10; I(2) = 0%). One study, with data from 57 participants, reported on the long-term effect of positive and negative reinforcement on sucking cessation and found a statistically significant difference in favour of the psychological interventions (RR 6.25, 95% CI 1.65 to 23.65). Head-to-head comparisonsOnly one trial demonstrated a clear difference in effectiveness between different active interventions. This trial, which had only 22 participants, found a higher likelihood of cessation of habit with palatal crib than palatal arch (RR 0.13, 95% CI 0.03 to 0.59). AUTHORS' CONCLUSIONS: This review found low quality evidence that orthodontic appliances (palatal arch and palatal crib) and psychological interventions (including positive and negative reinforcement) are effective at improving sucking cessation in children. There is very low quality evidence that palatal crib is more effective than palatal arch. This review has highlighted the need for high quality trials evaluating interventions to stop non-nutritive sucking habits to be conducted and the need for a consolidated, standardised approach to reporting outcomes in these trials.

Counseling on Early Childhood Concerns: Sleep Issues, Thumb-Sucking, Picky Eating, School Readiness, and Oral Health.

Family physicians are often a source of information and advice on early childhood concerns regarding sleep, thumb-sucking/pacifier use, picky eating, school readiness, and oral health. Evidence indicates that family variables are important in the genesis of sleep difficulties, and that traditional behavioral methods are not as effective as previously thought. Attention to family psychosocial well-being, especially maternal functioning, is important in addressing childhood sleep difficulties. Thumb-sucking and pacifier use may be associated with negative consequences if they persist, and referral is recommended after four years of age if appropriate behavioral interventions are ineffective. Picky eating is heavily influenced by environmental factors, and food neophobia is a normal stage of development. The main approaches to childhood eating problems include social modeling of normal eating behaviors, repeated exposures to new foods, and positive mealtime experiences. School readiness focuses on supporting the psychosocial variables that are associated with school success. Reading with the child enhances literacy skills. Quality early childhood education programs are also effective in enhancing school success. Delaying school entry is not beneficial and may be detrimental. School readiness includes the schools' role in supporting the learning needs of all children regardless of their abilities and skills. Oral health is increasingly recognized as an important contributor to overall health. Oral health should be incorporated into well-child visits beginning at the eruption of the first tooth.

[Finger or thumb sucking. New interpretations and therapeutic implications]. / Il problema del succhiamento del dito. Nuove interpretazioni e implicazioni terapeutiche.

AIM: Finger sucking is frequently found in children and sometimes in adults too. Often reasons are found to explain why certain children feel the need to suck their thumbs or fingers, but these explanations are always derived from clinical observation without any rational support, searching for motives for this bad habit from family life; strict parents, jealousy at the birth of a sibling, difficulty accepting the end of breastfeeding etc. Some think that a child should continue to suck after actual nutrition has ended and the substitution of the mother's nipple with a thumb or finger could fill this need. Research however, using anatomical and neurophysiological data, explains why an infant forms the habit of thumb sucking from a neurological standpoint abandoning the psychological explanations proposed until now. METHODS: Forty thumb-sucking subjects with ages ranging from 5 to 25 years and a control group of 20 non-thumb-sucking subjects with correct swallowing patterns were analyzed evaluating postural and neurological effects of thumb sucking. Instruments used for this evaluation were a device for electromyography to measure the muscular tone and a baropodometer, stabilometer and a scoliosometer to analyse posture. RESULTS: Analyzed subjects had an evident improvement at the baropodometer and stabilometer and a scoliosometer examination to analyze posture and at the electromyography analysis. CONCLUSION: The results obtained confirm that a thumb-sucking subject puts the thumb in the mouth to stimulate the nasal-palatal receptors of trigeminus and obtain muscular balance and a release of physical and psychological tension.

Psycho-Neurological Status in Children with Malocclusions and Muscle Pressure Habits.

Non-nutritive sucking behaviors such as finger- and tongue-sucking, tongue thrust, lips- or cheek-sucking, nail-, lip- or tongue-biting and other pressure habits represent risk factors for malocclusion. The association between psycho-neurological disorders and different types of malocclusion in children with sucking habits was long studied. During neurological examination, many children with sucking habits are diagnosed as Minimal Cerebral Dysfunction or Attention Deficit Hyperactivity Disorder (ADHD) bearers. The aim of this study is to assess the psycho-neurological status and motor disorders in children with malocclusion and normal occlusion. 135 children, aged between 8 and 12 years old, were examined, 42 children with normal occlusion and 93 children with different types of malocclusion. Besides clinical examination, all children were studied by the following psychoneurological methods: 1) Parent's Questionnaire, 2) Diagnostic interview Kiddie-Sads 3) Physical and Neurological Exam for Subtle Signs and 4) stabilometric tests. This study shows as in presence of dentofacial anomalies, pressure habits, ADHD reports significant effects on the functional state of the motor system: increases are noted in all basic parameters of statokinesiograms (crossed distance, sway area and ellipse surface), which lead to increased physiologic energy costs to maintain the vertical position of the body.

Associations between psychological factors and the presence of deleterious oral habits in children and adolescents.

OBJECTIVES: This study aimed to evaluate the associations between psychological factors and the presence of deleterious oral habits in children and adolescents. STUDY DESIGN: 147 students aged 8 to 14-years-old were divided in two groups concerning the presence and absence of DOH Habit group (HG) and Habit free group (HFG). Participants were asked about the presence of DOH using the domain III (Oral Habits) of the Nordic Orofacial Test-Screening (NOT-S). Symptoms of anxiety and depression were evaluated using the Brazilian Portuguese versions of the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI), respectively. Saliva was collected 30 min after waking and at night to determine the diurnal decline in salivary cortisol (DDSC). Data were analyzed using the Chi-squared, Mann-Whitney, Spearman's correlation and logistic regression. RESULTS: The prevalence of DOH was higher in females than males (65.1 vs 34.9; p < 0.05). The most frequent DOH was nail biting (58.7%). HG presented more depressive symptoms than HFG (p < 0.05). There was positive correlation between salivary cortisol levels and age (p < 0.01). Logistic regression analysis found association between symptoms of anxiety and the presence of DOH (OR = 2.35; p < 0.05). CONCLUSIONS: In conclusion, children and adolescents with DOH presented more symptoms of depression than their counterparts. Moreover, they were more likely to report symptoms of anxiety.

Case history: improved maxillary growth and development following digit sucking elimination and orofacial myofunctional therapy.

Orofacial myologists are frequently called upon to address retained oral habit concerns. During this process, current I.A.O.M. recommended treatment includes addressing tongue, lip, and jaw rest posture concerns. Following digit sucking remediation, we may also be called upon to address these rest posture issues, and tongue thrust more aggressively together. In this process, facial growth and development and jaw structure may coincidentally improve as a result of 'nature taking its course' by addressing both swallow AND rest posture. In a select subset of clients, dramatic improvements may occur if the timing is right. This article discusses one such case that appears to have yielded a significant improvement in oral postures influencing improved facial and oral growth and development.

Fingers in mouths: from cause to management.

Digit sucking is a habit that occurs in childhood and can lead to malocclusion if it persists for a long time. Understanding the cause and available management approaches for habit cessation can lead to more positive outcomes for clinicians, parents and children alike. Increasing clinicians' awareness of the causes and management of digit sucking behaviours can aid in their effective and systematic management, thereby reducing the risk of future malocclusion in some individuals.

Frequency of oral habits, dysfunctions, and personality traits in bruxing and nonbruxing children: a comparative study.

The aim of the current study was to compare personality traits, presence of oral myofunctional dysfunctions, and other parafunctional habits in bruxing and nonbruxing children. Fifty-four patients aged 10 to 15 years were seen at the Comprehensive Pediatric Dental Clinic and examined by dentists using the RDC/TMD; speech therapists and psychologists were included in the study. Patients were divided into two groups: bruxing (A) and nonbruxing (B). Mean age was 13.1 years, S.D. 1.6. No significant differences in age or gender were found between groups. Group A comprised 44.44% of the population and showed a high frequency of middle conscientiousness scores and low frequency of low neuroticism scores. Presence of TMD, unilateral chewing, and high tongue tip position at rest were all significantly higher. Frequency of oral habits was higher in bruxers, who showed significantly increased gum chewing, and lip, cheek, and object biting compared to nonbruxing controls. Bruxism is considered a risk factor for temporomandibular dysfunction (TMD).

Hypnotic intervention in a 7-year-old thumbsucker: a case study.

Thumbsucking is a common habit among younger children. Usually, the child outgrows this habit by age 6. When a child over the age of 6 continues to suck his or her thumb, it can be a cause of potential harm due to peer pressure, ridicule, and shunning. It can also lead to malocclusions requiring eventual orthodontic interventions. In this case study, the author demonstrates a hypnotic intervention in a 7-year-old girl. Validation of her habit and imaging a role model sucking her thumb were employed in trance. Using this approach, the child was able to end her dependence on thumbsucking in 1 session.

Invisalign teen for thumb-sucking management. A case report.

AIM: Currently and with increasing frequency, treatments with Invisalign orthodontic devices are aimed also to adolescent patients: this evolution involves the management of some atypical characteristics, and among them also thumb- sucking. CASE REPORT: A 13-year-old adolescent girl with protracted thumb sucking and dentoalveolar open bite is presented. Infantile neuropsychiatric assessment was required before and after treatment. Small areas of the aligners were occlusally flipped like a bite ramp, in particular on the palatal surface of the upper incisors, in order to discourage thumb sucking. The selection of an invisible orthodontic device was shown to be interesting because it does not impact on the fragile and complex neuropsychiatric situations. Moreover, the active daily application of the device further motivates young patients. The vertical attachments were fundamental in repositioning the front teeth and to close the dentoalveolar open bite. Treatment was ended in eight months with no behavioural or neuropsychiatric consequences in the short period. Invisalign was shown to be a useful device for orthodontic correction even in the complex management of adolescent thumb sucking.

Confirmational study: a positive-based thumb and finger sucking elimination program.

This article emphasizes the critical need for information specifically regarding the topic of retained sucking behaviors. The study aimed to confirm results provided by Van Norman of 723 subjects in 1997. Parent surveys were collected on 441 subjects who received an orofacial myofunctional treatment program provided by one certified orofacial myologist. Results of this study do confirm that retained digit sucking behavior may be addressed successfully and expediently by a program based on positive behavior modification techniques.

Concomitant trichotillomania cessation and thumb-sucking elimination: of course, they're related...aren't they?

This article presents an overview of the current research literature that reveals some controversy, discussion of the need for more research, and report of some definitive success. In addition, four case studies of hair pulling and thumb-sucking are highlighted.

Knowledge and attitude of pediatricians toward digit sucking habit in children.

BACKGROUND: Finger sucking and prolonged dummy sucking are the most prevalent oral habits among infants, toddlers, and children. Pediatricians are more likely to see infants and children much earlier than dentists. Thus, it is essential for these specialists to be aware of the harmful nature of digit sucking habit and its associated complications. AIMS AND OBJECTIVES: The present study was designed to evaluate the knowledge and attitude among pediatricians about digit sucking habit in children. METHODOLOGY: The survey was carried out using a self-administered questionnaire which was delivered to the study subjects by hand or by mail. The returned questionnaires from the pediatricians were statistically analyzed using descriptive statistics (percentage). RESULTS: This study showed that many respondents were unaware that oral habits could be responsible for malocclusion. A high percentage of respondents preferred not to examine oral features in digit sucking child. Among the etiological factor that may contribute to digit sucking habit in a child, most of the respondents expressed that habitual, psychological and inadequate parental care are possible causes. Most of the participants answered that parental and child counseling is essential to stop the habit. Most of the respondents did not refer the digit sucking child to the dentist for the better management of associated malocclusion. CONCLUSION: Knowledge and attitude among pediatricians about digit sucking habit in children were found to be unsatisfactory. Continuing dental education programs and symposiums can be conducted for pediatricians to enhance their knowledge about pernicious oral habits.

[Hypnosis and orthodontic treatments]. / L'hypnose dans les traitements d'orthodontie.

INTRODUCTION: After being discarded from hospitals due to its lack of scientific evidence, medical hypnosis is once more in the spotlight thanks to neuroscience and medical imaging, which have proven its specificity. Medical hypnosis is currently enjoying real enthusiasm, and now the doors are opening not only to medical and surgical units but also to our orthodontic clinics. MATERIALS AND METHODS: This article defines hypnosis and its different levels of application and the required techniques. It also explores all the different fields in which it can be used in orthodontic treatment. DISCUSSION: Hypnosis can be applied from the very first contact with the patient and can be useful and therapeutic at every step of the process. It is useful to think of it in our discipline as a treatment in its own right contributing to heal parafunctions and tongue disorders more efficiently.

Non-orthodontic intervention and non-nutritive sucking behaviours: A literature review.

Anterior open bite (AOB) is one of the most complex malocclusions to manage. AOB is caused by either by skeletal, genetic or environmental factors. Numerous treatment options are currently utilised to manage AOB. These vary from non-invasive behavioural shaping to orthodontic and surgical interventions. This paper reviews the available orthodontic and non-orthodontic interventions used in the management of AOB. The literature review was carried out using the PubMed search engine from the first of January 2000 to the first of June 2017. Two major keywords (open bite and anterior open bite) were used in addition to 23 minor keywords in the review. AOB is one of the most complex malocclusions to treat with high relapse rates. Long term outcome in treatments of patients with AOB was substantially low. Relapse rates were not taken into consideration for some of the literature reviewed. Despite limitations of the literature, it is recommended that orofacial myofunctional therapy (OMT) and non-orthodontic intervention (NOI) be used in conjunction as an effective treatment option for Anterior Open Bite.

Mothers' attitude toward digit sucking habits in children of United Arab Emirates.

The purposes of this study were to evaluate maternal attitudes and knowledge towards digit sucking habits and to investigate the association between various factors and the presence of these habits. A cross-sectional sample of 150 mothers of children currently engaged in digit sucking habits were interviewed. The information collected was from a questionnaire completed by the mothers. The analyzed data regarding the mothers revealed that younger mothers represented 54% of the sample, 47.3% were well-educated and 70.0% were unemployed. Regarding the children, female children (65.3%) practiced digit habits more than males, and 45.3% of the children were younger than 3 years of age. Significant factors associated with maternal attitudes towards digit sucking habit included: 88.6% of mothers never tolerated this habit, 75.0% of the mothers were unemployed and provided instruction to cease the habit, and 89.9% of the mothers never sought advice from a dentist. Overall, mothers did not view digit sucking habits to be an acceptable behavior regardless of their nationality. Mothers indicated that they tried to stop the habit with a variety of techniques but without any professional advice. The study concludes that mothers would benefit from receiving information about a motivational program, professional advice, and suggestions to discourage this habit.

The comparative effectiveness of two digit-sucking deterrent methods.

A study was conducted to compare the effectiveness of the crib and positive reinforcement in eliminating anterior open bites and increased overjets caused by digit-sucking. The overjet and overbite were measured using an overjet ruler at the start and end of the seventeen-week observation period. Forty patients consented to participate but measurements were only obtained for 11 subjects. The trend in this study is that the crib is more effective than positive reinforcement in preventing digit-sucking.