“We are what we repeatedly do. Excellence, then, is not an act, but a habit” The seminar is tailor made for students with an intent to help understand the subject, hope this makes up my little contribution in simplifying the topic.

1. ORAL HABITS IN
CHILDREN

2. “We are what we repeatedly do.
Excellence, then, is not an act, but a
habit”

3.  Introduction
 Definitions
 Classifications
 Prevalence of oral
habits
 Thumb sucking
habit
 Tongue thrusting
habit
Contents Part I

4. • Habit can be defined as a fixed or
constant practice established by
frequent repetition.
Dorland (1957):
• Habit is a frequent or constant practice
or acquired tendency, which has been
fixed by frequent repetition.
Buthersworth (1961):

5. • “ a tendency towards an act or as act
that has become a repeated
performance relatively fixed,
consistent, easy to perform and almost
automatic”.
Boucher(1963) defined habit as
• “an act, which is socially
unacceptable”.
Finn(1987)defined habit as

6. Oral Habits
• Frequent or constant practice or
acquired tendency, which has been fixed
by frequent repetition.
Buttersworth(1961)
• Oral habits are learned patterns of
muscular contractions, which are
complex in nature
Moyers( 1982)

7. CLASSIFICATIO
N

8.  Intentional/Meaningful
Eg:Nail biting, Digit
sucking,Lip biting
 Masochistic/Self
inflicting
Eg:Gingival stripping
 Unintentional/Empty
Eg: Abnormal
pillowing,chin propping
 Functional
Eg:Mouth
breathing,Tongue
thrusting,Bruxism
OBSESSED(deep rooted) NON OBSESSED
(easily learned and dropped)

9. 1.JAMES W. (1923)
Include the habits of
normal function such as:
a)correct tongue position,
b)proper respiration,
c)proper deglutition and
d)normal usage of lips in
speaking.
USEFUL HARMFUL

10. II.KINGSLEY(1958)
 Individual
habit:
FUNCTIONAL MUSCULAR
COMBINED

11. III MORRIS AND BOHANNA (1969)
A)Pressure habits
Eg: Thumb sucking
Tongue thrusting
 Non pressure habit
Eg: Mouth breathing
B) Biting habits
Eg: Pencil biting

12. IV KLEIN E(1971)
 Meaning habits :
 suggests the existence of a direct psychological
cause and effect relationship.
 Empty habits :
 are simple habits without a detectable cause

13. Klein classified abnormal pressure habits
into intrinsic and extrinsic
a) Intrinsic pressure habits (within the mouth)
sucking
THUMB
FINGER
TONGUE
LIP
CHEEK
biting
NAIL
TONGUE
LIP
MOUTH
BREATHIN
G
MOUTH
BREAT
HING INCORRECT
SWALLOWIN
G
TONGUE
THRUSTIN
G

14. b) Extrinsic pressure habits (face)

15. C) Functional pressure

16. V. BARRETS (1978)
1. Intra oral habits

17. 2)Extra oral habits

18. VII.FINN 1975
 Compulsive
 Non Compulsive
 Secondary habits

19. Compulsive habits
 Tends to suffer increased anxiety when attempts are made to
correct the habit.

20.  Easily dropped from the child’s behaviours pattern as
he matures.
 Naturally modified or eliminated through the
maturation process.
 More consistent behaviour
 Increased level of maturity and responsibility.
Non compulsive oral acts –

21. GRABER
 Thumb and finger sucking
 Tongue thrust and tongue sucking
 Lip and nail biting
 Mouth breathing
 Abnormal swallowing habit
 Speech defects
 Postural defects
 Psychogenic Bruxism or Occlusal neurosis
 Defective occlusal habits.

22. PREVALENCE of Oral Habits
Kharbanda et al 2003
 5-13 yr old children, Delhi -25.5%
 Tongue thrusting – most common (18.1%)
followed by mouth breathing (6.6%)
 Thumb sucking (0.7%) and lip biting (0.04%)- relatively less
common
 There was no significant difference between boys and girls

23. PREVALENCE of Oral Habits
Shetty SR, Munish AK
 Mangalore - 29.7% of children.
 Digit sucking(3.1%), Pencil biting-(9.8%) and Tongue thrust-
(3.02%) Highly prevalent among 3-6 yrs.
 Mouth breathing(4.6% )and bruxism (3.1%) - significant in 7-
12 yrs
 Lip/cheek biting(6%)and nail biting (12.7%) - more common
in 13-16 yrs.
 Digit sucking, tongue thrust, mouth breathing and bruxism -
more prevalent among boys
 Lip/cheek biting, nail biting and pencil biting -more prevalent
among girls.

24. DEVELOPMENT OF A HABIT

25. Development of a habit
 The newborn develops some instincts, which
are composed of elementary reflexes.
 Instinct : pattern and order are inherited,
 Habit: pattern and order are acquired,
if constantly repeated during the lifetime of
an individual.

26.  At the beginning,
 the infant makes an effort by
frequent learning and
practice,
 later on the muscles start
responding more readily.
 At the onset it takes a long
time for the impulses to pass
along the efferent nerves to
muscle involved

27.  It has been stated that unconscious mental pattern of
childhood develops from five sources namely
 Instinct,
 Insufficient or in correct outlet of energy,
 Pain or discomfort,
 Abnormal physical size of parts,
 Imitation of or imposition of others

28. 1) Functional matrix- MELVIN MOSS
2) Psychoanalytical – SIGMOND FREUD
THEORIES

29. BUCCINATOR, SUPERIOR
CONSTRICTOR, PTERYG
PMANDIBULAR RAPHE
HARMONIOUS
PRESSURE
BALANCE
ORAL
HABIT
S
NORMAL
DENTOFACIAL AND
SKLETAL GROWTH
TONGUE
LIPS
ABNORMAL SOFT TISSUE
PRESSURE, ALTERED
MUSCULAR CONTRACTION
ALTERED DENTOFACIAL AND
SKLETAL GROWTH

30. Acc to Freud
 Personality develops through a series of
childhood stages during which the pleasure-
seeking energies of the id become focused on
certain erogenous areas.
 This psychosexual energy, or libido, was
described as the driving force behind behavior.
 Psychological development of child from birth
to adolescence is divided into five stages

31.  Stages successfully completed: Healthy
personality
 Unsuccessful @ appropriate age: Fixation
The Oral Stage:
 first year of human life
 erotic pleasure oral stimulation (Char’)
 During the oral stage,
 primary source of interaction : mouth,
 Rooting and Suckling reflex is especially
important.

32. Mouth: Vital for eating
the infant also develops a sense of trust and
comfort through this oral stimulation
the infant is entirely dependent upon caretakers,.
Infant derives pleasure from oral stimulation
gratifying activities such as tasting and suckling.

33.  Issues with dependency or
aggression.
 Oral fixation can result in habits
like:
 nail biting, thumb or finger
PRIMARY
CONFLICT
WEANING
PROCESS
IF, FIXATION OCCURS @ THIS STAGE,

34. THUMB/ DIGIT SUCKING
THUMB/DIGI
T SUCKING

35. Thumb/Finger sucking
Definition:
Placement of the thumb or
one or more fingers in
varying depths into the
mouth.
– Gellin- 1978
Repeated and forceful
sucking of thumb with
associated strong buccal and
lip contractions
- Moyers

36.  I.U Life
 First 2 yrs.
 Disappears with maturation.
 No: malocclusion
 Abnormal IF, persists
 IF not controlled at this age: May cause deleterious
effects on dentofacial structures.

38. Significance: new born infant
FEELING OF
 euphoria,
 sense of security,
 warmth and being wanted.

39. CLASSIFICATION
Based on clinical observation
1. Normal thumb sucking
2. Abnormal thumb sucking

40. A. Psychological
B. Habitual*

41. O’BRIEN(1996)
A)Nutritive sucking habits:
Provides essential nutrients
Ex- Breast feeding , Bottle feeding.
B)Non nutritive sucking habits:
Ensures a feeling of well-being, warmth and a sense of
security.
Ex- Thumb/ finger sucking, Pacifier sucking

42. Classification of NNS habits
Johnson and Larson 1993 (JDC )
Level Description
Level 1 (+/-) Boys or girls of any chronological age with a habit that
occurs during sleep.
Level II (+/-) Boys below age 8yr with a habit that occurs at one
setting during waking hours
Level III (+/-) Boys below age 8yr with a habit that occurs at multiple
sittings during waking hours
Level IV (+/-) Girls below age 8yr or a boy over 8 yrs with a habit that
occurs at one setting during waking hours
Level V (+/-) Girls under age 8 yr or a boy over age 8 yrs with a habit
that occurs at multiple sittings during waking hours
Level VI (+/-) Girls over age 8 yrs with a habit during waking hours

43. Subtelny’s grading(1973)
1.Type A:- 50%

44. Subtelny’s grading(1973)
2.Type B :- 13-15%

45. Subtelny’s grading(1973)
3. Type C :- 18% 4. Type D :- 6%

46. Sucking reflex- Engel 1962
 Seen even at 29 week of I.U. life
 First coordinated neuromuscular activity of infant
 Disappears during normal growth btw 1-3 ½ yrs
Purpose:
 Nutritional/Physiological gratification
 Emotional gratification
 Also experience pleasurable stimuli from lips, tongue
and oral mucosa & learn assct’ enjoyable sensations
such as closeness of a parent.

47.  Babies restricted from suckling due to disease or other
factors become restless and irritable.
 This deprivation motivates the infant to suck the thumb
or finger for additional gratification

48. SUCKLIN
G SUCKING
SEEN WITH BREAST
FEEDING
BREAST NIPPLE FORMS A
PERFECT ANTERIOR SEAL NO
NEED FOR ADDITIONAL NEGATIVE
PRESSURE
HARMONIOUS, FEELING OF
LOVE, WARMTH, AFFECTION
AND BETTER NOURSMENT OF
THE CHILD
SEEN WITH BOTTLE
FEEDING
NEGATIVE PRESSURE CREATED IN
THE ORAL CAVITY BY THE ACTION OF
BUCCINATOR AND ORBICULARIS
ORIS
DELETERIOUS
(FEELINGS OF DETACHMENT FROM
MOTHER AND INADEQUATE
NOURISHMENT)

49. INFANTILE OR VISCERAL
SWALLOW
Characteristic of the infantile or
visceral swallow as listed by
Moyer’s:
 The jaws are apart, with the tongue
between the gum pads.
 The mandible is stabilized primarily by
contraction of the muscles of the VIIth
cranial nerve and the interposed
tongue.
 The swallow is guided, and to a great
extent controlled by sensory
interchange between the lips and the

50. MATURE SWALLOW
 By 18 months of age the mature swallow characteristics listed
by Moyers are observable.
 The teeth are together
 The mandible is stabilized by contraction of the mandibular
elevators, which are primarily 5th cranial nerve muscles.
 The tongue tip is held against the palate about and behind
the incisors and peripheral portions flow between opposing
posterior segments.
 There are minimal contractions of the lips during the mature
swallow.

51. PHASES OF SUCKING

52. Buccinator mechanism
 OO: orbicularis oris
 LP: lower fibers of lip
 B: buccinator’s muscle
 PMR: pterigomandibular raphe
 SPC: superior constrictor muscle

53. Buccinator mechanism
When the child places the thumb between teeth
Negative pressure is created within Mouth
and tongue gets lowered down
Pressure against upper anteriors
Cheek pressure against the upper
posteriors
Increased activity of Buccinator
mechanism, and the absence of
opposing tongue muscle force
V shaped maxillary arch with high vault
palate

54. Variables affecting malocclusion
Sorokohit and Nanda (1989)
 1) Position of the digit
 2) Associated orofacial muscle contraction
 3) Mandibular position during sucking
 4) Facial skeletal pattern
 5) Intensity, frequency and duration of force applied.

55. THEORIES: Psychology of Non Nutritive digit
sucking
Theories to explain the cause of occurrence
of this habit
• Freudian theory (1905)
• Learning theory (Davidson, 1967)
• Oral drive theory (Sears and Wise, 1982)
• Johnson and Larson (1993)

56. FREUDIAN THEORY(1905)
 Distinct phases of psychological
development
 Oral and anal phases seen in first 3
years of life.
 Oral phase- mouth believed to be
Oro-erotic zone.
 The child has tendency to place his
finger or any object into the oral
cavity.

57.  Prevention of such an act : results in emotional insecurity
and passes the risk of the child diversifying into other
habits.
 Thumb sucking considered as manifestation of insecurity,
maladjustment , internal conflicts

58. The Learning Theory: Davidson 1967
• Non-nutritive sucking stems from adaptive response
• Infant associates sucking with hunger, satiety & being held.
• These events are recalled by finger or thumb.
• i.e habit stems from an adaptive response and assumes no underlying
psychological cause as a result of learning

59. BENJAMIN’S THEORY (1962):
 Thumb sucking arises from “ROOTING
REFLEX”, common to all mammilian infants.
 It is max’ during first 3months of life.
 If it persists, may lead to abnormal habit.

60. ORAL DRIVE THEORY
 Sears and wise(1950)
 Acc to this, theory prolongation of nursing strengthens
the oral drive.
 (i.e prolonged sucking can lead to thumb sucking)

61. PREVALENCE
 Birth to 2years of age: - 50-67%
 2 to 5 years of age:- 24-43%
 6 to 10 years of age:- 17%
 Above 10 years :- 10%
Brahm and Morris

62. INCIDENCE:
Popovich and Thompson-1973, Kelley et al 1973:
• Higher incidence in girls than boys :11.7% girls and
8.3% boys.
• Subtenly and Subtenly 1973: Equal distribution
• Race: Low incidence in Negroid races.
(Brenchley 1992)

63. ETIOLOGY
 Hanna 1958 : retained infantile
swallow
 Pearson 1948 : hereditary (JDC 1993)
 Cook 1944 : teething
 Kelston 1949 : postnatal sucking reflex
(JDC 1993)
 Humphrey 1950 : subclinical hunger
(BDJ 1950)
 Mcdonalds, Graber 1958: insecurity
attention
 Levy 1928 : inadequate sucking during
feeding
 Cumley 1955 : revenge (JDC 1993)

64. The trident Factors affecting thumb
sucking : Graber and Swain (1985)
 Intensity:
Implies how vigorously the habit is pursued.
The digit may rest passively in the mouth or
may be sucked with much enthusiasm.
 Frequency: Indicates how often during the
day the habit is Practiced.
 Duration: Indicates the number of years the
habit is continued

65. Phases of Development of Thumb Sucking
(Moyers)
 Phase I
 Normal and sub clinically significant.
 It is seen during first three years of life.
 The habit is considered normal during this phase and
unusually terminates at the end of phase one.

66. Phase II
 Clinically significant sucking:
 The 2 phase extends between 3- 6 years of age. The
presence of sucking during this period is an indication
that the child is under great anxiety.
 Treatment should be initiated during this phase.

67. Phase III
 Intractable sucking:
 Any thumb sucking persisting beyond 4 and 5 year of
life should alert the dentist to the psychological aspect of
approach.

68. VARIABLES INFLUENCING
 Age
 Sex
 RACE :negroids, eskimo :1969 Owen (MUNN)
 Pacifier : Ravn 1967 (Am J Ortho)
 Feeding methods : Levy 1928
 Siblings : Larsson 1993 (JDC)
 Parental status :Calisti 1960 (JDR)
 Working mother

69. DIAGNOSIS
• History of the digit sucking activity
• Evaluation of the child’s emotional status
• Extra oral examinations
• Intra oral examinations

70. HISTORY: Mathewson, Forrestor
• Parents
• Feeding patterns
• Three major questions: (Graber 1972)
 Frequency
 Duration (most imp)
 Intensity
 Direction, type

71. EMOTIONAL STATUS
• Essential to determine meaningful or empty habit.
• Identify the child who wants to stop but just needs some
help

72. CLINICAL FEATURES
– Digits
– Lips
– Facial form
– Dentofacial changes
– Other features

73. DIGITS
 Reddened
 Exceptionally clean and chapped
 Short clean finger/ thumb nail (dish
pan thumb)
 Fibrous roughened callus on superior
aspect of finger nail
 Grooves on thumb

74. LIPS
Upper lip :
 Short and hypotonic
 Passive or incompetent during swallowing
Lower lip :
 Hyperactive

75. FACIAL FORM ANALYSIS
 Maxilla protrusion
 Mandibular retrusion
 High mandibular plane
angle
 Facial profile- straight
/ convex
 Saddle nose (due to
pressure of index
finger)

76. Dentofacial changes associated with prolonged non
nutritive sucking habits - Johnson and Larson 1993
Effects on Maxilla:
 Proclined maxillary incisors
 trauma to maxillary central incisors
 Maxillary arch length
 Clinical crown length of maxillary
anteriors
 palatal arch width ie High palatal arch
 Increased atypical root resorption in
primary central incisors

77. Effects on Mandible:
 Retroclination / proclination of mandibular
incisors
Retroclination : direct apical & lingual force
from digit
Proclination: indirect force from tongue
beneath digit
 Decreased clinical crown length of
mandibular anteriors
 Increased mandibular inter molar
distance:Uncontained arch
 Retrusion of mandible

78. Effects on Inter-arch relationship:
 Anterior open bit
 Decreased overbite

79.  Increased overjet
 Unilateral or bilateral
Class II malocclusion.

80. Posterior cross bite

81.  Lip incompetence
 Lower lip function under the maxillary
incisors
Effect on tongue placement and function:
 Tongue thrust
 Lip to tongue resting position (oral seal)
 Lower & lateral tongue position
Effect on lip placement and
function:

82.  Other features
 Other habits- habitual mouth breathing, tongue thrust
swallow
 Middle ear infections
 Enlarged tonsils
 GI disturbances
 Speech defects (lisping)

83. TREATMENT CONSIDERATIONS:
FINN
 Psychological status of the child
 Age factor
 Motivation of child
 Parental cooperation
 Friendly rapport
 Other factors (goal orientation for time limit)

84. TREATMENT
CONSIDERATIONS:FORRESTER
 Emotional significance
 Age of the patient
 Status of the child’s occlusion

85. Emotional significance
 Diagnosis and management of any psychological
problem should be planned before treatment of any
potential or present dental problem.
 The frequency, duration and intensity of the oral habit
are important in evaluating the psychological status of
the child.

86.  The events that precede the habit such as the use of a
security blanket, the dependency on a favorite
toy, problems with sleep, nightmares, nervousness and
anxiousness will yield information concerning the
possible psychological stimuli of the habit.
 If the oral habit is associated with an emotional problem
this would suggest the need for psychological
consultation.

87. Age factor :1) Younger than 3 years
 No active intervention :general emotional immaturity.
 Most children will outgrow the habit by 5
 Most class 1 open bite malocclusion will be self
correcting when the permanent incisors erupt if the habit
doesn’t cease prior to their eruption.

88.  The parents should be advised generally to ignore the
active habit, and give the child as much attention as
possible when he is not thumb sucking.
 They should also be advised,
 For class II children: further orthodontic treatment will
be necessary when the child is older.

89. 3- to 7 year olds
 Caution : Depending on the type of the habit and
whether he is actively pulling his maxilla anteriorly or just
sucking his digit with buccal constriction.
 Finger suckers : concern then thumb suckers because
anterior orthopedic force vectors associated with finger
sucking leverage.
 It is advised counseling the child with good molar
intercuspation with little anterior pull. i.e passive sucking
child.

90. Older then 7 years
 Anterior open bite that is usually not closed by itself
because of functional patterns that have been
established.
 They will require active orthodontic treatment.
 The appliances delivered should not be punitive,
 Should be multipurpose
 Should help the child to control his habits by giving him
a reminder

91. Motivation of the child to stop the habit:
 Important to assess : the maturity : in response to new
situations and to observe the child’s reactions to any
suggestion.
 The treatment approach for the digit sucking habit
should deal directly with the child.
 The first ingredient needed to stop the habit is
 the child’s desire to stop.

92. Parental concern regarding the habit:
 If the parent is unable to cope with the situation
positively then both the parent and the child should be
dealt with during treatment.
 Parents : silent partners.
 Important : child should not be offered to deal with this
difficult habit.
 Negative reinforcements : threats, nagging and ridicule
would only entrench the habit.

93. Other factors:
 Self-correction again depends on the severity of the
malocclusion, anatomic variation in the perioral soft
tissue and the presence of other oral habits, such as
 tongue thrusting,
 mouth breathing and
 lip biting habits.

94. Treatment (Pinkham)
 Counseling
 Reward system
 Reminder therapy
 Adjunctive therapy

95. TREATMENT
MODALITIES
Thumb sucking

96. TREATMENT MODALITIES
 Once the decision for treatment has been made, one
must next determine what intervention is appropriate.
 The treatment considerations are
 psychological status, age factor, maturity of the
patient, and patient co-operation.
 The combinations of explanations with consideration of
physical appearance and social acceptance may be
sufficient for the child to give up the behavior.

97.  In addition to their own intention some children may
require additional help.
 Another tool that is helpful for this type of child is the use
of positive reinforcement.
 Rewards for progress in diminishing the habit should
include praise and something special that is agreeable
to patient and parent.

98. Psychological Therapy :
A. Dunlop's hypothesis
 If a subject is forced to concentrate on the performance
of the act and the time he practices it, he could learn to
stop performing the act.
 Forced purposeful repetition of habit eventually
associates with unpleasant reactions and the habit is
abandoned.
 The child should be asked to sit in front of the mirror and
asked to observe himself as he indulges in the habit

99. B. Six steps in cessation of habit (Larson &
Johnson)
Step 1: Screening for psychological component.
Step 2: Habit awareness.
Step 3: Habit reversal with a competing response.
Step 4: Response attention.

100. Step 5: Escalated DRO (differential reinforcement of other
behaviors)
Step 6: Escalated DRO with reprimands.
(Consists of holding the child, establishing eye contact
and firmly admonishing the child to stop the habit

101. C. Three alarm system: (Norton & Gellin-
1968)
 A chart is designed with days of the week and blank
spaces.
 When the child engage in his habit he is told to
wrap the digit he sucks with coarse adhesive tapes.
 The child feels the tape in his mouth it is the first alarm
and this reminds him to stop the habit.

102. D. Reward system
 Children should be encouraged and rewarded for not
practicing the habit. “contingency contracting” is a
contract made between the child and dentist or child and
parent.

103. E. ACE BANDAGE APPROACH
 In this approach,
Bandage should be wrapped around
the finger and stars should be
entered into the calendar.
 Reminds the parent and child
 Every 20 stars: REWARD

104. F. THUMB BUDDY TO LOVE
 This is commercially available and is a positive teaching tool and
chemical free method.
 It contains thumb puppet that is inserted into the child's thumb and a
calendar at the back of the book.
 By having the thumb puppet, the child stays motivated to stop the
habit.

105. G. THUMB - HOME CONCEPT : Skinaz
2000
 This is the most recent concept.
 Eliminating chronic thumb sucking by preventing a co-
varying response: “The behavior is believed to lose its
appeal by being reframed as a duty.

106.  Thus, make the child to suck all the ten finger the same
length of time so that it produce unpleasant reaction and
gradually it quits the habit”.
 Forced repetition of the habit will eventually associate it
with unpleasant reaction.

107. H. CHEMICAL TREATMENT
 Bitter and sour
 Very minimal success e.g.
quinine, asafetida, pepper, caster oil etc.
 NEWER anti-thumb sucking solutions
 Femite
 Thumb-up
 Anti-thumb

108. I. REMAINDER THERAPY
 Painting something that tastes yucky on the thumbs can
make them less satisfying.
 Physical barriers like band.
 Aids, gloves etc can also be used.

109. J. THUMB GUARD
 It is an appliance that is worn when the child is tempted
to suck.
 Once the guard is worn they cannot generate vacuum
and so sucking is not much satisfying.
 Another approach is long sleeve gown by doubling the
length of the sleeve.

110.  It makes difficulty for the child to suck.
 While providing remainder therapy the child should be
instructed that these are just to remind them to take the
thumb out and it is not a punishment.

111. K. PARENT COUNSELING
 A different approach that can be practiced when its
known that the child, wants to discontinue the habit, it
requires the cooperation of the parent and their consent
to disregard the habit and not mention it to the child.
 In private conversation with the child, the problem and
its effect must be elicited.

112.  The parents' role in correction is very significant.
 Over anxiety and the resulting nagging approach or
punishment often creates greater tension and
intensification of the habit.
 Thus a change in the home environment and routine
help the child to overcome the habit.

113.  Nagging, scolding or frightening the child should be
avoided since this could cause negativism and tend to
make him resort to the habit.
 From a psychological point of view the child should
make the decision that he doesn't want to do it anymore.

114.  “Parents should not force the preschoolers to break the
habit since they only know the pleasure derived from the
habit but they cannot understand why the habit to be
stopped”.
 Some children practice the habit while watching T.V
especially when there is no other person to take care of
them during day time. So in such case, parents should
spend more time with children during day time

115. Other Extra-oral approaches
a) Thermoplastic thumb (Allen 1992)
b) Alemaran2000 : Long sleeve gown (J Cons)

116. INTRAORAL APPROACHES :
• Mink and Haskell 1991 : Blue
grass appliance
• Pediatric clinics of University
of Kentucky and University of
Louisville
• Six sided roller made of
Telfon attached with 0.045
stainless steel wire soldered
to molar orthodontic bands.

117. • Patient instructed to turn the roller instead of sucking the
digit.
• Patient got a new toy to play with tongue & got
distracted
• Time : 3- 6 months

118.  Location of roller: most superior aspect of palate
 Not in contact with palate
 No obstruction in eating or speech
 Not used in preschool children
 7 – 13 yr age

119. Chris Baker 2000 : Modified blue grass
appliance
4mm acrylic beads
Adv: reduced bulk
Less obstruction, attractive for children
Used in age group 1 ½ - 12 years
Modification:
Attachment with quad helix
Removal time: 6 months after habit cessation

120. QUAD HELIX
 Maxillary expansion
 Posterior cross bite correction
 Alignment of maxillary and mandibular anteriors
 Reminder Therapy

121.  Palatal Crib : Hayrett
1970
 Hayrakes : Korner and
Keider 1955 (Angle
Ortho)
 Spurs
 Triple Loop Activator
(TLA) : Viazis 1991 (Am
J Ortho)
 Tongue connector
appliance (TCA) : Viazis
1993 (Am J Ortho)