My Child is a Thumb-Sucker. Should I Worry?

When people find out that I’m an orthodontist, they often ask me questions about their children’s habits – and specifically about thumb sucking.

Thumb sucking is common among children.  In fact, fetuses are often seen sucking their thumbs when ultrasounds are performed during pregnancy.  At a young age, thumb sucking does not pose a threat to the teeth. However, if thumb sucking continues into later childhood it can lead to orthodontic problems – namely, it can cause the teeth to become crooked, it can affect the growth of the jaws, and can cause severe problems with the bite.  The longer the habit continues, the worse the problems become and the more difficult they are to correct.  So, depending on your child’s age, thumb sucking may be more or less of a concern.

What can thumb sucking do to the teeth?  THIS:

The bite of a 14 year-old thumb sucker – note the extreme mal-alignment and lack of proper bite

So, should you be worried about your child’s thumb sucking habit?

Here is an algorithm to help you decide:

Don’t worry about it. Thumb sucking is perfectly normal at this age, and will not likely result in damage to the teeth or bite

Don’t worry about it.  Thumb sucking is perfectly normal at this age, and will not likely result in damage to the teeth or bite

thumbsucking-ages-_ages 3 - 5

Don’t be overly alarmed, but gently encourage your child to stop the habit, without shaming or pressuring.  If the habit is stopped before age 5, there will likely be no permanent effects on the teeth and bite.  Consider a sour-tasting nailpolish to help the child stop the habit.

thumbsucking-ages-_ages 6 - 9

Thumb sucking at this age will likely affect the teeth and bite, and the habit should be stopped as soon as possible.  Visit the orthodontist to consider a habit-breaking device (see below).

thumbsucking-ages-_ages 9 +

Thumb sucking will lead to severe problems that will require braces, tooth extractions, or even jaw surgery to repair.  Prompt action is required.

What will the orthodontist do?

If your child is over 6 years old and is having trouble stopping the habit (or sucks while sleeping), the best course of action is for the orthodontist to make a thumb-crib appliance.  This appliance consists of a metal mesh which spans the roof of the mouth and is cemented in place.  It is invisible (hidden on the inside of the mouth), and is not sharp or painful.  With it in place, if the child attempts to suck his thumb, it no longer fits comfortably in place.  And because it no longer feels soothing, the thumb sucking habit will stop. The appliance is cemented in place for at least 6-8 months to prevent the habit from recurring.  If the habit is stopped early enough, the damage that it caused to the teeth and bite should largely reverse itself, or be correctable with braces.

Thumb sucking thumb crib appliance
Example shows a Thumb Crib Appliance which is used to help children who habitually suck their thumbs to break the habit.

So whether or not you should worry about your child’s thumb habit largely depends on the age of the child.  Please use the algorithm I’ve provided, and share it with your friends.  The more parents are aware of how and when to treat thumb habits, the better the outcomes will be for their children.

Invisalign from your Dentist: What Could Go Wrong?

As an orthodontist, people are always telling me about their friends who are getting Invisalign, and often it is being done by a general dentist.  Whenever I hear such a story, I mention that I hope the person at least got the opinion of an orthodontist before starting treatment.  And my question usually elicits surprise – what’s wrong with a dentist doing Invisalign?  What could go wrong?

A lot can go wrong, actually. Invisalign is just a tool to straighten teeth and, like any tool, what matters is the skill and training of the user, not the tool itself.  Many people don’t realize that in order to become a certified Invisalign provider, all a dentist needs to do is complete a single, 10 hour course.  That’s it!  And even if dentists take a few continuing education courses in Invisalign, they still have nowhere near the training of an orthodontist, who has trained for over 3000 hours in the use of braces and Invisalign even before graduating!

“Ok”, you might ask, “dentists are not as trained as orthodontists.  But Invisalign is Invisalign, right?  What’s the difference if I get it from my dentist or my orthodontist?”  And the answer is that there is often a huge difference in the quality of the result, depending on who does the treatment.  Because in order for Invisalign to properly correct your teeth and bite, the treatment needs to be planned by a doctor who understands orthodontics.  If not planned properly, the Invisalign will not move the teeth as predicted.  What could go wrong?  Patients can end up with un-esthetic results – protrusive teeth, asymmetric teeth, teeth that won’t fully straighten, etc.  Patients can end up with gum disease, jaw aches, and unstable results.

I’ll give you an example from my own practice.  I recently got a referral from a general dentist who offers Invisalign to his patients.  He had been treating this particular patient with Invisalign for almost 2 years, and he told me that somehow the teeth were just not behaving.  He had taken multiple moldings of the teeth over the years, and asked Invisalign for corrections, but the teeth were just not getting any better.  He hated how his teeth looked, and had difficulty chewing because his back teeth did not bite together properly.  This was how the patient’s teeth looked after 2 years of Invisalign.

Crooked upper teeth.
Slanted lower teeth.
Back teeth don’t touch when biting, patient had trouble chewing.

I told the dentist that this patient would require 1-2 years of braces to correct the problem, and that it was not correctable by Invisalign.  And the dentist was shocked.  He asked me “if this case was not treatable with Invisalign, why did Invisalign accept the case?” And my reply to him was, “because Invisalign is not the doctor, they are just the manufacturer.  They rely on us to tell them what to do, not the other way around.”

And this is what is so crucial to understand about Invisalign –

it is not a magical solution for effortless tooth-straightening.  It requires the skill and training of an orthodontist to tell the Invisalign company how to move the teeth.  Otherwise, the plan that Invisalign generates might not be realistic.

What can go wrong if your treatment is not done by an orthodontist?

You can potentially waste 2 years of your life, thousands of dollars, and end up with a worse problem than you started with, as this patient learned to his dismay.

Look on every street corner and you will find a general dentist with an Invisalign sign in the window.  But if you are hoping to get Invisalign, make sure that you choose an orthodontist.  Because Invisalign doesn’t straighten your teeth.  The doctor using the Invisalign does.  Your dentist is not an orthodontist….even if he does Invisalign.