Main

Silva M, Manton D. J Dent Child (Chic) 2014; 81: 133–139

Silva M, Manton D. J Dent Child (Chic) 2014; 81: 140–146

These two related papers explore the effects of sucking and other habits, on the orofacial structures of children.

Both nutritive and non-nutritive sucking can be associated with a child showing an anterior open bite and posterior crossbite. Breastfeeding may be associated with a less severe malocclusion compared with sucking a nursing bottle. The teat of the nursing bottle displaces the tongue anteriorly, and the teat is sucked with a 'pistonlike' action.

Ideally, non-nutritive sucking should stop by 3 years of age when any malocclusion will resolve spontaneously; if non-nutritive sucking extends beyond six years of age, spontaneous correction is unlikely. Sucking a pacifier, with its classical symmetrical open bite, has a greater impact on the occlusion than digit sucking. If rewards and positive reinforcement, tastants and thumb guards fail, there are several corrective appliances; but rakes and spurs belong to a bygone age. An intriguing appliance is the Bluegrass appliance. This contains a distractive toy such as a bead that can be rolled by the tongue. Of note, the use of pacifiers facilitate more rapid transition to oral feeding in pre-term infants. They are also associated with decreased risk of sudden infant death syndrome.

Several factors may be associated with persistence of tongue thrusting (an immature swallowing pattern), such as enlarged tonsils, use of pacifiers, and learning difficulties. Exercises may raise awareness and avoidance of the habit.

Self-injurious behaviour of the oral tissues is managed as following: if minor, then psychological counselling, but for those with learning disabilities, then a pharmacological approach may be more appropriate. Only when it is carried out 'unknowingly' and is severe such as those with Lesch-Nyhan syndrome, should extraction of teeth be considered.

Nasal breathing is associated with the classical adenoid facies (including mandibular retrusion, increased anterior facial height, narrowing of the nostrils and lip incompetence). Again, nasal breathing could either be the cause or as a consequence of the craniofacial abnormalities. Treatment would appear to range from invasive intervention, to prevention of dental diseases associated with 'increased evaporation of saliva and drying of the mouth'.

The cause and management of bruxism in children would appear to be as imprecise as it is for adults. Bruxism has been reported in children with cerebral palsy.