Author: Adam R. Pershing, DMD

Thumb sucking is a damaging habit that can cause tooth and surrounding skeletal structures to develop abnormally as your child grows. If your child has a persistent thumb sucking problem past the age of four to five, thumb and finger appliances, or thumb sucking appliances, can help your child stop this habit.

There are a variety of appliances available, each one different from the other, and they all do the same thing: they prevent your child from placing their thumb into their mouth. Over time and with consistent wear, your child’s thumb sucking days will be over.

Types of Thumb Sucking Appliances

There are five types of thumb sucking appliances available to your child. Choosing one just depends on the severity of the habit and what will work best for your child. These types include:

• A removable appliance can be removed and replaced in the mouth at any time. This appliance will only work if your child constantly wears it as instructed. A child who does not want to stop their thumb sucking habit will more than likely remove the appliance often. Because of this, the success rate of removable thumb sucking appliances is quite low. However, a great advantage to this type of appliance is that it can be removed before eating and thorough cleaning of the teeth and gums can continue without it inserted.
• A fixed appliance cannot be removed from the mouth at will. Thumb suckers will have no choice but to break their habit. However, since they cannot be removed, eating, speaking, and thoroughly cleaning your child’s teeth and gums will be a little more challenging.
• A thumb crib uses a sort of cage or fence that rests just below the roof of your child’s mouth. Thumb crib appliances work by preventing the pressure and sucking sensation at the roof of the mouth. Without the comforting stimulus that comes with thumb sucking, the habit is deemed useless by the wearer over time.
• A bluegrass appliance involves a roller, which is placed at the front half of the roof of the mouth. Instead of sucking their thumb, your child is given the alternative of turning the roller over with their tongue. This device is based around positive reinforcement and is less aggressive. It can be placed in children as young as six or seven years old.

How long should my child use this device?

The appliance can be used to break a thumb sucking habit until it stops altogether, but it also needs additional use after the habit breaks. This is to ensure that the habit does not promptly return. Typically, for children with mild to moderate thumb-sucking habits, it is worn for around three to six months. A persistent thumb sucker may need to use the appliance for a year.

Benefits of Thumb Sucking Appliances

More than just breaking the habit of your child sucking their thumb, there are other great benefits to using this appliance.

• Allows proper development of the upper jaw and front teeth: Thumb sucking constricts the upper arch, flares the upper teeth, and tips the lower teeth back.
• Increased confidence and self-esteem: Thumb suckers are often embarrassed of the act of thumb sucking and of the physical changes it does to their teeth and bite.
• Easier to speak and eat: The changes in the position of a thumb sucker’s teeth make it challenging to speak and bite into food. Your child may be self-conscious about smiling, speaking, and eating in public.

It is important to be prepared for when a minor or major orthodontic emergency occurs. If you find yourself in a situation where you are unsure if you need urgent medical attention, you will need to first assess the severity of the problem. Dislodged, fractured, or knocked-out teeth usually require urgent attention. With minor emergencies, the problem is usually just an irritant and can be tended to at home until you can schedule an appointment with your orthodontist.

Minor Emergencies

The following are common minor orthodontic emergencies that can be treated at home until you can see your orthodontist:

Loose or Broken Brackets, Bands, or Wires

You can experience discomfort with your braces if you do not follow your orthodontist’s instructions. Eating foods that can easily damage or alter braces can result in loose brackets, bands, or wires, which can ultimately lead to breakage. This type of malfunction can result in your hardware poking the inside of your mouth, causing painful irritation or other types of injuries. Placing orthodontic wax over the hardware problem will temporarily relieve your discomfort until you can see your orthodontist.

Wire, Tie, or Bracket Shifts from its Proper Position

As you talk and eat food normally throughout the day, your braces will slightly adjust on their own. However, if an archwire or other hardware component significantly deviates from its proper position, it can poke the inside of your mouth and cause discomfort. You can use tweezers to adjust the hardware temporarily, so that you can eat and speak normally until you are able to see your orthodontist.

Severe Tooth Pain or Loosening

Some discomfort is normal when it comes to the shifting or loosening of your teeth as your braces do their job. Over-the-counter pain relievers and anti-inflammatory medications can help decrease the pain. However, it’s important to recognize when your discomfort far exceeds what is normal. High impact, such as by a sports or vehicle accident, against your braces and teeth can cause severe pain. You will need to see your orthodontist as soon as you can so they can re-strengthen your teeth and maintain your treatment timeline.

Broken Retainers

Retainers are important for the longevity of your post-treatment routine and they are very fragile. If it ever breaks or bends in a strange way, visit your orthodontist for a repair or replacement.

Swallowing Part of Your Equipment

Though this is a less likely occurrence, swallowing an appliance can still happen. If your retainer has broken into small pieces in your mouth, it’s possible to accidentally swallow it when you’re sleeping or not paying attention. In most cases, the bit of your retainer will pass through your digestive system without harm. However, if you are choking or finding it hard to breathe, you will need to go to the emergency room immediately.

Major Emergencies

If you have sustained a high-impact blow to the mouth and are experiencing severe bleeding and pain, you will need to go to the hospital immediately. The emergency room may not have the expertise or equipment you need to repair your braces; however, you should still go if you’ve also sustained trauma to your neck or head. After you’re cleared to leave the emergency room, visit your orthodontist as soon as possible to repair or replace any damage done to your braces.

Early orthodontic treatment, also known as interceptive orthodontic treatment, is used to prevent future orthodontic issues. Between the ages of seven and 14, the teeth and jaw are still developing, making them more malleable for effective interceptive orthodontic treatment. Sometimes patients as young as seven years old are able to begin orthodontic treatment, though their candidacy depends on specific conditions of their mouths.

Is your child a candidate for early orthodontic treatment?

To determine if your child is eligible for early orthodontic treatment, we recommend visiting the orthodontist at age seven. The earlier problems are caught, the better your child’s oral health will be in the future.

Your child must have at least one of the following conditions in order to be considered for early orthodontic treatment:

• Crowded teeth: When a child’s jaw is too small, the result is severe dental crowding, where some or all of their teeth overlap.
• Gapped teeth: Excessively spaced teeth. A gap in the upper front teeth is the most common type an orthodontist sees.
• Underbite: The lower front teeth overlap the upper teeth as a result of the lower jaw being pushed forward.
• Jaw irregularities: An unusual jaw size or narrow dental arch.
• Crossbites: When the jaw shifts to one side.
• Thumb or pacifier sucking: Long-term thumb or pacifier sucking has affected the teeth or jaw growth.
• Mouth breathing: If your child only breathes through their mouth, it can cause crooked teeth, facial deformities, or poor growth.
• Extra or missing teeth: Orthodontic treatment will need to be adjusted accordingly. For extra teeth, extractions may be necessary.

Types of Early Orthodontic Treatment

Palatal Expanders

When the jaw has formed abnormally and is not wide enough for permanent teeth to erupt, this device expands the jaw over time to create more space. A wider jaw allows your child to receive more effective and quicker orthodontic treatment, by means of clear aligners or traditional metal braces. This device is also useful for children with a narrow palate; it helps align the upper teeth and jaw. Other common conditions where a palatal expander may be needed include impacted teeth, crossbites, dental crowding, and breathing problems. Palatal expanders can only be used on younger children since their jaws are still developing.

Traditional Braces

An orthodontist’s go-to for orthodontic treatment, traditional braces are commonly used in instances of misaligned teeth, crooked teeth, or other bite problems. While this equipment is reserved for patients between ten and 14, some children younger than ten might need traditional braces if they have severely overcrowded teeth, an underbite, gapped teeth, or missing teeth.

Headgear

This device may be necessary if your child’s jaw is severely misaligned. It is used together with braces and is secured around the head and face with a neck strap. It’s important to note that braces are only capable of correcting teeth positioning. Headgear encourages proper jaw growth. There are three common types of headgear:

• Cervical pull for overbites and underbites
• Reverse-pull for underbites and crossbites
• High pull for open bites

Clear Aligners

Also known as invisible braces, clear aligners have steadily grown in popularity over the years because they are removable, hard to see, and comfortable to wear. While usually meant for adults, some younger children can use them if they still have baby teeth.

Clear aligners are a popular and effective way to straighten teeth – without the look or hassle of traditional braces.

Just like traditional braces, clear aligners put a small amount of pressure on the teeth to move them into place. Unlike traditional braces, they are made of a clear and completely removable plastic that you can take out during eating, brushing and flossing, or important events.

Clear aligners are made from digital molds of your teeth. A tray is made from the digital mold of your current teeth, with changes that target misalignment. Typically, you wear one aligner for one to two weeks until you advance to the next one. Each week, your aligner moves your teeth incrementally until you reach your perfect smile.

Clear aligners are best for minor misalignment of the teeth, while traditional braces might be better if you have severe misalignment, gaps, or bite issues.

Clear aligners for teens feature two elements especially made for their needs:

• Eruption tabs that make room for teeth that haven’t fully grown in yet.
• Compliance Indicators that track how often the aligner is being used. It must be used for 22 hours a day, or treatment will be affected.

Benefits of Clear Aligners for Teens

• A discreet look

Not only do clear aligners have a discreet look in the day-to-day, you are also free to take them out for prom or other special events.

• Easier for contact sports and playing an instrument

Both traditional braces and clear aligners can be affected by impact from contact sports, which can set back treatment. Conveniently, clear aligners can be removed before contact sports to avoid any potential issue. If desired, they can also be removed before playing an instrument.

• No food restrictions

Since clear aligners must be removed before eating, there are no food restrictions to what you can eat during treatment.

• Maintaining oral hygiene is easier

Clear aligners are removed before brushing and flossing, which make maintaining oral hygiene almost the same as before treatment. The main difference is that it is important to brush after eating, including lunch. If food is stuck in teeth, aligners won’t fit back in.

• Appointments are faster, easier, and never an emergency

Because there are no wires or brackets, if the aligner is damaged, you won’t need an emergency visit. Since aligners don’t require adjustments like traditional braces, appointments take less time. Appointments will be quick and occur every six to eight weeks.

Ensuring Your Teen’s Success

It’s important to keep a few things in mind while you are going through the clear aligner process.

• Compliance is key.

It’s important to wear your aligner for the majority of the day and night. Taking your aligners out too much or for too long will stall treatment.

• They can get lost.

At your appointment, you will be given a case to store your aligner while you brush, play a sport or instrument, or eat. They can easily get lost and accidentally thrown away if you’re not careful.

• The aligners must be cleaned regularly

It’s important to clean your aligners, and can do so with a brush and toothpaste, or with a denture cleaner solution.

• It’s especially important to maintain your oral hygiene

Aligners will push any food further into teeth and gum line, so it’s important to brush and floss after every meal.

Knowing what to expect after your first orthodontic appointment will help alleviate any anxiety or concerns you may have about treatment. Your orthodontic team will do what they can to help you feel at ease, such as answering all your questions and discussing possible financing options.

What happens at the initial appointment?

• Introductions: Getting braces for the first time can be daunting, so it’s important that proper introductions are made to help ease anxiety. You will meet with your orthodontic team; they will do everything they can to make sure you’re comfortable.
• Paperwork and health history: A team member will ask you to fill out paperwork regarding your relevant health history. It also informs your orthodontic team if you’ve had X-rays in the past or any previous oral issues you may have experienced.
• Exam and X-rays: During a thorough examination of your teeth, an orthodontic team member will use advanced 3D scanning, X-rays, and visual inspection. This helps them understand the unique needs of your teeth to build an effective treatment plan.
• Treatment plan: Generally, there may be a few orthodontic treatment options available to you. Together with your team, you will decide which plan works best for you. This can even be based on budget, predicted results, and treatment length.
• Patient questions: Once a treatment plan has been chosen, you will be given the floor to ask any and all questions. Your orthodontic team wants to make sure you have a solid understanding of what to expect in the next coming months, so questions are highly encouraged in order to address concerns and alleviate anxiety.
• Finances: A team member will review your insurance and discuss the payment options for your treatment. Some orthodontic offices offer flexible financing options or payment plans to help make costs more manageable.
• Your next appointment: Once your first appointment is completed, a team member will schedule your following appointment to put your treatment plan into action.

Orthodontic headgear is used to correct a severely abnormal bite, correct dental overcrowding, and support normal jaw alignment and growth. It is typically recommended for younger children whose jaws are still developing.

Types of Orthodontic Headgear

Whereas braces are permanently fixed on the teeth, headgear can be removed and is worn partially outside the mouth. Depending on the patient’s needs, there are three types of orthodontic headgear your orthodontist can choose from:

Cervical Pull

This type of headgear is used to correct a malocclusion called an overjet, which appears as a protruding top jaw and front teeth. This device can also correct overbites, which is when the top and bottom teeth don’t meet properly. Cervical pull headgear uses straps that wrap around the neck and attach to the braces in the mouth.

High Pull

This type of headgear corrects an overjet or overbite. Straps are attached from the upper jaw to the top and back of the head. This device is also used in children with excessive jaw growth in the back of their mouth.

Reverse Pull

This type of headgear is used for underdeveloped upper jaws or underbites. When the lower teeth jut out past the upper teeth, it results in an underbite. This device uses rubber bands to attach to braces on the top teeth.

Using Orthodontic Headgear

It is vital to follow the orthodontist’s instructions when using headgear. Successful treatment can only be achieved if the device is worn anywhere from 12 to 14 hours a day, sometimes longer. A strict routine is important, for even small lapses will inhibit the rate of treatment. In total, headgear may be required anywhere from one to two years.

Orthodontists understand that wearing such a device in public may be embarrassing. That is why they recommend wearing the headgear promptly after school, through the rest of the evening, and overnight.

Discomfort is normal, especially when using headgear for the first time. At each visit, the orthodontist will adjust the headgear, and it could feel like there is more pressure being applied on the jaw. This sensation is very temporary. If discomfort does not lessen, over-the-counter pain medication may be taken to relieve pain. Additionally, cold foods such as popsicles may provide some relief.

What is an orthodontist?

Orthodontists are dental specialists who diagnose and treat problems with the position, alignment, and spacing of the teeth, and related irregularities in the face and jaw. They provide and maintain oral appliances like braces.

When would I need an orthodontist?

Orthodontists treat bite problems and teeth misalignment. Treatment will not only improve functioning of the mouth, but also leave you with a great smile.

How do I know if I need orthodontic treatment?

There are two main reasons to seek orthodontic treatment: bite problems and teeth misalignment. Teeth that are protruding, erupting out of position, or overcrowded are common indications that treatment is needed. Less obvious signs include mouth breathing, frequent biting of the cheek or palate, speech difficulties, and thumb sucking that goes past the age of three to four years of age. Other signs of orthodontic problems include jaw clicking, and your teeth not meeting when you close your mouth.

When should I start treatment?

It’s never too late to start orthodontic treatment, but starting early can make treatment faster and easier. The American Association of Orthodontists recommends that a child who may need orthodontic treatment should come in for a first visit around age seven.

Do braces hurt?

Some people experience minor aches and pain in the first few days after they get braces. Braces are periodically adjusted, which can cause soreness and typically lasts a few days. Over-the-counter pain relievers can help, but are usually unnecessary.

How long does treatment take?

Treatment differs for each person, but most commonly lasts between six months to two years. After the braces come off, a retainer must be worn for an additional several months.

How often do I need to come in for an appointment?

Appointment frequency varies from person to person, but typically ranges from every four to ten weeks.

Will I need to have any teeth extracted?

In cases of severe crowding (where the mouth isn’t big enough to hold all the teeth) or in the case of an impacted tooth (where a tooth is trapped beneath the gum line by other teeth), an extraction may be necessary. In the case of younger patients, early treatment may make extraction unnecessary.

Will I have to watch what I eat?

Yes. You might need to avoid some foods because they can damage braces; you will be given a list when you start treatment. For example, sticky foods like caramel and taffy should be avoided, as they might cling to the metal and wires in your mouth.

Will I be able to play sports/play my instrument?

Yes, but there are some things to consider. Because you might experience pain right after getting braces or getting your braces adjusted, it might take a couple days before you can play your instrument. As always, we recommend wearing a mouthguard while playing most sports.

Do I still need to see my regular dentist while I’m getting orthodontic treatment?

Definitely. With braces, it’s more important than ever to take care of your oral health, as it’s easier for food to collect between teeth and plaque to develop.

Will I need to wear a retainer after my braces come off?

Wearing your retainer is an important part of orthodontic care and helps to make your new smile permanent. If this step is skipped, teeth can shift out of place.

Is orthodontic treatment expensive?

Orthodontic care is a long-term investment in your health and well-being. There are financing options that can make orthodontic care affordable.