Often babies and children develop a habit of sucking objects to comfort and calm them. They frequently suck dummies (known as pacifiers in the USA), fingers, thumbs or other items like blankets. Eventually, most children grow out of the habit, or stop due to encouragement from their parents. Some children, however, continue sucking as a habit. If they continue to do so as their adult teeth start to grow through (around the age of six), there is a risk that these adult teeth will grow into the wrong position causing them to stick out too far or not meet properly when biting. As a result these children often need dental treatment to fix the problems caused by their sucking habit. Possible treatments to help children break their sucking habits examined in studies in this review include the use of two different braces in the mouth; giving advice and incentives for changing behaviour (known as psychological advice/treatment); applying a bitter, nasty tasting substance to the children’s thumbs/fingers or combinations of these treatments. None of the studies included looked at barrier methods, for example the use of gloves or plasters or withdrawal of dummies.
What was the research?
A systematic review of the evidence to find out the effects of interventions in children to stop sucking habits which are not linked to food.
Who conducted the research?
The research was conducted by a team led by Felicity R. P. Borrie from Dr. Gray’s Hospital in Elgin, on behalf of the Cochrane Oral Health Group. David R. Bearn, Nicola P. T. Innes and Zipporah Iheozor-Ejiofor were also on the team.
What evidence was included in the review?
Data was extracted from 6 randomised controlled trials. A total 252 children participated in the trials.
What did the evidence say?
Use of an orthodontic brace (such as a palatal crib or arch) or a psychological intervention (such as use of positive or negative reinforcement), or both, was more likely to lead to cessation of the habit than no treatment. Most of the trials that compared two different interventions were inconclusive but one study suggested that, of two different types of braces, a palatal crib is more effective than a palatal arch design.
How good was the evidence?
The evidence presented is of low quality due to the small number of participants in the few available studies and problems with the way in which the studies were conducted. There was a high risk of bias across the studies.
What are the implications for dentists and the general public?
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. There is insufficient evidence to determine the effect of other interventions evaluated for the cessation of digit sucking in children. However, although it is not possible to draw definitive conclusions from the data, in the case of a digit sucking habit, given that the use of a bitter tasting substance requires no clinical input, is a non-invasive, low risk procedure, is cheap and can be carried out by parents in the home setting, it is likely to continue as first line of treatment despite little evidence to support it.
What should researchers look at in the future?
Clinical trials should be conducted for cessation of sucking habits using intervention groups that have a psychological input, are provided with an orthodontic appliance or have application of a bitter substance to the digit, all compared with a no-treatment control group. These trials should be well designed and follow the Consolidated Standards of Reporting Trials (CONSORT) statement. This topic was not identified as a high priority topic during the Cochrane Oral Health Group prioritisation exercise and is therefore unlikely to be updated in future.
Borrie FRP, Bearn DR, Innes NPT, Iheozor-Ejiofor Z. Interventions for the cessation of non-nutritive sucking habits in children. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD008694. DOI: 10.1002/14651858.CD008694.pub2.