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Kronicle of Dental Science

Jul-Dec 2017. Vol 2 Issue 1. Pages 25-30

An Original Study
Thumb sucking causing callus formation: An indicator for malocclusion
DR. Saurabh Shekhar, MDS; [1] DR. Ritesh Raj, MDS. [2]

1. Senior resident, Department of Dentistry

2. Professor and Head of Department, Department of Oral and Maxillofacial Surgery
1. Anugrah Narayana Magadh Medical College and Hospital, Gaya, Bihar-INDIA
2. Patna Medical College and Hospital, Patna, Bihar, INDIA

Correspondence: DR Saurabh Shekhar, Senior Resident,

Department of Dentistry, Anugrah Narayana Magadh
Medical College and Hospital, Gaya, Bihar, INDIA.
[email protected]

Keywords: Thumb sucking, Malocclusion, Callus, Children

ABSTRACT malocclusion. Callus was seen in 26% cases

of the 3.1-4 years age group; of which, 94
Background and setting: The sucking of % had finger sucking habit and 97 % of
digits has been considered to affect the them had malocclusion. In the 4.1-5 years
occlusal development and dentition of a group, 12% had calluses; off whom, 87% had
child. When a dentist comes across a child the habit and 87% presented with
with severe malocclusion like over-jet, malocclusion. Off the 250 children in the
posterior cross-bite, anterior teeth age bracket 5-6 years, 8% had callus; 7%
spacing, etc., it is often difficult for
had the digit sucking habit, and 7% had
him to decide if a child has developed a
digit-sucking habit. The presence of a malocclusion.
callus on the finger is indicative of suck Conclusion: The presence of a callus is a
ing off that finger and indirectly definite indication of the digit sucking;
suggests malocclusion. which is an indirect indicator for
Aims and Objectives: To determine the malocclusion.
presence of calluses on fingers of 1000
INTRODUCTION
randomly picked school going children of
this district; and to co-relate it with
The oral habits such as tongue thrusting,
the presence of malocclusion in order to
thumb sucking, etc., can obstruct the normal
counsel or treat the child early and
development and growth of the jaws,
prevent the development of malocclusion in
encouraging the commencement of
his later years.
malocclusion together with the alterations
Materials and Methods: 1000 school in the normal speech patterns and
children (250 in each age group) between 2 swallowing, depending on criteria such as
and 6 years of age, of both sexes, were the intensity, duration, frequency and
randomly picked to observe the presence of facial pattern.[1]
callus on their fingers. They were then
asked about their finger sucking habits There are different phases in the sucking
and finally checked for alterations in habit:
occlusion.
Phase 1: Normal and subclinical sucking
Results: Of the children in the age group
2-3 years, it was found that 24% had The thumb sucking from birth to 3
years. Pacifier or medicaments can be used
calluses and 28% presented with
to treat the malocclusion.
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Phase 2: Clinically significant sucking support. The child fails to answer in the
affirmative when asked about the habit,
3-7 years. Psychological
and the dentist is forced to observe signs
counselling and appliance therapy is
that would indicate finger/ thumb sucking.
required.
The signs he would look out for would be
Phase 3: Intractile sucking an extra clean, wrinkled or red digit, and
calluses. [3]
After 4 years the habit becomes a
psychological problem for the children. This study aims to identify the presence
[2] of calluses on fingers of 1000 school
going children, both males and females
The causes for the sucking habit include
between the ages 2 and 6 years, and with
250 of them comprising each age group;
  The rooting reflex from various schools of the district, and
 The lack of sucking satisfaction to correlate it with malocclusion.
 during eating
 Peer modelling
 Psychological reasons.[3] Materials and Methods:
Digit and dummy sucking habits are examples 1000, otherwise healthy school going
of the non-nutritive sucking habits (NNS). children, between ages of 2 and 6 years;
There are 2 theories that explain this of both sexes; were selected for the
behaviour— learned and emotional. The study.
emotional theory is based on Freud’s
principles and relays NNS to the oral phase After abiding by the local and ethical
of child’s development. If this habit guidelines, the children, in the presence
continues further than the oral phase of of their parents, who were asked to sign
development then it has become a addiction the patient consent form; were examined
and if a child returns to NNS at a later for calluses on their digits.
stage this is sign of relapse. The end Criteria for selection included:
results, fixation and regression are
considered to indicate emotional  Only those patients with the chief
disturbance.  complaint of malocclusion
 Only those patients in the age
The learned behaviour theory states that range of 2-12 years, verified by
NNS is a channel for an excess sucking their date of birth, as confirmed
urge because of effective feeding and this from the patient and/or parents.
theory has been proved by ultrasound
picture of fetuses in-utero. This theory The observations were tabulated on an
had gained favour in earlier days. [4], excel sheet. The children/parents were
[5] asked about the digit sucking habits which
was also tabulated. Using a mirror and
Finger sucking can lead to problems such as probe, any alterations in occlusion such
psychological; and malocclusion. The various as open bite, posterior cross-bite etc.
malocclusions that occur, include, anterior was examined in each child and noted in
open bite, retruded and crowded mandibular the same excel sheet. Graphs were plotted
incisors, flaring incisors, posterior cross- using the above values.
bite, increased over-jet, anteriorly
displaced maxilla and retruded mandible. The
exact age at which the habit should be Results:
stopped so as not to affect the
permanent dentition, is still controversial. The results showed that out of the 250
Many of these conditions self-correct, if /1000 children, per 4 age groups, maximum
there are no co-habits such as tongue malocclusion (25%) was seen in 3.1-4 years
thrusting, lip biting, etc.; and the habit age group and they presented with the
discontinues before the permanent teeth maximum sucking habit (24%). Callus
eruption. The clinician must look out for formation was seen in 26% of these
the digit sucking habit if the child suffers children indicating the positive co-
from maxillary over-jet with incisor spacing relation between the 3 factors; namely the
and with no mandibular incisors for lingual callus formation, finger sucking habit and
malocclusion.
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1000 children Habit Callus Mal Occ

2-3 years 53- 60- 52-
3.1-4 years 61- 65- 63-
4.1-5 26- 30- 26-
5.1-6yrs 18- 20- 17-

TABLE 1: Age wise distribution of the children of ages 2 to 6 years, divided into
different groups showing the distribution of the presence of callus, digital sucking habit
and the malocclusion as a consequence of it.

TABLE 2 Age wise distribution of the children of age groups 2 to 6 years, divided into
different age groups, showing percentage distribution of the presence of callus, digital
sucking habit; and malocclusion as a consequence of it.

1000 children Habit Callus Mal Occ

2-3 years (53)21.2% (60)24% (52)20.8%
3.1-4 years (61)24.4% (65)26% 63(25.2%)
4.1-5 (26)10.4% (30)12% (26)10.4%
5.1-6yrs (18)7.2% (20)8% (17)6.8%

FIGURE 2: Overjet related to thumb-sucking

FIGURE 1: Callus on thumb
 29

Graph 1: % age wise distribution of the habit (digit sucking); callus: and malocclusion in
various age groups.

TABLE 3: %age wise distribution of habit (digit sucking); callus: malocclusion in males

and females of various age groups.

Graph 2: Distribution of the habit-finger sucking; callous on finger; and malocclusion;

out of the 250/1000 children divided into different age groups
 30

Graph 3: %age wise distribution of habit (digit sucking); callus: malocclusion based on
the total number of males and females classified into each age group.

1000 children Habit Call Habit Callus Mal Occ

2-3 years 88% 100% 87%
3.1-4 years 94% 100% 97%
4.1-5 87% 100% 87%
5-6yrs 90% 100% 85%

Table 4: The presence of callus on the fingers (100%) is an indication of presence of a

digit sucking habit(94% in age group 3.1 to 4 years and 87% in 4.1 to 5 years) and the
patients have supporting malocclusion (97% in 3.1 to 4 years and 85% in 5-6years), too.
This observation proves that the callus on the fingers of a child could be an indicator
for malocclusion.

94% in the age group 3.1 to 4 years, had The role of digit sucking to malocclusion in
the highest presence of a co-existing 1258 children with an age range of 3-12
digit sucking habit, among those who years was studied by Thomson and Popovich
exhibited calluses; and 85% in the 5.1 to and they observed that 462 (36.72%) children
6 years had the least co-relation between had sucking habits. Bowden, in his
the presence of callus and malocclusion. longitudinal study on effects of digit
sucking in 116 children between the ages of
DISCUSSION 2 and 8 years found a higher tendency of
malocclusion in cases where the habit
Sucking habits during the primary dentition
persisted. Larsson found in his studies,
period are reported to have limited harmful
anteriorly placed maxilla and proclination
effects. Whereas, when a child engages in
of upper anteriors in relation to digit
non-nutritive, protracted
sucking. [6] Thumb sucking resulted in a
sucking habit, it often causes malocclusion.
major reduction in mandibular molar arch
The ensuing malocclusion is characterised by
depth and inter-canine width when compared
proclination and spacing of the maxillary
with finger sucking in a study by Yemitan T
anterior teeth and the retrusion of
A, et. al. (2010). There was no
mandibular anterior teeth, narrow and high
statistically significant association
arched maxilla together with an anterior
between duration of digit habits and changes
open bite. Almost all children who have the
in dental arch depths. In addition, some
habit of sucking their thumb, have an
changes in the dental arch parameters
anterior open bite but the converse is not
persisted well beyond the cessation of the
true [6] The habit of sucking objects
digit habit. [7] After finding a strong
especially the fingers begins at birth and
association between sucking habits and
continues till about 3 years of age. Peer
malocclusion in deciduous dentition, Katz et
pressure at school, then causes the
al. emphasized the need for longitudinal
discontinuation of the habit. In some cases,
studies to better support the clinical
the habit fails to stop, and in such cases,
decisions. Few longitudinal studies
the treatment should be started; between 4-6
associating malocclusion and sucking habits
years of age. [2] The differences in
in children until 30 months of age were
malocclusion are dependant more on the
found in the literature.[8] Our study showed
extent rather than the force of the habit.
Thumb sucking causes the direct pressure on a 31% thumb sucking habit among 145/250
the teeth with a shift in the pattern of males in the age group 2-3 years; and a 7.6%
resting lip and cheek pressure. [6] in females among 105/250 of them. Callus was
seen in 34.5% males and 9.5% females;
malocclusion was observed in
 31

18.6% males and 23.8% females. In the 3.1-4 3. Julia A. McMillan, Ralph D. Feigin,
years age group; 40.9% of the 115/250 males Catherine DeAngelis, M. Douglas Jones.
had the habit as 9.6% of 135/250 females; Chapter 27. Oral Problems. Pages 785-786.
callus was seen in 41.7% males and 12.6% Oski's Pediatrics: Principles & Practice.
females; malocclusion in 40% males and 12.6% Edited by Lippincott Williams & Wilkins,
females. In the 4.1-5 years age group 9.7% 2006 - Medical - 2808 pages
males out of 134/250 cases and 11.2% out of
116/250 females had the habit, callus was 4. R S Levine. Briefing paper: Oral
seen in 9% males and 15.4% females, aspects of dummy and digit sucking.
malocclusion in 3.7% males and 18.1% British Dental Journal. 1999; 186: 108
females; in the 5.1-6 years age group 4.6%
5. Borrie FRP, Bearn DR, Innes NPT,
males had habit and 10% females, 10% males
Iheozor-Ejiofor Z. Inter ventions for the
and 5.9% had callus, and 6.9% and 6.7% had
cessation of non-nutritive sucking habits
malocclusion. Therefore the observation of
inchildren. Cochrane Database of
the callus on the digits was seen in both
Systematic Reviews 2015, Issue 3. Art.
male and female children with habits and on
No.: CD008694. DOI:
clinical examination they presented with
10.1002/14651858.CD008694.pub2.
malocclusion that varied in severity.
6. Singh S P, Utreja A, Chawla H S.
Distribution of malocclusion types among
CONCLUSION
thumb suckers seeking orthodontic
Most parents are unaware of the harmful treatment. J Indian Soc Pedod Prev Dent
oral habits and their consequences. It is 2008; 26, Suppl S3:114-7
the dentists’ duty to inform the parents
7. Yemitan TA1, daCosta OO, Sanu OO,
of the detrimental effects of these
Isiekwe MC. Effects of digit sucking on
deleterious habits and the suspected
dental arch dimensions in the primary
psychological bases that have been
dentition. Afr J Med Med Sci. 2010 Mar;
implicated in their causation. Malocclusion
39(1):55-61.
is difficult to be identified in their
initial stages. Hence unearthing of the 8. Suzely Adas Saliba Moimaz, Artênio José
callus on the children’s fingers could be Ísper Garbin, Arinilson Moreira Chaves
used as a marker for an existing or Lima, Luiz Fernando Lolli, Orlando Saliba
impending malocclusion. and Cléa Adas Adas Saliba Garbin.
Longitudinal study of habits leading to
malocclusion development in childhood. BMC
Oral Health. 2014; 14: 96
Competing Interest: The author has no
competing interest regarding the article.

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