Malocclusion and Open Bite
Thumbsucking habits affect the natural positions of the tongue, lips, teeth, and jaw. A thumb or
finger inside the mouth misplaces these structures by taking up the space where the tongue, lips,
teeth, and jaw are normally located. If this habit continues over a period of time, it can cause an
open bite or other malocclusion. Often, a person with a severe malocclusion will require orthodontic
treatment and sometimes, even surgical intervention. A malocclusion can even affect the way your
child chews and swallows. When the teeth and jaws are not meeting correctly, your child will develop
an incorrect way to chew and swallow. This can lead to meal time problems and accusations that
have long term negative consequences. (See section under Health Concerns for more information).
The nose has protective barriers to filter and “air condition” the air we breathe. These include cilia
(tiny hairs), turbinates (twisting passageways), and the mucus membrane. When your child
breathes through his mouth instead of his nose, the air is transported to the lungs without the benefit
of these protective barriers. This increases the likelihood of upper airway infections, middle ear
infections, colds and more. Chronic mouth breathing may also alter normal facial growth. Because
the jaw is held in an open posture, dental development is disrupted. Teeth in the upper jaw are
meant to merge with the matching teeth in the lower jaw, fitting together like a puzzle. The intrusion
of the thumb prevents this from happening. This, in turn, leads to malocclusion problems that
orthodontic treatment alone might not be able to correct. Another symptom related to altered facial
growth may be a lack of development of the walls of the nasal cavity. As your child pushes up on the
roof of the mouth, the floor of the nasal chamber is also being pushed upward and reshaped into a
smaller, narrower opening. This can dramatically affect the child’s breathing capacity.
Deformed Hard Palate
High, narrow palates are often associated with sucking habits. The frequency, intensity and duration
of a sucking habit are factors that affect the location and type of damage that can occur to the teeth,
palate, lips, and mandible (jaw). Sometimes the actual bone structure is altered if a child sucks
often, uses excessive force or continues the habit for long periods of time. As the thumb or any other
object presses against the developing bones of the child’s palate, these bones may be molded into
an unnatural “V” shape, rather than the ideal “U” shape.
Since clear, precise speech is dependent upon the ability of the tongue, jaw, and lips to move rapidly
from place to place within the mouth, it is important that they have a convenient resting place (“home
base”). When a thumb, finger, pacifier or other object is inserted into the mouth, it displaces the
natural resting positions of the tongue, jaw, and lips. Even when the thumb is removed, the
structures remain in the incorrect position, creating yet another undesirable habit. Since the tongue
has now learned the “wrong” place to rest, that “wrong” place is where many speech sounds are
produced, leading to such speech problems as lisping, articulation disorders, certain voice
disorders, and overall mumbling and imprecise speech.
Health and Social Consequences
I will share with you a few of the many stories that taught me the advantages of Unplugging The
Thumb… some of what I learned came as a complete surprise to me. I am very thankful that these
patients came to me and shared their medical histories. It enabled me to show others the health and
social consequences of this habit.
- Headaches – I remember Michelle, a five-year-old thumb sucker whose father brought her to my
clinic to eliminate a sucking habit and a lisp. While I was taking the medical history, he said that
Michelle had been diagnosed as having migraine headaches. The headaches occurred almost daily,
and they were accompanied by bouts of throwing up. She had seen several medical professionals,
but no one could find any reason for her headaches. I started her on Unplugging The Thumb
program. She phoned me the next day to report that she had quit sucking her thumb the first day.
This continued for 5 more days and then she came in for her scheduled appointment. Her father
reported that the migraines had completely stopped and that she was symptom free. He said there
had been no other changes in her life, only the cessation of her sucking habit. He stated that there
was no doubt in his mind that stopping the sucking habit had led to relief from the migraines.
- Nutritional deficiencies and extreme pickiness- Brett, age 9 years, was diagnosed with anorexia.
They called me for chewing and swallowing consultation because a nutritionist he had been seeing
was not making any headway. I discovered that Brett had such a strong thumb sucking habit that his
parents had given up on trying to eliminate it. The years of thumb sucking had caused a severe
open bite malocclusion and chewing was extremely difficult for him. When he did eat, it was only
selective foods and very small amounts. When I examined him, I found that he was unable to chew
his food effectively and ended up swallowing large pieces of food as well as a lot of air. This caused
him stomach distress. It was so difficult for Brett to maneuver many foods such as meats that he
ended up avoiding much of the chewing process. Although not consciously aware of it, he began to
eat less and less over time, eventually putting himself at risk. Our first target was to implement
Unplugging The Thumb. He stopped on the first day and completed the program perfectly. We then
were in a good position to provide therapy to help him improve his tongue, jaw, and lips so that
chewing and swallowing could be achieved more easily. Orthodontic treatment was provided and the
combination of factors led to a successful ending to his difficulties.
- Germs – Joey, four years old, was known as a little terror. Not too many kids have been kicked out
of two preschools by the age of four! I was called in to evaluate and treat him in his home. He was
a smiling, sweet boy with a devilish look about him and I immediately liked him a lot. After some
probing, I learned that he had frequently missed going to school due to colds, ear infections, and
other respiratory infections. He was an ardent thumb sucker as well as an active little boy. Because
I treated him in his home, I took the opportunity to observe him playing, interacting with his cat and
dog, and even playing outdoors. What I saw was Joey moving from thumb inside the mouth to
picking up a dirty rubber ball and throwing it to the dog. Then he sat in his sandbox for awhile,
thumb in mouth….a thumb covered with germs galore by then! This was repeated over and over
throughout his day.....touching “germy” items, thumb inside mouth, touching and sucking thumb. I
provided Unplugging The Thumb immediately since his speech problems were directly related to his
sucking habit and subsequent malpositioned tongue and jaw. I never expected the extreme
changes that occurred. Joey’s behavior improved tremendously and his self-esteem soared from
having conquered his sucking habit. He was enrolled in a new preschool and functioned well. He
responded well to speech therapy and progressed quickly. But it was approximately 6 months later
that his parents and I realized that he had not had any respiratory infections, ear infections or colds.
In short, if we remind ourselves that a thumb or finger is often attached to a little girl or boy who
forgets to wash after potty, plays with dirty outdoor toys, crawls around on floors, etc. , then it is no
surprise to us that eliminating the sucking habit will be very beneficial.
Studies have found that interaction in class as well as participation is affected and limited by sucking
behaviors. Some children enter an almost trace-like state while sucking their thumbs or fingers. In
such a state, they are not able to concentrate on subject matter being presented. Another study
found that thumb suckers in first grade were considered less attractive, less happy, and less likable.
And the other children were less likely to choose a thumb sucker for a friend. (Friman and Schmitt,
Thumb Sucking: Pediatricians Guidelines. Clinical Pediatrics 1989) When this is how a first grader is
perceived, it is hard to imagine the damage it can do to the self-esteem of an 8 or 10 year old….or
an adult who never eliminated the problem!
Adult sufferers - Last, I would like to share stories of adults who have emailed or phoned me,
asking for help to eliminate sucking habits. Since they usually lived far from me, and since they were
too old to benefit from Unplugging The Thumb, I created programs as well as I could and worked with
them via internet….. Each of them wished with all their hearts that someone had helped them when
they were younger, before the habit became so entrenched that it invaded every aspect of their
• Mandy is a high school teacher who was in her first year of teaching when she contacted me.
She found it difficult to get through an entire class without sucking her thumb. She became a clock
watcher, waiting for each class to end so she could go hide somewhere “safe” and suck on her
thumb. She said she had no other addictive tendencies and that thumb sucking was her only bad
habit. It interfered with her ability to date and mingle socially. No one had tried to help her when she
was a child and now she was feeling very hopeless about ever being able to stop.
• Katie was a 16 year old who had recently tried to stop sucking her thumb at the
encouragement of her youth counselor, who was a good friend of the family. The counselor
contacted me first because she was very concerned about Katie. She said that Katie’s behavior had
changed, she was unhappy, not sleeping well, and more. I told her to have Katie contact me
directly, which she did. Being a young lady now, Katie had decided that she must stop her sucking
habit if she was going to “fit in” socially and lead a normal life. She did not know where to seek
guidance and had spent the last two weeks trying to stop “cold turkey” on her own. She ended up
staying awake nearly every night, so as to avoid sucking her thumb while asleep. She had done
some research online and realized that she had an abnormal tongue resting posture from the
sucking habit. Katie also worried about that bit of new information. In all other ways, she was a
model child who had never had any other bad habits. Her mother also ended up writing to me,
begging me to help her if I could. I was able to refer her to a colleague who lived near her and she
was able to finally combat her problem. They all agreed that this could have been avoided if the
adults in her life had known years ago that there was a kind method to eliminate her habit.
• Jessica contacted me because the crevice at the base of her thumb began to peel and was
very sore. Also, she said her teeth were “getting worse” and she was becoming very worried. She
was a college graduate in her twenties and had a good job at a bank. She admitted that she sucked
her thumb around her friends, her family, and her boyfriend in spite of a lot of negative attention
from them. She said she’d been allowed to suck her thumb wherever and whenever she wanted
during her childhood, but as an adult her family became intolerant. Now that she was experiencing
pain and dental problems, she was very scared and wanted help. I am not sure about the ending of
this story. I sent a suggested plan of action to Jessica, but never heard back. With some adults, the
habit has been ongoing for so many years and has become so entrenched that perhaps it cannot be