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 Table of Contents  
Year : 2016  |  Volume : 1  |  Issue : 1  |  Page : 15-18

Association of nonnutritive sucking habits and malocclusion: A cross-sectional study

Department of Pediatric Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India

Date of Web Publication7-Sep-2016

Correspondence Address:
Deepa Guruanthan
Saveetha Dental College, Chennai, Tamil Nadu, India
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Source of Support: None, Conflict of Interest: None

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Aim: The aim of this study is to determine the relationship between nonnutritive sucking habits (NNSHs) and development of malocclusion. Objective: The objective of the study is to assess the association of NNSHs and malocclusion. Materials and Methods: A total of 400 children between the age group of 3-6 years were examined for the presence of NNSHs, and factors that influence the habit were assessed through a questionnaire that was distributed to the parents of all the children and their oral cavity was examined for the presence of malocclusion. Results: Out of the 230 children who took part in the study, 61% of them showed the presence of a digit-sucking habit. Factors such as parent's education, socioeconomic factors, and duration of breastfeeding had a positive influence on NNSH. It was found that 58.1% of digit suckers showed the presence of malocclusion. Conclusion: Digit-sucking habits were found in three-fourth of the children and found a significant association between NNSH and malocclusion.

Keywords: Children, habits, malocclusion

How to cite this article:
Ramesh N, Guruanthan D, Karthikeyan SA. Association of nonnutritive sucking habits and malocclusion: A cross-sectional study. Int J Pedod Rehabil 2016;1:15-8

How to cite this URL:
Ramesh N, Guruanthan D, Karthikeyan SA. Association of nonnutritive sucking habits and malocclusion: A cross-sectional study. Int J Pedod Rehabil [serial online] 2016 [cited 2019 Nov 12];1:15-8. Available from: http://www.ijpedor.org/text.asp?2016/1/1/15/189966

  Introduction Top

Normally developed infants have an inherent, biological drive for sucking. This need for sucking can be satisfied either through nutritive sucking, including breast- and bottle-feeding, whereby the infant obtains food or through nonnutritive sucking on objects such as digits, pacifiers, or toys that may serve primarily to satisfy psychological needs. [1]

Habits are acquired automatisms, represented by an altered pattern of muscle contraction with complex characteristics, which proceed unconsciously and on a regular basis. [2] Some habits occur in the oral region and may have harmful effects on health; promoting changes in dental, bone, and muscle tissues; and their development being determined by intensity, frequency, and duration of inappropriate pressure. [3]

The craniofacial growth and development, including muscles, bones, and teeth, has been investigated by scientists over the last years. Based on the functional matrix hypothesis of Moss and Salentijn, [4] one can infer that the breastfeeding process would work as a matrix that provides the biomechanical stimuli ideally necessary for craniofacial development. [5],[6] Conversely, nutritive and nonnutritive suction and oral breathing would also work as inadequate functional matrices, misshaping the bone, and muscle structures that will form the dental spaces. [7] In this context, as teeth erupt and get in contact with all the relations already established, visible and transitory or permanent alterations start to appear. These alterations end up causing bone and muscle disorders and malocclusion in children. [8],[9]

Malocclusion is a disorder affecting normal development of the occlusion and has a multifactorial etiology. Factors such as socioeconomic status and parents education have been associated with higher prevalence of nonnutritive sucking habits (NNSHs) which lead to malocclusion. [10] The objective of this study is to assess the influence of factors such as parents education, birth rank, socioeconomic status, duration of breastfeeding on NNSHs, and the effect of these habits on dentition.

  Materials and Methods Top

A cross-sectional survey was conducted through a questionnaire and clinical examination. The sample size was determined using open Epi software 2.1.3 version (Centres of disease control and prevention, georgia, USA), with power of 80% and confidence interval level 95%. The estimated sample size was 230. Ethical approval to conduct the study was given by Saveetha University, Chennai (SRB/STUG15/42). The study included 400 children, out of which 230 children had NNSH. The questionnaires were distributed to the parents of all these children. The questionnaires included a written informed consent form that was filled by each parent. The exclusion criteria included children with any kind of chronic illness and disability. The questionnaire included questions on parent's education, socioeconomic status, duration of sucking habits, birth rank, child's previous or persisting sucking habits, methods used to intervene, and duration of breastfeeding. The assessment of malocclusion was done in children with both primary and mixed dentition. All the examinations were done by one examiner using mouth mirror and pen light. The assessment of malocclusion involved the following parameters of degree of overbite, amount of overjet, and posterior crossbite. Intra-examiner reliability was assessed at 15-day interval and had a kappa value of 0.8. The data were collected over a period of 3 months. Data entry was done in SPSS version 18 (IBM corporation, Chicago, US) and statistical analysis was performed. Chi-square analysis was used to analyze the association of NNSH and malocclusion.

  Results Top

A total of 230 children participated in the study, of which 57% were boys and 43% were girls. Of the 230 questionnaires distributed to the parents of children who were part of the study, 61% of the parents found that their child had a digit-sucking habit while 21% of the parents found that their child had a dummy-sucking habit. Fifteen percent of the parents found that their children used other objects for sucking apart from digit or dummy objects while 3% have noticed that their child possess both digit- and dummy-sucking habit. This is illustrated in [Figure 1].
Figure 1: Distribution of the nonnutritive sucking habit

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It was seen that 73.9% of the children had 2-5 h duration of sucking habit while 18.3% had duration of less than an hour and 7.8% >6 h. The duration had much a significant relationship with the prevalence of the habit as shown in [Table 1].
Table 1: Association of the habit and breastfeeding to malocclusion

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In the present study, it is seen that 33.8% had malocclusion when breastfed for 1-2 years while 66.2% were found with the presence of malocclusion with a breastfeeding duration between 0 and 1 year as shown in [Table 1].

According to this study, it is seen that 17.8% of the children with digit sucking had parents with middle school level of education and 47.4% of the digit suckers were found to belong to the lower economic status of the society as illustrated in [Table 2].
Table 2: Distribution of the socioeconomic status, education of the parents, birth order of the child to the type of habit

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  Discussion Top

The study was based on parent's opinion on their child's NNSHs and a clinical examination of the child. Hence, the questions were addressed to the parents of the children who were examined. NNSHs have aroused considerable interest because of their association with dental occlusal disorders and the child behavior as a whole. Knowledge about the factors associated with the development and persistence of these habits is of paramount importance. [11]

Studies show that participants had a higher frequency of finger sucking in relation to other objects or the pacifier [12],[13] since the finger is always more accessible than the pacifier. [14] The present study also shows that digit sucking is more common than dummy sucking as children also have easy access to their fingers and these children are usually not exposed to pacifiers.

It was reported that in the district of Baghdad, the percentage of children having increased overjet, overbite, openbite, and crossbite is higher in the group having NNSHs. [15] This was in accordance with the present study which showed an increased presence of malocclusion in children with an NNSH.

The findings of a study done by Wareen et al. (2002) [16] indicated that longer the duration of the NNSH, higher was the prevalence of malocclusion in children with mixed dentition. However, the present study did not show any statistically significant association of duration of sucking and malocclusion. This can be attributed to the smaller sample size and poor memory of the parents on the exact duration of sucking.

A study conducted in Pune suggested that a reduced duration of breastfeeding leads to the child's indulgence in various NNSHs, and disturbance of orofacial equilibrium takes place which has been associated with various malocclusions. [17] This is in accordance with the present study which shows that longer the duration of breastfeeding, lower is the prevalence of malocclusion.

A study by Larsson [18] showed results in accordance to the present study which reported no significant relationship between the child's birth rank and the NNSH.

In a study conducted in Saudi, it found that the association of parent's education and the NNSH showed that the higher the level of parents' education, the greater was the probability that the child was a dummy sucker and the findings of digit sucking did not show significant association between the level of parent's education and the prevalence of the habit. [19] The present study showed that parents with middle school education showed greater prevalence of digit-sucking habits and this can be due to the fact that they have noticed the habit more.

The results from previous studies show that family income did not predict digit- or dummy-sucking habits. [20],[21],[22] This in contrast to the present study showed that children belonging to the lower socioeconomic class had a higher prevalence of digit sucking. This may be due to fact that these parents had low awareness and did not take measures to intervene.

  Conclusion Top

The results of the study show that digit-sucking habits were found in three-fourth of the children who were part of the study. There was a significant association between NNSH and malocclusion. It was also found that there was no significant effect of birth rank and the prevalence of the habit. The duration of the habit did not significantly alter the presence of malocclusion.


The limitations of this study were the small sample size and the study was done over a large area.


A longitudinal study over a period to evaluate the association between various factors and NNSHs and to evaluate the association between NNSHs and malocclusion is recommended.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Johnson ED, Larson BE. Thumb-sucking: Literature review. ASDC J Dent Child 1993;60:385-91.  Back to cited text no. 1
Moyers RE, editor. Etiology of Malocclusion - Heredity and Congenital Causes, General and Local Factors and Abnormal Habits. In: Ortodontia. 3 rd ed. Rio de Janeiro: Guanabara Koogan; 1991. p. 127-40.  Back to cited text no. 2
Graber TM. The finger-sucking and associated problems. J Dent Child 1958;25:5.  Back to cited text no. 3
Moss ML, Salentijn L. The primary role of functional matrices in facial growth. Am J Orthod 1969;55:566-77.  Back to cited text no. 4
Linder-Aronson S. Respiratory function in relation to facial morphology and the dentition. Br J Orthod 1979;6:59-71.  Back to cited text no. 5
Legovic M, Ostric L. The effects of feeding methods on the growth of the jaws in infants. ASDC J Dent Child 1991;58:253-5.  Back to cited text no. 6
Hanson ML, Cohen MS. Effects of form and function on swallowing and the developing dentition. Am J Orthod 1973;64:63-82.  Back to cited text no. 7
Venetikidou A. Incidence of malocclusion in asthmatic children. J Clin Pediatr Dent 1993;17:89-94.  Back to cited text no. 8
Warren JJ, Bishara SE. Duration of nutritive and nonnutritive sucking behaviors and their effects on the dental arches in the primary dentition. Am J Orthod Dentofacial Orthop 2002;121:347-56.  Back to cited text no. 9
Tomita NE, Sheiham A, Bijella VT, Franco LJ. The relationship between socioeconomic determinants and oral habits as risk factors for malocclusion in preschool children. Pesqui Odontol Bras 2000;2:169-75.  Back to cited text no. 10
Santos SA, Holanda AL, Sena MF, Gondim LA, Ferreira MA. Nonnutritive sucking habits among preschool-aged children. J Pediatr (Rio J) 2009;85:408-14.  Back to cited text no. 11
Kharbanda OP, Sidhu SS, Sundaram K, Shukla DK. Oral habits in school going children of Delhi: A prevalence study. J Indian Soc Pedod Prev Dent 2003;21:120-4.  Back to cited text no. 12
Paunio P, Rautava P, Sillanpää M. The Finnish Family Competence Study: The effects of living conditions on sucking habits in 3- years-old Finnish children and association between these habits and dental occlusion. Acta Odontol Scand 1993;51:23-9.  Back to cited text no. 13
Bishara SE, Warren JJ, Broffitt B, Levy SM. Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life. Am J Orthod Dentofacial Orthop 2006;130:31-6.  Back to cited text no. 14
Rasheed NA. Prevalence of Thumb sucking habit and its relation to malocclusion in preschool children. Al-Anbar Med J 1963;5:321-7.  Back to cited text no. 15
Warren JJ, Slayton RL, Bishara SE, Levy SM, Yonezu T, Kanellis MJ. Effects of nonnutritive sucking habits on occlusal characteristics in the mixed dentition. Pediatr Dent 2005;27:445-50.  Back to cited text no. 16
López Del Valle LM, Singh GD, Feliciano N, Machuca Mdel C. Associations between a history of breast feeding, malocclusion and parafunctional habits in Puerto Rican children. P R Health Sci J 2006;25:31-4.  Back to cited text no. 17
Larsson E. Dummy- and finger-sucking habits with special attention to their significance for facial growth and occlusion 1. Incidence study. Sven Tandlak Tidskr 1971;64:667-72.  Back to cited text no. 18
Farsi NM, Salama FS. Sucking habits in Saudi children: Prevalence, contributing factors and effects on the primary dentition. Pediatr Dent 1997;19:28-33.  Back to cited text no. 19
Yarrow LJ. The relationship between nutritive sucking experiences in infancy and non-nutritive sucking in childhood. J Genet Psychol 1954;84:149-62.  Back to cited text no. 20
Larsson E. Dummy- and finger-sucking habits in 4-year-olds. Sven Tandlak Tidskr 1975;68:219-24.  Back to cited text no. 21
Larsson EF, Dahlin KG. The prevalence and the etiology of the initial dummy- and finger-sucking habit. Am J Orthod 1985;87:432-5.  Back to cited text no. 22


  [Figure 1]

  [Table 1], [Table 2]


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