Regulations Governing Teledentistry Platforms

Regulations Governing Teledentistry Platforms

Here's the article outline for 'Understanding Common Fee Structures in Orthodontics' focusing on orthodontic treatment for kids:

Navigating the Digital Smile: Teledentistry Regulations for Pediatric Orthodontic Care


In recent years, teledentistry has emerged as a groundbreaking approach to delivering dental care, particularly in pediatric orthodontics. As technology continues to reshape healthcare delivery, regulatory frameworks have become crucial in ensuring patient safety, quality of care, and ethical practice.


The landscape of teledentistry regulations is complex and evolving. Healthcare authorities recognize the potential of remote dental consultations while simultaneously maintaining stringent standards to protect young patients. Key regulatory considerations include patient privacy, diagnostic accuracy, and the limitations of virtual assessments.


State medical boards and dental associations have been actively developing comprehensive guidelines that address the unique challenges of digital orthodontic consultations. These regulations typically mandate secure communication platforms, robust patient verification processes, and clear protocols for when in-person examinations become necessary.


Kids may feel mild discomfort when braces are first applied Child-friendly orthodontic solutions dental braces.

Privacy protection stands at the forefront of these regulatory efforts. Platforms must comply with HIPAA regulations, ensuring that children's sensitive medical information remains confidential and securely transmitted. Encryption, secure data storage, and strict access controls are non-negotiable requirements for teledentistry providers.


Licensing presents another critical regulatory dimension. Orthodontists must be licensed in the patient's state of residence, creating a complex framework for digital healthcare delivery. This requirement ensures accountability and maintains professional standards across different jurisdictions.


While teledentistry offers tremendous potential for improving access to orthodontic care, regulations continue to emphasize that digital platforms cannot completely replace traditional in-person examinations. Most guidelines recommend hybrid models where initial consultations and follow-ups can be conducted remotely, but critical diagnostic and treatment stages require physical assessments.


Insurance companies and healthcare providers are also developing specific frameworks to reimburse and validate teledentistry services. These evolving policies reflect a growing recognition of digital healthcare's importance, especially in reaching underserved pediatric populations.


As technology advances, regulatory bodies must remain adaptive. The goal is to create a balanced approach that leverages digital innovation while prioritizing patient safety and care quality. Continuous dialogue between technology developers, healthcare professionals, and regulatory agencies will be essential in refining these frameworks.


For parents and patients, understanding these regulations provides reassurance that teledentistry platforms are not a wild west of medical practice, but a carefully monitored and professionally regulated approach to modern healthcare delivery.


The future of pediatric orthodontic care lies in thoughtful integration of technology and robust regulatory oversight, ensuring that every digital smile is as safe and precise as its traditional counterpart.

The Current Legal and Regulatory Landscape for Teledentistry Platforms Offering Orthodontic Services


Teledentistry has emerged as a transformative technology in orthodontic care, but navigating its legal and regulatory framework remains complex and challenging. The current landscape is a patchwork of state-specific regulations, evolving federal guidelines, and ongoing legal interpretations that continue to shape how these platforms operate.


At the state level, regulations vary dramatically. Some states have embraced teledentistry with clear, progressive guidelines, while others maintain more restrictive approaches that significantly limit remote orthodontic consultations. This inconsistency creates a challenging environment for platforms seeking to provide nationwide services.


Key regulatory considerations include patient privacy, informed consent, and the standard of care. HIPAA compliance is paramount, requiring robust digital security measures to protect patient information. Additionally, platforms must demonstrate that remote diagnostics and treatment planning meet the same clinical standards as traditional in-person orthodontic care.


The licensing landscape adds another layer of complexity. Many states require practitioners to be licensed in the specific state where the patient resides, which can create significant operational challenges for teledentistry platforms hoping to offer nationwide services.


Professional organizations like the American Dental Association have been instrumental in developing preliminary guidelines, but the regulatory framework remains fluid. Emerging technologies continue to outpace existing regulations, creating a dynamic and sometimes uncertain legal environment.


Insurance reimbursement represents another critical aspect of the regulatory landscape. Many insurance providers are still adapting their policies to accommodate teledentistry services, with coverage varying widely across different states and providers.


Moving forward, platforms must remain agile, continuously monitoring regulatory changes and proactively adapting their business models. Collaboration with legal experts, state dental boards, and professional organizations will be crucial in navigating this complex regulatory terrain.


The future of teledentistry depends on striking a delicate balance between innovation, patient safety, and regulatory compliance. As technology advances and healthcare delivery models evolve, we can expect continued refinement of the legal and regulatory framework surrounding these platforms.

Insurance Coverage and Impact on Orthodontic Expenses

Patient Privacy and Data Protection in Online Orthodontic Consultation Platforms


In the rapidly evolving landscape of digital healthcare, teledentistry platforms have emerged as a revolutionary way to provide orthodontic consultations. However, with this technological advancement comes a critical responsibility: protecting patient privacy and ensuring robust data security.


The sensitive nature of medical information demands stringent protection mechanisms. Patients sharing personal health details, dental records, and facial images online are essentially entrusting platforms with their most intimate information. This trust must be safeguarded through comprehensive data protection strategies.


Regulatory frameworks like HIPAA in the United States and GDPR in Europe have established clear guidelines for handling patient data. These regulations mandate encryption of personal information, secure storage protocols, and strict access controls. Online orthodontic platforms must implement multi-layered security systems that prevent unauthorized access and potential data breaches.


Key protective measures include end-to-end encryption for patient communications, anonymized data processing, and transparent consent mechanisms. Platforms must clearly communicate how patient data will be used, stored, and potentially shared with healthcare providers.


Moreover, these platforms need robust authentication processes to verify patient identities while maintaining anonymity. Biometric verification, two-factor authentication, and advanced cybersecurity protocols are essential in creating a secure digital consultation environment.


Patient trust is paramount. By demonstrating a commitment to privacy and implementing comprehensive data protection strategies, online orthodontic consultation platforms can revolutionize dental care while respecting individual privacy rights.

Payment Plan Options for Pediatric Orthodontic Care

Here's a human-like essay on the topic:


Licensing and Professional Certification Standards for Orthodontists Providing Remote Treatment Assessments


The landscape of dental healthcare is rapidly evolving with the emergence of teledentistry platforms, which present both exciting opportunities and complex regulatory challenges. Orthodontists seeking to provide remote treatment assessments must navigate a nuanced framework of professional standards and licensing requirements that ensure patient safety and quality care.


Currently, state dental boards are developing increasingly sophisticated guidelines for remote consultations and diagnostic processes. These standards typically require orthodontists to maintain the same level of professional competence and ethical practice as they would in traditional clinical settings. This means comprehensive documentation, secure patient data management, and clear communication protocols are essential.


Professional certification for teledentistry now demands specialized training beyond traditional orthodontic credentials. Practitioners must demonstrate proficiency in digital imaging interpretation, virtual patient screening techniques, and advanced telecommunication technologies. Many professional organizations are developing specific certification programs that validate an orthodontist's capability to conduct thorough remote assessments.


Key considerations include verifying patient identity, ensuring diagnostic image quality, and establishing clear referral pathways for cases requiring in-person examination. Licensing requirements increasingly emphasize the practitioner's ability to recognize technological limitations and maintain appropriate clinical boundaries in remote interactions.


As teledentistry continues to expand, we can expect more standardized national guidelines that balance innovation with rigorous professional standards, ultimately improving patient access to specialized orthodontic care while maintaining high-quality diagnostic practices.

Factors Influencing Orthodontic Treatment Costs

Informed Consent and Parental Authorization Protocols for Pediatric Teledentistry Orthodontic Services


In the rapidly evolving landscape of digital healthcare, teledentistry has emerged as a groundbreaking approach to providing orthodontic services for children. At the heart of this innovative medical practice lies a critical framework of informed consent and parental authorization protocols that ensure both ethical and legal compliance.


The process begins with comprehensive communication between healthcare providers and parents or legal guardians. Unlike traditional in-person consultations, teledentistry requires an extra layer of transparency and detailed explanation about the virtual examination process. Parents must fully understand the capabilities and limitations of remote orthodontic assessments, including the potential need for follow-up in-person evaluations.


Specific consent forms tailored to pediatric teledentistry must clearly outline several key elements. These include the scope of the virtual examination, potential diagnostic limitations, privacy protections for digital medical records, and the specific technological platforms being utilized. Additionally, parents must provide explicit authorization for image and video capture, understanding how these digital records will be stored, shared, and protected.


Technological safeguards play a crucial role in these protocols. Secure, HIPAA-compliant platforms with robust encryption ensure that sensitive medical information remains confidential. Parents should receive detailed information about data protection measures, giving them confidence in the digital consultation process.


Age-appropriate consent is another critical consideration. For younger children, parental consent is comprehensive, while teenagers might be invited to participate in the consent process, acknowledging their growing autonomy in healthcare decisions.


Ultimately, these protocols represent a delicate balance between leveraging technological innovation and maintaining the highest standards of patient care and ethical medical practice. As teledentistry continues to evolve, these consent mechanisms will remain fundamental to building trust and ensuring the best possible outcomes for pediatric orthodontic care.

Comparing Different Orthodontic Practices and Their Pricing Strategies

Teledentistry has emerged as a transformative approach in modern dental healthcare, particularly in the realm of virtual orthodontic consultations. The technical and technological standards for secure virtual platforms are crucial in ensuring patient safety, data protection, and high-quality remote care.


At the core of these standards are robust cybersecurity protocols that protect sensitive patient information. Encryption technologies must meet HIPAA compliance requirements, ensuring that all patient data transmitted during virtual consultations remains confidential and secure. This includes end-to-end encryption for video consultations, secure file transfers, and protected digital imaging storage.


The technological infrastructure must support high-resolution imaging capabilities that allow orthodontists to conduct comprehensive remote assessments. This requires advanced camera technologies, standardized image capture protocols, and seamless integration of digital diagnostic tools. Platforms need to support multiple file formats and enable precise visual examination of dental structures.


User authentication and access control represent another critical component of these standards. Multi-factor authentication, secure login procedures, and role-based access controls help prevent unauthorized access to patient records and consultation platforms.


Interoperability is equally important, with platforms needing to integrate smoothly with existing electronic health record systems. This ensures comprehensive patient data management and continuity of care across different healthcare providers and systems.


Performance standards must also address real-time communication capabilities, minimizing latency and ensuring smooth video consultations. High-quality audio-visual technologies are essential for effective remote diagnostics and patient interactions.


As teledentistry continues to evolve, these technical standards will need continuous refinement to address emerging technologies, changing patient needs, and advancing cybersecurity landscapes. Regulatory bodies must remain adaptive and proactive in establishing guidelines that balance innovation with patient protection.


The future of orthodontic care increasingly depends on secure, reliable, and technologically advanced virtual platforms that can deliver professional, comprehensive care regardless of geographical limitations.

Additional Fees and Potential Hidden Expenses in Orthodontic Treatment

Teledentistry has emerged as a promising avenue in pediatric orthodontic care, offering innovative solutions for remote dental consultations and monitoring. However, its implementation is not without significant challenges and regulatory considerations.


The primary limitations of teledentistry in pediatric orthodontics revolve around the inherent complexity of comprehensive dental assessments. While digital platforms can facilitate initial screenings and follow-up consultations, they cannot entirely replace hands-on clinical examinations. Young patients require precise physical measurements, direct tissue evaluations, and nuanced assessments that digital interfaces may struggle to capture accurately.


Regulatory frameworks governing teledentistry platforms are still evolving, presenting a complex landscape for healthcare providers. Different jurisdictions maintain varying standards for remote dental consultations, creating potential legal and ethical uncertainties. Licensing requirements, patient privacy protections, and data security standards represent critical considerations that practitioners must navigate carefully.


Technical constraints also pose significant challenges. Not all families have consistent, high-quality internet access or sophisticated digital devices necessary for effective teledentistry interactions. Moreover, pediatric patients might find digital consultations less engaging or comfortable compared to traditional in-person appointments.


Despite these limitations, teledentistry offers meaningful advantages, particularly for patients in rural or underserved areas. It can provide initial assessments, ongoing monitoring, and preliminary orthodontic screenings that might otherwise be inaccessible.


Successful implementation requires a balanced approach that recognizes both the potential and the constraints of digital dental platforms. Healthcare providers must develop comprehensive protocols that integrate digital technologies with traditional clinical practices, ensuring patient safety and optimal care quality.


As technology continues to advance and regulatory frameworks mature, teledentistry's role in pediatric orthodontics will likely become more refined and sophisticated, offering increasingly nuanced and effective remote healthcare solutions.

Emerging Regulatory Frameworks and Future Developments in Digital Orthodontic Healthcare Delivery


The landscape of teledentistry is rapidly evolving, presenting both exciting opportunities and complex regulatory challenges. As digital healthcare platforms continue to transform how orthodontic care is delivered, regulatory bodies are working to create comprehensive frameworks that balance innovation with patient safety.


Currently, the regulatory environment for teledentistry platforms is somewhat fragmented. Different jurisdictions have varying approaches to digital healthcare delivery, which creates a patchwork of guidelines that can be challenging for practitioners and technology developers to navigate. The primary concerns revolve around patient privacy, data security, and the quality of remote diagnostic and treatment processes.


Key developments are emerging that suggest a more standardized approach is on the horizon. Regulatory agencies are increasingly recognizing the potential of digital orthodontic platforms to improve access to care, particularly in underserved areas. This recognition is driving more nuanced and supportive regulatory frameworks that aim to facilitate innovation while maintaining rigorous patient protection standards.


Several critical areas are receiving particular attention. Data protection remains a paramount concern, with regulators pushing for robust encryption and secure patient information management. Additionally, there's growing emphasis on establishing clear guidelines for remote diagnostics, ensuring that digital assessments meet the same high standards as traditional in-person examinations.


Technology validation is another crucial aspect of these emerging frameworks. Regulators are developing more sophisticated mechanisms to assess the clinical effectiveness of digital orthodontic tools, creating pathways for innovative platforms to demonstrate their reliability and efficacy.


Looking forward, we can anticipate more integrated and flexible regulatory approaches. The goal is to create a balanced ecosystem that encourages technological innovation while protecting patient interests. This will likely involve closer collaboration between healthcare providers, technology companies, and regulatory bodies.


The future of teledentistry regulation is not about restriction, but about creating smart, adaptive frameworks that can keep pace with technological advancements. As digital healthcare continues to evolve, regulatory approaches will need to become more dynamic and responsive.


Practitioners and technology developers should stay informed about these emerging frameworks, actively participating in discussions and contributing to the development of responsible, patient-centered digital healthcare solutions.

A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care provider.

Etymology

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The word patient originally meant 'one who suffers'. This English noun comes from the Latin word patiens, the present participle of the deponent verb, patior, meaning 'I am suffering', and akin to the Greek verb πάσχειν (paskhein 'to suffer') and its cognate noun πάθος (pathos).

This language has been construed as meaning that the role of patients is to passively accept and tolerate the suffering and treatments prescribed by the healthcare providers, without engaging in shared decision-making about their care.[1]

 

Outpatients and inpatients

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Patients at the Red Cross Hospital in Tampere, Finland during the 1918 Finnish Civil War
Receptionist in Kenya attending to an outpatient

An outpatient (or out-patient) is a patient who attends an outpatient clinic with no plan to stay beyond the duration of the visit. Even if the patient will not be formally admitted with a note as an outpatient, their attendance is still registered, and the provider will usually give a note explaining the reason for the visit, tests, or procedure/surgery, which should include the names and titles of the participating personnel, the patient's name and date of birth, signature of informed consent, estimated pre-and post-service time for history and exam (before and after), any anesthesia, medications or future treatment plans needed, and estimated time of discharge absent any (further) complications. Treatment provided in this fashion is called ambulatory care. Sometimes surgery is performed without the need for a formal hospital admission or an overnight stay, and this is called outpatient surgery or day surgery, which has many benefits including lowered healthcare cost, reducing the amount of medication prescribed, and using the physician's or surgeon's time more efficiently. Outpatient surgery is suited best for more healthy patients undergoing minor or intermediate procedures (limited urinary-tract, eye, or ear, nose, and throat procedures and procedures involving superficial skin and the extremities). More procedures are being performed in a surgeon's office, termed office-based surgery, rather than in a hospital-based operating room.

A mother spends days sitting with her son, a hospital patient in Mali

An inpatient (or in-patient), on the other hand, is "admitted" to stay in a hospital overnight or for an indeterminate time, usually, several days or weeks, though in some extreme cases, such as with coma or persistent vegetative state, patients can stay in hospitals for years, sometimes until death. Treatment provided in this fashion is called inpatient care. The admission to the hospital involves the production of an admission note. The leaving of the hospital is officially termed discharge, and involves a corresponding discharge note, and sometimes an assessment process to consider ongoing needs. In the English National Health Service this may take the form of "Discharge to Assess" - where the assessment takes place after the patient has gone home.[2]

Misdiagnosis is the leading cause of medical error in outpatient facilities. When the U.S. Institute of Medicine's groundbreaking 1999 report, To Err Is Human, found up to 98,000 hospital patients die from preventable medical errors in the U.S. each year,[3] early efforts focused on inpatient safety.[4] While patient safety efforts have focused on inpatient hospital settings for more than a decade, medical errors are even more likely to happen in a doctor's office or outpatient clinic or center.[citation needed]

Day patient

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A day patient (or day-patient) is a patient who is using the full range of services of a hospital or clinic but is not expected to stay the night. The term was originally used by psychiatric hospital services using of this patient type to care for people needing support to make the transition from in-patient to out-patient care. However, the term is now also heavily used for people attending hospitals for day surgery.

Alternative terminology

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Because of concerns such as dignity, human rights and political correctness, the term "patient" is not always used to refer to a person receiving health care. Other terms that are sometimes used include health consumer, healthcare consumer, customer or client. However, such terminology may be offensive to those receiving public health care, as it implies a business relationship.

In veterinary medicine, the client is the owner or guardian of the patient. These may be used by governmental agencies, insurance companies, patient groups, or health care facilities. Individuals who use or have used psychiatric services may alternatively refer to themselves as consumers, users, or survivors.

In nursing homes and assisted living facilities, the term resident is generally used in lieu of patient.[5] Similarly, those receiving home health care are called clients.

Patient-centered healthcare

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The doctor–patient relationship has sometimes been characterized as silencing the voice of patients.[6] It is now widely agreed that putting patients at the centre of healthcare[7] by trying to provide a consistent, informative and respectful service to patients will improve both outcomes and patient satisfaction.[8]

When patients are not at the centre of healthcare, when institutional procedures and targets eclipse local concerns, then patient neglect is possible.[9] Incidents, such as the Stafford Hospital scandal, Winterbourne View hospital abuse scandal and the Veterans Health Administration controversy of 2014 have shown the dangers of prioritizing cost control over the patient experience.[10] Investigations into these and other scandals have recommended that healthcare systems put patient experience at the center, and especially that patients themselves are heard loud and clear within health services.[11]

There are many reasons for why health services should listen more to patients. Patients spend more time in healthcare services than regulators or quality controllers, and can recognize problems such as service delays, poor hygiene, and poor conduct.[12] Patients are particularly good at identifying soft problems, such as attitudes, communication, and 'caring neglect',[9] that are difficult to capture with institutional monitoring.[13]

One important way in which patients can be placed at the centre of healthcare is for health services to be more open about patient complaints.[14] Each year many hundreds of thousands of patients complain about the care they have received, and these complaints contain valuable information for any health services which want to learn about and improve patient experience.[15]

See also

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  • Casualty
  • e-Patient
  • Mature minor doctrine
  • Nurse-client relationship
  • Patient abuse
  • Patient advocacy
  • Patient empowerment
  • Patients' Bill of Rights
  • Radiological protection of patients
  • Therapeutic inertia
  • Virtual patient
  • Patient UK

References

[edit]
  1. ^ Neuberger, J. (1999-06-26). "Do we need a new word for patients?". BMJ: British Medical Journal. 318 (7200): 1756–1758. doi:10.1136/bmj.318.7200.1756. ISSN 0959-8138. PMC 1116090. PMID 10381717.
  2. ^ "Unpaid carers' rights are overlooked in hospital discharge". Health Service Journal. 8 September 2021. Retrieved 16 October 2021.
  3. ^ Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn, L. T.; Corrigan, J. M.; Donaldson, M. S. (2000). Kohn, Linda T.; Corrigan, Janet M.; Donaldson, Molla S. (eds.). To Err Is Human: Building a Safer Health System. Washington D.C.: National Academy Press. doi:10.17226/9728. ISBN 0-309-06837-1. PMID 25077248.
  4. ^ Bates, David W.; Singh, Hardeep (November 2018). "Two Decades Since: An Assessment Of Progress And Emerging Priorities In Patient Safety". Health Affairs. 37 (11): 1736–1743. doi:10.1377/hlthaff.2018.0738. PMID 30395508.
  5. ^ American Red Cross (1993). Foundations for Caregiving. St. Louis: Mosby Lifeline. ISBN 978-0801665158.
  6. ^ Clark, Jack A.; Mishler, Elliot G. (September 1992). "Attending to patients' stories: reframing the clinical task". Sociology of Health and Illness. 14 (3): 344–372. doi:10.1111/1467-9566.ep11357498.
  7. ^ Stewart, M (24 February 2001). "Towards a Global Definition of Patient Centred Care". BMJ. 322 (7284): 444–5. doi:10.1136/bmj.322.7284.444. PMC 1119673. PMID 11222407.
  8. ^ Frampton, Susan B.; Guastello, Sara; Hoy, Libby; Naylor, Mary; Sheridan, Sue; Johnston-Fleece, Michelle (31 January 2017). "Harnessing Evidence and Experience to Change Culture: A Guiding Framework for Patient and Family Engaged Care". NAM Perspectives. 7 (1). doi:10.31478/201701f.
  9. ^ a b Reader, TW; Gillespie, A (30 April 2013). "Patient Neglect in Healthcare Institutions: A Systematic Review and Conceptual Model". BMC Health Serv Res. 13: 156. doi:10.1186/1472-6963-13-156. PMC 3660245. PMID 23631468.
  10. ^ Bloche, MG (17 March 2016). "Scandal as a Sentinel Event--Recognizing Hidden Cost-Quality Trade-offs". N Engl J Med. 374 (11): 1001–3. doi:10.1056/NEJMp1502629. PMID 26981930.
  11. ^ Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary. London: Stationery Office. 6 February 2013. ISBN 9780102981476. Retrieved 23 June 2020.
  12. ^ Weingart, SN; Pagovich, O; Sands, DZ; Li, JM; Aronson, MD; Davis, RB; Phillips, RS; Bates, DW (April 2006). "Patient-reported Service Quality on a Medicine Unit". Int J Qual Health Care. 18 (2): 95–101. doi:10.1093/intqhc/mzi087. PMID 16282334.
  13. ^ Levtzion-Korach, O; Frankel, A; Alcalai, H; Keohane, C; Orav, J; Graydon-Baker, E; Barnes, J; Gordon, K; Puopulo, AL; Tomov, EI; Sato, L; Bates, DW (September 2010). "Integrating Incident Data From Five Reporting Systems to Assess Patient Safety: Making Sense of the Elephant". Jt Comm J Qual Patient Saf. 36 (9): 402–10. doi:10.1016/s1553-7250(10)36059-4. PMID 20873673.
  14. ^ Berwick, Donald M. (January 2009). "What 'Patient-Centered' Should Mean: Confessions Of An Extremist". Health Affairs. 28 (Supplement 1): w555 – w565. doi:10.1377/hlthaff.28.4.w555. PMID 19454528.
  15. ^ Reader, TW; Gillespie, A; Roberts, J (August 2014). "Patient Complaints in Healthcare Systems: A Systematic Review and Coding Taxonomy". BMJ Qual Saf. 23 (8): 678–89. doi:10.1136/bmjqs-2013-002437. PMC 4112446. PMID 24876289.
[edit]
  • Jadad AR, Rizo CA, Enkin MW (June 2003). "I am a good patient, believe it or not". BMJ. 326 (7402): 1293–5. doi:10.1136/bmj.326.7402.1293. PMC 1126181. PMID 12805157.
    a peer-reviewed article published in the British Medical Journal's (BMJ) first issue dedicated to patients in its 160-year history
  • Sokol DK (21 February 2004). "How (not) to be a good patient". BMJ. 328 (7437): 471. doi:10.1136/bmj.328.7437.471. PMC 344286.
    review article with views on the meaning of the words "good doctor" vs. "good patient"
  • "Time Magazine's Dr. Scott Haig Proves that Patients Need to Be Googlers!" – Mary Shomons response to the Time Magazine article "When the Patient is a Googler"

 

Infants may use pacifiers or their thumb or fingers to soothe themselves
Newborn baby thumb sucking
A bonnet macaque thumb sucking

Thumb sucking is a behavior found in humans, chimpanzees, captive ring-tailed lemurs,[1] and other primates.[2] It usually involves placing the thumb into the mouth and rhythmically repeating sucking contact for a prolonged duration. It can also be accomplished with any organ within reach (such as other fingers and toes) and is considered to be soothing and therapeutic for the person. As a child develops the habit, it will usually develop a "favourite" finger to suck on.

At birth, a baby will reflexively suck any object placed in its mouth; this is the sucking reflex responsible for breastfeeding. From the first time they engage in nutritive feeding, infants learn that the habit can not only provide valuable nourishment, but also a great deal of pleasure, comfort, and warmth. Whether from a mother, bottle, or pacifier, this behavior, over time, begins to become associated with a very strong, self-soothing, and pleasurable oral sensation. As the child grows older, and is eventually weaned off the nutritional sucking, they can either develop alternative means for receiving those same feelings of physical and emotional fulfillment, or they can continue experiencing those pleasantly soothing experiences by beginning to suck their thumbs or fingers.[3] This reflex disappears at about 4 months of age; thumb sucking is not purely an instinctive behavior and therefore can last much longer.[4] Moreover, ultrasound scans have revealed that thumb sucking can start before birth, as early as 15 weeks from conception; whether this behavior is voluntary or due to random movements of the fetus in the womb is not conclusively known.

Thumb sucking generally stops by the age of 4 years. Some older children will retain the habit, which can cause severe dental problems.[5] While most dentists would recommend breaking the habit as early as possible, it has been shown that as long as the habit is broken before the onset of permanent teeth, at around 5 years old, the damage is reversible.[6] Thumb sucking is sometimes retained into adulthood and may be due to simply habit continuation. Using anatomical and neurophysiological data a study has found that sucking the thumb is said to stimulate receptors within the brain which cause the release of mental and physical tension.[7]

Dental problems and prevention

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Alveolar prognathism, caused by thumb sucking and tongue thrusting in a 7-year-old girl.

Percentage of children who suck their thumbs (data from two researchers)

Age Kantorowicz[4] Brückl[8]
0–1 92% 66%
1–2 93%
2–3 87%
3–4 86% 25%
4–5 85%
5–6 76%
Over 6 9%

Most children stop sucking on thumbs, pacifiers or other objects on their own between 2 and 4 years of age. No harm is done to their teeth or jaws until permanent teeth start to erupt. The only time it might cause concern is if it goes on beyond 6 to 8 years of age. At this time, it may affect the shape of the oral cavity or dentition.[9] During thumbsucking the tongue sits in a lowered position and so no longer balances the forces from the buccal group of musculature. This results in narrowing of the upper arch and a posterior crossbite. Thumbsucking can also cause the maxillary central incisors to tip labially and the mandibular incisors to tip lingually, resulting in an increased overjet and anterior open bite malocclusion, as the thumb rests on them during the course of sucking. In addition to proclination of the maxillary incisors, mandibular incisors retrusion will also happen. Transverse maxillary deficiency gives rise to posterior crossbite, ultimately leading to a Class II malocclusion.[10]

Children may experience difficulty in swallowing and speech patterns due to the adverse changes. Aside from the damaging physical aspects of thumb sucking, there are also additional risks, which unfortunately, are present at all ages. These include increased risk of infection from communicable diseases, due to the simple fact that non-sterile thumbs are covered with infectious agents, as well as many social implications. Some children experience social difficulties, as often children are taunted by their peers for engaging in what they can consider to be an “immature” habit. This taunting often results the child being rejected by the group or being subjected to ridicule by their peers, which can cause understandable psychological stress.[11]

Methods to stop sucking habits are divided into 2 categories: Preventive Therapy and Appliance Therapy.[10]

Examples to prevent their children from sucking their thumbs include the use of bitterants or piquant substances on their child's hands—although this is not a procedure encouraged by the American Dental Association[9] or the Association of Pediatric Dentists. Some suggest that positive reinforcements or calendar rewards be given to encourage the child to stop sucking their thumb.

The American Dental Association recommends:

  • Praise children for not sucking, instead of scolding them when they do.
  • If a child is sucking their thumb when feeling insecure or needing comfort, focus instead on correcting the cause of the anxiety and provide comfort to your child.
  • If a child is sucking on their thumb because of boredom, try getting the child's attention with a fun activity.
  • Involve older children in the selection of a means to cease thumb sucking.
  • The pediatric dentist can offer encouragement to the child and explain what could happen to the child's teeth if he/she does not stop sucking.
  • Only if these tips are ineffective, remind the child of the habit by bandaging the thumb or putting a sock/glove on the hand at night.
  • Other orthodontics[12] for appliances are available.

The British Orthodontic Society recommends the same advice as ADA.[13]

A Cochrane review was conducted to review the effectiveness of a variety of clinical interventions for stopping thumb-sucking. The study showed that orthodontic appliances and psychological interventions (positive and negative reinforcement) were successful at preventing thumb sucking in both the short and long term, compared to no treatment.[14] Psychological interventions such as habit reversal training and decoupling have also proven useful in body focused repetitive behaviors.[15]

Clinical studies have shown that appliances such as TGuards can be 90% effective in breaking the thumb or finger sucking habit. Rather than use bitterants or piquants, which are not endorsed by the ADA due to their causing of discomfort or pain, TGuards break the habit simply by removing the suction responsible for generating the feelings of comfort and nurture.[16] Other appliances are available, such as fabric thumb guards, each having their own benefits and features depending on the child's age, willpower and motivation. Fixed intraoral appliances have been known to create problems during eating as children when removing their appliances may have a risk of breaking them. Children with mental illness may have reduced compliance.[10]

Some studies mention the use of extra-oral habit reminder appliance to treat thumb sucking. An alarm is triggered when the child tries to suck the thumb to stop the child from this habit.[10][17] However, more studies are required to prove the effectiveness of external devices on thumb sucking.

Children's books

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  • In Heinrich Hoffmann’s Struwwelpeter, the "thumb-sucker" Konrad is punished by having both of his thumbs cut off.
  • There are several children's books on the market with the intention to help the child break the habit of thumb sucking. Most of them provide a story the child can relate to and some coping strategies.[18] Experts recommend to use only books in which the topic of thumb sucking is shown in a positive and respectful way.[19]

See also

[edit]
  • Stereotypic movement disorder
  • Prognathism

References

[edit]
  1. ^ Jolly A (1966). Lemur Behavior. Chicago: University of Chicago Press. p. 65. ISBN 978-0-226-40552-0.
  2. ^ Benjamin, Lorna S.: "The Beginning of Thumbsucking." Child Development, Vol. 38, No. 4 (Dec., 1967), pp. 1065–1078.
  3. ^ "About the Thumb Sucking Habit". Tguard.
  4. ^ a b Kantorowicz A (June 1955). "Die Bedeutung des Lutschens für die Entstehung erworbener Fehlbildungen". Fortschritte der Kieferorthopädie. 16 (2): 109–21. doi:10.1007/BF02165710. S2CID 28204791.
  5. ^ O'Connor A (27 September 2005). "The Claim: Thumb Sucking Can Lead to Buck Teeth". The New York Times. Retrieved 1 August 2012.
  6. ^ Friman PC, McPherson KM, Warzak WJ, Evans J (April 1993). "Influence of thumb sucking on peer social acceptance in first-grade children". Pediatrics. 91 (4): 784–6. doi:10.1542/peds.91.4.784. PMID 8464667.
  7. ^ Ferrante A, Ferrante A (August 2015). "[Finger or thumb sucking. New interpretations and therapeutic implications]". Minerva Pediatrica (in Italian). 67 (4): 285–97. PMID 26129804.
  8. ^ Reichenbach E, Brückl H (1982). "Lehrbuch der Kieferorthopädie Bd. 1962;3:315-26.". Kieferorthopädische Klinik und Therapie Zahnärzliche Fortbildung. 5. Auflage Verlag. JA Barth Leipzig" alıntı Schulze G.
  9. ^ a b "Thumbsucking - American Dental Association". Archived from the original on 2010-06-19. Retrieved 2010-05-19.
  10. ^ a b c d Shetty RM, Shetty M, Shetty NS, Deoghare A (2015). "Three-Alarm System: Revisited to treat Thumb-sucking Habit". International Journal of Clinical Pediatric Dentistry. 8 (1): 82–6. doi:10.5005/jp-journals-10005-1289. PMC 4472878. PMID 26124588.
  11. ^ Fukuta O, Braham RL, Yokoi K, Kurosu K (1996). "Damage to the primary dentition resulting from thumb and finger (digit) sucking". ASDC Journal of Dentistry for Children. 63 (6): 403–7. PMID 9017172.
  12. ^ "Stop Thumb Sucking". Stop Thumb Sucking.org.
  13. ^ "Dummy and thumb sucking habits" (PDF). Patient Information Leaflet. British Orthodontic Society.
  14. ^ Borrie FR, Bearn DR, Innes NP, Iheozor-Ejiofor Z (March 2015). "Interventions for the cessation of non-nutritive sucking habits in children". The Cochrane Database of Systematic Reviews. 2021 (3): CD008694. doi:10.1002/14651858.CD008694.pub2. PMC 8482062. PMID 25825863.
  15. ^ Lee MT, Mpavaenda DN, Fineberg NA (2019-04-24). "Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials". Frontiers in Behavioral Neuroscience. 13: 79. doi:10.3389/fnbeh.2019.00079. PMC 6491945. PMID 31105537.
  16. ^ "Unique Thumb with Lock Band to Deter Child from Thumb Sucking". Clinical Research Associates Newsletter. 19 (6). June 1995.
  17. ^ Krishnappa S, Rani MS, Aariz S (2016). "New electronic habit reminder for the management of thumb-sucking habit". Journal of Indian Society of Pedodontics and Preventive Dentistry. 34 (3): 294–7. doi:10.4103/0970-4388.186750. PMID 27461817. S2CID 22658574.
  18. ^ "Books on the Subject of Thumb-Sucking". Thumb-Heroes. 9 December 2020.
  19. ^ Stevens Mills, Christine (2018). Two Thumbs Up - Understanding and Treatment of Thumb Sucking. ISBN 978-1-5489-2425-6.

Further reading

[edit]
  • "Duration of pacifier use, thumb sucking may affect dental arches". The Journal of the American Dental Association. 133 (12): 1610–1612. December 2002. doi:10.14219/jada.archive.2002.0102.
  • Mobbs E, Crarf GT (2011). Latchment Before Attachment, The First Stage of Emotional Development, Oral Tactile Imprinting. Westmead.
[edit]
  • "Oral Health Topics: Thumbsucking". American Dental Association. Archived from the original on 2010-06-19.
  • "Pacifiers & Thumb Sucking". Canadian Dental Association.