case_images: PMC5153467_01
case_images: (a) Picture showing convex facial profile. (b) Picture showing child sucking the great toe of the left feet.
case_images: CRID2016-2475784.001.jpg
case_images: PMC5153467_01_CRID2016-2475784.001.jpg
case_images: fig1
case_images: On examination her facial profile was convex (Figure 1(a)) with normal overjet and overbite. On taking history for oral habits, the mother stated that the child sucks the great toe of her left feet since infancy (Figure 1(b)).
case_images: (a) Picture showing deformed great toe of left feet. (b) Picture showing acrylic toe guard fitted onto the great toe of left feet.
case_images: CRID2016-2475784.002.jpg
case_images: PMC5153467_01_CRID2016-2475784.002.jpg
case_images: fig2
case_images: On examination, the great toe of her left foot was deformed compared to that of the right foot (Figure 2(a)) which led to the diagnosis of toe sucking habit and its possible implication on recurrent episodes of fever. In the subsequent visit upon finding the patient was reluctant to wear the socks, we implemented the method of negative reinforcement and reminder therapy which was accomplished with a toe guard fabricated with acrylic which fitted the great toe involved in sucking habit (Figure 2(b)).
case_images: Picture showing right central incisor erupting in an abnormal pathway.
case_images: CRID2016-2475784.003.jpg
case_images: PMC5153467_01_CRID2016-2475784.003.jpg
case_images: fig3
case_images: By now the upper incisor showed abnormal pathway of eruption (Figure 3) probably due to abnormal pressure exerted by the toe during sucking event that led to deflection of the developing tooth to an abnormal path.
case_images: Picture showing right central incisor not in cross-bite and distoangular rotation of upper central incisors.
case_images: CRID2016-2475784.004.jpg
case_images: PMC5153467_01_CRID2016-2475784.004.jpg
case_images: fig4
case_images: In the subsequent follow-up visit we noticed that the upper incisors showed distoangular rotation as they erupted into occlusion (Figure 4).
case_images: Picture showing patient wearing preorthodontic trainer for correction of distoangular rotation.
case_images: CRID2016-2475784.005.jpg
case_images: PMC5153467_01_CRID2016-2475784.005.jpg
case_images: fig5
case_images: Trainer for Kids, MRC, Australia) (Figure 5). The preorthodontic trainer was advocated to realign the incisors as well for myofunctional retraining of the oral musculature.