Protruding incisors are at risk for being fractured or knocked out by any of the common activities and accidents of childhood. Even if they somehow avoid damage, they can be the object of considerable teasing from other children.
A common cause for protruding upper incisors is thumb or finger sucking, which if done long enough will make the upper front teeth flare forward and will tip the lower front teeth backward.
Most children stop thumb/finger sucking once they get into the social pressure environment of school, but if they have already created a deformity in tooth position with the thumb, the deformity will be maintained even after stopping the thumb habit by the tongue protruding into the anterior open bite, and worse, the lower lip parking behind the upper incisors will push them even further forward horizontally.
Most parents are aware of the chili pepper sauce on the thumb regimen, but it does not always work well. Another treatment involves taking a sock, folding its top down and sewing it into a channel through which is passed a shoestring to be used as a drawstring, and the sock is tied onto the hand at bedtime (sometimes both hands have to be so covered, individually). For younger kids, the sock can have a face drawn or sewn onto it and the sock can become a personality, such as “Mr. Wizard,” who helps the child. The sock prevents the thumb or any finger from being extended to be sucked. It takes considerable discipline from the parent to do this every night for several months (and possibly daytimes after school), but it can work, especially for the child who only sucks at bedtime.
Another fun therapy that can be piggybacked onto that one (or which can stand alone) is to play a game where any day and night that no thumbsucking happened, a happy face sticker is put onto a calendar, and 5 happy faces in a week earns a trip to 31 Flavors, and 25 happy faces in a month earns a trip to Chuck E. Cheese with a friend!
A tried-and-true orthodontic therapy, for those who need it, is to place a permanent wire screen device in the mouth, soldered to bands which are cemented to the upper molars, and which forms a physical barrier to keep the thumb and fingers out and to keep the tongue from protruding forward. It must be left for several months, because if removed too soon the habit has been seen to return. While the device is in place, the front teeth will usually erupt and the open bite will usually close. If the upper incisors are flared severely forward, they may need a brief period of braces to upright them, but care must be used not to tip them back into the unerupted permanent canines.
