Could Sucking on a Pacifier Cause Malocclusion? A Randomized Controlled Trial

It’s an age-old debate and concern for parents that non-nutritive sucking on a dummy, pacifier, or even a thumb can cause dental issues. But could prolonged pacifier use really impact your child’s dental health?

Non-nutritive sucking habits, such as pacifier use and thumb-sucking, are common among infants and toddlers and typically cease by the age of 1 or 2. However, some children continue these habits for several more years.

While these habits have often been associated with problems like posterior crossbite and crowding of teeth, systematic reviews on pacifier use have emphasised the need for high-quality clinical trials, as the evidence regarding the harmful effects of non-nutritive sucking on dental occlusion remains weak.

This month, Dr. Jamal summarises the findings of a recent study, which investigated how pacifier use over the age of 1 may indeed contribute to malocclusion.

Our Summary

The randomised controlled trial, conducted in Finland, examined whether the type of pacifier and duration of use could influence dental occlusion by age 7. The study also compared the impact of an “orthodontic” pacifier with regular pacifiers on dental occlusion to see if one type posed less risk for malocclusions.

Study participants were divided into three groups:

Those who used study (orthodontic) pacifiers,
Those who used other types of pacifiers, and
Those who did not use pacifiers.

Pacifier use was assessed via a questionnaire at age 2, and a clinical examination of dental occlusion was conducted when the children were 7 years old. The primary outcome of the trial was posterior crossbite. However, overjet, overbite, and crowding, as well as the use and duration of pacifier use were also assessed.

Findings

This trial found that children who used pacifiers for 12 months or more were more likely to develop posterior crossbite by age 7. The risk was especially high for those who used regular pacifiers, as opposed to orthodontic pacifiers.

Although children using the orthodontic pacifier showed a slightly reduced risk of posterior crossbite compared to those using conventional pacifiers, the difference was not statistically significant. Prolonged thumb-sucking (lasting over 12 months) was also associated with tooth crowding, demonstrating that thumb-sucking, like pacifier use, can contribute to malocclusion.

The trial concluded that prolonged use of non-orthodontic pacifiers after the age of 1 year can lead to malocclusions, such as posterior crossbite. As a result, parents and patients with young children should be advised to avoid or minimise pacifier use after this age.

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Limitations

The study relied on parental reporting of pacifier use, and clinicians were aware of which pacifier each child used. Additionally, the study did not track dental outcomes beyond age 7, so the long-term effects remain unknown.

About Dr. Jamal

Dr. Jamal Giri is an orthodontist and associate professor at B.P. Koirala Institute of Health Sciences in Nepal. He obtained his orthodontic training from the Institute of Medicine, Tribhuvan University, Nepal, in 2014.

Currently pursuing a PhD at the University of Adelaide, Dr. Jamal’s research focuses on the genetic and environmental factors influencing malocclusion development. He also holds a postgraduate certificate in clinical education from the University of Edinburgh and a master’s in medical education from the University of Nottingham.Dr. Jamal teaches on the Diploma in Orthodontics and Dentofacial Orthopaedics at the London Dental Institute.

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