What you need to know about pacifiers and their impact on teeth
Many parents worry about the pacifier’s impact on the teeth. Don’t worry! In this blog post, we will break down the dos and don’ts, and update you on the research in the field.
Why use a pacifier?
From birth, babies have a natural sucking reflex. The baby will try to satisfy this need with the mother’s breast, a pacifier, a thumb, or another. It is not only a vital reflex for the baby to get food but sucking also has a calming effect on the baby, reminding the baby of something safe and familiar in an otherwise foreign world.
Benefits of pacifiers
- The pacifier helps calm and soothe the baby, and can therefore help to make the baby fall asleep
- The pacifier helps to lower the heart rate, blood pressure, and stress levels
- The pacifier has a pain-relieving effect
- The pacifier comforts the baby and provides security when it gets upset
- Pacifier use may be beneficial if infants need early oral stimulation to develop or maintain the sucking reflex
- Pacifiers counteracts mouth breathing
- The pacifier has a protective effect on the incidence of sudden infant death syndrome (SIDS) (1)
“Mouth breathing means that you frequently - both day and night - use your mouth to breathe instead of your nose. It is better to breathe through the nose, as it protects the mucous membranes, increases oxygen uptake, counteracts cavities in the teeth, and counteracts an altered jaw position due to the tongue’s resting position.”
Different pacifiers
There are many different pacifiers on the market – all with different nipple shapes and materials.
Conventional or round pacifier nipples are designed to resemble the shape and size of the mother's nipple and to promote a similar tongue placement and sucking technique when breastfeeding since the round shape allows the sides of the tongue to elevate and cup around the nipple, just like it does during breastfeeding.
Orthodontic pacifiers either have a flat bottom with a slightly rounded top or are flat on both sides.
These are designed so that the child does not have to suck as hard to keep it in the mouth (compared with a round nipple), which (in theory) eases the pressure on the teeth and jaw.
These pacifiers are often marketed by manufacturers as more “dental-friendly” or “orthodontic approved”, but despite claims, there aren’t any studies showing that orthodontic pacifiers decrease the risk of dental malocclusion (that the teeth are not aligned properly) compared to conventional pacifiers (2-4).
Pacifier impact
Studies show that prolonged use of pacifiers can result in dental malocclusion (5). This includes open bite, overbite, and crossbite. Seen in young children who use pacifiers, this is colloquially known as 'dummy teeth' or 'pacifier teeth'.
No matter the nipple shape, all pacifiers can result in “pacifier teeth” (2). It all comes down to how intense and long your child uses the pacifier, with studies showing a relationship between hours of use per day and degree of dental malocclusion (6).
"It is important to note, that pacifier teeth are not dangerous"
- Dental Hygienist, Carina Løvstad
Multiple studies show that there is no significant association between using a pacifier and dental malocclusion on the permanent teeth - if the child stops using the pacifier before the permanent teeth erupt (7-10).
Evidence linking pacifier use to issues with speech development or speech delay is limited (11, 12). Research suggests that while prolonged day-to-day pacifier use lasting several hours may have significance with atypical speech errors, a strong speech-related justification against pacifier use is not evident (13).
Thumb sucking vs. pacifiers
Both pacifiers and thumb-sucking affect the teeth, but since it is generally easier to wean your child from a pacifier habit than a thumb-sucking habit American Academy of Pediatrics (AAP) recommends pacifier use over thumb-sucking (14, 15).
"One of the benefits of pacifiers is to prevent the baby does not start sucking on the thumb. Concerning teeth and jaws, the pacifier is preferable. It is very difficult for the baby to stop using his or her thumb whereas a pacifier can be taken away from the baby much more easily".
- Dental Hygienist, Carina Løvstad
Stop in time
The official recommendation of the American Academy of Pediatric Dentistry (AAPD) is children stop their non-nutritive sucking habits by 3 years of age, to ensure that the teeth’s position gets normalized before the permanent teeth appear (15). The American Academy of Pediatrics (AAP) does not have an official recommended age for dropping the pacifier, however, they state that it’s best to wean at any point between 2 and 4 years (5, 16).
It is important to remember that all children are different, and the long-term use of the pacifier influences the alignment of the teeth. It will depend on how much they use it, for how long, and the intensity.
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Pacifier Dos |
Pacifier Don’ts |
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Choose a pacifier with a valve, as the valve helps the nipple to form naturally after the baby's mouth, tongue, and palate. |
Do not use pacifiers to replace feedings |
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Use pacifiers when your baby is fed and full |
Do not put sugar or honey on the pacifier |
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Use pacifiers to satisfy the baby’s desire for non-nutritive sucking |
Do not let the child use a pacifier all the time |
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Use pacifiers to help relieve pain |
Do not freeze pacifiers |
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Use the pacifier when your baby needs to fall asleep |
Do not leave latex pacifiers in direct sunlight |
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Sterilize the pacifiers frequently |
Do not tie pacifiers to strings or cords |
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Replace pacifiers every 4-6 weeks |
Do not use damaged pacifiers |
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Throw out at the first sign of damage |
Do not put pacifiers in the dishwasher |
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Stop using a pacifier before the age of 3 |
Do not let the child use pacifiers after the age of 3 |
FAQ
1. Do pacifiers affect permanent teeth?
If your child stops using the pacifier before the age of three (so before the permanent teeth erupt), the baby teeth’ position generally gets normalized, and the permanent teeth will not be affected.
2. Does pacifiers’ shape affect the palate and the mouth development?
Long-term pacifier use (after the age of three) can cause alignment issues with both the baby teeth the permanent teeth and the jaws. This can affect the child’s chewing or biting ability, and it can have consequences for the child’s jaw joint and its appearance.
Note this is after long-term pacifier use. If your child stops using the pacifier before the age of three (so before the permanent teeth erupt), the baby teeth’ position generally gets normalized, and the permanent teeth will not be affected.
3. When should you stop using a pacifier?
Many studies have shown that if your child stops using a pacifier before the age of three, the baby teeth’ position generally gets normalized, and the permanent teeth will not be affected.
4. Which pacifier shape (round, flat, or ortodontic) is best regarding the teeth?
There are no studies that confirm that one type of pacifier is better than others concerning tooth alignment issues. Different pacifier nipples affect the teeth differently, but no pacifier nipple is better than others. If the child stops using the pacifier at the age of 3, the baby teeth often align into the correct position by themselves, and the permanent teeth will not be affected.
5. Can long-term pacifier use cause an overbite, crossbite, or open bite later in life?
Yes, long-term pacifier use can cause alignment issues with the teeth and jaws later in life. However, this applies to long-term use. If your child stops using the pacifier before the age of three (before the permanent teeth erupt), the baby teeth’ position generally gets normalized, and the permanent teeth will not be affected.
6. Can a pacifier be orthodontic approved by dentists?
If "orthodontic approved by dentists" means that a dentist has approved that a pacifier does not affect the teeth, then no! Different pacifiers affect the teeth differently. However, the important thing is how long the child uses the pacifier. If your child stops using the pacifier before the age of three (before the permanent teeth erupt), the baby teeth’ position generally gets normalized, and the permanent teeth will not be affected.
7. Can it be harmful to children’s teeth if they share their pacifiers with other children regarding bacteria?
No, it is not harmful to the teeth to share a pacifier when it comes to bacteria. But concerning illnesses such as colds, or other infectious childhood diseases it is a good idea to keep a pacifier private and not share it.
8. Can children use pacifiers after a tongue- and lip-tie laser?
To clarify, a tongue tie occurs when the band of tissue that connects the tongue to the floor of the mouth is abnormally short, tight, or thick, resulting in restricted movement of the tongue. Lip-tie is a similar condition involving the band of tissue that connects the upper lip to the gum.
It is recommended to use a pacifier after a tongue- and lip-tie laser if the child is under 3 years old and already uses a pacifier. However, for children over 3 years old and for children who do not use a pacifier they should do tongue exercises instead. Please contact your doctor for information about tongue exercises after a tongue- and lip-tie laser.
9. Will BIBS Colour size 3 harm the teeth more than a size 1?
It is not dangerous to give a newborn a size 3. However, most newborns prefer a smaller size. All BIBS pacifiers no matter their size can be used from when your baby is born. A larger pacifier will - of course - press more on the teeth than a smaller size pacifier. But keep in mind that if your baby stops using the pacifier before they are three years old (that is before the permanent teeth erupt), the baby teeth’ position generally gets normalized, and the permanent teeth will not be affected.
10. Will pacifiers affect the child's speech development?
Evidence linking pacifier use to issues with speech development or speech delay is limited. Research suggests that while prolonged day-to-day pacifier use lasting several hours may have significance with atypical speech errors, a strong speech-related justification against pacifier use is not evident.
Sources:
1. Fern R Hauck 1, Olanrewaju O Omojokun, Mir S Siadaty, Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis, 2005 Nov;116(5):e716-23. doi: 10.1542/peds.2004-26313. Medeiros R, Ximenes M, Massgnam C, et al. Malocclusion prevention through the usage of an orthodontic pacifier compared to a conventional pacifier: A systematic review. Eur Arch Paediatr Dent 2018;19(5):287-95
4. Adair SM, Milano M, Dushku JC. Evaluation of the effects of orthodontic pacifiers on the primary dentitions of 24- to 59-month-old children: preliminary study. Pediatr Dent 1992; 14: 13–18.
5. Manual of Pediatric Dentistry, 2022-2023/P. TBD: https://www.aapd.org/globalassets/media/policies_guidelines/p_pacifiers.pdf
6. Steven M. Adair, DDS, MS Michael Milano, DMD Jennifer C. Dushku, BA, Evaluation of the effects of orthodontic pacifiers on the primary dentitions of 24- to 59-month-old children: preliminary study, s. (Pediatr Dent 14:13-18, 1992)
7. Poyak J. Effects of pacifiers on early oral development. Int J Orthod Milwaukee. 2006;17(4):13-16.
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(4):347-56
9. Duncan K, McNamara C, Ireland AJ. Sucking habits in childhood and effects on the primary dentition: Findings of the Avon Longitudinal Study of Pregnancy and Childhood. Int J Paediatr Dent 2008;18(3):178-88.
10. Bishara SE, Watten JJ, Broffitt B, et al. Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life. Am J Orthod Dentofacial Orthop 2006;130(1):31-6
11. Nelson AM. A comprehensive review of evidence and current recommendations related to pacifier usage. J Pediatr Nurs 2012;27(6):690-9
12. Burr S, Harding S, Wren Y, Deave T. The relationship between feeding and non-nutritive sucking behaviours and speech sound development: A systematic review. Folia Phoniatr Logop 2021;73(2):75-88
13. Strutt C, Khattab G, Willoughy J. Does the duration and frequency of dummy (pacifier) use affect the development of speech? Int J Lang Commun Disord 2021;56(3):512-27
14.Thumbs, Fingers, and Pacifiers (American Academy of Pediatrics Copyright 2019)
15. Fast facts: AMERICAN ACADEMY OF PEDIATRIC DENTISTRY 2014: https://www.aapd.org/assets/1/7/FastFacts.pdf
16: Steven M. Adair, DDS, MS, Pacifier Use in Children: A Review of Recent Literature, Pediatric Dentistry – 25:5, 2003
General blog information
The content on the BIBS Blog is designed to provide general information and education. While we aim to support the use of our baby products, including pacifiers, bottles, and cloths, this content does not replace professional medical advice or imply endorsements unless clearly stated. We make every effort to ensure the information shared is accurate and reliable; however, we cannot guarantee it will meet all your needs. Please use the information provided at your own discretion. BIBS is not responsible for any outcomes related to the use or misuse of our products or any other outcomes resulting from the information found on our blog.
