Pacifier Teeth: Effects, Treatment & Prevention

What are Pacifier Teeth?

Pacifier teeth refer to the types of malocclusion (misalignment) that can occur in children after prolonged pacifier use. This is also sometimes referred to as “pacifier teeth.”

Children with pacifier teeth may have an open bite, where the front teeth in the upper and lower jaws do not overlap. They can also develop a posterior crossbite, meaning the lower teeth are positioned outside the upper teeth when the mouth closes.

What are the Benefits of Pacifiers?

Babies have a natural sucking reflex that begins in the womb.¹ Pacifiers engage that instinct and can increase the well-being of many babies and, in turn, parents.

Pacifiers offer children a sense of security and help them self-soothe when they’re fussy. They can also help babies fall asleep. 

During the first year of life, pacifiers can significantly decrease the risk of Sudden Infant Death Syndrome (SIDS).²

Pacifiers vs. Thumb-Sucking

Pacifiers and thumb-sucking share similar benefits and drawbacks, but with key differences:

The pros of pacifiers include:

• A calming effect — Pacifiers allow fussy babies to comfort themselves.
• Faster sleep — Many babies fall asleep more quickly with pacifiers.
• Reduced risk of SIDS — Studies show that using a pacifier during sleep lowers the risk of SIDS by as much as 90%.³
• Convenience — Pacifiers are disposable and easy to clean. When you’re ready to break your child’s habit, you can simply throw them away.

The cons include:

• Dental misalignment — Malocclusions can occur if your child uses pacifiers long past the recommended age.
• Nipple confusion — Introduced too early, a pacifier can disrupt the breastfeeding process. It’s recommended to wait 2 to 4 weeks after birth to introduce your infant to a pacifier.⁴
• Dependency — Your baby might become reliant on the pacifier, especially if they need it to sleep. Many parents are woken multiple times at night when the baby drops their pacifier.
• Ear problems — Pacifier use can increase the risk of a middle ear infection. However, middle ear infections are least common from birth to 6 months old, which is the prime time for pacifier use.

Thumb-sucking comes with its own positives and negatives. The pros of thumb-sucking include:

• Emotional comfort — Thumb-sucking, like pacifiers, can calm an irritable baby.
• Availability — A child has constant access to this source of comfort, so parents won’t be called on in the middle of the night to replace it.
• Self-regulation — Thumb-sucking gives a baby the tools they need to self-regulate at any time.

Its cons include:

• No effect on SIDS — There’s no evidence that thumb-sucking reduces SIDS.
• Stubborn habit to shake — It can be more challenging to break the habit of thumb-sucking than pacifier use.
• Germ exposure — Thumb-sucking can increase the germs your child is exposed to because it is more difficult to sanitize.
• Speech impairments — An overuse of thumb-sucking can cause a child to speak less or develop a speech impediment.
• Dental issues — The increased risk of problems associated with the prolonged use of a pacifier is also associated with a thumb-sucking habit.
• Airway issues – Children who suck their thumbs after age 4 will have a narrowed airway and an increased risk of obstructive sleep apnea in adulthood.⁵  

Common Dental Problems Pacifiers Cause 

Here are the most common dental problems associated with pacifier use:

Anterior Open Bite

An anterior open bite occurs when the upper and lower teeth slant outwards. This prevents the front teeth from overlapping when the mouth is closed. 

The sucking motion associated with pacifiers can encourage a child’s teeth to slant forwards. Studies show that children who suck on pacifiers or thumbs are four times as likely to have an open bite as those who do not.⁶

An open bite can make tearing food with the front teeth difficult. It can also cause speech impediments.

Posterior Crossbite

A posterior crossbite is where the top back teeth are positioned inside the lower back teeth when the mouth is closed. Between 8 and 16 percent of children have a posterior crossbite, some due to pacifier use.

It can cause many issues, including headaches and toothaches, trouble closing the jaw, and cavities.

Overjet

Overjet is a condition where only the upper teeth slant at an outward angle, jutting far further than the lower teeth. It can complicate chewing, speaking, and even smiling.

Other Issues

Prolonged pacifier use can also cause a baby to develop crooked teeth, tooth gaps, and shape changes to the roof of the mouth. They can even affect a child’s swallowing reflex if left untreated.

According to Dr. Nandita Lilly, one of NewMouth’s in-house dentists, “thumb-sucking and pacifier use can lead to dental issues, including incomplete eruption of anterior teeth, mouth breathing habits, poor tongue posture, thrusting of the tongue, speech problems, and a compromised airway that can cause sleep apnea in adulthood. “

How to Prevent Pacifier Teeth 

The best prevention for misalignments is to wean your baby off pacifiers and thumb sucking at the recommended age of 2 years old.⁶ Breaking the habit at an appropriate time can prevent pacifier teeth.

You can also use an orthodontic pacifier instead of a conventional one, but it is still important to wean the child from these oral habits at an early age. Studies show the use of orthodontic pacifiers is associated with a lower risk of developing malocclusions.⁷

How to Wean Your Baby Off Pacifiers 

Most children naturally end their pacifier habit between the ages of two and four.⁸

Some pediatric dentists advise starting the weaning process by the time your child turns 2.⁹ Other sources recommend intervening if your child has not given up the habit by age 3.¹⁰

A few best practices to wean your child off their pacifier use are:

• Use positive reinforcement — Children respond better to praise for not performing the behavior rather than a scolding for doing it.
• Treat the cause, not the symptom — If your child is resistant to ending their pacifier habit, it may indicate underlying levels of insecurity or anxiety.
• Offer a reward — Give your child an incentive for setting the pacifier aside, especially during a difficult time.

Treatment for Pacifier Teeth

If your child has developed pacifier teeth, you will need to seek treatment from an orthodontist. There are many treatment options for correcting malocclusions, including braces, Invisalign, and other appliances.¹¹

Early intervention is likely to have the best result. Talk to a dentist or orthodontist right away if you notice your child developing pacifier teeth.

Summary

Pacifier teeth are a preventable and treatable condition that may result from prolonged pacifier use in children past the recommended age. 

Misalignments such as an anterior open bite, posterior crossbite, and overjet are possible outcomes.

Weaning children off pacifiers at the appropriate age of 2 can prevent dental malocclusions. However, if not weaned by age 4, orthodontic interventions are available.