Hey parents, did you know that pacifiers can affect the development of your child’s mouth?

Pacifiers can cause 2 major growth changes to your child’s smile.

1. Anterior open bite – a space in the front between the upper and lower teeth
2. Posterior crossbite – narrower palate which reverses the positioning of the back teeth. The bottom teeth are closer to the lips/cheek than the top teeth.

Anterior open bites are due to the pacifier preventing the front incisors from overlapping. This causes the upper teeth to splay outward and have greater spacing between them.

The upper lip also sticks out more and in extreme cases the lips may not even touch! The upper teeth have an increased risk of trauma because they are not supported by the bottom teeth.

Posterior crossbites happen because the palate becomes constricted and narrow. The upper jaw is overall tighter so the upper teeth does not overlap with the bottom teeth. This can lead to fractures and wearing of the teeth.

How does a pacifier cause these changes?

The pacifier re-shapes the front teeth and jaws as the teeth are coming out and the jaws are growing. The teeth usually come out straight but the pacifier redirects them outward thus preventing them from overlapping.

The sucking forces cause the upper jaw to “squish inward” and make it narrower than the lower jaw. The upper jaw is more vulnerable to the strong cheek muscles because it is softer than the lower jaw.

The effects are based on DURATION of pacifier use, not frequency. This means using it for a single 5 hour session is worse than using it for 5 minutes 3 times a day.

If my child stops using their pacifier, will the effects reverse?

The answer is yes and no. If your child stops using the pacifier before 3 years old, there is a higher chance of reversing the effects. After 3 years old, the changes become more settled in the bone.

It is ideal to reduce pacifier usage as much as possible if they have bite changes. The tongue and cheek muscles act on the bone and teeth to self-correct the bite over time.

How do I get my child to stop using their pacifier?

The impacts of a pacifier are based on “hours per day”. Reducing pacifier use depends on your child’s age and duration of use.

The most important factor is to use positive reinforcement (rewards, incentives, praise) not negative reinforcement (criticism or scolding)! Negative reinforcement can cause rebelling and further entrenchment of the habit.

If your child uses their pacifier to fall asleep, then remove the pacifier once they’re asleep and keep it out of reach.

If they use it during daytime, then reduce the hours by only letting them use it during certain time windows. If they are really attached to it, then friends, siblings or caregivers can remind your child to stop.

How can we treat my child if the bite change doesn’t self-correct?

Your child may need orthodontics to correct the open bite and crossbite if the changes are seen later in life. We have to wait until there are more adult teeth out before this happens though!

Treatments usually include braces and palatal expanders. Long term pacifier use may cause such extreme changes that even orthodontics may not fully correct the bite!

The final word…

Pacifiers are common and help kids fall asleep (don’t be hard on yourself!). Using a pacifier for hours and hours can cause changes to the jaws and facial development. If it is for a few minutes then it won’t cause a major change. Overall, the effects are reversible if the habit stops early (before 3 years old). Try removing the pacifier slowly with small encouraging steps and be positive! If the bite changes last into later years then an orthodontics consult will be recommended.

References:

Bortolo GP, Sarmento LC, Gomes APM, Gomes AMM, Pacheco MCT, Dadalto ECV. Cessation of the pacifier sucking habit and self-correction of the anterior open bite in the primary dentition: case report. RGO, Rev Gaúch Odontol. 2021;69:e20210060. http://dx.doi.org/10.1590/1981-863720210006020200085

Dean, J. A., Jones, J. E., Sanders, B., Walker Vinson, L. A., & Yepes, J. (2022). Chapter 23: Managing the Developoing Occlusion. In McDonald and Avery’s Dentistry for the Child and Adolescent (11th ed.). essay, Elsevier.

Nowak, A. J., Christensen, J. R., Marby, T., Townsend, J., & Wells, M. (2019). Chapter 27: Oral habits. In Pediatric Dentistry: Infancy Through Adolescence. (6th ed.,). Elsvier

American Academy of Pediatric Dentistry. Policy on Pacifiers. The Reference Manual of Pediatric Dentistry; Chicago, Ill.: American Academy of Pediatric Dentistry; 2024:79-82