Pacifiers are a common and effective soothing tool for infants, satisfying the natural, non-nutritive sucking reflex present from birth. Their use is also associated with a reduced risk of Sudden Infant Death Syndrome in the first six months of life, making them generally beneficial for young babies. However, the constant presence of a pacifier introduces a persistent external force that can interfere with the natural development of the teeth and jaw structure. The specific effects depend heavily on the duration, frequency, and intensity of the sucking habit.
Specific Dental Changes Caused by Pacifiers
Prolonged pacifier use can lead to a group of dental misalignments collectively known as malocclusions. The most recognizable effect is an anterior open bite, where the upper and lower front teeth fail to overlap or touch when the mouth is closed. This gap occurs because the pacifier physically prevents the teeth from erupting into their proper vertical position.
The continuous pressure from the pacifier can also cause the upper front teeth to push outward, leading to a condition called increased overjet. This protrusion of the upper teeth is often referred to as “buck teeth” and increases the risk of dental trauma. Another significant issue is a posterior crossbite, which happens when the upper jaw narrows and the back upper teeth bite inside the lower back teeth instead of slightly outside them.
These changes are typically related to the position of the teeth (dental effects) rather than the underlying bone structure (skeletal effects) in the early years. If the pacifier habit is stopped early enough, many of these dental misalignments can resolve naturally. The longer the habit persists, the less likely the bite is to self-correct, increasing the need for professional orthodontic treatment.
How Pacifier Use Influences Oral Development
The mechanism behind these dental issues is the persistent pressure dynamics exerted by the pacifier on the developing oral structures. The presence of the nipple prevents the tongue from resting naturally against the roof of the mouth, which is a position essential for stimulating proper arch development. The tongue’s correct position acts as an internal mold, helping the upper jaw widen appropriately.
With the pacifier in place, the constant sucking action and cheek muscle contraction apply inward pressure on the upper jaw. This sustained force can lead to a high, narrow palate, which is the underlying cause of the posterior crossbite.
Changes to the shape of the jawbone itself are considered skeletal effects. These are more severe than simple tooth movement and are more likely to occur with prolonged use past the toddler years. Skeletal changes, where the bone structure is altered, are much more resistant to natural correction and may require extensive orthodontic procedures, such as palatal expansion. Dental changes, conversely, often self-correct after the habit stops.
Age Limits and Preventing Long-Term Damage
The most important factor in preventing long-term dental damage is the age at which the pacifier habit ceases. Pediatric dentists and pediatricians agree that the risk of developing a malocclusion increases significantly after a child turns two years old. The American Academy of Pediatric Dentistry and the American Dental Association recommend actively discouraging pacifier use after age four, as the effects become much more difficult to reverse naturally.
Weaning the child off the pacifier can be a gradual process.
Weaning Strategies
- Limit use to only naptime and bedtime initially.
- Introduce alternative comfort objects, like a blanket or stuffed animal, to act as a transitional object for soothing.
- Make the cessation a positive, celebratory event, such as a “pacifier party” where the child trades the pacifier for a new toy.
Some parents opt for “orthodontic pacifiers,” which are designed with a flattened, symmetrical nipple intended to reduce pressure on the jaw and palate. While these designs aim to support healthy oral development by mimicking the shape of a breastfed nipple, they do not eliminate the risk of dental misalignment entirely. The duration of use remains the primary concern. If dental issues persist several months after the child has completely stopped using the pacifier, consulting a pediatric dentist is advised to determine if intervention is necessary.