Pacifier Use and Oral Health: What Healthcare Professionals Need to Know

Healthcare professionals, particularly those caring for expecting mothers, newborns, and young children, are in a key position to provide guidance to parents about pacifier use and oral health. Early conversations about pacifier use and oral health can help parents make educated decisions about infant sucking.

Non-nutritive Sucking

In utero, the sucking reflex begins to develop and is essential for infant development. Non-nutritive sucking such as sucking on a pacifier, thumb or other object is not associated with feeding. Non-nutritive sucking gives infants a way to self-soothe, reorganize, and helps satisfy an infant with a strong sucking urge who wants to suck beyond their nutritional needs. 

Soother or Thumb

Parents may not be aware of whether pacifier or digit sucking is preferable. An internationally recognized association, the American Academy of Pediatric Dentistry, recommends pacifiers over fingers and thumbs because a pacifier habit is easier to discontinue.¹ Another important reason to choose a pacifier is that bedtime pacifier use has been associated with a reduction in the risk of sudden infant death syndrome (SIDS).²  Experts recommend using a pacifier when placing the infant to sleep.³  For mothers who are breastfeeding, it is advisable to wait until breastfeeding is established before offering a pacifier.⁴  In addition, breastfeeding is protective against SIDS.⁵

Which pacifier is best for orofacial development?

Evidence shows that the use of a pacifier can be associated with anterior open bite, anterior overjet, and posterior crossbite. In a recent systematic review of the literature, only one randomized clinically controlled study noted a reduction in the occurrence of anterior open bite and increased overjet with a thin neck pacifier.⁶ Wagner and Heinrich-Weltzien demonstrated that changing to a thin neck pacifier reduces pacifier‐associated malocclusion in the primary dentition compared to conventional pacifiers.⁷ More research is needed to determine the best pacifier design for an infant’s mouth when evaluating the narrowing of the palate and posterior cross-bite. 

Cleaning Pacifiers

Clean pacifiers frequently. Boiling water, microwave steam, dishwasher, and hot soapy water are methods to clean pacifiers. Children whose parents clean their pacifier by sucking it may introduce bacteria and is not a recommended method for cleaning. Mutans Streptococci and other bacteria, are associated with dental caries. Studies indicate that Mutans Streptococci can colonize the mouths of predentate infants through vertical transmission from parent to child and horizontal transmission from child to child.⁸ Bacteria are only one factor in the etiology of dental caries, a disease that involves an interaction between teeth, fermentable carbohydrates and biofilm and includes various influences such as dietary habits, fluoride exposures, oral hygiene as well as saliva.⁹

Discontinuing a Pacifier Habit

A time to discontinue a pacifier habit varies depending on the child’s age, intensity of sucking and duration of sucking. Identifying factors associated with prolonged sucking habits may help healthcare professionals target parents and provide interventions and counseling. Breastfeeding less than 6 months, lower maternal education, and infrequent dental visits are factors associated with prolonged sucking habit.^10,11 Early dental visits provide an opportunity to encourage parents to help their children stop sucking habits by age three years or younger.¹²