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Thumb Sucking, Pacifiers and Teeth: A Fact-Based Guide

By December 14, 2022Orthodontics
High angle shot of an adorable baby sucking their fingers while laying on a blanket.

As a parent, you receive a constant flood of information when it comes to raising kids. Everything from sleep to screen time, nutrition to emotional well-being, academics to activities — there’s a lot out there. Understandably, it’s hard to separate fact from fiction sometimes or decide what to do for your child and your family.


If you have babies or toddlers, one thing you might be wondering about is what to do about thumb sucking or pacifiers. You might’ve heard or read things like, “Thumb sucking is bad for teeth!” or “Pacifiers cause teeth damage!” Conversely, you might also have heard that thumb sucking and pacifier use is natural, and should be left to run their course. Which is right? And what should you do? 


Dr. Patel and the team at The Brace Place are here to ease the confusion. We’ve put together a fact-based guide to thumb sucking and pacifiers — from an orthodontist who’s treated thousands of kids. We’ll answer questions like “Are pacifiers bad for teeth?” and “What does thumb sucking do to teeth?” 



Thumb sucking and pacifiers for babies: it’s ok!


Let’s start with infancy and thumb sucking. Simply put, thumb sucking for babies is perfectly natural and a common part of the developmental process. In fact, a Johns Hopkins Medicine article says about 90% of newborns show some kind of hand sucking a mere two hours after birth. 


Sucking habits — hands, fingers, or thumbs — help babies self-soothe. And putting things in their mouths is a way babies learn about and experience the world around them. So you can breathe a sigh of relief if your baby sucks their thumb and there’s no need to discourage it during infancy.


And pacifiers? When it comes to pacifier use, one study by the American Academy of Family Physicians found that about 75-85% of babies in Western countries use a pacifier sometime during infancy. It can be an extension of their natural sucking reflex. And research has shown that pacifier use when a baby sleeps reduces the risk of Sudden Infant Death Syndrome (SIDS). So it’s ok to offer a pacifier if your baby accepts one.



Orthodontic pacifiers


Consider giving your baby an orthodontic pacifier during their early months instead of a traditional one. What’s the difference? An orthodontic pacifier’s nipple has a flat end, while a traditional pacifier has a rounded nipple. The flat shape is meant to mimic nursing and encourage a more natural tongue movement. A 2018 systematic review of studies found that orthodontic pacifiers reduced the risk of an open bite in comparison with rounded pacifiers (though the authors stated a more well-designed, randomized, and controlled trial was needed). 



At what age are pacifiers bad for teeth? And thumb sucking? 


Up until around age one, thumb sucking and pacifier use typically won’t have any negative effects on your baby’s tiny teeth or jaw. And since sucking is a natural and useful part of infancy, it’s ok to let your baby suck their thumb or pacifier in that early stage.


But when are pacifiers bad for teeth? And when should you discourage thumb sucking? Well, prolonged thumb sucking or pacifier use is shown to increase the likelihood of affecting teeth and jaw growth if continued into later toddlerhood or elementary school. You might have to step in to help your child stop sucking their thumb at that point. Or decide how and when to take their pacifier away. 


Kids who still have a persistent habit of sucking their thumb or using their pacifier by kindergarten are more likely to develop orthodontic issues like crooked teeth or a bad bite. A meta-analysis in the International Journal of Orthodontics concluded that pacifier use after age three causes high incidences of an anterior open bite, posterior crossbite, a narrow upper arch, and a high, narrow palate. These issues become even more serious in kids who still use a pacifier after age five.


In addition, several studies — like the one published in the Journal of the American Dental Association — found that the most significant issues occurred in children who continued their thumb or pacifier sucking habit beyond age four. 


The good news? Most kids stop thumb sucking on their own between ages two and four. And the same thing goes for pacifiers — many grow out of it and chances are you won’t need to decide when to take their pacifier away. 


Now, we should mention that the occasional thumb sucking shouldn’t affect your little one’s teeth. Some toddlers still pop their thumb in their mouth without sucking in times of stress or to help soothe themselves as they doze off. This is called passive thumb sucking and is considered fairly normal. How can you tell what’s passive thumb sucking and what’s not?  Look for more aggressive jaw movements when their thumb is in their mouth or listen for popping noises when they take their thumb out. 



What can you do to stop thumb sucking and pacifier use?


Is your child around two or three years old and still has a strong thumb sucking or pacifier habit? The American Academy of Pediatrics Dentistry says you should step in after age three. However, the American Dental Association recommends giving a bit more time and discouraging these habits if they continue past age four.


So based on the research, we suggest gently getting your little one to give up, or least decrease their thumb or pacifier sucking around age two or three to be safe. If you can’t get your child to stop thumb sucking or using their pacifier by age four, we recommend coming in to see your pediatric dentist or us at The Brace Place


Whether you decide on a “cold turkey” style or a more gradual approach, here are six quick tips for helping your child stop thumb sucking or using their pacifier:


1.Empower your child to start on their own. Talk to your child calmly and gently about their habit and why they need to start trying to stop. The name of the game is empowerment (not shame or criticism): let them know you can help when they’re ready. Sometimes even bringing it up is all you need to get the ball rolling.


2. Use positive reinforcement. Praise your child whenever you notice they haven’t sucked their thumb or pacifier when they normally would.


3. Reward them. Use a sticker chart, prizes, or other external motivations you know they respond to.


4. Allow them to talk about their feelings. As we mentioned earlier, stress or anxiety can cause a child to suck their thumb or use a pacifier. If you see this is the case, take time to find out what they’re feeling and decide on what to do instead. Maybe your child needs a cuddle, a walk or some fresh air, and a chance to talk about what’s bothering them.


5. Distract them or change their activity. Sometimes it’s simply that your little one is bored, fidgety, or just having a hard day and is cranky. Offer a new activity like coloring, a new game, puzzles, fidget toys, or playing outside for a change of scenery.


6. Put in a habit-breaking appliance. If your at-home efforts just aren’t working, you can come into The Brace Place and find out if a special appliance will work for your child. A habit-breaking appliance blocks your child’s thumb from coming in contact with the back of the upper teeth, helping stop thumb sucking by making it less enjoyable. Rest assured, it’s not painful and is effective when all else fails!


Remember that some techniques work for one child but not another. And it can change from one day to the next. Or hour by hour! Consider what works for you and your little one. In the end, what you can prevent at an early age will help determine your child’s need for braces or Invisalign later on.



What happens to teeth after prolonged thumb sucking or pacifier use?


It’s no surprise that Dr. Patel has seen and treated many orthodontic issues from thumb sucking and pacifier habits that have gone on too long. After all, he’s been an orthodontist for more than 20 years! 


What are the most common orthodontic issues that happen to teeth from extended thumb sucking and pacifiers? Here we list the top three Dr. Patel has seen in his many years of orthodontic experience:


  • Protruding front teeth – Sucking on a thumb or pacifier puts pressure behind the front teeth, making them tilt or stick out. Also known as ‘’buck teeth,” these protruding front teeth are more susceptible to injury, can cause speech problems, or make it hard to close the lips or mouth comfortably.


  • Crossbite – A crossbite is when some of the top teeth sit inside of the bottom teeth when teeth are closed together. You can have an anterior cross bite (front teeth) or a posterior crossbite (back teeth). Typically, crossbite teeth from thumb sucking or a pacifier is a posterior crossbite: the sucking action causes a narrow upper arch (which Dr. Patel might suggest opening up later on with an orthodontic expander).


Crossbites can lead to jaw pain and uneven enamel wear because the teeth don’t stack together well. And sometimes a child with a crossbite tries to compensate by shifting the jaw to one side, further causing mismatched jaw growth.


  • Open bite – What is an open bite? Have your child close their teeth together, like when they say “cheeeese!” for a photo. If your child’s top teeth don’t overlap their bottom teeth (in an overbite or normal bite) or their lower and upper arches don’t touch at all, this is considered an open bite. An open bite can contribute to speech problems, or swallowing and chewing issues that make eating a difficult task.


Baby with a pacifier in their mouth and wearing a Santa hat on their head


Helping your child stop thumb sucking and pacifier use in Tulsa and Claremore, OK


Have questions about your child’s thumb sucking or pacifier use? Or concerned about the effects on their teeth? The team at The Brace Place is happy to help. 

Contact us to book a free initial consultation at our Tulsa or Claremore, OK office.