Short answer: An orthodontic pacifier is a pacifier whose tip is flattened to fit the palate and tongue better. It has not been clearly proven to provide marked protection compared with a classic pacifier; what mainly determines the effect on the teeth and jaw is how long and how often it is used. It is generally recommended that the pacifier be stopped around age 2–3; if the habit continues after age 3–4, an orthodontic evaluation is useful.
Orthodontic pacifier is the general name for pacifiers whose tip, the part that goes into the mouth, is flattened to fit the baby's palate and tongue better. Often listed in searches as "orthodontic pacifier" too, these products are usually presented on their packaging with the phrase "suited to tooth and jaw development." But does an orthodontic pacifier really protect tooth structure, does a pacifier spoil the teeth and, most importantly, when should the pacifier be stopped? In this article, we cover these questions that parents ask most often in the light of current scientific knowledge and in a measured tone.
What is an orthodontic pacifier?
An orthodontic pacifier is a pacifier with a tip that is slightly domed on top, flat underneath and thin at the neck, instead of the classic round (cherry-shaped) tip. The aim of the design is to allow the tongue to lie in its natural forward-and-downward position during sucking and to put less pressure on the palate than round-tipped pacifiers.
Most of these pacifiers try to imitate the flattened shape the nipple takes in the mouth during breastfeeding. However, the word "orthodontic" does not mean assured treatment or protection; it is only a design term that describes the tip shape. An orthodontic pacifier is, after all, a pacifier, and when used for a long time and often it can have effects similar to other pacifiers.
How do pacifiers affect the teeth and jaw?
When used briefly and in moderation, a pacifier does not cause a lasting problem in most children; what mainly determines the effect is the duration, frequency and intensity of use. The sucking reflex is natural in babies, and non-nutritive sucking (pacifier or thumb) is the way many babies soothe themselves.
Problems generally appear when pacifier use continues every day for long hours after the age of three. In this case, the changes commonly seen are:
- Anterior open bite: The upper and lower front teeth not touching when the mouth is closed, leaving a gap in between.
- Posterior crossbite: The upper jaw narrowing because of the tongue sitting low and the pressure of the cheek muscles, with the side teeth closing in reverse.
- Upper front teeth tilting forward: The upper incisors positioned outward beyond the lip.
- Change in palate shape: The palate taking on a narrower and deeper appearance.
The encouraging part is that a significant portion of these changes tend to correct themselves on their own when the habit is stopped while the baby teeth are still in place. If the habit is still continuing when the permanent front teeth begin to come in (usually around age 6–7), the chance of the changes becoming permanent increases. The effects of thumb sucking progress in a similar way; we covered this topic in detail in our article on the effects of thumb sucking on tooth structure.
Does an orthodontic pacifier really make a difference?
In short: it has not yet been clearly proven that an orthodontic pacifier provides marked protection compared with a classic pacifier. Although some studies suggest that anterior open bite may be seen slightly less in children who use a flat-tipped pacifier, the number of studies in this area is limited and the results do not fully support one another.
The common point that stands out in scientific reviews is this: whichever type of pacifier is used, long-term and intensive use can negatively affect tooth and jaw development. In other words, choosing an orthodontic pacifier should not be a reason to delay the time of stopping the pacifier. Even if the tip design provides a small advantage, it does not eliminate the effect of a pacifier that sits in the mouth for most of the day.
For this reason, our advice to parents is that while there is no harm in choosing an orthodontic pacifier, the main attention should go to the habit of use: giving the pacifier only before sleep and at moments of fussiness, and not leaving it in the mouth during play and talking.
What to look for when choosing a pacifier
When choosing a pacifier, safety and suitability for age come before tip shape. The following points matter for both oral health and general safety:
- Size suited to age: Choose a pacifier suitable for the age range stated on the packaging; a tip that is too large or too small can change the way of sucking.
- One-piece and sturdy construction: One-piece, sturdy pacifiers should be preferred so that the tip does not separate from the body and get swallowed.
- Shield with ventilation holes: The shield in front of the mouth must be wide enough that it cannot fit into the mouth and must have air holes.
- Regular checking and replacement: Pacifiers that are cracked, sticky or worn thin should be replaced right away.
- Do not tie a cord around the neck: Long strings and cords that hang the pacifier around the neck carry a risk of strangulation; short, safe clips should be preferred.
- Do not sweeten it: Dipping the pacifier in honey, sugar, jam or syrup increases the risk of cavities; honey is also not suitable for babies under one year of age for health reasons.
It is also not recommended to "clean" the pacifier by putting it in your own mouth; in this way, cavity-causing bacteria from an adult's mouth can pass to the baby. You can find the problems caused by falling asleep with sweet drinks and the night bottle in our article on baby bottle tooth decay.
For breastfed babies, the general advice is to wait to start a pacifier until the breastfeeding routine is established (in most sources, the first 3–4 weeks). It is appropriate to make this decision together with your baby's doctor.
When and how should the pacifier be stopped?
It is generally recommended that the pacifier be reduced and stopped around age 2–3; pediatric dentistry and orthodontic sources set the goal of ending non-nutritive sucking habits by around age 3 at the latest. Limiting use to sleep times only after the age of one also makes the weaning process easier.
Some approaches that can help in the weaning process:
- Gradual reduction: First remove daytime use, then give it only when falling asleep, and in the final stage stop it completely.
- Choose the right time: Trying to stop during stressful periods such as moving, the birth of a sibling, starting daycare or illness makes the process harder.
- Alternative comforters: A favorite toy, reading a book before bed or a calm routine can help take the place of the pacifier.
- Positive reinforcement: Celebrate days or nights without the pacifier with small words of praise and marks on a calendar.
- Do not punish: Methods such as scolding or putting a bitter substance on the tip of the pacifier can increase anxiety; being calm and consistent is more effective.
Some children may turn to thumb sucking after giving up the pacifier. Because the thumb is always at hand, stopping this habit can be harder than stopping the pacifier; for this reason it is important to watch the transition period closely.
When is an orthodontic evaluation needed?
If a pacifier or thumb-sucking habit continues after age 3–4, or if you notice a marked change in how the teeth close, an orthodontic evaluation is useful. In the evaluation, the child's bite, palate width, and tongue and lip habits are examined; whether any intervention is needed is determined at the exam.
These situations are good reasons to consult a specialist:
- A marked gap remaining between the front teeth when the mouth is closed,
- The side teeth closing in reverse or the jaw shifting to one side,
- The upper front teeth tilting markedly forward,
- The sucking habit continuing even though the permanent teeth have started to come in,
- The tongue being pushed forward between the teeth when swallowing.
If the habit cannot be stopped on its own, reminder-type appliances may come up in some children. We described these options in our article on habit-breaking appliances; however, they are not necessary in every child, and the decision is made through a dentist's exam. A first orthodontic check-up at around age 7 helps possible problems be noticed early; for information on approaches in this period, you can look at our page on early orthodontic treatment.
Keep in mind that the pacifier period often overlaps with the teething period; fussy babies may want the pacifier more. To make this period easier, you can make use of the suggestions in our article on teething symptoms in babies and ways to soothe them. If you are curious about when the permanent molars that follow the baby teeth come in, our article on when molars come in will also be a guide.
Orthodontic check-up for children in Ankara
If your child's pacifier or thumb-sucking habit has gone on for a long time, or if there is a change in how their teeth close that concerns you, our orthodontist at our clinic in Park Oran Ofis in Oran, Çankaya, can evaluate the mouth structure. At the exam, whether monitoring or intervention is needed according to your child's age and development is discussed; for your questions, you can reach us through our contact page.
Frequently asked questions
Does an orthodontic pacifier prevent crooked teeth?
There is no strong evidence that an orthodontic pacifier prevents crooked teeth. Although some studies suggest a limited benefit, what mainly determines the effect on the teeth and jaw is how long and how often the pacifier is used.
At what age should the pacifier be stopped?
The general recommendation is that the pacifier be reduced and stopped around age 2–3. Limiting use to sleep times after the age of one makes weaning easier. If the habit continues after age 3–4, it is helpful to consult a specialist.
Does an open bite caused by a pacifier correct itself?
When the habit is stopped during the baby-teeth period, changes such as anterior open bite tend to correct themselves in many children. If the habit continues while the permanent teeth are coming in, the change can become permanent; whether it needs monitoring or treatment is determined at the exam.
Is it harmful to sweeten the pacifier with honey or sugar?
Yes, dipping the pacifier in honey, sugar or syrup increases the risk of cavities in baby teeth. Honey is also not recommended for babies under one year of age for health reasons. The pacifier should be given plain and clean.
Should I choose an orthodontic pacifier or a regular pacifier?
Either type can be used as long as it is suited to the age, one-piece and sturdy. There is no harm in choosing an orthodontic pacifier; however, whichever type is chosen, limiting the duration of use and stopping the pacifier on time matters more.
