The Truth About Pacifiers and the Effects on Teeth

If you’re like a lot of parents, you give your baby a pacifier. They’re wonderful for soothing a fussy baby, satisfying their natural desire to suck, providing comfort, and helping baby exercise their mouth muscles. There's even evidence that offering a pacifier at all sleep times can offer some protection against Sudden Infant Death Syndrome (SIDS). How a pacifier can reduce the risk of SIDS is still unclear, though safe infant sleep guidelines in various countries support the use of a pacifier during naps and bedtime in the first six months of life and often even up to 1 year of age.

Yet, some parents may worry that giving their baby a pacifier could damage their teeth even before or while they are coming in. 

Here, we’ll separate fact from fiction and answer your questions about the safe use of pacifiers for your baby, how to prevent pacifier teeth, plus when and how to break the pacifier habit. (Spoiler alert: Contrary to what someone might tell you, your child will not be using their “passie” at their high school graduation!)

Do Pacifiers Cause Tooth Damage?

Does a pacifier affect teeth? The answer to this question is no, not when they are used responsibly and within the recommended time limit of no more than six hours per day.  The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend weaning your baby off the pacifier at around six months of age because of an increased risk of ear infection, not tooth damage. Ultimately, they state that pacifier use after the age of two and definitely after the age of four should be avoided to minimize the risk of impact on teeth.

Babies up to one year of age have a natural desire to suckle, and a pacifier is an excellent way to satisfy that urge. Unlike thumb or finger sucking, pacifiers can be sterilized regularly and replaced if need be. Many pacifiers come with caps to keep them clean between use.  Be sure to choose a pacifier shape that supports oral development, usually indicated by the word "orthodontic.” Finally, it’s much easier to wean your baby off a pacifier than it is to wean them off sucking their thumb or fingers.

Tips for Pacifier Use

Whether it's your first baby or your fourth, each one is a unique little person with their own special needs and preferences. Some babies never quite take to soothers, while others enjoy feeding that desire to suckle. If your baby loves the pacifier, there are some easy guidelines to follow to ensure they’re getting the greatest benefits from it:

• Make sure you have the right size for baby’s mouth. (Recommended ages are typically listed on pacifier packaging.) 
• Consider using an orthodontic pacifier with a flat nipple designed to help support the natural movement of baby’s mouth muscles.
• Purchase several pacifiers to have on hand in the nursery, your diaper bag, or next to the rocker where you nurse. It’s also helpful to have multiple pacifiers so you can rotate them while they are being cleaned and sanitized.
• Limit pacifier use to no more than six hours daily. Early weaning from a pacifier can help prevent misaligned teeth. Weaning your baby from their pacifier can begin as early as six months, though the mouth and teeth develop differently for every infant. Gently wean your child off the pacifier around age 2 (if they haven’t yet self-weaned) and no later than the age of 4.
• Use of pacifiers in children older than 24 months should be a decision made by each parent, based on consultation with a medical and/or dental professional. At the latest, pacifier weaning should start by 36 months as recommended by pediatric dentists. Research shows prolonged use after two years, and definitely after age 4, has the most adverse effect on teeth.

Breaking the Pacifier Habit

Many parents are nervous about weaning their baby off the pacifier. However, it doesn’t have to be as difficult as you might fear. Start slowly by preparing your child. With older children, you can discuss a plan for saying goodbye to their soother. There are even picture books about the topic that you can read together. Putting pacifiers away without easy access to your little one can be helpful too. Distraction, such as games or cuddling, can prove effective as well. Be encouraging and praise their progress as it happens. We promise that while success might not arrive in one day, it will come eventually!

References

1.  Alm B et al. Breastfeeding and dummy use have a protective effect on sudden infant death syndrome. Acta Paediatr. 2016; 105(1):31–38. 
2. Moon RY, AAP Task Force on SIDS. SIDS and other sleep-related infant deaths: Evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016; 138(5):e20162940
3. Kids First Pediatric Dentistry, (November 2021). Do Pacifiers Hurt Tooth Development? 
4. 2 Lieberthal AS et al. Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013; 131(3):e964-99.
5. Proffit WR. On the etiology of malocclusion. The Northcroft lecture, 1985 presented to the British Society for the Study of Orthodontics, Oxford, April 18, 1985. Br J Orthod. 1986; 13(1):1–11.
6. AAPD. Perinatal and infant oral health care. Latest revision 2016. In: AAPD, editor. The reference manual of pediatric dentistry. 2019-2020. Chicago IL: AAPD; 2020. p. 228–32.
7. Lubbe W, Ham-Baloyi W. When is the use of pacifiers justifiable in the baby-friendly hospital initiative context? A clinician's guide. BMC. Pregnancy. Childbirth. 2017; 17(1):130.
8. AAPD. Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Latest revision 2018. In: AAPD, editor. The reference manual of pediatric dentistry. 2019-2020. Chicago IL: AAPD; 2020. p. 209–19.