Thumb Sucking and Pacifiers: Effects on Teeth

Does thumb sucking or pacifier use hurt a child’s teeth?

It can, but only in certain conditions. The American Dental Association (ADA) says thumbsucking is a natural reflex for children, and sucking can make babies feel secure and happy. It matters for teeth when it goes on strongly for years, after adult teeth start to come in.

The ADA says that after adult teeth come in, sucking may cause problems with the proper growth of the mouth and the alignment of the teeth. It can also cause changes in the roof of the mouth. Your child’s dentist can watch for these changes at regular visits.

What decides whether there is a problem?

Mostly how hard, how long and how old. The ADA says the intensity of the sucking is a factor. Children who rest a thumb passively in the mouth are less likely to have trouble than those who suck vigorously. Some aggressive thumb suckers may develop problems with their baby teeth.

The American Academy of Pediatrics (AAP) says that if a child sucks strongly on a pacifier, thumb or fingers beyond 2 to 4 years of age, it may affect the shape of the mouth or how the teeth line up. Strong, long habits cause the most concern.

Is a pacifier better or worse than a thumb?

They affect teeth in much the same ways. The ADA says pacifiers can affect teeth essentially the same as fingers and thumbs, but a pacifier is often an easier habit to break. You can take a pacifier away, and you cannot take away a thumb.

The AAPD notes that pacifiers may be beneficial in the first few months of life, for example by offering comfort and soothing. It also says that prolonged use past 12 months can raise the risk of ear infection, and past 18 months can influence the growing mouth, which can lead to an open bite, a crossbite and other bite problems. You can read about these in our glossary: open bite and crossbite. Ask your child’s doctor and dentist when to start phasing out the pacifier.

When do most children stop?

Most stop between ages two and four. The ADA says children usually stop between two and four years old, or by the time the adult front teeth are ready to erupt. The AAP adds that, most often, children will stop on their own.

If you are unsure where your child stands, ask the dentist at your next visit to check how the teeth and bite are growing. A quick look can settle a lot of worry.

How can I help my child stop?

Gentle steps work better than pressure. The ADA suggests praising your child for not sucking. It also notes that children often suck when they feel insecure or need comfort, so the answer may be to address the worry, not the thumb.

Try these steps:

1. Praise and reward your child when they do not suck, as the AAP suggests.
2. If boredom is the trigger, keep their hands busy with something fun.
3. Explain what you are doing, so your child feels part of it.
4. Avoid harsh words, teasing or punishment. The AAP says these can upset your child and do not work.
5. Ask your dentist for advice and encouragement. The ADA says a dentist can explain to your child what could happen to their teeth.

The AAP also says a child might still suck to go to sleep or calm down when upset. When that happens in private, it is usually not harmful. Too much pressure to stop may cause more harm than good.

Should I offer a pacifier at all?

That is a choice for you and your child’s doctor. The American Academy of Pediatric Dentistry (AAPD) supports parents in deciding whether to introduce a pacifier based on the infant’s needs and parental preference. The AAP says offering a pacifier at nap time and bedtime helps reduce the risk of sudden infant death syndrome (SIDS).

The AAPD also warns about prolonged use, as the table above shows. Ask your pediatrician about safe use, and ask your dentist how the habit is affecting your child’s teeth.

When should I call the dentist?

Call if you see changes. The ADA says to consult your dentist if you notice changes in your child’s baby teeth or are concerned about the habit. Changes in how the teeth line up are a good reason to book a visit.

The ADA says that if simple tips do not work, your dentist or pediatrician may suggest a bitter coating for the thumb or a mouth appliance. That is a conversation to have in the office, not a decision to make at home.

For more on what to expect at a first visit, read when a baby should see the dentist and our child’s first dental visit guide. If you are also wondering about timing, see when baby teeth fall out.

What should I tell the dentist at the visit?

Bring a few simple facts. Note when your child started sucking, how often it happens, whether it happens mostly at sleep time, and whether it is a thumb, fingers or a pacifier. Say what you have already tried. Mention anything you have noticed about the front teeth, such as a gap or teeth that seem to stick out.

Honest details help the dentist judge how strong the habit is, since intensity is one factor the ADA names. They also help the dentist choose gentle advice that fits your child, rather than a one-size answer.

Next step

If your child is past age four and still sucks a thumb or pacifier, or you see changes in the teeth, ask for an exam. Read about dentistry for kids at Town Center Dental, then call (636) 273-5866 or request an appointment.