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Pacifiers, Thumb Sucking, and All Things Habit

Thumb sucking Habits

“When should I take the pacifier away? 

When does he really need to stop sucking his thumb? 

Is this going to cause problems with her teeth?”


These are some of the most common questions I get from patients, friends, and even family members about their children’s behavior patterns and habits. Today, I am going to try to help you answer some of these frequent questions.


Historical Perspective

Questions about non-nutritive (non-eating) sucking are not new. In fact, orthodontists have been writing about these issues for over 100 years. In 1915, Martin Dewey wrote about the effects of a pacifier or rubber nipple on the developing dental arches. He even wrote that the use of pacifiers is “permitted by many physicians whose attention has never been called to the evil results of this practice.”3 He continues to urge to orthodontists and parents to discontinue the habits to prevent maldevelopment.

Obviously research has progressed quite a bit since 1914.


Current Research

When the child has primary dentition (baby teeth), it is normal for them to engage in both pacifier and finger sucking.4 Most children have a non-nutritive sucking habit at 24 months, but only 40% do at 36 months. Only 1% of children at age 5 still have a pacifier habit. 1 Thumb and finger sucking habits can last longer and are still present in 4% of children at age 7-8.


Though these habits can have effects on dental development, the most significant problems arise when the habit is prolonged and severe. The effect is really determined by the frequency and the duration of the habit.4 Longer durations of these habits are associated with an increased risk in developing malocclusions (dental and skeletal problems).2 Kids can develop posterior crossbites (a dental/ skeletal malocclusion) at age 2-3 with a prolonged pacifier habit.1  Other dental malocclusions can result from abnormal tongue posture, finger sucking, or lip biting.


As an orthodontist, I normally recommend that these habits be discontinued by the time the permanent dentition (adult teeth) start erupting. On average, permanent teeth begin to erupt around age 6. Once the permanent teeth begin erupting, there is an even greater potential for harmful effects on the teeth and jaw development.


Interventions / Treatment

Intervention, depending on the severity of the habit, can be difficult. Luckily, the social pressures of school are a strong deterrent for pacifier use.4 Other habits such finger sucking or tongue sucking may be harder to break. The best starting point is to involve the dentist or orthodontist when the child’s permanent teeth begin to erupt. Most of the time this involvement begins as  a discussion with the orthodontist, child, and parent about the prolonged effects of the habit.  This simple approach works in many cases, while other times it is not effective.


The most important factor in breaking the habit is the child’s motivation to quit- the child has to want to break the habit. If the child is motivated to break the habit, the orthodontist can become involved with simple orthodontic interventions to act as reminder therapy.   In other children, implementing a reward system for not engaging in the habit can be successful. Since every child and every habit is different, I recommend talking to your orthodontist about what might be best for your child.


If you have any other questions, send us a message or schedule an appointment with your orthodontist today.



  1. Bishara SE, Warren JJ, Broffitt B, Levy SM. Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life. American Journal of Orthodontics and Dentofacial Orthopedics. ;130(1):31-36.
  2. Dogramaci EJ, Rossi-Fedele G. Establishing the association between nonnutritive sucking behavior and malocclusions: A systematic review and meta-analysis. J Am Dent Assoc. 2016;147(12):926-934.e6.
  3. Howard CC. A brief review of certain histological and etiological factors in the treatment of malocclusion. American Journal of Orthodontics and Dentofacial Orthopedics. ;1(7):345-354.
  4. Proffit W, Fields H, Sarver D. Contemporary orthodontics. 5th ed. Canada: Elsevier; 2013.

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