Changes in oral bioaccessibility of heavy metals in non-digestive sucking habits due to the formation of complexes between digestive fluid components and metals/metalloids.

Humans, especially infants, are exposed to harmful substances through various means, including non-nutritive sucking behaviors. Here, we compared the "one-compartment model" and the "three-compartment model" within the "suck model" to assess the oral bioaccessibility of heavy metals in various products and evaluated whether these models can be employed to assess 12 heavy metals present in consumer products. Several certified reference materials, including plastic, paint, glass, and metals, were employed to ensure sample homogeneity. By comparing the two models, we validated that a considerable amount of complexes were formed between saliva components and the extracted heavy metals and that some of these complexes dissociated during reactions with the gastric/intestinal fluids. Furthermore, we observed that in the cases of Cu and Pb, additional complexes were formed as a result of reactions with gastric/intestinal fluids. We measured the total concentrations of the extracted heavy metals using artificial saliva through acid digestion and found that up to 99.7% of the heavy metals participated in the formation of complexes, depending on the characteristics of the sample (e.g., composition) and the target element. This result indicates that the current suck model may notably underestimate the oral bioaccessibility of heavy metals in products associated with sucking behaviors. Therefore, we propose a more conservative and simpler test method for assessing oral bioaccessibility of heavy metals that involves measuring the total concentrations of heavy metals extracted from consumer products using artificial saliva. By doing so, we can account for potential variations in the digestive milieu (e.g., due to ingested food) and the inconsistency in complex formation-dissociation characteristics.

Relationship of early weaning and non-nutritive sucking habits with facial development.

OBJECTIVE: To determine the frequency of malocclusion features, convex facial profile and non-nutritive sucking habits among children with and without early weaning. METHODS: The cross-sectional study was conducted at the National Institute of Child Health, Karachi, from June to December 2020, and comprised of either gender aged 3-6 years. The subjects were clinically examined, and details of lactation period, bottle feeding, thumb and pacifiers sucking were gathered from the parents to assess association with malocclusion. Data was analysed using SPSS 20. RESULTS: Of the 180 subjects, 100(55.5%) were boys and 80(45.5%) were girls. There was significant association of early weaning with non-nutritive sucking habits, absent primate spaces, deviated midlines, and complete overbite (p<0.05). Breastfeeding <2 years was significantly associated with anterior crossbite (p<0.05). Early weaning had no association with convex facial profile, distoclusion, anterior and posterior crossbite and increased overjet (p>0.05). Non-nutritive sucking habits had significant relationship with deviated dental midlines (p>0.05). Conclusion: Early weaning was found to be a factor in establishing non-nutritive sucking habits, and was strongly associated with crowding, disturbed vertical overlapping of incisors and developing decreased facial height. Breastfeeding for less than the recommended duration had a tendency to lead to anterior cross-bite.

Factors associated with non-nutritive sucking habits at 2 years of age among very preterm children: EPIPAGE-2 cohort study.

BACKGROUND: The association between prolonged non-nutritive sucking habits (NNSHs, ie, sucking pacifiers or fingers) and maxillofacial growth anomalies in the general population has been widely described. Because maturation of sucking abilities is not fully achieved in very preterm infants (<32 weeks' gestation), neonatal services worldwide rely on the use of pacifiers to promote the development of adequate sucking reflexes, possibly prolonging NNSHs during infancy. OBJECTIVE: We aimed to describe the frequency and to identify factors associated with NNSHs at age 2 years in very preterm children. METHODS: The study was based on data from EPIPAGE-2, a French national prospective cohort study of preterm births during 2011 that included 2593 children born between 24 and 31 weeks' gestation. The primary outcome was NNSHs at 2 years. Multivariable log-linear regression models with generalized estimation equations were used to study the association between the characteristics studied and NNSHs. Multiple imputations were used to take into account missing data. RESULTS: The frequency of NNSHs was 69% in the overall sample but higher among girls (adjusted risk ratio [RR] 1.12, 95% confidence interval [CI] 1.05, 1.17), children born from multiple pregnancies (eg, twins/triplets) (RR 1.07, 95% CI 1.00, 1.11), children who were fed by nasogastric tube (RR 1.07, 95% CI 1.01, 1.13), or those who benefitted from developmental care programmes (RR 1.10, 95% CI 1.02, 1.19). The NNSHs frequency was lower if mothers were not born in France (RR 0.70, 95% CI 0.64, 0.77), children had 2 or more older siblings (RR 0.88, 95% CI 0.82, 0.96), or children were breast-fed at discharge (RR 0.90, 95% CI 0.85, 0.95). CONCLUSIONS: NNSHs at 2 years seemed associated with cultural background, development care programmes, and breast feeding. Whether NNSHs at 2 years among very preterm children are associated with future maxillofacial growth anomalies deserves further attention.

The association between nutritive, non-nutritive sucking habits and primary dental occlusion.

BACKGROUND: The development of primary dentition can be affected by oral sucking habits. Therefore, this study aims to investigate the association of nutritive and non-nutritive sucking habits with primary dentition development. METHODS: One thousand one hundred and fourteen children aged 2 to 5 years old in Hong Kong were recruited in a cross-sectional study. Information on their nutritive (e.g. breastfeeding and bottle feeding) and non-nutritive sucking habits (e.g. pacifier use and thumb/digit sucking) was collected via questionnaires. The children's primary occlusions were examined in three dimensions. RESULTS: Children who were breastfed for more than 6 months had a lower proportion of daily pacifier use (p < 0.05). Children who used pacifiers daily had a higher proportion of thumb/digit sucking (p < 0.05). Children who used pacifiers daily for more than one year had higher chances of developing an anterior open bite (p < 0.05) and a reduced overbite (p < 0.05). Those exhibiting daily thumb/digit sucking for more than one year had higher chances of developing Class II incisor and Class II canine relationships, an increased overjet and anterior open bite (p < 0.05). CONCLUSION: Pure breastfeeding for more than 6 months is inversely associated with daily pacifier use and daily pacifier use is positively associated with daily thumb/digit sucking. Children with more than one year of daily pacifier use and thumb/digit sucking have higher chances of developing abnormal dental relationships in the sagittal (i.e. Class II incisor and Class II canine relationships and increased overjet) and vertical (i.e. anterior open bite) dimensions, respectively.

Risk Factors for High-Arched Palate and Posterior Crossbite at the Age of 5 in Children Born Very Preterm: EPIPAGE-2 Cohort Study.

Introduction: Children born very preterm have an immature sucking reflex at birth and are exposed to neonatal care that can impede proper palate growth. Objectives: We aimed to describe the frequency of high-arched palate and posterior crossbite at the age of 5 in children born very preterm and to identify their respective risk factors. Methods: Our study was based on the data from EPIPAGE-2, a French national prospective cohort study, and included 2,594 children born between 24- and 31-week gestation. Outcomes were high-arched palate and posterior crossbite. Multivariable models estimated by generalized estimation equations with multiple imputation were used to study the association between the potential risk factors studied and each outcome. Results: Overall, 8% of children born very preterm had a high-arched palate and 15% posterior crossbite. The odds of high-arched palate were increased for children with low gestational age (24-29 vs. 30-31 weeks of gestation) [adjusted odds ratio (aOR) 1.76, 95% confidence interval (CI) 1.17, 2.66], thumb-sucking habits at the age of 2 (aOR 1.53, 95% CI 1.03, 2.28), and cerebral palsy (aOR 2.18, 95% CI 1.28, 3.69). The odds of posterior crossbite were increased for children with pacifier-sucking habits at the age of 2 (aOR 1.75, 95% CI 1.30, 2.36). Conclusions: Among very preterm children, low gestational age and cerebral palsy are the specific risk factors for a high-arched palate. High-arched palate and posterior crossbite share non-nutritive sucking habits as a common risk factor. The oro-facial growth of these children should be monitored.

The effect of pacifier sucking on orofacial structures: a systematic literature review.

BACKGROUND: Non-nutritive sucking habits may adversely affect the orofacial complex. This systematic literature review aimed to find scientific evidence on the effect of pacifier sucking on orofacial structures. METHODS: A search on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted to find all pertinent articles published from inception until February 2018, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the studies was evaluated using the risk of bias judgements in non-randomized studies of interventions (ROBINS-I). RESULTS: Among the 2288 articles found, 17 articles met the selection criteria: seven prospective cohort studies, nine cross-sectional studies, and one randomized clinical trial. Using ROBINS-I, 12 studies were evaluated to have a serious overall risk of bias and five, a moderate one. These studies claimed a strong association between a pacifier sucking habit and the presence of an anterior open bite and posterior crossbite. Functional/orthodontic pacifiers were shown to cause significantly less open bites than the conventional ones. CONCLUSIONS: High level of evidence of the effect of sucking habits on orofacial structures is missing. The available studies show severe or moderate risk of bias; hence, the findings in the literature need to be very carefully evaluated. There is moderate evidence that the use of pacifier is associated with anterior open bite and posterior crossbite, thus affecting the harmonious development of orofacial structures. Functional/orthodontic pacifiers reduce the prevalence of open bite when compared to the conventional ones, but evidence is needed concerning the effects on posterior crossbite. Well-designed randomized controlled trials are needed to further analyze the effects of functional/orthodontic and conventional pacifiers on orofacial structures.

Attitudes of Saudi mothers towards prolonged non-nutritive sucking habits in children.

OBJECTIVES: The purpose of the present study was to evaluate Saudi mothers' attitude towards non-nutritive sucking habits by their children and report the methods they used to stop these habits. METHODS: Across-sectional study involved 181 mothers of preschool children currently engaged in non-nutritive sucking habits (digit and pacifier) were studied. The information was obtained from a self-administered questionnaire completed by the mothers. RESULTS: The majority of mothers (69.1%) were from high socio-economic families, (77%) had university or higher education and more than half of them (58.6%) were employed. About 75% of the children were pacifier users, and 25% of them habitually sucked their digits. Nearly half of the mothers (43.5%) thought that the reason of acquiring the habit was because their children cried a lot at night. The majority of studied mothers (88.7%) considered sucking a harmful habit to their children' teeth, and 69.1% never accepted the sucking habit. High percentage (80.8%) of mothers tried to intervene with these habits and 61.0% of them tried their intervention when children were one year old or less. Most proposed reasons for mothers' intervention with sucking habits were their concerns that the habit might continue until the child become older (53.3%) followed by their concern that the habit might affect their children's permanent teeth (45.3%). The methods used by mothers were mostly non-invasive procedures which included restricting the use of pacifier to specific times in the day (63.0%), followed by reinforcement of positive behaviors and using rewards (26.0%). None of the mothers sought advice from pediatrician while only one mother (0.6%) consulted a dentist about sucking habits. CONCLUSION: This study shows that Saudi mothers are concerned about sucking habits and recognized the harmful effect on their children. These mothers, however, are in great need for education about ways of preventing the habits in the first place as well as professional advice and help in treatment cessation of already established habits.