The effect of early childhood non-nutritive sucking behavior including pacifiers on malocclusion: a randomized controlled trial.

BACKGROUND/RATIONALE: Systematic reviews on the effects of pacifiers on occlusion have highlighted the need for quality RCTs. TRIAL DESIGN: Single region, three parallel-armed, prospective, randomized controlled trial. OBJECTIVES: To investigate the correlations between early childhood non-nutritive sucking habits and malocclusion. Specifically to test whether the use of a study pacifier has differing effects compared to other pacifiers and control, and whether the duration of pacifier use or digit sucking influence the occlusion. PARTICIPANTS: The subjects were firstborn children, born in 2008 in Vantaa, Finland. INTERVENTION: One-third of participants were offered study pacifiers, free of charge, from birth up to 2 years of age. The history of the subjects' sucking habits, including pacifier use was screened in a questionnaire at the age of 2 years, and clinical examinations were performed at the age of 7 years. In addition, the subjects were divided into groups that were equally matched regarding their mother's level of education. OUTCOMES: Posterior crossbite, anterior crossbite, overjet, deep bite, open bite, and crowding. RANDOMIZATION METHOD: Three districts were randomly allocated to three study groups by drawing lots. BLINDING: It was not possible to blind the clinicians or parents from the intervention. Blinding during data analysis was performed. RESULTS: From the original cohort of 2715 children born in the town of Vantaa, 1911 were excluded and 353 were lost to follow-up. The remaining 451 children were divided into three groups according to the use of pacifiers. The prevalence of posterior crossbite at the age of 7 years was higher if a non-study pacifier had been used (P = .005) even when matched for the mother's level of education (P = .029). The prevalence of posterior crossbite was higher if the pacifier habit had continued for 12 months or more compared to 11 months or less, 7% and 1%, respectively, (P = .003). Digit sucking for 12 months or more was associated with crowding (P = .016). The prevalence of crossbite in the study pacifier group was less than in control pacifiers. HARMS: No adverse harms were reported other than effects on the dentition. CONCLUSION: The use of pacifiers is associated with the posterior crossbite, especially if their use continues for a year or more. Parents/guardians should be advised to stop the use or reduce the use of pacifiers to a minimum after their child's first birthday. TRIAL REGISTRATION: ClinicalTrials.gov NCT01854502.

Advancing the assessment of pacifier effects with a novel computational method.

BACKGROUND: Numerous studies have demonstrated a high likelihood of malocclusions resulting from non-nutritive sucking. Consequently, quantifying the impact of pacifiers can potentially aid in preventing the development or exacerbation of malocclusions and guide the design of improved performance pacifiers. METHODS: This work proposes and assesses a computational methodology that can effectively gather crucial information and provide more precise data regarding the consequences of non-nutritive pacifier sucking. The computational framework utilized is based on solids4Foam [1, 2], a collection of numerical solvers developed within the OpenFOAM® computational library [3]. The computational model focuses on the palate of a six-month-old baby and incorporates various components such as palate tissues, pacifier and tongue, and considers the negative intraoral pressure generated and the tongue displacement. Different models were tested, each offering varying levels of detail in representing the palate structure. These models range from a simplified approach, with one tissue, to a more intricate representation, involving up to five different tissues, offering a more comprehensive palate model compared to existing literature. RESULTS: The analysis of results involved examining the distribution of stress on the palate surface, as well as the displacement and forces exerted on the dental crowns. By comparing the obtained results, it was possible to evaluate the precision of the approaches previously described in the literature. The findings revealed that the predictions were less accurate when using the simplified model with a single tissue for the palate, which is the most common approach proposed in the literature. In contrast, the results demonstrated that the palate model with the most intricate structure, incorporating five different tissues, yielded distinct outcomes compared to all other combinations. CONCLUSIONS: The computational methodology proposed, employing the most detailed palate model, has demonstrated its effectiveness and necessity in obtaining accurate data on the impact of non-nutritive sucking habits, which are recognized as a primary contributor to the development of dental malocclusions. In the future, this approach could be extended to conduct similar studies encompassing diverse pacifier designs, sizes, and age groups. This would foster the design of innovative pacifiers that mitigate the adverse effects of non-nutritive sucking on orofacial structures.

Effects of non-nutritive sucking habits on malocclusions: a systematic review.

The development of the craniomandibular system is guided by genetic interactions and environmental factors, including specific habits such as breastfeeding, bottle feeding, thumb sucking and the use of pacifiers. These habits can have a considerable impact on the growth of the developing jaws and can lead to malocclusion in children. This review aims to investigate potential associations between non-nutritive sucking habits (NNSHs) and malocclusions compared to the presence of nutritive sucking habits (NSHs). To carry out this systematic review, we followed the PRISMA protocol and performed a bibliographic search of the existing literature until April 2023 in the following electronic databases: Medline, PubMed, The Cochrane Library and Embase. Out of a total of 153 records, we included 21 studies. We found that the chances of diagnosing a malocclusion were higher for children with bottle nutrition when compared to breast-fed children. Breastfeeding provides protection against malocclusions. In the same manner, persistent NNSH habits appeared to be associated with increased chances of having malocclusions. The longer the child was breastfed, the shorter the duration of the pacifier habit and the lower the risk of developing moderate/severe malocclusions. The duration of the habits has a positive influence on the appearance of occlusion defects.

Influence of bad oral habits upon the development of posterior crossbite in a preschool population.

BACKGROUND: A study is made of posterior crossbite in deciduous dentition and its possible association to extrinsic factors (bad oral habits). METHODS: A total of 1168 Spanish children between 3 and 6 years of age were included in the study. Exploration of the oral cavity was performed to assess the presence of crossbite (uni- or bilateral and/or functional), and a questionnaire was administered to the parents or caregivers to determine the presence of bad oral habits and their duration. RESULTS: In occlusion, 19.7% of the cases (n = 230) presented uni- or bilateral posterior crossbite. On adopting centric relation confronting the midlines, crossbite persisted in 165 children, indicating that 65 cases were due to premature contacts (functional crossbite). The identified favoring factors were pacifier use, thumb sucking, oral breathing and tongue thrusting or immature swallowing. DISCUSSION: Most studies in the literature report a relationship between posterior crossbite and bad oral habits. The proportion of posterior crossbites identified in our study (16.6%) is consistent with the data published by authors such as Kobayashi, Limeira or Paolantonio, among others, but differs from the results of Zhifei Zhou, Peres or Germa. In coincidence with most studies, we recorded a statistically significant association between posterior crossbite and bad oral habits. CONCLUSIONS: Bad oral habits favor the appearance of posterior crossbite, and the duration of the habit, its intensity (in the case of thumb sucking) and type (in the case of pacifier use) act as influencing factors. Functional study characterized the types of posterior crossbites and identified those attributable to premature contacts. This aspect has not been addressed by previous studies, and we consider the findings to be very interesting for analyzing and identifying the features of true crossbites.

The impact of co-sleeping less than 6 months on children's anxiety, oral habits, and malocclusion in a Spanish sample between 2 and 5 years old: a cross-sectional study.

OBJECTIVES: Families often use co-sleeping to mitigate potential physiological and emotional effects on infants. The purpose of this study was to investigate whether the early termination of co-sleeping is associated with high levels of anxiety, non-nutritive sucking habits for self-comfort, and increased malocclusion. METHODS: A cross-sectional study was performed on the parents of 215 children [aged 2-5 years (3.94 ± 0.89)], who were divided according to the duration of co-sleeping (≤6 months or >6 months). The parents completed a questionnaire about co-sleeping, sucking, breastfeeding habits, and anxiety. Finally, a clinical examination was carried out to diagnose malocclusion according to the World Health Organization (WHO) index, and the aesthetic component of the Index of Orthodontic Treatment Need (IOTN-AC) was recorded. RESULTS: Children that co-slept for 6 months or less had an increased incidence of pacifier use (P < 0.05), finger sucking (P < 0.01), and atypical swallowing (P < 0.05). Lower anxiety levels were found in the group with a longer duration of co-sleeping (P < 0.01). In the assessment of malocclusions, the group that co-slept for ≤6 months had higher IOTN scores (P < 0.01) and WHO indices (P < 0.05); in addition, there were differences in anterior open bite (P < 0.05), posterior crossbite (P < 0.01), skeletal Class II (P < 0.01), canine Class II (P < 0.05), and overjet (P < 0.05). CONCLUSION: A co-sleeping duration of >6 months appears to be a protective factor associated with less anxiety, fewer negative sucking habits, and a decreased incidence of malocclusions in co-sleeping children.

Functional comparison of pacifiers using finite element analysis.

BACKGROUND: Pacifiers have been shown to affect maxillary growth related to the anatomic structure of the palate and forces placed upon it during sucking. This study compares and evaluates the mechanical behavior of pacifiers of different design and size (i.e., fit), identified by brand and size, positioned in age-specific palatal models with respect to both contact area and force when subjected to peristaltic tongue function and intraoral pressure related to non-nutritive sucking. METHODS: Nonlinear finite element analyses were used to simulate dynamic mechanical interaction between the pacifiers and palates. Time-varying, external pressure loads were applied which represent intraoral pressure arising from non-nutritive sucking and peristaltic behavior of the tongue. The silicone rubber pacifier bulb was represented using a hyperelastic material model. RESULTS: Results from the finite element analyses include deformation, stress, strain, contact area, and contact force. Mechanical interaction was evaluated in terms of the spatial distribution of the contact area and force between the pacifier and the palate. The resulting palatal interaction profiles were quantitatively compared to assess how pacifier fit specifically affects the support provided to two areas of the palate, the palatal vault and the Tektal wall. CONCLUSIONS: Pacifiers interact with the palate differently based on their fit (i.e., design and size) regardless of whether they are labeled conventional or orthodontic. Finite element analysis is an effective tool for evaluating how a pacifier's design affects functional mechanics and for providing guidance on biometric sizing.

Pathways to anterior open bite after changing of pacifier sucking habit in preschool children: A cohort study.

BACKGROUND: Pacifier use is a major cause of anterior open bite (AOB), which negatively impacts the quality of life of children affected. AIM: To assess the direct and indirect pathways related to pacifier sucking habit and AOB in preschool children. DESIGN: This 2-year cohort study evaluated a random sample of preschool children (2-5 years of age) from Southern Brazil. Caregivers answered a questionnaire addressing socio-economic and behavioural characteristics. Anterior open bite was recorded following the criteria recommended by Foster and Hamilton. Structural equation model was performed to assess the direct and indirect pathways among variables at baseline (T1) to predict the AOB at follow-up (T2). RESULTS: Regarding the AOB, 407 children were evaluated at T1 and 187 at T2. The prevalence of AOB was 32.9% at baseline and 16.0% at follow-up. The presence of AOB at follow-up was directly affected by the change in pacifier sucking habit from T1 to T2. Considering the indirect paths, the AOB at T1 influenced the AOB in T2 via a change of pacifier sucking habit. CONCLUSION: These findings suggest that the non-habit of sucking pacifiers is a fundamental strategy for the prevention of AOB as well as the promotion of health in childhood.

Nutritional and non-nutritional habits and occurrence of malocclusions in the mixed dentition.

Malocclusions are changes in the development of craniofacial structures of high prevalence. Associated risk factors are diverse and nutritional and non-nutritional suction habits are the most reported. The aim of this study was to estimate the prevalence of malocclusions in the mixed dentition and to study possible association with practices of breastfeeding and suction habits among Brazilian schoolchildren. A cross-sectional study involving a sample of 664 6-year-old children and their families was carried out. Data collection was done through interviews with mothers in the homes and oral examinations of children in schools. Multivariate analyses were performed using the Poisson regression with a robust estimator. The prevalence of overjet over 4 mm was 21.1% and of posterior crossbite was 12.2%; 91.9% of the children were breastfed, 79.0% used a nursing bottle and 49.4% used a pacifier. Significant and independent associations were observed between father's unemployment, private school, interruption of breastfeeding before the fourth month and pacifier use with certain malocclusions. High rates of malocclusion were found in the studied sample. Socioeconomic conditions, breastfeeding practices and suction habits were shown to be statistically associated with their occurrence.

Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3-5 years old children.

BACKGROUND: Pacifier sucking habit has been associated in the literature with alterations of dental occlusion, and it could be a predisposing factor for other poor oral habits among children. Orthodontic pacifiers have been introduced in the market aiming to reduce these disadvantages caused by the conventional type of pacifiers. The aim of this study was to evaluate the prevalence of poor oral habits and malocclusions, after usage of orthodontic pacifiers in children with primary dentition. METHODS: A sample of 198 pre-school children, aged 3-5 years, (96 males and 102 females) who had exclusively used an orthodontic pacifier were included in order to assess the level of poor oral habits and the absence/presence of dental malocclusion. Firstly, children's parents/legal guardians were given a validated questionnaire, then the children were clinically examined at a dental clinic. RESULTS: Most of the children (79.79%) had started using the orthodontic pacifier within the first 3 months of life, and the 43.49% of them continued using it over a period of 2 years. The recorded percentage for those who had used it throughout sleep was 89.39%. Mouth breathing during the night was reported for 36.04% of the children. Tongue thrust swallow affected 16.16% of the sample. The 5.56% of the data indicated the presence of fingersucking/thumbsucking habit. The noted percentages for children with lip biting, lingual interposition between teeth at rest and those with nail biting, were 5.56, 12.63 and 15.15%, respectively. The regression revealed a significant contribution between early start of using an orthodontic pacifier with the prevalence of fingersucking/thumbsucking (OR 0.13, 95% CI 0.04-0.47, p = 0.0004). This also reported a noticeable increase of the malocclusion prevalence among the female gender (OR 2.74, 95% CI 1.42-5.31), as well as those who were not exclusively breastfed (OR 2.26, 95% CI 1.17-4.37). CONCLUSIONS: Orthodontic pacifiers does not favor the development of poor oral habits, even if it has been used for a period of 2 years in children with primary dentition. Children who begin to use orthodontic pacifier between 0 and 3 months, are less likely to acquire fingersucking/thumbsucking habit. The use of an orthodontic pacifier appears not to be correlated with the prevalence of malocclusion in primary dentition, differently from what stated in literature about the conventional type of pacifier.

Effects of conventional and orthodontic pacifiers on the dental occlusion of children aged 24-36 months old.

AIM: To investigate the effects of conventional and orthodontic pacifiers on the prevalence of malocclusion (MO) considering frequency, duration, and intensity of the sucking habit. DESIGN: Data were collected at three time-points: birth, T1; (12-24 months old), T2; (24-36 months old), T3 and were divided into three groups: control (GC; 110), without non-nutritive sucking habits; orthodontic pacifiers (GOrth; 55); conventional pacifiers (GConv; 55). A questionnaire was applied. Clinical examination was performed at T3. The groups were compared as to the prevalence and severity of anterior open bite (AOB), accentuated overjet, anterior crossbite, posterior crossbite (PCB). RESULTS: The use of pacifiers was associated with occurrence of MO compared to GC (P < 0.05). Frequency, intensity, and duration of pacifier use was also associated with of MO. There was significant difference in the prevalence of MO between GConv and GOrth for AOB (P = 0.027). Only GConv exhibited higher odds of PCB compared to GC (P = 0.040). The prevalence of MO was significantly higher in pacifiers users (P < 0.001). CONCLUSION: The prevalence of MO was higher among children who used pacifiers. According to a general trend, the use of conventional pacifiers was associated to severe anterior open bite and overjet.

Perinatal health and malocclusions in preschool children: Findings from a cohort of adolescent mothers in Southern Brazil.

INTRODUCTION: Pregnancy in adolescence has long-term consequences that can negatively influence oral conditions. In this study, we aimed to assess malocclusion in deciduous dentition and its association with prolonged breastfeeding, pacifier use, and perinatal health indicators pertaining to the periods immediately before and after birth. METHODS: This cross-sectional study was nested in a cohort of adolescent mothers who became pregnant from 13 to 19 years of age (mean age, 17.3 ± 1.6 years). A total of 509 mother-child dyads were included. Information on perinatal indicators, including Apgar score (0-10), which is a standardized assessment of the condition of the infant at birth (heart rate, breath rate, muscle tone, reflex irritability, and skin color), head circumference, birth weight, and need for intensive care unit admission were collected after delivery through interviews with the mothers. By the time the children were 24 to 36 months of age, malocclusion was assessed, and information on the use of pacifiers and breastfeeding was collected. Multivariate Poisson regression was used to assess the effect of independent variables on the outcome (malocclusion). RESULTS: The prevalence of malocclusion was 62.33%, and open bite was the most frequent one (47.45%). After adjustments, children with no need for intensive care unit admission had a lower risk of malocclusion (prevalence ratio [PR] = 0.75; 95% CI, 0.56-0.99), whereas those with an Apgar score less than 7 had a higher risk (PR = 1.32; 95% CI, 1.06-1.64). Children who had used a pacifier (PR = 1.82; 95% CI, 1.02-3.24) or were still using it (PR = 3.88; 95% CI, 2.65-5.68) had a higher chance of malocclusion compared with children who never used a pacifier. Children breastfeeding for 24 months or longer were less likely to have malocclusion (PR = 0.46; 95% CI, 0.34-0.73). CONCLUSIONS: Poor perinatal health and pacifier use may be risk factors for malocclusion development in deciduous teeth. Long duration of breastfeeding is associated with better occlusal conditions in children of adolescent mothers. Further studies are needed with other age groups.

Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding.

BACKGROUND: To successfully initiate and maintain breastfeeding for a longer duration, the World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of artificial teats or pacifiers for breastfeeding infants. Concerns have been raised that offering the pacifier instead of the breast to calm the infant may lead to less frequent episodes of breastfeeding and as a consequence may reduce breast-milk production and shorten duration of breastfeeding. OBJECTIVES: To assess the effect of restricted versus unrestricted pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed, on the duration of breastfeeding, other breastfeeding outcomes and infant health. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2016) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials comparing restricted versus unrestricted pacifier use in healthy full-term newborns who have initiated breastfeeding. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: We found three trials (involving 1915 babies) for inclusion in the review, but have included only two trials (involving 1302 healthy full-term breastfeeding infants) in the analysis. Meta-analysis of the two combined studies showed that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 1.01; 95% confidence interval (CI) 0.96 to 1.07, two studies, 1228 infants), and at four months of age (RR 1.01; 95% CI 0.94 to 1.09, one study, 970 infants, moderate-quality evidence), and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.98 to 1.02, two studies, 1228 infants), and at four months of age (RR 0.99; 95% CI 0.97 to 1.02, one study, 970 infants). None of the included trials reported data on the other primary outcomes, i.e. duration of partial or exclusive breastfeeding, or secondary outcomes: breastfeeding difficulties (mastitis, cracked nipples, breast engorgement); infant's health (dental malocclusion, otitis media, oral candidiasis; sudden infant death syndrome (SIDS)); maternal satisfaction and level of confidence in parenting. One study reported that avoidance of pacifiers had no effect on cry/fuss behavior at ages four, six, or nine weeks and also reported no effect on the risk of weaning before age three months, however the data were incomplete and so could not be included for analysis. AUTHORS' CONCLUSIONS: Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. Evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.

Effect of a thin-neck pacifier on primary dentition: a randomized controlled trial.

OBJECTIVES: To evaluate changes in occlusal characteristics in the primary dentition that occur after introducing a thin-neck pacifier (TNP) to children with previously diagnosed pacifier-associated anterior open bite (AOB) and increased overjet. SETTING AND SAMPLE POPULATION: Department of Preventive and Pediatric Dentistry, Jena University Hospital, Germany. Subjects were 86 children (mean age 20.3 months) with a pacifier-associated open bite or overjet ≥2 mm. MATERIAL & METHODS: Randomized controlled trial. Subjects were randomly assigned: group I (n = 28), intervention group using a TNP; group II (n = 30), control group, using a conventional or physiological pacifier; and group III (n = 28), intervention group, Gold standard, weaned off pacifier. Participants were re-examined after 3, 6, 9 and 12 months by an operator, blinded for the treatment. RESULTS: After 12 months data for 63 children (mean age 33.1 months) were analyzed (I: n = 24; II: n = 22; III: n = 17). There was a significant difference between the groups regarding mean overjet (group I: 2.7 ± 0.5 mm, group II: 3.2 ± 0.7 mm, group III: 2.4 ± 0.5 mm, Kruskal-Wallis, p = 0.002) and AOB (group I: -1.2 ± 0.3 mm, group II: -2.2 ± 0.3 mm, group III: -0.8 ± 0.8 mm, Kruskal-Wallis, p < 0.001). The differences between group I and II regarding increased overjet (3.1 ± 0.2 mm vs. 3.6 ± 0.3 mm, Mann-Whitney, p < 0.001) and extent of AOB (-1.2 ± 0.3 mm vs. -2.2 ± 0.3 mm, Mann-Whitney, p < 0.001) were statistically significant. CONCLUSION: Use of TNP resulted in better clinical measurements for in overjet and overbite compared with the continuing use of conventional or physiological pacifiers.

[Effects of breast-feeding duration, bottle-feeding duration and oral habits on the occlusal characteristics of primary dentition].

OBJECTIVE: To assess the effects of breast-feeding duration, bottle-feeding duration and oral habits on the occlusal characteristics of primary dentition in 3-6-year-old children in Beijing. METHODS: This cross sectional study was conducted via an examination of the occlusal characteristics of 734 children combined with a questionnaire completed by their parents/guardians. The examination was performed by a single, previously calibrated examiner and the following variables were evaluated: presence or absence of deep overbite, open bite, anterior cross bite, posterior cross bite, deep overjet, terminal plane relationship of the second primary molar, primary canine relationship, crowding and spacing. Univariate analysis and multiple Logistic regressions were applied to analyze the associations. RESULTS: It was found that a short duration of breast-feeding (never or ≤6 months) was directly associated with posterior cross bite (OR=3.13, 95%CI=1.11-8.82, P=0.031) and no maxillary space (OR=1.63, 95%CI=1.23-2.98, P=0.038). In children breast-fed for ≤6 months, the probability of developing pacifier-sucking habits was 4 times that for those breast-fed for >6 months (OR=4.21, 95%CI=1.85-9.60, P=0.000 2). The children who were bottle-fed for over 18 months had a 1.45-fold higher risk of nonmesial step occlusion and a 1.43-fold higher risk of class II canine relationship compared with those who were bottle-fed for 6-18 months. Non-nutritive sucking habits were also found to affect occlusion: a prolonged digit-sucking habit increased the probability of an anterior open bite, while a pacifier-sucking habit was associated with excessive overjet and absence of lower arch developmental space. Tongue-thrust habit was associated with anterior open bite (OR=4.21, 95%CI=1.85-9.60, P=0.000 2) and posterior cross bite (OR=7.24, 95%CI=1.30-40.13, P=0.024). Lower lip sucking habit was associated with deep overjet and had a negative association with class III canine relationship. Unilateral chewing was associated with spacing in mandibular (OR=1.57, 95%CI=1.03-2.41, P=0.037). Mouth breathing was associated with chronic rhinitis and adenoidal hypertrophy and had an association with spacing in maxillary. The chi-square test did not indicate a statistically significant association between upper lip sucking habit and any occlusal characteristics. CONCLUSION: Breast-feeding duration was shown to be associated with the prevalence of posterior crossbite, or no maxillary space in the deciduous dentition and development of a pacifier-sucking habit. Children who had a longer duration of bottle-feeding were more likely to develop class II canine relationship. Children who had an oral habit were more likely to develop abnormal occlusal characteristics.

Non-nutritive sucking habits and their effects on the occlusion in the deciduous dentition in children.

AIM: The study evaluated the presence of non-nutritive sucking habits and and their effects on the occlusion in the deciduos dentition in Spanish children. MATERIALS AND METHODS: Study design: Cross-sectional survey. A clinical examination was performed by an experienced examiner in 275 children aged 3 to 6 years and the collected data included the presence of anterior open bite (vertical dimension), unilateral or bilateral posterior crossbite (transverse dimensions), midline deviation and sagittal relationships between incisors, molars and canines. In addition, the parents of each child completed a questionnaire about oral habits. Data analysis included descriptive statistics (frequency distribution). Statistical significance for the association between the non-nutritive sucking habits and development of malocclusion was determined using Chi-square and Fisher's exact tests. Multiple logistic regression analysis was used in order to adjust the results for confounding effects of non-nutritive habits before assessing statistical significance. RESULTS: Non-nutritive sucking habit was observed in 224 children (81.5%) and malocclusions were present in 152 children (55.2%). There were significant relationships between pacifier sucking habit and transverse dimension alteration (OR= 3.29, CI: 0.97- 11.17, p=0.044), midline deviation (OR= 3.00, CI: 1.22-7.38, p=0.013). Children with a history of finger sucking (or thumb sucking) had an increased risk of malocclusion 4.25 times higher (CI: 0.92-19.58, p=0.044) and there was a significant relationship between finger sucking and vertical relationship (OR= 8.25, CI: 2.50-27.25, p=0.001). Children with non- nutritive sucking habits had an increased risk of malocclusion 2.55 higher compared to those without non-nutritive sucking habits (p=0.004). CONCLUSION There was an impact of non-nutritive sucking habit and development of malocclusions in this sample of children.

Children using Day Nurseries' Facilities can be Associated with more Risk to Nonnutritive Sucking Habits.

INTRODUCTION: This study evaluated the expression of nonnutritive sucking habits and the presence of malocclusion in children using day nurseries' facilities. MATERIALS AND METHODS: The 195 children (7-40 months) attending 18 public day nurseries were evaluated clinically in Ponta Grossa, Brazil. Statistical package software was used for descriptive, univariate, bivariate, and multiple logistic regressions of the data about the socioeconomic condition, educational family status, malocclusions, and prevalence of nonnutritive sucking habits among the children. RESULTS: The pacifier users had a statistically significant, explanatory association with open bite [odds ratio (OR) = 10.97; 95% confidence interval (CI): 4.95, 24.31; p < 0.0001]. The children older than 25 months had more open bite than younger children (OR = 6.07; 95% CI: 2.81, 13.11; p < 0.0001). Of the children examined, 35.4% had an anterior open bite, 0.51% had posterior cross-bite, and 1.03% showed finger-sucking habits. A high frequency of pacifier-sucking habits was found (52%), with a significant association between this habit and anterior open bite (p < 0.0001, OR = 7.49; 95% CI: 3.71, 15.15). The 126 children without open bite (36.5%) were pacifier users. There was suggestive, though nonsignificant, evidence of a difference in pacifier use by gender (males, 34%; females, 46%; p = 0.07). The 69 children with open bite (81.16%) were pacifier users and (18.84%) nonusers. The boys showed a slightly greater association with open bite (OR = 21.33; 95% CI: 6.12, 74.40; p < 0.0001) than girls (OR = 5.03; 95% CI: 1.26, 20.00; p = 0.02) in the age group of 25 to 40 months; however, it was not observed in younger children. CONCLUSION: Pacifier use is a predictor for open bite in children from the lower socioeconomic classes using day nurseries' facilities. CLINICAL SIGNIFICANCE: The parents, guardians, and caregivers working in public day nurseries should be advised to monitor nonnutritive sucking habits in order to avoid or minimize the occurrence of malocclusion. It demonstrates that the permanence of the children in day nurseries may be linked with deleterious oral habits, and it discusses strategies to minimize the occurrence of alterations in the normal occlusion.

Anterior Open Bite In 27 Months Old Children after Use of a Novel Pacifier - A Cohort Study.

OBJECTIVES: The aim of the present cohort study was to evaluate the influence of a novel pacifier on the first formation of malocclusion, the anterior open bite in children. STUDY DESIGN: 129 newborn children whose parents had decided to use pacifiers were randomly attributed to two experimental groups (D=Dentistar, n=56, Novatex, Pattensen, Germany; N=NUK, n=73, Mapa, Zeven, Germany). Children (n=42) who did not use a pacifier were not randomized and served as reference (C). Primary outcome was the presence of anterior open bite. It was hypothesized that D would result in lower incidence when compared to N. At the age of 27 months the children were examined with respect to anterior open bite. Fisher's exact test served to detect significant differences between groups D and N (SPSS 22.0). RESULTS: 121 children with a mean age of 26.7 months were included in the final analysis (D: n=45; N: n=42; C: n=34). In group D three children (6.7%) showed an anterior open bite. The respective values were 21 (50.0%) for N and 0 for C. The results for group D compared to N were significantly different (chi(2)-test, p<0.001). CONCLUSION: In comparison to a commonly used pacifier the novel one causes significantly less anterior open bites.

Effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition.

BACKGROUND: Early transition from breastfeeding and non-nutritive sucking habits may be related to occlusofacial abnormalities as environmental factors. Previous studies have not taken into account the potential for interactions between feeding practice, non-nutritive sucking habits and occlusal traits. This study assessed the effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition in 3-6-year-old children in Peking city. METHODS: This cross sectional study was conducted via an examination of the occlusal characteristics of 734 children combined with a questionnaire completed by their parents/guardians. The examination was performed by a single, previously calibrated examiner and the following variables were evaluated: presence or absence of deep overbite, open bite, anterior crossbite, posterior crossbite, deep overjet, terminal plane relationship of the second primary molar, primary canine relationship, crowding and spacing. Univariate analysis and multiple logistic regressions were applied to analyze the associations. RESULTS: It was found that a short duration of breast-feeding (never or ≤ 6 months) was directly associated with posterior cross bite (OR = 3.13; 95% CI = 1.11-8.82; P = 0.031) and no maxillary space (OR = 1.63; 95% CI = 1.23-2.98; P = 0.038). In children breast-fed for ≤ 6 months, the probability of developing pacifier-sucking habits was 4 times that for those breast-fed for >6 months (OR = 4.21; 95% CI = 1.85-9.60; P = 0.0002). Children who were bottle-fed for over 18 months had a 1.45-fold higher risk of nonmesial step occlusion and a 1.43-fold higher risk of a class II canine relationship compared with those who were bottle-fed for up to 18 months. Non-nutritive sucking habits were also found to affect occlusion: A prolonged digit-sucking habit increased the probability of an anterior open bite, while a pacifier-sucking habit associated with excessive overjet and absence of lower arch developmental space. CONCLUSION: Breastfeeding duration was shown to be associated with the prevalence of posterior crossbite, no maxillary space in the deciduous dentition and development of a pacifier-sucking habit. Children who had a digit-sucking habit were more likely to develop an open bite.

The association between traumatic dental injuries and atypical external root resorption in maxillary primary incisors.

Atypical root resorption (ARR), which is observed on radiographs of primary incisors, has been reported in the dental literature to result from digit sucking; thus ignoring any association between ARR and traumatic dental injuries (TDI). The purpose of this study was to evaluate and compare the contributions of sucking habits and TDI to external ARR in primary incisors. A history of dental trauma was assessed based on clinical and radiographic findings. Periapical radiographs of the premaxilla were evaluated for the presence of ARR. The presence or history of sucking habits was based on parents' report. Data were collected from files of 727 patients with a mean age of 52 months. Sixty-four children (8.8%) presented ARR in one or both central incisors. All 64 had experienced some type of TDI. Five hundred and forty-nine (76%) of the children had sucking habits; of them, 501 were pacifier-suckers and 48 digit suckers. Digit sucking was found in only 4 (6%) of the 64 children presenting ARR. These findings support the association of traumatic dental injury, and not of digit sucking, with ARR in primary incisors.

Clarifying the effect of behavioral and clinical factors on traumatic dental injuries in childhood: a hierarchical approach.

AIM: To explore associations between traumatic dental injuries (TDI) in Brazilian preschool children and clinical, behavioral, and socio-demographic factors using a hierarchical approach. MATERIAL AND METHODS: A cross-sectional study was conducted involving 1316 children aged 0-5 years at public preschools in the city of Canoas (southern Brazil). Demographic (sex and age), socioeconomic (mother's schooling, income and family structure) and behavioral (use of pacifier, breastfeeding duration and bottle use at 12 months) factors were collected through a questionnaire. TDI (Andreasen criteria) and malocclusion (overjet and anterior open bite) were recorded by trained and calibrated examiners. Poisson regression was employed to determine factors associated with TDI using a hierarchical approach. RESULTS: The prevalence of TDI was 13.3%. In the final model, the probability of TDI was 50% higher in children who used a pacifier (PR: 1.50; 95% CI: 1.08-2.10), 77% higher in children with overjet between 3 and 5 mm (PR: 1.77; 95% CI: 1.22-2.57) and nearly threefold higher in children with overjet > 5 mm (PR: 2.73; 95% CI: 1.77-4.20) compared with children with overjet ≤ 2 mm. Additional analysis demonstrated that overjet represented the pathway by which pacifier use was associated with TDI. CONCLUSION: Pacifier use is strongly associated with the occurrence of TDI in the primary dentition, and accentuated overjet represents a pathway to this association. These findings suggest the need for prevention strategies that address early counseling on pacifier use to reduce the occurrence of TDI.