Pacifiers and Thumb Sucking

For most infants, the sucking of thumbs and pacifiers is a happy, everyday part of life. Since sucking is a natural, instinctual baby habit, infants derive a sense of comfort, relaxation, and security from using a thumb or pacifier as a sucking aid.
According to research from the American Academy of Pediatric Dentistry (AAPD), the majority of children will cease using a pacifier before the age of four years old. Thumb sucking can be a harder habit to break and tends to persist for longer without intervention. Children who continue to suck thumbs or pacifiers after the age of five (and particularly those who continue after permanent teeth begin to emerge) are at high-risk for developing dental complications.
How can thumb sucking and pacifier use damage children’s teeth?
Pacifier and thumb sucking damage can be quite insidious. Both can be difficult to assess with the naked eye, and both tend to occur over a prolonged period of time. Below is an overview of some of the risks associated with prolonged thumb sucking and pacifier use:
Jaw Misalignment – Pacifiers come in a wide range of shapes and sizes, most of which are completely unnatural for the mouth to hold. Over time, pacifiers and thumbs can guide the developing jaws out of correct alignment.
Tooth Decay – Many parents attempt to soothe infants by dipping pacifiers in honey, or some other sugary substance. Oral bacteria feed on sugar and emit harmful acids. The acids attack tooth enamel and can lead to pediatric tooth decay and childhood caries.
Roof Narrowing – The structures in the mouth are extremely pliable during childhood. Prolonged, repeated exposure to thumb and pacifier sucking actually causes the roof of the mouth to narrow (as if molding around the sucking device). This can cause later problems with developing teeth.
Slanting Teeth – Growing teeth can be caused to slant or protrude by thumb and pacifier sucking, leading to poor esthetic results. In addition, thumb sucking and pacifier use in later childhood increases the need for extensive orthodontic treatments.
Mouth Sores – Passive sucking is much less harmful than aggressive sucking. Aggressive sucking (popping sounds when the child sucks) may cause sores or ulcers to develop.
If you intend to purchase a pacifier:

  • Buy a one-piece pacifier to reduce the risk of choking.
  • Buy an “orthodontically correct” model.
  • Do not dip it in honey or any other sugary liquid.
  • Rinse with water (as opposed to cleansing with your mouth) to prevent bacterial transmissions.

How can I encourage my child to stop thumb or pacifier sucking?
In most cases, children naturally relinquish the pacifier or thumb over time. As children grow, they develop new ways to self-soothe, relax, and entertain themselves. When thumb sucking or pacifier use persists past the age of five, a gentle intervention may be required.
Here are some helpful suggestions to help encourage the child to cease thumb sucking or pacifier use:

  • Ask the pediatric dentist to speak with the child about stopping. Often, the message is heard more clearly when delivered by a health professional.
  • Buy an ADA recommended specialized dental appliance to make it difficult for the child to engage in sucking behaviors.
  • Implement a reward system (not a punishment), whereby the child can earn tokens or points towards a desirable reward for not thumb sucking or using a pacifier.
  • Wrap thumbs in soft cloths or mittens at nighttime.

If the above suggestions do not seem to be working, your pediatric dentist can provide more guidance. Remember: the breaking of a habit takes time, patience, and plenty of encouragement!

Baby Bottle Tooth Decay

Maintaining the health of primary (baby) teeth is exceptionally important. Although baby teeth will eventually be replaced, they fulfill several crucial functions in the meantime.
Baby teeth aid enunciation and speech production, help a child chew food correctly, maintain space for adult teeth, and prevent the tongue from posturing abnormally in the mouth. When baby teeth are lost prematurely, adjacent teeth shift to fill the gap, causing impacted adult teeth and the potential need for orthodontic treatment. This phenomenon can lead to impacted adult teeth, years of orthodontic treatment, and a poor aesthetic result.
Babies are at risk for tooth decay as soon as the first primary tooth emerges – usually around the age of six months. For this reason, the American Academy of Pediatric Dentistry (AAPD) recommends a “well-baby check-up” with a pediatric dentist around the age of twelve months.
What is baby bottle tooth decay?
The term “baby bottle tooth decay” refers to early childhood caries (cavities), which occur in infants and toddlers. Baby bottle tooth decay may affect any or all of the teeth, but is most prevalent in the front teeth on the upper jaw.
If baby bottle tooth decay becomes too severe, the pediatric dentist may be unable to save the affected tooth. In such cases, the damaged tooth is removed, and a space maintainer is provided to prevent misalignment of the remaining teeth.
Scheduling regular checkups with a pediatric dentist and implementing a good homecare routine can completely prevent baby bottle tooth decay.
How does baby bottle tooth decay start?
Acid-producing bacteria in the oral cavity cause tooth decay. Initially, these bacteria may be transmitted from mother or father to baby through saliva. Every time parents share a spoon with the baby or attempt to clean a pacifier with their mouths, the parental bacteria invade the baby’s mouth.
The most prominent cause of baby bottle tooth decay however, is frequent exposure to sweetened liquids. These liquids include breast milk, baby formula, juice, and sweetened water – almost any fluid a parent might fill a baby bottle with.
When sweetened liquids are used as a naptime or bedtime drink, they are a heightened risk because they remain in the mouth for an extended period of time. Oral bacteria feed on the sugar around teeth and emit harmful acids. These acids wear away tooth enamel, resulting in painful cavities and pediatric tooth decay.
Infants who are not receiving an appropriate amount of fluoride are at increased risk for tooth decay. Fluoride works to protect tooth enamel, simultaneously reducing mineral loss and promoting mineral reuptake. Through a series of questionnaires and examinations, the pediatric dentist can determine whether a particular infant needs fluoride supplements or is at high-risk for baby bottle tooth decay.
What can I do at home to prevent baby bottle tooth decay?
Baby bottle tooth decay can be completely prevented by a committed parent. Making regular dental appointments and following the guidelines below will keep each child’s smile bright, beautiful, and free of decay:
Do not transmit bacteria to your child via saliva exchange. Rinse pacifiers and toys in clean water and use a clean spoon for each person eating.
Clean gums after every feeding with a clean washcloth.
Use an appropriate toothbrush along with an ADA-approved toothpaste to brush when teeth begin to emerge. Fluoride-free toothpaste is recommended for children under the age of two.
Use a pea-sized amount of ADA-approved fluoridated toothpaste when the child has mastered the art of “spitting out” excess toothpaste. Though fluoride is important for the teeth, too much consumption can result in a condition called fluorosis.
Do not place sugary drinks in baby bottles or sippy cups. Only fill these containers with water, breast milk, or formula. Encourage the child to use a regular cup (rather than a sippy cup) when the child reaches twelve months old.
Do not dip pacifiers in sweet liquids (honey, etc.).
Review your child’s eating habits. Eliminate sugar-filled snacks and encourage a healthy, nutritious diet.
Do not allow the child to take a liquid-filled bottle to bed. If the child insists, fill the bottle with water as opposed to a sugary alternative.
Clean your child’s teeth until he or she reaches the age of seven. Before this time, children are often unable to reach certain places in the mouth.
Ask the pediatric dentist to review your child’s fluoride levels.
If you have questions or concerns about baby bottle tooth decay, please contact our office

Fluoride

Fluorine, a natural element in the fluoride compound, has proven to be effective in minimizing childhood cavities and tooth decay. Fluoride is a key ingredient in many popular brands of toothpaste, oral gel, and mouthwash, and can also be found in most community water supplies. Though fluoride is an important part of any good oral care routine, overconsumption can result in a condition known as fluorosis. The pediatric dentist monitors fluoride levels, and checks that children are receiving the appropriate amount.
How can fluoride prevent tooth decay?
Fluoride fulfills two important dental functions. First, it helps staunch mineral loss from tooth enamel, and second, it promotes the remineralization of tooth enamel.
When carbohydrates (sugars) are consumed, oral bacteria feed on them and produce harmful acids. These acids attack tooth enamel – especially in children who take medications or produce less saliva. Repeated acid attacks result in cavities, tooth decay, and childhood periodontal disease. Fluoride protects tooth enamel from acid attacks and reduces the risk of childhood tooth decay.
Fluoride is especially effective when used as part of a good oral hygiene regimen. Reducing the consumption of sugary foods, brushing and flossing regularly, and visiting the pediatric dentist biannually, all supplement the work of fluoride and keep young teeth healthy.
How much fluoride is enough?
Since community water supplies and toothpastes usually contain fluoride, it is essential that children do not ingest too much. For this reason, children under the age of two should use an ADA-approved, non-fluoridated brand of toothpaste. Children between the ages of two and five years old should use a pea-sized amount of ADA-approved fluoridated toothpaste, on a clean toothbrush, twice each day. They should be encouraged to spit out any extra fluid after brushing. This part might take time, encouragement, and practice.
The amount of fluoride children ingest between the ages of one and four years old determines whether or not fluorosis occurs later. The most common symptom of fluorosis is white specks on the permanent teeth. Children over the age of eight years old are not considered to be at-risk for fluorosis, but should still use an ADA-approved brand of toothpaste.
Does my child need fluoride supplements?
The pediatric dentist is the best person to decide whether a child needs fluoride supplements. First, the dentist will ask questions to determine how much fluoride the child is currently receiving, gain a general health history, and evaluate the sugar content in the child’s diet. If a child is not receiving enough fluoride and is determined to be at high-risk for tooth decay, an at-home fluoride supplement might be recommended.
Topical fluoride can also be applied to the tooth enamel quickly and painlessly during a regular office visit. There are many convenient forms of topical fluoride, including foam, liquids, varnishes, and gels. Depending on the age of the child and their willingness to cooperate, topical fluoride can either be held on the teeth for several minutes in specialized trays or painted on with a brush.
If you have questions or concerns about fluoride or fluorosis, please contact our office.

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