Dr. Emile Rossouw, Chair, EIOH Orthodontics, weighs in on the pacifier issue. How old a child should be when using a pacifier recently became international conversation when photos of soccer star David Beckham’s 4 year-old daughter with a pacifier in her mouth were published online.
The short answer is that a pacifier at 4 years old is not necessarily bad or inappropriate. It may actually serve a positive purpose.
Pacifiers are OK provided that they are not becoming a habit, or creating a significant malocclusion. Malocclusion refers to a number of possible misaligned bite issues, including upper protrusion or buck teeth, spacing or crowding problems, open bite, overbite, underbite or crossbite, which occurs when any or all of the upper teeth fit into the wrong side of the lower teeth.
The general rule is to assess the comfort or security issue of the child first. Young children often use only a pacifier, some use a bottle and some may still be breastfed or be in a transition phase being weaned from either the breast on to the bottle, or from the bottle to a cup. Often, the suckling sensation (comfort/security feeling) is replaced by a pacifier and/or some form of blanket, toy etc.
A child should ideally be weaned from the pacifier by the time the permanent incisors erupt as this is when malocclusions such as open bites or posterior crossbites are consolidated. The latter is around 5-6 years old, but can be earlier or later depending on the growth and development of the child.
The development of such malocclusions also depends on the specific growth pattern of the child as some children are not affected and others develop fairly extensive malocclusions. I would rather see a young child using a pacifier if this provides the comfort feeling needed, than having it taken away and then the child replaces it with some other form of comfort/security, seeking attention or develop a bad habit.
Such habits can include finger sucking, nail-biting, pen-biting, blanket sucking and many more which could include socially unacceptable, attention-seeking characteristics. We can correct the malocclusion, but psychological issues are more difficult to deal with as the child matures.
Additionally, pacifiers dipped in sugar, honey, juice or sweetened drinks, can lead to tooth decay. Cavity-causing bacteria can pass from saliva in a parent or caregiver’s mouth to the baby. When the parent or caregiver cleans a pacifier in his/her mouth before giving it back to the baby, the bacteria can be easily passed.
Dr. Emile Rossouw holds a dental degree, advanced degrees in pediatric dentistry and orthodontics, and a PhD in dental science all from the University of Stellenbosch in his native South Africa. His published research covers clinical orthodontics, biomaterial, jaw growth and long-term stability.