Multidisciplinary Evaluation of Pacifier Removal on Oro-Dentofacial Structures: A Controlled Clinical Trial

Abstract

It is well recognized that pacifier habit leads to occlusal and orofacial functional changes in children. However, the effects of the interruption of prolonged pacifier habit on the development of the dento-facial complex has not yet been fully characterized. Thus, the aim of this study was to investigate the influence of pacifier removal on aspects of oro-dentofacial morphology and function in preschool children. For that, a pacifier group (n = 28) and a control group (n = 32) of 4-year-old children with and without pacifier habit, respectively, were followed up by a group of dentists and speech therapists at baseline, 6 and 12 months after habit removal. Bite force and lip pressure were assessed using digital systems, and the evaluation of breathing and speech functions was performed using validated protocols, together with the measurements of dental casts and facial anthropometry. The Two-way mixed model ANOVA was used in data analysis. After 12 months, a decrease in malocclusion frequency was observed in pacifier group. Additionally, a change over time was observed in facial, intermolar and palate depth measurements, as well in bite and lip forces and speech function scores, increasing in both groups (p < 0.01). The upper and lower intercanine widths and breathing scores differed between groups at baseline and changed over time reducing the differences. The presence of speech distortions was more frequent in the pacifier group at baseline and decreased over time (p < 0.05). The interruption of pacifier habit improved the maxillary and mandibular intercanine widths, as well as the breathing and speech functions, overcoming the oro-dentofacial changes found.Trial Registration: This clinical trial was registered in the Brazilian Clinical Trials Registry (ReBEC; http://www.ensaiosclinicos.gov.br/), protocol no. RBR-728MJ2.

Malocclusion in primary dentition: a cross-sectional study in a Lisbon population

“…A study found that after removing the pacifier habit in 4-year-old children, the frequency of malocclusion and changes in breathing and speech decreased significantly. 15 Healthcare professionals who follow preschool-aged children should consider this natural correction while bearing in mind that early intervention in these habits is essential. Campos et al 26 did not find a statistically significant association between malocclusion and the mother's level of education.…”

“…[9][10][11] Studies on the prevalence of malocclusion in Portuguese children populations are scarce but have shown a considerable prevalence of these oral conditions in the primary dentition. 12,13 Since malocclusion can be related to some oral behaviors, namely non-nutritive sucking habits, 14,15 early diagnosis and intervention are essential for its control. Knowing the distribution and factors associated with malocclusion in the primary dentition will help understand the disease at those ages and plan and implement preventive measures.…”

Understanding the relationship between orofacial structures and feeding habits of preschoolers: A multivariate analysis

“…Facial morphology was evaluated with a sliding caliper (Bone Caliper in aluminum 240 mm, Cescorf, Brazil) to determine the facial height (linear distance between the nasion and gnathion; n‐gn) and the bizygomatic width (distance between the zygomatic points; zy‐zy). The ratio between morphological facial height and bizygomatic distance was was also calculated (n‐gn/zy‐zy) (Scudine et al, 2021).…”

“…The morphological occlusion was evaluated from dental casts of the maxillary and mandibular arches and included (Baume, 1950; Foster & Hamilton, 1969): sagittal relationship of the primary molars (distal step, mesial step or flush terminal plane), incisors transversal and vertical relationship, maxillary and mandibular intercanine widths, maxillary and mandibular intermolar widths and palatal depth (Scudine et al, 2021).…”

“…Further, lip strength was recorded using the Iowa Oral Performance Instrument (IOPI system, model 2.2; Northwest Co., LLC, Carnation, WA, USA). After instructions, the bulb was positioned between the lips in the midline and the child was asked to press it as hard as possible for 2 s (Scudine et al, 2021), keeping the teeth occluded to avoid the influence of the jaw elevator muscles. Maximum lip compression was measured three times with an interval of 1 min between measurements and the maximum pressure generated was considered as the final value.…”