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.

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.

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.

Evaluation of the effect of nutritive versus non-nutritive pacifiers as adjuncts to local anaesthesia in male neonatal circumcision using the plastibell technique - A prospective randomised controlled study

BACKGROUND

Male circumcision is the most common surgical procedure worldwide and is often carried out for religious, cultural, medical and public health reasons. It is commonly performed during the neonatal period. Many studies have now shown that pain is a common intra- and post-operative complication. To ensure proper analgesia during the procedure, many surgeons opt for the use of pacifiers as an adjunct to anaesthesia during neonatal circumcision. The aim of this study is to compare nutritive pacifiers (NPs) versus non-NPs (NNPs) as adjuncts to local anaesthesia in male neonatal circumcision using the Plastibell technique.

METHODS

A prospective randomised controlled study was carried out between October 2019 and March 2020. A total of 100 neonates were circumcised using the Plastibell technique and randomised into NP (Group A, n = 33), NNP (Group B, n = 33) and controls (Group C, n = 34), respectively. The differences in pain scores using the Neonatal Infant Pain Scale, total crying time and heart rate during circumcision were recorded and assessed.

RESULTS

The age of participants ranged from 5 to 28 days and the weight ranged from 2.5 to 5.0 kg. The overall mean age, birth weight and current weight of the participants were 15.5 ± 6.1 days, 3.4 ± 0.4 kg and 3.5 ± 0.6 kg, respectively. The control group had the highest average pain score of 5.5 (4.5-5.8) compared to the intervention groups with median pain score (NP: 3.3 [1.3-4.3] and (NNP: 4.3 [3.1-5.1], respectively). NPs had significantly lower pain scores (P = 0.023) and reduced total crying time (P = 0.019) at all stages of the circumcision compared to those given NNPs and controls.

CONCLUSION

This study showed that NPs were superior to NNPs in providing additional pain control during male neonatal circumcision.

Toward a speech-motor account of the effect of Age of Pacifier Withdrawal

Recently published works suggest that prolonged pacifier use affects abstract word processing later in life. Using the pacifier beyond age 3 years affects the conceptual relations used to define the meaning of words at age 6 years. Similarly, when semantically categorizing a set of abstract, concrete and emotional words, children aged 8 years who used the pacifier for a longer period of time were slower to process abstract stimuli, but not concrete and emotional ones. The children of these studies had typical development and no diagnosis of cognitive or linguistic disorders. These results, although correlational, suggest a possible relationship between extended use of a pacifier and the development of language skills, particularly for abstract words. The first goal of this theoretical work is to outline current evidence suggesting an association between prolonged pacifier use and the processing of abstract words. The second goal is to propose an account of the effect of Age of Pacifier Withdrawal (APW) within the DIVA neurocomputational model of speech development and production (Guenther & Vladusich, 2013). Using the pacifier during social interaction for a longer period might impede the processing of proprioceptive information and speech-motor programs (i.e., by limiting the co-articulation of speech, it could inhibit the building and consolidation of speech-motor articulatory gestures) as well as auditory input (because the child receives inaccurate input about his/her own speech). Thus, it seems useful to explore the auditory speech representation of children who use a pacifier beyond 3 years of age. We suggest that after the first year of life pacifier use should be impeded during social interaction and limited to use at bed time.

Binky Bites and Other Oronasal Pressure Injuries

Initial examination and exploration of childhood injuries may not lead to an obvious explanation of abuse. Although abusive oronasal injuries have been described, ones including nasal destruction are rare. We describe 4 children abused using implements that ultimately were thought to have caused significant nasal tissue destruction. In 2 of the cases, a forced pacifier placement was implicated in causing pressure injuries. In the other 2 cases, gags were part of the children's injuries. All 4 children had other findings of abuse and neglect.

Pacifiers: A Cause for Confusion

Pacifier avoidance is recommended in the newborn nursery to optimize exclusive breast-feeding rates according to the Baby-Friendly Hospital Initiative. There are many reasons why parents may choose to provide a pacifier to their infant, particularly due to the association between pacifier use with sleep and risk reduction for sudden infant death syndrome. Early use of a pacifier does not likely cause direct harm to infants or lead to difficulty breast-feeding. Pediatricians should partner with families to share a clear message in support of establishing exclusive breast-feeding, ideally before introduction of a pacifier. [Pediatr Ann. 2020;49(5):e204-206.].

The effects of early pacifier use on breastfeeding: A randomised controlled trial

BACKGROUND

The majority of observational studies have found associations between pacifier use and shorter breastfeeding duration. Results from four randomised controlled trials did not reveal any difference in breastfeeding outcomes. The relationship between early pacifier use and breastfeeding outcomes remains unclear.

AIM

To investigate whether a recommendation of early pacifier use affects the proportion of breastfeeding at six months compared to a recommendation to avoid pacifier use during the first two weeks.

METHODS

An open, randomised controlled trial with parallel group design; 239 primiparous mothers and their term infants were randomly assigned to an intervention group or a control group. The primary outcome was the proportion of breastfeeding at six months. Secondary outcomes were the proportions of breastfeeding and breastfeeding problems at two and four months. To investigate factors which may influence breastfeeding, a multivariate logistic regressions analysis was performed.

FINDINGS

A total of 209 participants (87.5%) completed the study. There were no significant differences between the groups with respect to breastfeeding at six months. No negative association for breastfeeding between early versus late introduction of pacifier was found. Factors significantly associated with cessation of breastfeeding at six months were: use of nipple shield, intention to breastfeed, severe breastfeeding problems at two weeks, pacifier use at two months and lower educational level.

CONCLUSION

Early versus late recommendation of pacifier introduction did not affect the proportion of breastfeeding at six months. However, the compliance to the randomised group was insufficient. No negative association was found in the observational analysis.

[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.

SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment

Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue.

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.

The Effect of a Unique Pacifier on Anterior Open Bite and Overjet in the Primary Dentition: A Pilot Study

PURPOSES

Pacifiers are the most common device used by children to satisfy their sucking needs. Because of their design, reports of anterior open bite and increased overjet are common. The purposes of this pilot study were to measure the effects of a unique pacifier in toddlers who have existing open bites and increased overjets; and secondly to determine the feasibility of recruiting and retaining toddlers for a six-month study.

METHODS

Toddlers with existing open bite and increased overjet currently using a conventional pacifier were recruited from a university pediatric dental clinic. Baseline information was obtained. Visual examination and intraoral measurements were obtained. The study pacifier was introduced to replace the existing pacifier. Follow-up data was collected at three and six months post-intervention.

RESULTS

Eight of the 11 toddlers (73 percent) completed the study. Recruitment was challenging because of the inclusion criteria and transportation; retaining participants required numerous reminders to parents. There was a significant difference between initial and final open bite and overjet measurements.

CONCLUSION

It is feasible to recruit and retain toddlers but it required significant staff interventions. There was a significant improvement in reducing existing open bite and overjet with the pacifier after six months.

Dental Abrasion of Incisor caused by a Babies' Dummy Clip: A Case Report

Tooth surface loss (TSL), the non-carious loss of tooth tissue, is considered pathological if the teeth involved experience sensitivity and pain, are functionally compromised or they detract from the patient's appearance. TSL is a common clinical finding in many patient groups, although differences between the primary and permanent dentition contribute to TSL occurring at a faster rate and with worse outcomes in the primary dentition. This case report presents localized abrasion and associated apical periodontitis affecting a single primary tooth in a 2-year-old infant following the misuse of a babies' dummy clip whilst teething. Abrasion is rare in the primary dentition. CPD/CLINICAL RELEVANCE: This article highlights an unusual presentation of dental abrasion affecting the primary dentition caused by a previously unreported foreign object; abrasion in this case was a side-effect of soothing the discomfort of teething.

Prolonged pacifier usage in infancy does not cause eating behavior problem later

The objective of this study conducted in children aged 3-7 years was to determine whether pacifier use during infancy is associated with eating problems in later periods. A total of 85 children (55.2 ±12.3 months) admitted to hospital with eating problems and with no organic pathology in scans, and 97 healthy children (52.24±10.97 months) without eating problems, were assigned to case and control groups, respectively. Eating problems were classified into five groups and investigated via a questionnaire. The presence of eating problems was analyzed for association with pacifier use. There was no significant difference between the two groups in terms of pacifier use (chi-square test: 0.141, p=0.707), and pacifier use is not related to a poor appetite in later periods. Pediatric healthcare providers and parents should be informed with regard to the subject.

Oral habits in a population of Albanian growing subjects

AIM

The aim of this study was to assess the prevalence of oral habits in an Albanian population of schoolchildren.

STUDY DESIGN

A sample of 2617 subjects, aged 7-15, was examined by clinical observation without radiograms. The sample comprised 1257 males and 1360 females, with no history of orthodontic treatment. Aestethical frontal and profile analysis, intraoral and functional analysis were performed.

STATISTICS

Gender and age differences were compared by chi-square test. The relationship between malocclusions and oral habits was assessed by t-test and the level of significance was assessed at 0.01.

RESULTS

The findings indicated that oral habits were present in 2225 subjects (85.0%), 1103 males (87.7%) and 1121 females (82.4%); the most frequent oral habit was pacifier sucking (30%) and it was mostly present in the 7-11 years group. It was observed a significant correlation between oral habits and dental malocclusions, open bite, altered overjet and maxillary contraction. CONCLUSION The high number of oral habits observed in the studied sample suggest that prevention strategies adopted in other countries could be successfully integrated in the development of an effective national programme in Albania aimed at reducing malocclusion risk factors.

Oral habits as risk factors for anterior open bite in the deciduous and mixed dentition - cross-sectional study

AIM

Anterior open bite (AOB) is an occlusal anomaly commonly associated with oral habits (OH). The aim of this study was to determine the prevalence of OH as a risk factor for the AOB.

MATERIALS AND METHODS

A group of children aged between 3 and 12 years were observed. The statistical methodology included independent chi-square test, Fisher's exact test and binary logistic regression.

RESULTS

The frequency of oral habits was of 43.5% in the deciduous dentition and 54.2% in the mixed dentition. There was a statistically significant association of pacifier sucking: 61.7 and 16.1 odd ratios (OR), and tongue thrust: 3.9 and 9.2 OR with AOB in both groups, respectively. Thumb sucking occurred only in the deciduous dentition with 5.6 OR.

CONCLUSION

OH and AOB have a high frequency in children. They hinder the normal development of dental and skeletal structures. As OH are risk factors for AOB, the damaging habits most frequently associated are: pacifier sucking, thumb sucking, and tongue thrust. Due to the correlation between the prevalence of AOB and OH, prevention strategies incorporating psychological data related to children should be integrated into a national public health programme.

Recurrent acute otitis media in infants: analysis of risk factors

OBJECTIVE

Recurrence acute otitis media (RAOM) may cause a considerable morbidity and a great parental concern. The aim of this study was to analyze the risk factors that are likely to be responsible for RAOM in infants, and their impact on treatment failure.

METHODS

A retrospective study on 340 infants with RAOM was conducted. Data were collected from hospital charts. A 10 days course of amoxicillin/clavulanate was used for treatment of recurrence, while surgical management in the form of adenoidectomy and/or myringotomy was reserved for patients with persistent disease. We analyzed various risk factors that may affect the prognosis of RAOM, including: age, prematurity, upper respiratory tract infections (URTI), duration of breastfeeding, use of pacifiers, parental smoking, seasonality, the presence of siblings (family size), gender, adenoid hypertrophy, allergy, and craniofacial abnormalities.

RESULTS

Use of pacifiers, short duration of breastfeeding, older infantile age, winter season, URTI and presence of adenoid hypertrophy were identified as risk factors for RAOM. Treatment failure may be due to adenoid hypertrophy, short duration of breastfeeding and it is more common in older age infants. We did not find a significant association between RAOM and gender, prematurity, exposure to passive smoking, the presence of siblings, allergy, craniofacial abnormalities.

CONCLUSIONS

Factors that may cause recurrence of the disease in infant population are use of pacifiers, short duration of breastfeeding, older infantile age, winter season, upper respiratory tract infections and adenoid hypertrophy. Also, treatment failure may be caused by adenoid hypertrophy and short duration of breastfeeding. Good understanding of these factors may help to decrease the recurrence rate and to improve the treatment of the disease.

Pacifier use in the first month of life

QUESTION

As a family physician who frequently attends deliveries and follows up with neonates, parents often ask me if they can provide their newborns with pacifiers in order to calm infants down, reduce crying, and improve sleep. Is pacifier use safe in the first month of life?

ANSWER

While pacifiers are useful for soothing, there is concern that their use might cause early weaning of breastfeeding owing to "nipple confusion." Several organizations, such as the World Health Organization and the United Nations Children's Fund, recommend avoiding use of pacifiers in term infants who breastfeed. However, evidence suggests that it might not be pacifier use that causes premature cessation of breastfeeding, and that use of pacifiers might only be a sign of a maternal decision to stop breastfeeding.

Early childhood caries (ECC) and neglect in child care: analysis of an Italian sample

AIM

Dental caries was identified as the single most common chronic childhood disease; its prevention should be a priority for dentists. With the aim of describing the correlation between early childhood caries (ECC) and the phenomenon of child neglect, a questionnaire which recorded socio-economic and dental service use data was provided to a randomly chosen sample of parents at three pediatric health service centers in Bari (Italy).

MATERIALS AND METHODS

In order to evaluate the association among risk factors and ECC, contingency tables were created and the value of the Odds Ratio (OR) was calculated, indicating the confidence intervals and chi square values. A student's t-test for independent samples was performed to evaluate the differences between the averages. A value of p≤0.5 was considered to be significant for all tests used.

RESULTS

Of the 63 children examined, 61.9% (n=39; 95%CL=49.9- 73.9) presented with ECC, of which 47.6% (n=30; 95%CL=34.9-60.6) were classified as Wyne's Type I; 12.7% (n=8; 95%CL=5.6-23.5) were classified as Type II; and 1.6% (n=1; 95%CL=0-8.5) as Type III. Interestingly, the frequency of Types II and III were shown to be higher in low-income families (chi-square=8.50; p=0.03).

CONCLUSION

Dentists should recognize children's susceptibility to ECC and their exposure to risk factors for neglect, thus facilitating a primary prevention visit.

Prevalence and factors associated with anterior open bite in 2 to 5 year old children in Benin city, Nigeria

BACKGROUND

Anterior open bite is said to exist when there is an actual vertical gap between the upper and lower incisors with the teeth in centric occlusion. This could occur in the anterior or posterior region, and may be attributed to the supra eruption of the posterior teeth or the infra eruption of the anterior teeth and it is common in both adults and children.

OBJECTIVE

To evaluate the prevalence of anterior open bite (AOB) in 2 to 5 -year -old children and the aetiological factors responsible for it.

METHODS

The study group comprised 1031 children (429 boys and 602 girls) between the ages of 2 to 5-years, who were examined for the presence of AOB and the relationship with various oral habits.

RESULTS

AOB was present in 29 (2.8%) of the subjects. Sucking habits were observed in 267 (25.9%) children. Only 29(10.9%) of the children with sucking habits had an AOB which was asymmetric in 20 (7.5%) and symmetric in 9 (3.4%). The asymmetric AOB was significantly higher in children with thumb sucking habits than in finger suckers (P<0.05). There was no significant difference between frequency, duration of sucking habits and AOB. The 4-year olds showed a significant difference in the number of children with AOB (P<0.05). Sucking habits of 1-2 hours and duration of 24 to 60 months exhibited the highest prevalence of an AOB in 13 (44.8%) and 17 (58.6%)children respectively.

CONCLUSION

The prevalence of AOB in this study is 2.8%. Thumb sucking is the most important aetiological factor in the formation of an AOB in 2 to 5-year-old children.

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. 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; however, this remains unclear.

OBJECTIVES

To assess the effect of unrestricted versus restricted 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 (14 March 2012).

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials comparing unrestricted versus restricted pacifier use in healthy full-term newborns who have initiated breastfeeding regardless of whether they were born at home or in the hospital.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data were checked for accuracy.

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) 0.99; 95% confidence interval (CI) 0.93 to 1.05), and at four months of age (RR 0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.98 to 1.13), and at 4 months of age (RR 1.01; 95% CI 0.98 to 1.03).

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. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.

Is early use of pacifier a risk factor for diarrhea?

AIM

Non nutritive suckling has been always used by mothers for calming and comforting infants and young children. Previous studies have suggested that pacifiers may get contaminated but only three studies have shown a possible association between the use of pacifiers and diarrhea or enteric infections. The goal of this study was to investigate whether the early start of pacifier within the first month of life is a risk factor for diarrhea in early childhood.

METHODS

Case-control study. Subjects 12 to 36 month old were recruited. Cases were children with at least 1 episode of diarrhea per year of life.

RESULTS

Among cases (N.=63), those who had started using pacifier in the first month of life were 61.9%, while among controls (N.=78) they were 29.4%, OR 3.89, CI95% 1.92-7.85. Type and frequency of pacifier hygiene practices were not associated with diarrhea.

CONCLUSION

Our results suggest that the recommendation to postpone pacifier use after the first month of life not to interfere with the duration of breastfeeding, may have also the effect to reduce the risk of episodes of diarrhea in the first three years of life.

PURLs. Should breastfeeding babies be given pacifiers?

Tell breastfeeding moms who ask that question that pacifier use will not interfere.

Prevalence of malocclusion and related oral habits in 5- to 6-year-old children

PURPOSE

To verify the prevalence of malocclusion and the influence of harmful oral habits on deciduous dentition in 5- and 6-year-old children enrolled in Brazilian public elementary schools during 2010.

MATERIALS AND METHODS

Exams were conducted in 1385 children from 56 Brazilian elementary schools using the method recommended by the World Health Organization (WHO) for epidemiological surveys on oral health. Information about the type of arch, social and economic data and harmful oral habits of the children were collected through a structured questionnaire.

RESULTS

In relation to canine occlusion, a high prevalence of Class I (74.5%), followed by Class II (19.4%), was found. Among all participants, 22% showed high overjet, 7.8% showed edge-to-edge occlusion and 2.3% showed anterior crossbite. In relation to overbite, 13.2% had short overbite, 14.3% open bite and 16.8% high overbite. The presence of posterior crossbite occurred in 14.6% of children. Maxillae predominantly exhibited the type I arch (67.9%) and mandibles predominantly exhibited type II (51.7%). In relation to harmful oral habits, 43.4% used a pacifier, 84.8% used a bottle and finger sucking was reported by 17.2%.

CONCLUSION

There was a high prevalence of malocclusion associated with oral habits harmful to deciduous dentition.

SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment

Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death that occur during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from focusing only on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths, including SIDS. The recommendations described in this policy statement include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunizations, consideration of using a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in the accompanying "Technical Report--SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue of Pediatrics (www.pediatrics.org/cgi/content/full/128/5/e1341).

Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition

OBJECTIVE

Nutritional, immunological and psychological benefits of exclusive breastfeeding for the first 6 months of life are unequivocally recognized. However, mothers should also be aware of the importance of breastfeeding for promoting adequate oral development. This study evaluated the association between breastfeeding and non-nutritive sucking patterns and the prevalence of anterior open bite in primary dentition.

MATERIAL AND METHODS

Infant feeding and non-nutritive sucking were investigated in a 3-6 year-old sample of 1,377 children, from São Paulo city, Brazil. Children were grouped according to breastfeeding duration: G1--non-breastfed, G2--shorter than 6 months, G3--interruption between 6 and 12 months, and G4--longer than 12 months. Three calibrated dentists performed clinical examinations and classified overbite into 3 categories: normal, anterior open bite and deep bite. Chi-square tests (p<0.05) with odds ratio (OR) calculation were used for intergroup comparisons. The impact of breastfeeding and non-nutritive sucking on the prevalence of anterior open bite was analyzed using binary logistic regression.

RESULTS

The prevalence estimates of anterior open bite were: 31.9% (G1), 26.1% (G2), 22.1% (G3), and 6.2% (G4). G1 would have significantly more chances of having anterior open bite compared with G4; in the total sample (OR=7.1) and in the subgroup without history of non-nutritive sucking (OR=9.3). Prolonging breastfeeding for 12 months was associated with a 3.7 times lower chance of having anterior open bite. In each year of persistence with non-nutritive sucking habits, the chance of developing this malocclusion increased in 2.38 times.

CONCLUSIONS

Breastfeeding and non-nutritive sucking durations demonstrated opposite effects on the prediction of anterior open bite. Non-breastfed children presented significantly greater chances of having anterior open bite compared with those who were breastfed for periods longer than 12 months, demonstrating the beneficial influence of breastfeeding on dental occlusion.

Pacifier use versus no 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. 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; however, this remains unclear.

OBJECTIVES

To assess the effect of pacifier use versus no 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 STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010).

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials comparing pacifier use versus no pacifier use in healthy full-term newborns who have initiated breastfeeding regardless of whether they were born at home or in the hospital.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.

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) 1.00; 95% confidence interval (CI) 0.95 to 1.06), and at four months of age (RR 0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.97 to 1.02), and at 4 months of age (RR 1.01; 95% CI 0.98 to 1.03).

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. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.

Influence of the mode of nutritive and non-nutritive sucking on the dimensions of primary dental arches

INTRODUCTION

Sucking is innate in both infants and young children. It is termed nutritive when referring to suckling from the breast or bottle-feeding and non-nutritive when applied to sucking of a digit or pacifier. Few studies have attempted to assess the impact of the type of sucking on the size of the dental arches. The aim of this study was to quantify the influence of the mode of nutritive suckling and non-nutritive sucking habits (NNSH) on the measurements of the dental arches.

PATIENTS AND METHODS

This was a transverse descriptive study involving 226 Senegalese children. The mode of feeding and the presence or not of a NNSH (digit or pacifier) were gathered from parents of all children using a structured questionnaire. Quantitative variables regarding intra- and inter-arch relationships were recorded using plaster moulds taken from the children. Statistical analyses were used to compare the different variables according to gender, the mode of feeding and the presence or not of a NNSH.

RESULTS

The subjects in the study (123 boys and 103 girls) were aged between 5 and 6years old. The children who had enjoyed mixed feeding (breast/bottle combination) had a great length of the anterior maxillary arch and a significantly greater depth of the palatal arch than children receiving breast-feeding alone. The children with antecedents or a current NNSH had a longer anterior maxillary arch than subjects with no NNSH (P=0.01). Regarding inter-arch relationships, the children with antecedents or a current digit-sucking habit had less overbite than their peers who had no NNSH (P=0.04).

CONCLUSION

The results of this study show that bottle-feeding, even partial, as well as NNSH are associated with changes in certain dimensions of the maxillary dental arch and in inter-arch relationships. Longitudinal studies are required to investigate further the nature of this association.

Association between sociodemographic factors and nutritive and non-nutritive sucking habits among Iranian girls

Prolonged duration of finger- and pacifier-sucking may be a risk factor for maldevelopment of orofacial structures and dental occlusion. This study assessed the prevalence of nutritive and non-nutritive sucking habits and their association with some contributing factors among 7-year-old girls in Mashhad, Islamic Republic of Iran. Based on a questionnaire to the parents of 436 schoolgirls, the rate of current or previous pacifier-sucking was 26.6% and of finger-sucking was 10.6%. Child's birth rank and number of siblings and parents' educational level were significantly related to ever pacifier-sucking but not to finger-sucking. The highest prevalence of ever pacifier-sucking was among children who had been breast- and bottle-fed but finger-sucking was more common among exclusively breastfed children.

Retention mucocele on the lower lip associated with inadequate use of pacifier

Mucocele forms because of salivary gland mucous extravasation or retention and is usually related to trauma in the area of the lower lips. Ruptured ducts release the mucous that accumulates into adjacent tissues, leading to swelling. This report describes a large mucocele involving the lower lip, which was produced in a child by incorrect use of a pacifier. A few important concepts are discussed to help clinicians in the diagnosis and treatment of this pathology.

Feeding and nonnutritive sucking habits and prevalence of open bite and crossbite in children/adolescents with Down syndrome

OBJECTIVE

To analyze the influence of breastfeeding, bottle feeding, and nonnutritive sucking habits on the prevalence of open bite and anterior/posterior crossbite in children with Down syndrome (DS).

MATERIALS AND METHODS

A cross-sectional study was carried out in 112 pairs of mothers/children with DS between 3 and 18 years of age at a maternal/children's hospital in Rio de Janeiro, Brazil. The children with DS were clinically examined for the presence of open bite as well as anterior and posterior crossbite. Information on breastfeeding, bottle feeding, and nonnutritive sucking habits was collected using a structured questionnaire. The control variables were age and mouth posture of children/adolescents and mother's schooling. Statistical analysis of the data was performed using the chi-square test and multiple logistic regression.

RESULTS

The prevalence of anterior open bite was 21%, anterior crossbite was 33%, and posterior crossbite was 31%. The use of bottle feeding for more than 24 months (prevalence ratio [PR] = 1.6) was associated with the occurrence of open bite. Having breastfed for less than 6 months (PR = 1.4) and pacifier sucking for more than 24 months (PR = 3.1) were associated with the prevalence of anterior crossbite. Finger sucking (PR = 2.9) and the use of bottle feeding for more than 24 months (PR = 2.6) were associated with posterior crossbite.

CONCLUSION

The prevalence of open bite and crossbite in children with DS was associated with the use of bottle feeding and pacifier sucking for more than 24 months, breastfeeding for less than 6 months, and finger sucking.

Pacifier-sucking and breast-feeding: a comparison between the 1960 s and the 1990 s

PURPOSE

Pacifiers and their forerunners have been condemned in past centuries, probably beginning in the 17(th) and 18(th) centuries when alcohol and opiates were incorporated as fillings in sucking rags in Great Britain. Nowadays, the modern pacifier is criticized for reducing breast-feeding time and encouraging weaning. The purpose of this study was to analyze if pacifier-sucking has been detrimental to breast-feeding in the past few decades.

METHODS

In the present study, 2 groups of young children born 30 years apart (1967 and 1995 to 1997) in the same geographic area were analyzed in the first 6 months of age regarding their sucking and feeding habits, including initial and prolonged pacifier-sucking and breast-feeding.

RESULTS

Findings do not support the commonly held opinion that pacifier-sucking reduces breast-feeding time. In the 30 years that separate the 2 groups, the pacifier-sucking habit increased by 32% and prolonged use of a pacifier increased. At the same time, breast-feeding at 6 months old has increased 20-fold in the contemporary group (born between 1995 and 1997) as compared with the 1967 group.

CONCLUSIONS

The results suggest that mothers might be unable to satisfy their child's sucking urge through breast-feeding alone, and that they use the pacifier as a supplement. Pacifier use does not negatively affect the prevalence of breast-feeding.

Risks and benefits of pacifiers

Physicians are often asked for guidance about pacifier use in children, especially regarding the benefits and risks, and when to appropriately wean a child. The benefits of pacifier use include analgesic effects, shorter hospital stays for preterm infants, and a reduction in the risk of sudden infant death syndrome. Pacifiers have been studied and recommended for pain relief in newborns and infants undergoing common, minor procedures in the emergency department (e.g., heel sticks, immunizations, venipuncture). The American Academy of Pediatrics recommends that parents consider offering pacifiers to infants one month and older at the onset of sleep to reduce the risk of sudden infant death syndrome. Potential complications of pacifier use, particularly with prolonged use, include a negative effect on breastfeeding, dental malocclusion, and otitis media. Adverse dental effects can be evident after two years of age, but mainly after four years. The American Academy of Family Physicians recommends that mothers be educated about pacifier use in the immediate postpartum period to avoid difficulties with breastfeeding. The American Academy of Pediatrics and the American Academy of Family Physicians recommend weaning children from pacifiers in the second six months of life to prevent otitis media. Pacifier use should not be actively discouraged and may be especially beneficial in the first six months of life.

[Prevalence and factors associated with non-nutritive sucking behavior. Cross sectional study among 5- to 6-year-old Senegalese children]

Sucking behaviours have been described in the literature under two facets i.e. nutritive and non nutritive. Nutritive sucking refers to breast feeding, bottle feeding or a combination of both. Non nutritive sucking habits are mentioned when children suck their thumb or another finger(s), a pacifier or any other object. Non nutritive sucking habits (NNSH) are suspected to potentially induce dentoalveolar anomalies and thus may constitute a public dental health problem. Anthropological and historical data suggest that non nutritive sucking habits are associated with modern pattern of life. The aim of this study is to investigate the prevalence and factors associated with NNSH in Senegalese children 5/6 years old. Data of this study were collected using a structured questionnaire administered by the investigators to mothers or caregivers of 443 children (231 boys and 212 girls) aged 5/6 years. Three types of data were collected: data on the social background of the children including place of residence (urban, suburban and rural) and the mother's occupation (workers, employee, executive, housewife), data regarding former and present sucking habits and information on the feeding pattern of the children when they were infants (breast feeding, bottle feeding or a combination of both). The results indicated a prevalence rate of 16.50% and 17.20% respectively for digit and pacifier sucking in this population. Also, a significant association was found between children's non nutritive sucking habits in one hand and the mothers' occupation and feeding pattern on the other hand. Breast fed children are less prone to develop a non nutritive sucking habit than bottle fed children. Longitudinal studies are necessary to verify the nature of these associations. The identification of factors associated with non nutritive sucking habits would permit to develop and target recommendations for the prevention of such habits.

Effects of breastfeeding and sucking habits on malocclusion in a birth cohort study

OBJECTIVE

To estimate the prevalence of malocclusion and to examine the effects of breastfeeding and non-nutritive sucking habits on dentition in six-year-old children.

METHODS

A cross-sectional study was carried out nested into a birth cohort conducted in Pelotas, Southern Brazil, in 1999. A sample of 359 children was dentally examined and their mothers interviewed. Anterior open bite and posterior cross bite were recorded using the Foster & Hamilton criteria. Information regarding breastfeeding and non-nutritive sucking habits was collected at birth, in the first, third, sixth and 12th months of life, and at six years of age. Control variables included maternal schooling and child's birthweight, cephalic perimeter, and sex. Data were analyzed by Poisson regression.

RESULTS

Prevalence of anterior open bite was 46.2%, and that of posterior cross bite was 18.2%. Non-nutritive sucking habits between 12 months and four years of age and digital sucking at age six years were the main risk factors for anterior open bite. Breastfeeding for less than nine months and regular use of pacifier between age 12 months and four years were risk factors for posterior cross bite. Interaction between duration of breastfeeding and the use of pacifier was identified for posterior cross bite.

CONCLUSIONS

Given that breastfeeding is a protective factor for other diseases of infancy, our findings indicate that the common risks approach is the most appropriate for the prevention of posterior cross bite in primary or initial mixed dentition.

Transverse features of subjects with sucking habits and facial hyperdivergency in the mixed dentition

INTRODUCTION

The aim of this study was to analyze the transverse characteristics of subjects with sucking habits and hyperdivergency in the mixed dentition.

METHODS

The test group consisted of 80 subjects with sucking habits and hyperdivergency in the intermediate mixed dentition, and it was compared with a control group of 185 subjects. The prevalence rate of posterior crossbite was recorded. Maxillary and mandibular intercanine and intermolar widths, and anterior and posterior transverse interarch discrepancies were measured on the dental casts. The statistical comparisons between the test and control groups were performed with independent sample t tests and chi-square tests (P <.05).

RESULTS

The prevalence rate of posterior crossbite in the test group was significantly greater (52%) than in the control group (14%) (P <.001). The test group had significantly smaller maxillary intermolar and intercanine widths and significantly greater posterior transverse discrepancy (P <.01). No significant differences were found for mandibular intermolar and intercanine widths or anterior transverse discrepancy.

CONCLUSIONS

Prolonged sucking habits and hyperdivergency in the mixed dentition were associated with narrow maxillary intermolar and intercanine widths, increased posterior transverse discrepancies, and increased prevalence of posterior crossbites.