Title Nonnutritive Sucking Habit Has an Unfavorable Effect on Dental And Facial Development
Clinical Question For children with primary dentition, will a nonnutritive sucking habit have an unfavorable effect dental and facial development when compared to children with no oral habit?
Clinical Bottom Line A nonnutritive sucking habit beyond the age of 3 years contributes to a higher incidence of unfavorable dental and facial development. The greater the longevity and duration of nonnutritive sucking habit, the greater the potential for harmful results.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
27692622Doğramacı/2016Patients aged 1-5 years Meta-Analysis
Key resultsThe authors looked at the effect of nonnutritive sucking (NNS) habit on malocclusion through a systemic review with meta-analysis. They found that that NNS was associated with varying risk of unfavorable dental development. Pacifiers and digit sucking were the most common form of nonnutritive sucking. The results of a meta-analysis that evaluated posterior crossbite and increased overjet in the primary dentition showed a significant association of crossbite with pacifier sucking over digit sucking (n = 5,560; risk ratio, 1.42; 95% confidence interval, 1.18-1.70; P = 0.0001), while digit suckers are more likely to develop an increased overjet and open bite compared with pacifier suckers. Longer duration of NNS was associated with an increased risk of developing malocclusions. This study concluded that there is an association between NNS and the development of malocclusion. Pacifier use was associated with a higher risk of developing most malocclusion features, when compared with digit sucking.
26251128Wagner/2015Patients aged 3 years (N=377)Prospective Cohort Study
Key resultsThe authors of this study determined the prevalence of malocclusion and associated risk factors among a group of children aged 3 years. They found that all children who sucked their thumb had a malocclusion, and children who used a pacifier had greater odds of having a malocclusion at the age of 3 years than children without pacifier use (OR = 3.36; 95 % CI: 1.87-6.05). Therefore, this study concluded that non-nutritive sucking habits were important risk factors for development of a malocclusion in the primary dentition.
Evidence Search PubMed - clinical queries - Nonnutritive sucking habit, malocclusion, dental and facial development
Comments on
The Evidence
Validity: Doğramacı/2016 is the only study found via a literature search that conducted a systematic review with meta-analysis to examine the association between NNS and malocclusion. Since this study is a meta-analysis, it provides the highest level of evidence on this topic, corroborating the significance of NNS in the development of specific malocclusions that have been previously discussed in the literature. The authors note that there was heterogeneity across the included studies in participant characteristics, clinical definitions, and outcome measure classifications. Wagner/2015 is a birth prospective design limited to patients in one area of Germany (Thuringia). Occlusal measurements were made at the age of 3 years by one calibrated clinician using a vernier caliper (accuracy 0.1 mm; Münchner Modell 042-751-00, Germany). Intra-rater reliability was good (Kappa = 0.80). Overall, measurement and criteria used in these studies were satisfying. Perspective: NNS habit has been a controversial topic between pediatricians and pediatric dentists, where pediatricians encourage children to have a pacifier to prevent sudden infant death syndrome and to insure a feeling of warmth and a sense of security, while pediatric dentists focus on dental and facial development of the child and to provide the best oral function and esthetics of the child.
Applicability Duration of NNS habit has shown significant influence on dental development; therefore, discouraging any kind of NNS habit after the age of 2 years is of great benefit to a child's dental and facial development. Moreover, lack of NNS habits will not harm the child's sense of security nor it will be a reason for sudden infant death syndrome. These studies are applicable to our patient population and their results provide evidence on which to base recommendations for our patients.
Specialty (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords Nonnutritive sucking, thumb sucking, pacifier sucking, malocclusion
ID# 3311
Date of submission 03/12/2018
E-mail alrashdi@livemail.uthscsa.edu
Author Murad Alrashdi, BDS
Co-author(s) e-mail
Faculty mentor Peter T. Gakunga, BDS, MS, PhD
Faculty mentor e-mail gakunga@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available