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Oral habits and orofacial development in children

Arthur J Nowak, DMD
John J Warren, DDS, MS
Section Editor
Ann Griffen, DDS, MS
Deputy Editor
Mary M Torchia, MD


Oral habits that are acquired during infancy (eg, nonnutritive sucking) can have adverse health consequences, such as early cessation of breastfeeding or increased risk of otitis media. The identification of such habits and assessment of immediate and long-term effects on the teeth and orofacial development should be made as early as possible [1,2]. After infancy, persistent oral habits have little effect on health but can affect facial growth, oral function, the occlusal relationship, and facial esthetics [3].

The short- and long-term effects of oral habits are reviewed here. Preventive dental care and counseling for infants and young children are discussed separately. (See "Preventive dental care and counseling for infants and young children".)


Nonnutritive sucking behavior (eg, sucking on a pacifier, thumb, or fingers) is a normal part of early development that may become a learned habit. It is a self-soothing behavior that occurs in 70 to 90 percent of infants in various populations [4-8]. The frequency of sucking on digits or pacifiers decreases with increasing age; by the age of four to five years, nonnutritive sucking usually is replaced by other coping mechanisms, and the prevalence decreases [4].

Children who use a pacifier are less likely to suck on their thumb or fingers [9,10]. Compared with pacifier sucking, digit sucking is more likely to persist into the fourth or fifth year of life, when it may become problematic [11-13]. If it persists into the period of permanent tooth eruption, nonnutritive sucking may contribute to the development of malocclusion [14]. Pacifier use does not appear to be related to an increased risk of development of early childhood caries [15].

Overview of effects — Nonnutritive sucking habits may be associated with increased prevalence of malocclusion in the primary dentition and mixed dentition, and increased risk of trauma to the upper front teeth [16-19].

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Literature review current through: Nov 2017. | This topic last updated: Feb 22, 2017.
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