Pacifier Teeth: How Pacifiers Affect a Child’s Bite

A pacifier can change how a child’s teeth, palate and jaw develop, but mostly when the habit lasts well past the toddler years. Short-term use in infancy is common and usually settles down on its own. The risk grows with each month the habit continues, especially beyond 18 months, and it is highest once a child reaches age 3. I’m Dr. Kamboj, and this guide explains what actually changes, what is likely to correct itself, and how to wean calmly.

TL;DR

• The American Academy of Pediatric Dentistry (AAPD) says pacifier use beyond 18 months can influence the developing mouth and face, and recommends stopping nonnutritive sucking by 36 months.
• The most common pacifier effects are an open bite (front teeth that don’t meet) and a crossbite (upper teeth sitting inside the lower teeth on one or both sides).
• True “buck teeth” are linked more strongly to finger and thumb habits than to pacifiers.
• Duration matters more than how often a child uses it, and an open bite tends to improve after the habit stops, particularly before age 3.
• A first dental visit by 12 months gives you a baseline and a plan for weaning.

Table of Contents

• What “pacifier teeth” actually means
• Does a pacifier cause buck teeth?
• At what age does a pacifier start to affect teeth?
• Duration matters more than frequency
• How to tell if a pacifier is affecting your child’s bite
• Will pacifier teeth go back to normal?
• Should a 2-year-old still have a pacifier?
• How to wean your child off the pacifier
• What about orthodontic pacifiers?
• When to see a dentist
• Our perspective at Clayton Dental Studio
• Bring your child in for a bite check in Humble
• FAQ
• Sources

What “pacifier teeth” actually means

Parents use “pacifier teeth” as a catch-all for any tooth or bite change blamed on a pacifier. Dentists are more specific. A pacifier sits between the teeth and presses on the roof of the mouth. Over months of steady sucking, the tongue sits lower and the cheeks squeeze the sides of the upper arch. Soft, growing bone responds to that pressure.

The changes we look for fall into a few groups:

• Anterior open bite: the top and bottom front teeth do not touch when the back teeth are closed. There is a gap, often round, where the pacifier sat.
• Posterior crossbite: the upper back teeth bite inside the lower ones. The upper arch is narrower than it should be.
• Increased overjet: the upper front teeth stick out past the lower ones. This is what most people mean by buck teeth.
• Palate shape: a narrower or higher roof of the mouth.
• Swallowing pattern: the tongue pushes forward against the teeth when swallowing.

The AAPD’s policy on pacifiers links use beyond 18 months with anterior open bite, posterior crossbite and Class II malocclusion (a bite in which the upper jaw sits too far forward relative to the lower).

A study of 84 children aged 2 to 5 in Brazilian Oral Research found pacifier use was significantly associated with open bite, posterior crossbite, increased overjet, an altered palate shape and an altered swallowing pattern. The strongest link was with open bite, with a prevalence ratio of 11.33. Malocclusion overall had a ratio of 2.33. That is a small study of children already in the habit, so it shows an association rather than a guarantee for your child. But it matches what we see in the chair.

Does a pacifier cause buck teeth?

Sometimes, but less often than people fear. According to the AAPD, increased overjet and Class II malocclusion are more strongly associated with finger habits than with pacifier habits. In other words, a thumb or finger tends to push the upper front teeth forward more than a pacifier does. If your child sucks a thumb, our guide to thumb sucking and its effects on teeth covers what to expect.

The pattern with pacifiers is different. A pacifier is more likely to leave a gap at the front (open bite) and a narrow upper arch (crossbite) than to tip the front teeth forward. That doesn’t make it harmless. An open bite can affect how a child bites into food and how the tongue rests, and a crossbite can make the jaw shift to one side when closing.

So if you are picturing protruding front teeth, the more accurate worry is a bite that doesn’t close properly. Both are worth catching early.

At what age does a pacifier start to affect teeth?

There is no single magic birthday, but there are useful markers.

The Finnish trial gives a useful picture of crossbite. At age 7, posterior crossbite was found in 7% of children whose pacifier habit lasted 12 months or more, compared with 1% of those whose habit lasted 11 months or less. Pacifier use over 11 months was associated with crossbite, with an odds ratio of 6.77 in the researchers’ multivariable model. Those are real differences, but notice that most children in even the longer-use group did not develop a crossbite. Risk goes up. It is not a certainty.

Duration matters more than frequency

Many parents ask whether limiting the pacifier to naps and bedtime solves the problem. It helps, and it makes weaning easier later, but the AAPD notes that malocclusion is affected more by how long the habit lasts than by how often the child sucks. Open bite also becomes more common when nonnutritive sucking continues beyond age 3.

In practice, this means the calendar is your best guide. A child who uses a pacifier only at bedtime until age 4 is likely at more risk than one who used it constantly but stopped at 15 months. If you can only change one thing, change the end date.

How to tell if a pacifier is affecting your child’s bite

You don’t need dental training to notice the main signs. Check at a calm moment, such as after a bath or while reading together, and ask your child to bite down gently on their back teeth.

1. Look at the front teeth. If the top and bottom front teeth don’t meet and you can see a gap, that may be an open bite.
2. Look at the sides. If the upper back teeth sit inside the lower ones, or the jaw seems to slide to one side when closing, a crossbite is possible.
3. Look at the lip and tongue. A tongue that pokes forward between the teeth when swallowing or speaking can go along with these changes.
4. Notice the roof of the mouth. If it looks unusually narrow or high, mention it to your dentist.
5. Listen to speech. Lisping on “s” and “th” sounds can go along with an open bite, though many young children lisp for other reasons.

These are things to bring up at a visit, not a diagnosis. Baby teeth also have natural spacing, and many perfectly healthy toddlers have small gaps. A dentist can tell the difference in a couple of minutes, without any discomfort.

If you notice your child breathing through the mouth a lot, that is worth mentioning too. Mouth breathing can affect the bite on its own, and we explain how in our guide to mouth breathing effects.

Will pacifier teeth go back to normal?

Often, yes, if the habit stops early enough. The AAPD states that an anterior open bite associated with pacifier use will improve after the pacifier is eliminated before age 3. Growing bone and soft tissue are adaptable, and once the pressure is gone the teeth and tongue tend to settle into a better position.

A 2021 controlled clinical trial of 4-year-olds in Frontiers in Pediatrics found something encouraging. After pacifier removal, the frequency of malocclusion decreased over 12 months. The children also showed improvements in the width between the upper and lower canines, and in breathing, speech and other orofacial measures.

The palate is part of this story as well. If your child’s palate looks narrow or high, it is worth understanding how that shape can interact with feeding and oral function. This piece on high palate and breastfeeding latch explains how feeding specialists think about it, which can help you decide who else to involve alongside your dentist.

What if the change doesn’t fully resolve? Some children keep a crossbite or open bite after stopping, especially if the habit went on for years or if the jaw shape has a genetic component. That is not a failure on your part. It simply means your dentist may suggest monitoring or a gentle correction when the timing is right. For a crossbite, we explain the options in our article on crossbite correction with aligners, which is more relevant for older children and teens. If baby teeth are lost early and space needs protecting, a space maintainer may come up.

Should a 2-year-old still have a pacifier?

A 2-year-old with a pacifier is very common, and there is no need to feel guilty. But it is the right time to start planning the exit. The AAPD suggests limiting or stopping pacifier use when the canines emerge, at approximately 18 months, and stopping all nonnutritive sucking by 36 months. That leaves a window of roughly a year and a half to wean at a pace that suits your child.

A sensible rule of thumb: the earlier you start, the gentler it can be. A 14-month-old often gives up a pacifier with far less drama than a 3-year-old who has used it as a comfort object for every upset.

How to wean your child off the pacifier

The AAPD advises that positive rewards work better than criticism or restraint, and it notes that forcing an early stop has been associated with prolonged finger sucking. The goal is to replace comfort, not simply remove it.

Here is a step-by-step approach that many families find manageable:

1. Shrink the habit first. Move from all-day use to naps and bedtime only. Keep the pacifier out of the car, the stroller and the playground.
2. Pick a calm week. Avoid weaning during a move, a new sibling, potty training or a new daycare.
3. Offer a substitute. A small stuffed animal, a blanket or a special bedtime song gives your child something else to hold.
4. Praise, don’t scold. Celebrate each nap or night without it. A sticker chart works well for children around age 3.
5. Try a story. Some families have the child “give” their pacifiers to a new baby, or leave them for a character in a book. Older toddlers often enjoy having a part in the decision.
6. Stay consistent. The first two or three nights are usually the hardest. Going back and forth teaches the child that persistence pays off.
7. Watch for a swap. If your child starts sucking a thumb or fingers instead, stay patient and keep rewarding other forms of comfort. Don’t punish or restrain.

If your child is anxious, or the pacifier is tied to sleep and security, talk to your pediatrician or dentist about a plan that fits your child’s temperament. Some children need a slower approach, and that is fine.

What about orthodontic pacifiers?

Parents often ask whether a “orthodontic” or flat-shaped pacifier avoids the problem. The research we have reviewed for this article looks at pacifier use in general, and the AAPD policy focuses on the habit’s duration rather than on the shape of the nipple. So the safest advice is not to rely on the design. Whatever pacifier you use, the end date matters most. Choose a one-piece model that fits your child’s age, and replace it if it shows wear.

When to see a dentist

The AAPD recommends establishing a dental home by 12 months, which includes guidance on stopping nonnutritive sucking habits by 36 months. We agree, and we would add that the first visit is not about drilling or fixing anything. It is about getting to know your child, checking how teeth and jaws are growing, and answering your questions. If you are wondering when to book, our guide to the right age for a first dental visit walks through what to expect.

Book sooner if you notice any of the following:

• A visible gap between the top and bottom front teeth when the back teeth are closed
• Upper back teeth that bite inside the lower ones
• A jaw that shifts to one side when your child bites down
• A pacifier or thumb habit that continues past age 3
• Persistent mouth breathing, snoring or a very narrow palate

Our perspective at Clayton Dental Studio

We see pacifier habits as a family question first and a dental question second. Almost every parent who asks us about them feels a little worried or guilty, and neither feeling helps a child. What helps is a clear picture and a plan.

Our approach is prevention. We would rather see your child early, document how the bite is developing and give you simple, realistic steps, than wait until a problem needs treatment. Clinical precision matters, but so does a calm, spa-like office where children and anxious parents feel comfortable asking anything.

Because we care for the whole family, from kids to grandparents, we can look at the bigger picture: breathing, swallowing, jaw comfort and how a child’s bite may change as they grow. Digital scanning with our Trios 5 system lets us record the bite without messy impression trays, which many children find easier. If a bite needs correcting later, we can talk about options such as clear aligners at the right stage, and we will always explain the why before the what.

Clayton Dental Studio

Bring your child in for a bite check in Humble

If you are in Humble or the greater Houston area and want a professional opinion on your child’s bite, we are happy to help. We offer general dentistry for the whole family, including preventive exams, and we can talk through weaning, habits and what we see in your child’s mouth in a relaxed, no-pressure visit.

For teens whose bite did not fully correct after childhood habits, we also provide clear aligner treatment. Call us or visit our website to schedule.

FAQ

At what age does a pacifier affect teeth?

Use beyond 18 months can influence the developing mouth and face, according to the AAPD. The risk of open bite is significantly higher with use of 36 months or longer. Some research suggests effects on the upper arch can begin even earlier, so reducing use after the first birthday is a sensible goal.

Will pacifier teeth go back to normal?

Often they do. The AAPD says an open bite linked to a pacifier will improve after the habit is stopped before age 3. A 2021 trial in 4-year-olds also found malocclusion became less frequent over the 12 months after removal. If the bite does not correct, a dentist can recommend monitoring or treatment.

Does a pacifier cause buck teeth?

Less often than a thumb or finger does. The AAPD links increased overjet and Class II malocclusion more strongly with finger habits than with pacifiers. Pacifiers are more commonly tied to open bite and crossbite, so watch for gaps at the front or an upper arch that looks narrow.

Should a 2-year-old still have a pacifier?

Many do, and it is not an emergency. But it is the time to start limiting use, since the AAPD suggests cutting back around 18 months and stopping by 36 months. Moving to naps and bedtime only is a good first step, followed by a gentle, reward-based goodbye.

What if my child switches to thumb sucking after the pacifier?

This happens, and the AAPD notes that forced early cessation has been associated with prolonged finger sucking. Stay calm, praise other ways of self-soothing and avoid punishment. If the habit continues, ask your dentist to check the bite and suggest a plan.

Sources

• AAPD Policy on Pacifiers
• Pacifier-sucking habit duration and frequency, Brazilian Oral Research
• Early childhood non-nutritive sucking behavior, European Journal of Orthodontics
• Multidisciplinary Evaluation of Pacifier Removal, Frontiers in Pediatrics
• High palate and breastfeeding latch

Recommended

• Mouth Breathing Effects: What It Does to Teeth and Health
• Crossbite With Aligners: Evidence First, Single Tooth 3–6 Months