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Where’s the evidence? Cochran Collaboration-nothing PubMed: 1. Non-Nutritive Sucking Habits in Sleeping Infants.Non-Nutritive Sucking Habits in.

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Presentation on theme: "Where’s the evidence? Cochran Collaboration-nothing PubMed: 1. Non-Nutritive Sucking Habits in Sleeping Infants.Non-Nutritive Sucking Habits in."— Presentation transcript:

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6 Where’s the evidence? Cochran Collaboration-nothing PubMed: 1. Non-Nutritive Sucking Habits in Sleeping Infants.Non-Nutritive Sucking Habits in Sleeping Infants. Hanzer M, Zotter H, Sauseng W, Pichler G, Müller W, Kerbl R. Neonatology Jul 31;97(1): Risks and Benefits of Pacifiers, Sexton S, Ruby N. Am Family Physician.2009 ;79 (8): Infant Pacifiers: An Overview. Schwartz RH, Guthrie KL. Clinical Pediatrics. 2008; 47: Changes in prevalence of non-nutritive sucking patterns in the first 8 years of life. Bishara S, Warren JJ et al. Am J Orthod Dentofacial Orthop. 2006;130: ADA EBD- nothing AAPD Reference Manual : 1. Management of the Developing Dentition. n.

7 NNS Effect on Teeth and Jaws Duration - Days, weeks, months, years Frequency - Number of times per day Intensity - How strong? Placement of pacifier/digit - Where and how Discontinuation - When did NNS stop?

8 Iowa Studies on Oral Facial Development

9 Influence Of Feeding And NNS on Development of the Dental Arches: Longitudinal Study at Months* Purpose The effects of initial feeding methods and NSS on dental arch development at months. Subjects 104 children from midwest communities; healthy full-term infants; no apparent congenital anomalies. *Nowak, Bishara et al. Pediatric Dent

10 Influence of Feeding and NNS on Development of The Dental Arches: Longitudinal Study at Months*(continued) Methods Clinical examination. Health, feeding, NNS and trauma histories. Nine arch measurements on plaster casts; overbite and overjet Findings Dental arch changes are minimal between feeding and NNS groups NNS habits reduce substantially by 30 months. No one feeding/sucking method can be recommended

11 Effect of Prolonged Non- Nutritive Sucking on Dental Arch Parameters* Purpose Effects of non-nutritive sucking and the primary dentition Subjects 123 healthy, full-term infants at 4-5 years old 20 habit; 90 no-habit Methods Non-nutritive sucking behavior data collected from birth At 4-5 years-old, study models obtained Categorized into groups depending on length of habit Dental arch measurements *Warren, J., Bishara, S., Nowak, A. et al., J Dent Res 79:283A, 2000

12 Effect of Prolonged Non-Nutritive Sucking on Dental Arch Parameters (cont.) Findings  Prolonged habit (3 years of age or older) Mandibular canine arch width greater Maxillary molar arch depth greater % overbite significantly less Overjet significantly greater More anterior open bites Conclusions  Prolonged habits may have a profound impact on occlusal and dental arch characteristics in the primary dentition *Warren J., Bishara, S., Nowak, A. et al J Dent Res 79:283A, 2000

13 6 wk6 mo.12 mo.24 mo.36 mo.48 mo. (n=1,237)(n=1,046)(n=794)(n=606)(n=496)(n=221) Any sucking habit (%) Pacifier (%) Digit (%) Pacifier and/or digit (%) Other objects (%) *Pediatric Dentistry 22:189, 2000 Non-Nutritive Sucking Habits by Age

14 Factors Predictive of Prolonged Non- Nutritive Sucking ● 600+ children followed 36 months or longer ● 23% -- prolonged habit at 36 months or older ● Factors associated:  Older maternal age  Higher maternal education level  First-born child Pediatric Dent 22: , 2000

15 Effects of Prolonged NNS DigitsPacifiersAnterior Open bite Narrowed Maxillary Arch WidthPosterior Cross Bite Elongated Maxillary Arch DepthMandibular Arch Width Shallower Palatal Depth

16 Duration and Posterior Crossbite ● No habits – 12 months – 5.8% ● Ceased Habit – months – 13.0% ● Continued habit – 48 months - >20% JADA 2001

17 Duration of Prolonged NNS 12 Months vs. 36 Months  Mandibular Canine Width  Maxillary Canine Arch Depth  Overjet JADA 2001

18 Duration of Prolonged NNS* 48 Months or Longer Narrow Maxillary Arch  Overjet  Prevalence of Open Bite  Prevalence of Posterior Cross Bite *JADA 2001

19 Discontinuation Of NNS PACIFIERDIGITS Germany2-3 Years3 – 7 Years Finland5 – 8 Years8 Years USA-2 – 6 Years USA-3 – 8 Years USA13.8 MO- USA20.5 MO- Average2 – 4 YEARS5 – 6 Years

20 Sucking Prevalence

21 Evidenced Based Conclusions ● NNS associated with increased prevalence of malocclusion in the primary dentition ● Prevalence increases with increasing duration ● NNS associated with an increase in Class II malocclusion in the mixed dentition ● To minimize dental/oral effects, intervention to address sucking habits should be addressed by 2- 3 years of age ● Interventions may include: a. Positive reinforcement b. Aversive tasting solutions c. Manage child’s stress and anxiety d. Intraoral and extraoral reminder devices.

22 Other NS and NNS facts or myths? Is there evidence? ● Pacifiers interfere with the duration of breastfeeding. ● Pacifier use increases the risk for otitis media. ● Pacifiers should be given to infants at nap and bed-time to reduce the risk of SIDS ● Breastfeeding and ECC ● Ankyloglossia- treat? MYTHBUSTERS Trooth- busters

23 Pacifers and breastfeeding Evidence 1.Cochrane: nothing 2.ADA EBD: nothing 3.PubMed: a. Pacifiers and Breastfeeding. O’Connor NR et al. Arch Pediatr Adolescent Med. 2009;163: b. Does the recommendation to use a Pacifier Influence the Prevalence of Breastfeeding? Jenik AG et al. J Pediatr 2009; 155: 342. Conclusions ● 1. Evidence does not support an adverse relationship between pacifier use and breastfeeding duration or exclusivity. ● Offering a pacifier at 15 days does not modify the prevalence or duration of breastfeeding.

24 Pacifiers and increased otitis media risk Is there evidence? 1. Cochrane- no 2. ADA EBD- no 3. PubMed- a. Risks and benefits of pacifiers. Risks and benefits of pacifiers. Sexton S, Natale R. Am Fam Physician Apr 15;79(8): Review b. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG. Fam Pract Aug;25(4): Epub 2008 Jun 17 c. Pacifier use in children: a review of recent literature.Pacifier use in children: a review of recent literature. Adair SM. Pediatr Dent Sep-Oct;25(5): Review. 4. AAP Guidelines- a. PEDIATRICS.2004;113: Diagnosis and Management of Acute Otitis Media Conclusions 1.Pacifier use associated with increased risk for AOM. 2.Pacifier use appears to be risk factor 3.AAP recommends weaning infants off pacifier in the 2 nd 6 months of life

25 Pacifer and SIDS Evidence? 1. Cochrane- no 2. PubMed- Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Hauck FR, Omojokun OO, Siadaty MS. Pediatrics Nov;116(5):e AAP Policies- 1. AAP Task Force on SIDS. Pediatrics 2005; 116: 1245 Recommendation ● AAP recommends offering a pacifier at nap time and bedtime to reduce the risk to SIDS


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