Dummies, thumb sucking and teeth

If your baby settles with a dummy, or your toddler drifts off with a thumb in their mouth, you may wonder what it is doing to their teeth and when to step in. Sucking is a normal comfort for young children. This guide follows UK sources, and says so where they differ.

Why do young children suck dummies and thumbs?

Sucking is a reflex that appears early in infancy, and it soon becomes a way to self-soothe. The British Orthodontic Society (BOS) gives two reasons a habit carries on: it brings comfort and security, and it can be a learned behaviour. It says most habits start in the first three months and are so common they are considered normal.

Dummy and thumb habits follow different paths, according to the BOS advice sheet for professionals. Dummy sucking falls away quickly after the early months and is almost non-existent after age 6. Thumb and finger sucking declines more slowly and is more likely to carry on into the adult teeth. The BOS leaflet for parents (2019 edition) says about one child in eight aged 7 to 11 has a prolonged thumb or finger habit.

How can sucking affect the teeth?

Not every child with a habit has problems. According to the BOS leaflet, it depends on how often and how hard a child sucks, and how old they are when they stop. A habit that goes beyond 6 hours a day is more likely to affect the teeth, the advice sheet adds.

A sucking habit can cause three kinds of change, the BOS leaflet says:

• A vertical gap between the front teeth (an anterior open bite), which can make biting certain foods difficult.
• Upper front teeth that stick out.
• A narrower upper jaw, so the back teeth do not meet in the right position (a crossbite).

A dummy can also move baby teeth. The leaflet says it appears to cause fewer problems than a thumb or finger habit, because it normally stops before the adult teeth start to appear, at around 6 or 7. Dummy effects are mainly on the baby teeth, the advice sheet says.

Speech is a common worry too. The BOS advice sheet says there can be some effect on speech, though the relationship is not a linear one. NHS Lothian’s speech and language therapists say babies who use a dummy have fewer chances to babble, and suggest taking the dummy out whenever your baby is babbling or chatting. Our guide to lisps in children looks at what the speech sources say.

The BOS advice sheet says the evidence behind this advice is mostly observational, and that more high quality controlled trials are needed. That is why this guide says “can” and “more likely” rather than promising any outcome.

Will the teeth settle if the habit stops?

It depends on the age. The BOS leaflet says that if a sucking habit stops by age 7, the teeth can often correct themselves with normal growth. If it carries on beyond 7, the position of the adult teeth can be permanently affected and self-correction is less likely. Braces may then be needed later to try to correct the position of the teeth.

The leaflet adds that orthodontic treatment cannot start until the habit has completely stopped, because treatment is unlikely to be successful otherwise. These are the BOS’s general statements, not a forecast for your child. A dentist can look at the teeth in front of them.

Using a dummy safely, and when to stop

For sleep, the NHS says to think about using a dummy to settle your baby, because some research suggests it can help lower the risk of sudden infant death syndrome (SIDS). The Lullaby Trust, a UK safer sleep charity, gives practical points:

• If you are breastfeeding, wait until it is well established, usually when your baby is around four weeks old.
• Offer the dummy for every sleep rather than occasionally. If it falls out while your baby sleeps, you do not need to put it back.
• If your baby spits it out, do not force it. Avoid neck cords and dummy attachments, which it says can be dangerous.
• Do not offer the dummy during awake time.

For teeth and hygiene, the NHS says not to dip a dummy in anything sweet, such as sugar or jam, and the Lullaby Trust names honey too. The NHS also says honey should not be given to babies under 1 year old, because they cannot digest it safely. The BOS says a dummy should never be sweetened, or the teeth will decay (see our guide to preventing tooth decay). A west London NHS site for parents gives two more hygiene points. Never suck your baby’s dummy to “clean” it, because that spreads germs between you and your baby. Keep plenty of spares instead.

On shape, the Lullaby Trust recommends an orthodontic dummy, which adapts to your baby’s mouth. The BOS advice sheet says orthodontic dummies, with flatter necks and teats, appear to cause less of an open bite than conventional ones, but have similar effects on crossbite.

When should a dummy stop?

UK sources do not agree on one age, so this guide does not pick one.

Source	What it says
The Lullaby Trust	Gently stop between 6 and 12 months, to avoid problems from longer use, such as misaligned teeth and ear infections
NHS Lothian	Try to stop by 10 to 12 months, using the dummy for sleep only as your baby gets older
West London NHS site	Frequent dummy, thumb or bottle use beyond 12 months can cause a gap in the top front teeth

Your health visitor or dentist can help you decide what suits your child.

How can you help a child give it up?

The BOS leaflet says a habit is not easy to stop because the child enjoys it, that it may stop in the day before it stops at night, and that the child must want to stop. It suggests:

• A wall chart with a daily reward, and daily praise for not sucking.
• A positive approach, avoiding nagging, teasing, punishing or shaming.
• For a thumb or finger, a reminder or barrier such as a sticky plaster, cotton glove, sock, thumb guard or a bitter-tasting paint-on nail varnish.

For a dummy, NHS Lothian suggests cutting back step by step to key times such as bedtime or when your child is ill. It suggests rewards such as activities, stickers or star charts, and says not to hand over sweets instead of the dummy.

A dentist or orthodontist can offer advice about thumb sucking, the BOS says, and may discuss a habit-breaker, a dental appliance that makes sucking a thumb more difficult.

A 2015 Cochrane review of ways to stop sucking habits found six small trials, 252 children in all, every one on thumb or finger sucking and every one at high risk of bias. It found low quality evidence that orthodontic appliances and psychological approaches such as positive and negative reinforcement help children stop, and called for better trials.

When to see a dentist

Good reasons to ask your dentist:

What we would do

We see children from their first visit, and our children’s dentistry page explains that appointments are kept short and unhurried. At the two examinations a year, our dentists keep track of how your child’s teeth and jaw are developing. If a dummy or thumb habit is on your mind, mention it at any visit and the dentist can look at your child’s teeth with you. Our guide to children’s dental health tips covers everyday care of milk teeth. If your child might need an appliance to help break a habit, your dentist can assess this and talk you through the options. For a new patient, a check-up is the first step.

Before any visit, including your child’s first dental visit, it helps to note how long and how often the habit happens, and at what time of day. The BOS advises orthodontists to ask about these first.

To arrange a visit, book an appointment at whichever of our five practices suits you.

Want us to take a look?

Book an appointment at whichever of our five practices suits you. We will check what is going on and talk you through your options.

Book an appointment Read about our children’s dentistry