Key takeaway
Pacifier use is normal and safe in infancy. But if the habit continues past age three, it can start reshaping the palate and creating bite problems, most commonly an anterior open bite, where the front teeth no longer meet when the mouth is closed. The good news: if the pacifier stops early enough, many of these changes reverse on their own.
Pacifiers are a lifesaver in the first year. They soothe fussy babies, help with sleep, and the Canadian Paediatric Society notes that pacifier use during sleep may even reduce the risk of sudden infant death syndrome (SIDS). Nobody should feel guilty about using one.
The question isn’t whether to use a pacifier. It’s when to stop.
What Happens Inside the Mouth
Every time your child sucks on a pacifier, the nipple presses up against the roof of the mouth and pushes the tongue down. In short bursts, this doesn’t matter. But when it’s happening for hours a day, especially overnight, over months and years, that repeated pressure can actually reshape the palate.
The three most common changes we see:
Anterior open bite. The front upper and lower teeth stop overlapping. When your child bites down, there’s a visible gap between the top and bottom front teeth. This is the hallmark pacifier-related bite change.
Posterior crossbite. The upper jaw narrows because the palate has been pushed upward, so the upper back teeth sit inside the lower back teeth instead of outside them. This is less obvious to spot at home but shows up clearly on exam.
Increased overjet. The upper front teeth start to flare forward, sticking out beyond where they should be.
These aren’t cosmetic issues. An open bite makes it harder to bite into food. A crossbite can cause the jaw to shift to one side during growth. And both can affect how the permanent teeth come in later.
The Age Three Threshold
Research consistently points to age three as the tipping point. A scoping review published in 2024 looking at 35 studies found that pacifier use beyond three years significantly increased the likelihood of bite changes requiring intervention. Before that age, the risk is much lower, and changes that do happen tend to self-correct once the habit stops.
This lines up with what most pediatric dental organizations recommend: aim to wean off the pacifier by age two to three. The Canadian Dental Association recommends discouraging prolonged sucking habits that can affect dental development, and the American Academy of Pediatric Dentistry takes a similar position.
So if your two-year-old is still attached to their pacifier, you’re not behind. But it’s a good time to start thinking about a plan.
Will the Bite Fix Itself?
Often, yes, if the pacifier stops early enough. Published case reports have documented anterior open bites self-correcting within four to six months of stopping the habit in children under age four. The bone and tissues in young children’s mouths are still growing and adapting, so once the pressure is removed, things tend to shift back.
The longer the habit continues past age three, the less likely full self-correction becomes. By age five or six, the changes may be significant enough to need orthodontic intervention, sometimes an appliance to widen the palate, sometimes braces down the road.
This is why timing matters more than perfection. You don’t need to take the pacifier away overnight at exactly age two. But having it gone by three gives the bite the best chance of bouncing back on its own.
Pacifiers vs. Thumb Sucking – They’re Not the Same
We have a separate post on thumb sucking and its effects on teeth, but the short version is: pacifiers and thumbs create different patterns of pressure, and pacifiers are generally easier to wean.
You can take a pacifier away. You can’t take away a thumb. That’s why many pediatric dentists actually prefer pacifiers to thumb sucking as a soothing habit, you have more control over when and how to end it.
Pacifier use tends to produce more open bites, while thumb sucking tends to push the upper front teeth forward (overjet) more aggressively. The weaning strategies are completely different too, which is why we address them separately.
Practical Tips for Weaning
There’s no single right way to do this, and what works for one child might not work for another. But a few approaches that parents in our practice have found helpful:
Gradual restriction. Limit the pacifier to naps and bedtime only, no daytime use. After a couple of weeks, drop the nap pacifier. Bedtime is usually the last to go.
The trade. A “pacifier fairy” exchange, the child gives up their pacifiers and gets a small toy in return. It sounds silly, but it works surprisingly often with three-year-olds who respond to ceremony.
Cold turkey. Some kids do better with a clean break. Expect a rough few nights, but most children adjust within a week.
Don’t cut the pacifier. Advice to snip the tip to reduce suction is common online. This creates a choking hazard and isn’t something we recommend.
When to Have Us Take a Look
If your child is approaching age three and the pacifier is still going strong, it’s worth mentioning at their next recall exam. We can check whether any bite changes are developing and help you make a plan.
If the pacifier has already stopped but you’ve noticed the front teeth aren’t meeting or something looks off with the bite, bring it up. Many changes self-correct, but it’s better to have a pediatric dentist in Toronto monitor the situation than to assume it will sort itself out.
Have questions about your child’s pacifier habit or bite?
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