Dental and oral development

Pacifier Use, Teeth, and Speech

How long and how much of the day: what pacifiers do to teeth, and what the evidence says about speech.

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A father holding a toddler who is using a pacifier

Written and reviewed by Dr. Yana Pekarski, DDS · Last updated August 27, 2026

Nonnutritive sucking is normal in infants and young children, and the AAPD supports parents who choose a pacifier.⁠2,5 Pacifier use is consistently associated with anterior open bite, posterior crossbite and overjet, and the risk grows with the duration, frequency and intensity of use, especially beyond age three.⁠1 The evidence on speech is small, and most speech measures have not been linked to pacifier use.⁠3,4 An open bite from pacifier use improves after the pacifier is given up before age 3, and the AAPD encourages stopping by 36 months.⁠5

What decides a pacifier’s effect: years of use and hours a day

Duration and hours per day. Not the pacifier. A pacifier used for settling in the first year, then at naps and bedtime, then given up, is a very different exposure from one that is in the mouth for most of the child's waking hours into the preschool years: the risk of bite changes grows with the duration, frequency and intensity of use.⁠1

That turns an anxious yes-or-no question into something you can act on. You do not have to remove a pacifier at once — you can start by reducing when it is available, since frequency of use is part of the risk.⁠1

How long-term pacifier use affects teeth and the bite

Teeth sit in a balance between the tongue pushing outward and the lips and cheeks pushing inward, and the duration of a force matters more than its strength.⁠2 Long-term pacifier use is associated with three kinds of change:⁠1,2

  • An open bite — the front teeth do not meet when the back teeth are closed⁠1,5
  • A posterior crossbite, where the upper back teeth bite inside the lower ones⁠1,5
  • Increased overjet, with the upper front teeth further ahead of the lower ones⁠1,2

Limiting pacifier use when the canines come in, around 18 months, has been recommended to limit the development of a crossbite.⁠5

RelatedEarly signs of bite problems

Stopping before age 3 matters. An open bite from pacifier use improves after the pacifier is given up before age 3,⁠5 though some changes from sucking habits can persist after the habit ends.⁠2

Do pacifiers cause speech delay?

The research on pacifiers and speech is small. In a study of 100 British children aged 2 to 5, most speech measures were not associated with pacifier use, however it was measured; more frequent daytime use was linked to more atypical speech errors, a link not seen in children older than 38 months.⁠3 A 2025 study of 98 toddlers aged 18 to 36 months found no association between pacifier use and vocabulary size.⁠4

Daytime use is the part that matters. In that study, how often a child used a pacifier during the day was linked to atypical speech errors; how many months they used one, and use at night, were not.⁠3

That points to a practical step: keep the mouth free during the hours a child is awake, alert and interacting.

RelatedFind a speech-language pathologist

Do orthodontic pacifiers prevent bite problems?

Pacifiers described as orthodontic have a flatter, thinner section where the teeth close. One systematic review found they caused less open bite than conventional pacifiers, but two other reviews found the evidence insufficient to prefer them, and fit matters whatever the label.⁠5

Shape does not remove the duration question. The risk of bite changes grows with how long, how often and how intensely a pacifier is used.⁠1

DrSensory sells an orthodontic silicone pacifier it chose rather than designed, and the guidance on this page applies to it exactly as it does to any other. → What the evidence actually says about pacifiers, which links to it with the disclosure in view.

Pacifier safety: two rules with no exceptions

Two rules with no exceptions:
  • Never dip a pacifier in anything sweet — not honey, sugar, juice, jam or syrup. The FDA advises against pacifiers containing or dipped in honey, which can carry the bacterium that causes infant botulism.⁠5
  • Never attach a pacifier to a cord, ribbon or chain around a child's neck. The US Consumer Product Safety Commission prohibits straps, cords or attachments that could pose a danger.⁠5

Also: inspect it regularly for wear, choose a one-piece pacifier with a firm shield that has vent holes and is at least 1.5 inches across, and keep it clean, since pacifiers can carry microbes.⁠5

How to wean a child off a pacifier gently

Related: what the evidence says about pacifiers — safer sleep, breastfeeding, ear infections and when to stop, on DrParenting.

Pacifiers do a job — usually settling, comfort, and transition to sleep — so plan what does that job instead.

Reduce the hours before removing the object

Move from all-day availability to specific situations — the car, sleep, distress — then to sleep only.

Make it a place, not a permission

Give the pacifier a place it lives, such as a bowl or a drawer, so the rule is about the place rather than a person saying no.

Replace the function

For settling, a consistent routine, a comfort object, or extra physical closeness at the same moment. For a child who is seeking oral input more generally — chewing clothing, mouthing objects — give that need somewhere else to go.

Pick a calm week

Not during illness, a house move, a new sibling, or the first week of a new setting.

Do not shame it

Reward days without it rather than criticizing: the AAPD prefers positive reward to criticism or restraint, to avoid power struggles that could extend the habit.⁠5

When to ask a dentist about pacifier use

  • The habit is continuing into the preschool years and is not reducing
  • You can see a change in the bite — front teeth not meeting, or upper teeth tipping forward
  • The upper teeth are biting inside the lower ones on one side
  • Your child is speaking noticeably less than peers, or is hard to understand
  • You have tried to wean and it is not working

Frequently Asked Questions

At what age should a child stop using a pacifier?

The AAPD encourages stopping nonnutritive sucking habits by 36 months. An open bite from pacifier use improves after the pacifier is given up before age 3, and limiting use when the canines come in, around 18 months, has been recommended to limit crossbite.⁠5 Your dentist can advise on timing for your child.

Do pacifiers cause speech delay?

The evidence is small. In one study of 100 children aged 2 to 5, most speech measures were not linked to pacifier use, but more frequent daytime use was linked to more atypical speech errors in the younger children.⁠3 Keeping the pacifier out during waking, interactive hours targets the use that study linked to errors.

Are orthodontic pacifiers better for teeth?

They have a flatter, thinner section where the teeth close. One systematic review found less open bite with orthodontic pacifiers, but two other reviews found the evidence insufficient to prefer them.⁠5 Shape does not remove the duration question: the risk grows with how long and how often a pacifier is used.⁠1

Will my child's teeth fix themselves after we stop?

Not always. An open bite from pacifier use improves after the pacifier is given up before age 3,⁠5 but some changes from sucking habits persist after the habit ends.⁠2 Changes that persist, or a crossbite, should be assessed by a dentist.

What is the easiest way to wean off a pacifier?

Reduce the hours before removing the object — from all-day availability to specific situations, then to sleep only — and replace the function it was doing, whether that is settling, comfort, or oral input. Give it a place it lives rather than making it a permission, choose a calm week, and reward days without it rather than criticizing, which can turn into a power struggle that extends the habit.⁠5

Is it safe to put honey or sugar on a pacifier?

No. The FDA advises against pacifiers containing or dipped in honey, which can carry the bacterium that causes infant botulism,⁠5 and there is no reason to add sugar.

Sources

  1. Hung M, Marx J, Ward C, Schwartz C. Pacifier use and its influence on pediatric malocclusion: a scoping review of emerging evidence. Dentistry Journal. 2025;13(7):319. doi:10.3390/dj13070319 (PMID 40710164)
  2. American Academy of Pediatric Dentistry. Management of the Developing Dentition and Occlusion in Pediatric Dentistry. In: The Reference Manual of Pediatric Dentistry. The AAPD's recommendations on non-nutritive sucking habits and their effect on the developing bite. aapd.org. Checked September 13, 2026.
  3. Strutt C, Khattab G, Willoughby J. Does the duration and frequency of dummy (pacifier) use affect the development of speech? International Journal of Language & Communication Disorders. 2021;56(3):512–527. doi:10.1111/1460-6984.12605 (PMID 33939239) One hundred British children aged 24 to 61 months: “the majority of speech outcomes are not significantly associated with dummy use”, with “a significant association between increased atypical errors and greater frequency of daytime dummy use”, not seen above 38 months; “only the frequency of daytime use seems relevant, not the duration or night-time use.”
  4. Barca L, Mazzuca C, Borghi AM. Impact of pacifier use and parenting characteristics on toddlers’ vocabulary development. Frontiers in Psychology. 2025;16:1599801. doi:10.3389/fpsyg.2025.1599801 (PMID 40771328) Ninety-eight children aged 18 to 36 months: “no significant association between pacifier use and either overall vocabulary size or the acquisition of abstract words.”
  5. American Academy of Pediatric Dentistry. Policy on Pacifiers. In: The Reference Manual of Pediatric Dentistry. Chicago, IL: AAPD; 2025:86–89. aapd.org. Checked October 30, 2026.
    Show the passageHide the passage
    “An anterior open bite with pacifier use will improve after elimination of the pacifier before age 3”; limiting use when canines emerge (about 18 months) has been recommended to limit posterior crossbite; one systematic review found orthodontic pacifiers induce less open bite, while two reviews found the evidence insufficient to prefer them; the FDA advises against pacifiers containing or dipped in honey; the CPSC prohibits straps, cords or attachments that could pose a danger; a firm shield with vent holes at least 1.5 inches across; regular inspection for wear; positive reward is preferable to criticism or restraint; the AAPD encourages discontinuing nonnutritive sucking habits by 36 months.

Medical disclaimer. This page is for general educational purposes and does not constitute medical or dental advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child.