The Dummy – An expensive Pacifier

Some mothers claim that nobody told them. Others say they never saw the warnings on the box and others still defend the use of pacifiers because their mothers and grandmothers recommended it – allowing for greater peace and quiet.

Yes, initially sucking serves life-enhancing purposes.

Thumb sucking emerges in infancy, but the habit may start even earlier.  Many babies have been sucking already for multiple months before they even leave the womb. So its no surprise that when allowed to continue to age 3 or 4, parents struggle to get the child to break the habit. In fact, over my 30 years in practice, I have met many adults who still find themselves thumb-sucking through their stress.

In a study with premature infants, researchers found that infants who sucked their thumbs or a pacifier had shorter hospital stays – that is because rhythmic sucking sooths them so that they spend less energy in crying.  

Research shows that sucking re-optimizes the heart beats and breathing patterns of upset babies, slowing them and regularizing the rhythms.  

In addition, sucking regulates the muscle movements of peristalsis in the babies’ guts – slowing these movements enables babies to digest their food more efficiently.

But the sucking sensation which is part of breast-feeding has the same effect (over and above the many other benefits), without the habit forming consequences which accompany pacifiers.

Bottle-fed babies don’t get the same benefits as breast feeding babies but do often suffer from similar negative consequences as the thumb- suckers or pacifier users.

What does research tell us about pacifier use?

Pacifier use has been associated with conditions that are considered risk factors for speech and language issues:

• Ear infections: Prolonged and frequent pacifier use appears to be a risk factor in the development of otitis media. Repeated middle ear infections can increase the risk of hearing loss – and even cause temporary conductive hearing loss. Children with hearing loss have more difficulty learning speech and language.
• Dental problems: Malocclusion (misaligned or malpositioned jaw/teeth) is associated with prolonged pacifier use. Differences in dental structures can lead to distortions during the articulation of speech sounds. In some cases, frequent pacifier use can cause the tongue to push forward between the teeth which set the stage for the development of a lisp when producing the /s/ and /z/ phonemes.

Results of Barbosa et al, indicate that finger sucking behaviors and prolonged use of a pacifier for 3 years or more may be detrimental to optimal speech development in young children.

A three-fold increase in relative odds of speech disorder was found for finger-sucking behavior and for use of a pacifier for 3 or more years.

Warren et al studied dental arch and occlusal conditions of 4 to 5 years old children with a variety of different nonnutritive sucking habit durations. They found that children with nonnutritive sucking habits past the age of 48 months, compared to children with a shorter duration of nonnutritive sucking habits, were more likely to have narrower maxillary arch widths, greater overjet, higher prevalence of open bite, and posterior crossbite.

Oral Habits Affect Tongue Posture in the Mouth

Most parents are not aware that oral habits like mouth breathing, tongue-tie and non-nutritive sucking habits (e.g. thumb sucking, finger sucking, dummy sucking and tongue sucking) affect tongue posture inside the mouth. 

The tongue plays a large part in influencing cranial and maxillary growth.

When a child is new born the forward thrusting of the tongue to express milk from the mothers breast  is the force that drives the horizontal or forward growth of the maxillae.

We are perfectly designed with the natural forces activated by the oral and facial muscles, together with the tongue, during breast feeding to best support oral andfacial development.

The tongue is ideally in contact with the roof of the mouth at rest and during the sub-conscious swallow.  In this position, the tongue exerts a lateral force which counterbalances the inward force exerted by the buccinator/cheek muscles. This is what maintains the integrity of the developing maxilla and allows the mandible to follow in the growing pattern.

The longer (hours per day, as well as months to years)the pacifier/thumb/finger/bottle is in the mouth, the greater the impact on the palatal arch, sinus development, repression of tongue, and facial and arch development. Very often there is an accompanied open bite from canine to canine, or the canines become over-erupted – the tongue no longer has a “stop” position, so an anterior tongue thrust may develop. In addition, speech-related problems that can arise with an anterior open bite:

1. Difficulty with Certain Sounds (Articulation Issues)

• Sibilant sounds: These are sounds like “s,” “z,” and “sh.” With an anterior open bite, the tongue may be unable to make proper contact with the roof of the mouth or the upper teeth, which is crucial for producing these sounds clearly. As a result, speech may become unclear, or the sounds may become distorted.
• “T” and “D” sounds: For proper pronunciation of “t” and “d” sounds, the tongue typically touches the roof of the mouth or the upper teeth. An open bite can interfere with this, making it more difficult to produce these sounds correctly, which can affect speech clarity.
• “Th” sounds: The “th” sound (as in “think” or “this”) requires the tongue to rest between the upper and lower teeth. In the case of an anterior open bite, the tongue may not make proper contact, which can result in slushy or imprecise pronunciation.

2. Impaired Fricative and Plosive Sounds

• Fricatives (e.g., “f,” “v”): The positioning of the upper and lower teeth plays a crucial role in creating fricative sounds, where air is forced through a narrow gap between the teeth. With an anterior open bite, the teeth may not come together properly, leading to difficulty articulating these sounds correctly.
• Plosives (e.g., “b,” “p,” “m”): Although the impact on plosives is less severe compared to other sounds, a misalignment of the teeth can still cause some distortion of these sounds due to improper tongue placement.

3. Lisping

• Lisping: People with an anterior open bite are more likely to develop a lisp, especially when pronouncing the “s” and “z” sounds. In this case, air may escape from the side of the mouth, creating a “whistling” sound or causing the “s” sound to sound more like “th.”

4. Difficulty with Blending Sounds

• Speech fluency: An anterior open bite can affect how well a person blends sounds together, particularly in rapid speech. The inability to properly articulate certain sounds can cause speech to sound choppy or unclear, disrupting fluency.

5. Voice and Resonance Changes

• Mouth breathing: Many individuals with anterior open bite may also breathe through their mouths due to difficulty closing the mouth fully. This can impact the resonance of their voice, often leading to a nasal or muffled tone.

6. Developmental Speech Issues in Children

• Delayed speech development: In children, an untreated anterior open bite can interfere with normal speech development. This can lead to delays in speech clarity, difficulty pronouncing words properly, or challenges in producing specific sounds as they grow.
• Poor oral motor skills: An anterior open bite may also contribute to difficulties with oral motor coordination, affecting not only speech but also activities like eating, drinking, and swallowing.

7. Compensatory Speech Patterns

• Substitute sounds: In response to the difficulty in pronouncing certain sounds, individuals with anterior open bite might develop compensatory speech patterns. For example, they may substitute different sounds that are easier to articulate or adjust their tongue position to work around the misalignment, resulting in less natural speech.

8. Impact on Self-Esteem and Communication

• Self-consciousness: Because speech can be affected, individuals with an anterior open bite might feel self-conscious or embarrassed about how they sound, which can lead to communication difficulties, particularly in social or professional settings.
• Difficulty in social interactions: Speech issues can also lead to difficulty in being understood, potentially causing frustration and strain in conversations.

Treatment Options to Address Speech Issues from Anterior Open Bite:

Treating an anterior open bite often involves addressing both the dental misalignment and the speech concerns. Some treatment options include:

1. Orthodontic Treatment: Braces or clear aligners can be used to realign the teeth and close the gap. This often helps improve both the function of the teeth and the ability to speak clearly.
2. Speech Therapy: A speech-language pathologist (SLP) can work with the individual to help correct speech patterns and improve articulation. Therapy may include exercises to train the tongue to position itself properly for certain sounds.
3. Dental Appliances: In some cases, dental appliances like retainers or splints can be used to help guide the teeth into a more functional position.
4. Surgical Intervention: In severe cases of open bite, especially when there is significant skeletal involvement, surgery may be required to reposition the jawbones and close the bite. This is typically considered after other methods, such as orthodontics, have been attempted.

In summary, an anterior open bite can lead to a variety of speech issues, primarily involving articulation, clarity, and fluency. Addressing the underlying dental condition and seeking speech therapy can help alleviate these problems and improve communication. In addition, most pacifier/thumb-sucking children mouth breathe, which as discussed in our mouth breathing section, has its own set of consequences.