{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:47:21Z","timestamp":1784310441070,"version":"3.55.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T00:00:00Z","timestamp":1631491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>It is well recognized that pacifier habit leads to occlusal and orofacial functional changes in children. However, the effects of the interruption of prolonged pacifier habit on the development of the dento-facial complex has not yet been fully characterized. Thus, the aim of this study was to investigate the influence of pacifier removal on aspects of oro-dentofacial morphology and function in preschool children. For that, a pacifier group (<jats:italic>n<\/jats:italic> = 28) and a control group (<jats:italic>n<\/jats:italic> = 32) of 4-year-old children with and without pacifier habit, respectively, were followed up by a group of dentists and speech therapists at baseline, 6 and 12 months after habit removal. Bite force and lip pressure were assessed using digital systems, and the evaluation of breathing and speech functions was performed using validated protocols, together with the measurements of dental casts and facial anthropometry. The Two-way mixed model ANOVA was used in data analysis. After 12 months, a decrease in malocclusion frequency was observed in pacifier group. Additionally, a change over time was observed in facial, intermolar and palate depth measurements, as well in bite and lip forces and speech function scores, increasing in both groups (<jats:italic>p<\/jats:italic> &amp;lt; 0.01). The upper and lower intercanine widths and breathing scores differed between groups at baseline and changed over time reducing the differences. The presence of speech distortions was more frequent in the pacifier group at baseline and decreased over time (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). The interruption of pacifier habit improved the maxillary and mandibular intercanine widths, as well as the breathing and speech functions, overcoming the oro-dentofacial changes found.<\/jats:p><jats:p><jats:bold>Trial Registration:<\/jats:bold> This clinical trial was registered in the Brazilian Clinical Trials Registry (ReBEC; <jats:ext-link>http:\/\/www.ensaiosclinicos.gov.br\/<\/jats:ext-link>), protocol no. RBR-728MJ2.<\/jats:p>","DOI":"10.3389\/fped.2021.703695","type":"journal-article","created":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T04:57:52Z","timestamp":1631509072000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Multidisciplinary Evaluation of Pacifier Removal on Oro-Dentofacial Structures: A Controlled Clinical Trial"],"prefix":"10.3389","volume":"9","author":[{"given":"Kelly Guedes de Oliveira","family":"Scudine","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila Nobre de","family":"Freitas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kizzy Silva Germano","family":"Nascimento de Moraes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Bommarito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosana de F\u00e1tima","family":"Possobon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosana Cristina","family":"Boni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula Midori","family":"Castelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1016\/0002-9416(85)90203-9","article-title":"The prevalence and the etiology of the initial dummy- and finger-sucking habit","volume":"87","author":"Larsson","year":"1985","journal-title":"Am J Orthod."},{"key":"B2","first-page":"681","article-title":"Risks and benefits of pacifiers","volume":"79","author":"Sexton","year":"2009","journal-title":"Am Fam Physician."},{"key":"B3","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.pedneo.2019.07.003","article-title":"Analgesic effect of non-nutritive sucking in term neonates: a randomized controlled trial","volume":"61","author":"Vu-Ngoc","year":"2020","journal-title":"Pediatr Neonatol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1001\/jamapediatrics.2016.3345","article-title":"Risk factors, protective factors, and current recommendations to reduce sudden infant death syndrome: a review","volume":"171","author":"Carlin","year":"2017","journal-title":"JAMA Pediatr."},{"key":"B5","doi-asserted-by":"publisher","first-page":"926","DOI":"10.1016\/j.adaj.2016.08.018","article-title":"Establishing the association between nonnutritive sucking behavior and malocclusions: a systematic review and meta-analysis","volume":"147","author":"Dogramaci","year":"2016","journal-title":"J Am Dent Assoc."},{"key":"B6","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1067\/mod.2002.121445","article-title":"Duration of nutritive and nonnutritive sucking behaviors and their effects on the dental arches in the primary dentition","volume":"121","author":"Warren","year":"2002","journal-title":"Am J Orthod Dentofacial Orthop."},{"key":"B7","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.ajodo.2003.06.011","article-title":"Nonnutritive sucking habits in Brazilian children: effects on deciduous dentition and relationship with facial morphology","volume":"126","author":"Katz","year":"2004","journal-title":"Am J Orthod Dentofacial Orthop."},{"key":"B8","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/j.ajodo.2008.03.018","article-title":"Incorrect orofacial functions until 5 years of age and their association with posterior crossbite","volume":"136","author":"Ovsenik","year":"2009","journal-title":"Am J Orthod Dentofacial Orthop."},{"key":"B9","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1590\/S0104-56872009000400009","article-title":"Correlation between feeding methods, non-nutritive sucking and orofacial behaviors","volume":"21","author":"Medeiros","year":"2009","journal-title":"Pro Fono."},{"key":"B10","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.ajodo.2015.12.015","article-title":"Malocclusion and its relationship to speech sound production: Redefining the effect of malocclusal traits on sound production","volume":"150","author":"Leavy","year":"2016","journal-title":"Am J Orthod Dentofacial Orthop."},{"key":"B11","doi-asserted-by":"publisher","first-page":"386","DOI":"10.14639\/0392-100X-770","article-title":"Association between oral habits, mouth breathing and malocclusion","volume":"36","author":"Grippaudo","year":"2016","journal-title":"Acta Otorhinolaryngol Ital."},{"key":"B12","first-page":"552","article-title":"Effects of different pacifiers on the primary dentition and oral myofunctional strutures of preschool children","volume":"24","author":"Zardetto","year":"2002","journal-title":"Pediatr Dent."},{"key":"B13","first-page":"19","article-title":"Occlusal and orofacial myofunctional evaluation in children with anterior open bite before and after removal of pacifier sucking habit","volume":"18","author":"Verrastro","year":"2007","journal-title":"Int J Orthod Milwaukee."},{"key":"B14","first-page":"148","article-title":"Prevalence of pacifier-sucking habits and successful methods to eliminate them\u2013a preliminary study","volume":"71","author":"Degan","year":"2004","journal-title":"J Dent Child (Chic)."},{"key":"B15","first-page":"16","article-title":"Utiliza\u00e7\u00e3o do m\u00e9todo de esclarecimento para remo\u00e7\u00e3o do h\u00e1bito de suc\u00e7\u00e3o de chupeta e\/ou mamadeira","volume":"2","author":"Boni","year":"2001","journal-title":"J Orthop-Orthod Pediatr Dent."},{"key":"B16","article-title":"Oral health surveys: basic methods","year":"2013"},{"key":"B17","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1177\/00220345500290040601","article-title":"Physiological tooth migration and its significance for the development of occlusion the biogenesis of overbite","volume":"29","author":"Baume","year":"1950","journal-title":"J Dent Res."},{"key":"B18","first-page":"76","article-title":"Occlusion in the primary dentition. Study of children at 2 and one-half to 3 years of age","volume":"126","author":"Foster","year":"1969","journal-title":"Br Dent J."},{"key":"B19","volume-title":"Orthodontics, Diagnosis Color Atlas of Dental Medicine","author":"Rakosi","year":"1993"},{"key":"B20","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.physbeh.2016.04.053","article-title":"Assessment of the differences in masticatory behavior between male and female adolescents","volume":"163","author":"Scudine","year":"2016","journal-title":"Physiol Behav."},{"key":"B21","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s40510-017-0182-0","article-title":"Changes in lips, cheeks and tongue pressures after upper incisor protrusion in Class II division 2 malocclusion: a prospective study","volume":"18","author":"Partal","year":"2017","journal-title":"Prog Orthod."},{"key":"B22","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/j.ijporl.2007.11.012","article-title":"Protocol of orofacial myofunctional evaluation with scores","volume":"72","author":"Fel\u00edcio","year":"2008","journal-title":"Int J Pediatr Otorhinolaryngol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.ijporl.2016.08.019","article-title":"Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy","volume":"90","author":"de","year":"2016","journal-title":"Int J Pediatr Otorhinolaryngol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"38","DOI":"10.52010\/ijom.2012.38.1.5","article-title":"MBGR protocol of orofacial myofunctional evaluation with scores","volume":"38","author":"Marchesan","year":"2012","journal-title":"Int J Orofacial Myology."},{"key":"B25","first-page":"323","article-title":"Changes in the dentition secondary to palatal crib therapy in digit-suckers: a preliminary study","volume":"19","author":"Villa","year":"1997","journal-title":"Pediatr Dent."},{"key":"B26","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1016\/j.ajodo.2006.02.004","article-title":"Treatment effects of a modified quad-helix in patients with dentoskeletal open bites","volume":"129","author":"Cozza","year":"2006","journal-title":"Am J Orthod Dentofacial Orthop."},{"key":"B27","first-page":"97","article-title":"Effect of dummy-sucking on the prevalence of posterior cross-bite in the permanent dentition","volume":"10","author":"Larsson","year":"1986","journal-title":"Swed Dent J."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008694.pub2","article-title":"Interventions for the cessation of non-nutritive sucking habits in children","author":"Borrie","year":"2015","journal-title":"Cochrane Database Syst Rev."},{"key":"B29","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/S0889-5406(94)70034-6","article-title":"The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3-year-old children","volume":"106","author":"Ogaard","year":"1994","journal-title":"Am J Orthod Dentofacial Orthop."},{"key":"B30","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.ajodo.2008.09.029","article-title":"Posterior crossbite in the deciduous dentition period, its relation with sucking habits, irregular orofacial functions, and otolaryngological findings","volume":"138","author":"Melink","year":"2010","journal-title":"Am J Orthod Dentofacial Orthop."},{"key":"B31","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/s12903-018-0538-y","article-title":"Palatal dimensions at different stages of dentition in 5 to 18-year-old Iranian children and adolescent with normal occlusion","volume":"18","author":"Eslami Amirabadi","year":"2018","journal-title":"BMC Oral Health."},{"key":"B32","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1093\/ejo\/cjn124","article-title":"Dentoalveolar development in subjects with normal occlusion. A longitudinal study between the ages of 5 and 31 years","volume":"31","author":"Thilander","year":"2009","journal-title":"Eur J Orthod."},{"key":"B33","author":"Proffit","year":"2018","journal-title":"Contemporary Orthodontics-E-Book."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e0162250","DOI":"10.1371\/journal.pone.0162250","article-title":"Visigen Consortium. Genetic and environmental contributions to facial morphological variation: a 3D population-based twin study","volume":"11","author":"Djordjevic","year":"2016","journal-title":"PLoS ONE."},{"key":"B35","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1186\/1471-2458-12-934","article-title":"Influence of the duration of breastfeeding on quality of muscle function during mastication in preschoolers: a cohort study","volume":"12","author":"Pires","year":"2012","journal-title":"BMC Public Health."},{"key":"B36","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1093\/ejo\/cjh090","article-title":"determination of bite force in northern Japanese children","volume":"27","author":"Kamegai","year":"2005","journal-title":"Eur J Orthod."},{"key":"B37","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1007\/BF00341264","article-title":"Lip closing pressure in disabled children: a comparison with normal children","volume":"9","author":"Chigira","year":"1994","journal-title":"Dysphagia."},{"key":"B38","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1590\/S2176-94512013000100006","article-title":"Association of breastfeeding, pacifier use, breathing pattern and malocclusions in preschoolers","volume":"18","author":"Bueno","year":"2013","journal-title":"Dental Press J Orthod"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1007\/s11325-017-1489-2","article-title":"Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing?","volume":"21","author":"Villa","year":"2017","journal-title":"Sleep Breath."},{"key":"B40","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.pio.2011.08.002","article-title":"Myofunctional and speech rehabilitation after orthodontic-surgical treatment of dento-maxillofacial dysgnathia","volume":"13","author":"Gallerano","year":"2012","journal-title":"Prog Orthod."},{"key":"B41","first-page":"31","article-title":"An\u00e1lise da associa\u00e7\u00e3o entre suc\u00e7\u00e3o, condi\u00e7\u00f5es miofuncionais orais e fala","volume":"15","author":"Fel\u00edcio","year":"2003","journal-title":"Pr\u00f3-Fono."},{"key":"B42","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1159\/000505266","article-title":"The Relationship between feeding and non-nutritive sucking behaviours and speech sound development: a systematic review","volume":"73","author":"Burr","year":"2021","journal-title":"Folia Phoniatr Logop."},{"key":"B43","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1159\/000492469","article-title":"Pacifiers, thumb sucking, breastfeeding, and bottle use: oral sucking habits of children with and without phonological impairment","volume":"70","author":"Baker","year":"2018","journal-title":"Folia Phoniatr Logop."},{"key":"B44","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/1471-2431-9-66","article-title":"The relationship of bottle feeding and other sucking behaviors with speech disorder in Patagonian preschoolers","volume":"9","author":"Barbosa","year":"2009","journal-title":"BMC Pediatr."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.703695\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T04:58:01Z","timestamp":1631509081000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.703695\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,13]]},"references-count":44,"alternative-id":["10.3389\/fped.2021.703695"],"URL":"https:\/\/doi.org\/10.3389\/fped.2021.703695","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,13]]},"article-number":"703695"}}