L’utilizzo del succhietto può causare problematiche odontoiatriche e ortodontiche? = Is pacifier use responsible for dental and orthodontics problems?

INTRODUCTIONThe use of pacifier is one of the most common non-nutritive sucking habits (NNSH) in the first years of life. Although evidence suggests the benefits that derive from its use, mothers are more and more anxious about causing troubles to their children due to the improper use of soother. For this reason, parents often rely on professionals for clarification on this topic. The purpose of this narrative review is to evaluate benefits and risks of pacifier use, thus guiding professionals through the elaboration of answers to submit to their patients' parents. This article can clarify doubts and provide practical recommendations concerning the use of pacifier, the different types of soothers, timing and other key elements to manage this habit.MATERIALS AND METHODSA search on the following databases was conducted initially without language nor date restrictions, to find all pertinent articles published from inception until 2021: Medline via PubMed, Scopus, Embase, Cochrane Central Register of Controlled Trials, Web of Science, OpenGrey and LILACS. Afterwards 14 articles were selected, published in the last 10 years with the keyword "malocclusion AND pacifier". In addition, other studies, resulting from the research related to the previously chosen articles, were considered.RESULTSSeveral cross-sectional studies have shown that exclusive breastfeeding has a protective effect against the development of dental skeletal anomalies and that this type of nutrition is able to prevent the establishment of NNSH.The authors of the articles considered, evaluated the onset of dysgnatia in prescholar children using pacifier, and stated that its prolonged use is correlated with a higher prevalence of anterior openbite, increased overjet, posterior cross-bite. Furthermore, from the myofunctional point of view, atypical swallowing, oral breathing, hypertonia of the facial muscles occurs with greater prevalence in subjects affected by the presence of a reduced transverse palatal diameter (ogival palate) that is a consequence of the use of pacifier. Hence, some authors have evaluated the action of different design of pacifiers on oral structures.There are anatomically designed soothers, called "orthodontic pacifiers", which are investigated and compared with the conventional ones. It was tested the ability of the orthodontic pacifier on reducing the onset of developmental problems. The use of this type of pacifier is associated with a lower prevalence of malocclusion than conventional ones. Finally, pacifier is considered as a cause of onset of infections because it acts as a bacterial reservoir or vector of infections, thus some authors evaluated different methods for the disinfection and sterilization of these devices with the aim to prevent this trouble.CONCLUSIONSThe use of pacifier is recommended at night in the first year of life, then it has to be avoided after 2 years. Three is the limit age of use beyond which it is essential to end this habit. Choosing an anatomically designed pacifier is helpful to prevent the onset of malocclusion.CLINICAL SIGNIFICANCEKnowing the consequences of using pacifier helps to prevent the onset of malocclusion in the pediatric subject, which may result in orthodontic intervention. The knowledge of the correct use of the pacifier allows professionals to provide recommendations to the parents to profit by beneficial effects of pacifier.