[Blog] Ep 22. Effect of Milk Bottles, Thumbsucking and Pacifiers on Teeth

ft Dr Vivek Jogani BDS MDS (Pediatric Dentist)

Introduction

From late-night feeds to toddler tantrums, parents are often on the lookout for tools and techniques to soothe their babies. Among the most common are milk bottles, pacifiers, and the ever-reliable thumb. While these habits offer comfort and convenience, they can also impact a child’s dental health. In a candid and informative episode of the Modern Indian Parent podcast, host Rinie Gupta sits down with pediatric dentist Dr. Vivek Jogani to explore the effects of these habits on a child’s teeth and jaw development.

This blog distills the key insights from their conversation and offers practical strategies for parents looking to balance comfort with healthy oral development.

Baby Bottle Syndrome: Dental Decay Due to Night Feeds and Feeding to Sleep

Dr. Vivek Jogani explains a common but often overlooked issue in early childhood dental health—Baby Bottle Syndrome, also known as nursing pattern decay. This condition occurs when children, especially toddlers, continue to receive milk feeds during the night or are fed to sleep with a bottle. The practice can lead to early childhood caries, which may start silently and go unnoticed until significant damage has been done.

What is Baby Bottle Syndrome?
It’s a form of tooth decay that primarily affects the upper front teeth of young children who are given bottles of milk, formula, or sweetened liquids to suck on during naps or nighttime sleep. Milk pools around the teeth while the child sleeps, promoting bacterial growth and acid attacks on tooth enamel.

When Does It Begin?
Dr. Jogani notes that by 18 months of age, nearly 70% of children show early signs of decay such as chalky white spots, plaque, or more serious dental issues, even if the child never complains of pain. Parents often miss these early signs because they expect visible discomfort or swelling. But dental decay in young children can be silent and may only be detected when it's already severe enough to require treatments like root canals or extractions.

How to Catch It Early?
Parents are encouraged to perform a simple “lift the lip” check regularly. When the child is asleep, gently lift their upper lip and examine the front teeth for any white patches, plaque, or swelling in the gums. If anything looks off, it’s time to consult a pediatric dentist immediately.

When and How to Wean Off Night Feeds
To prevent this kind of decay, Dr. Jogani recommends weaning off night feeds by 15 to 18 months of age. Daytime nursing can continue, but nighttime feeding should stop to prevent milk from pooling in the mouth during long stretches of sleep. If not stopped, night feeding can lead to progressive dental issues that may require emergency treatment later on.

Is Feeding to Sleep Also a Problem?
Yes. Many parents use bottle feeding as a sleep aid—laying the child down with a bottle until they doze off. According to both Dr. Jogani and sleep consultant Rinie, this habit not only interferes with healthy sleep routines but also heightens the risk of tooth decay.

Tips for Gently Weaning Off the Bottle
Weaning doesn’t need to be abrupt. Dr. Jogani suggests a gradual dilution method:

1. Start with 75% milk and 25% water for a few days.

2. Then shift to a 50:50 milk-water mix.

3. Finally, reverse the ratio to 25% milk and 75% water.

4. Eventually, the child will lose interest in the diluted milk.

This approach reduces the bottle's appeal and discourages feeding to sleep naturally.

Creative Parenting Tricks That Work

• After feeding, offer a sip of water or wipe the child’s teeth with a muslin cloth or wet gauze, even for toddlers.

• Make your child a part of the weaning process. Use a marker to color the bottle nipple black and tell your child it’s become “dirty” and must be thrown away.

• Let your child witness the bottle being discarded so they understand it’s gone, reducing tantrums and resistance.

• Try adding asafoetida (hing) on the bottle nipple to deter use. It’s safe in small amounts and helps digestion too.

• Introduce a “Bottle Fairy”: Ask your child to pack away the bottles for the Bottle Fairy to give to a baby. In return, surprise them with a grown-up sipper or straw cup.

These small steps combine emotional logic with gentle behavioral conditioning, helping children transition out of unhealthy habits without distress.

Effect of Pacifier Usage on the Teeth

Pacifiers can be a savior in calming a cranky baby, but their prolonged use may have unintended effects on dental alignment. Dr. Jogani acknowledges that pacifiers are not inherently harmful, especially when used for a limited time. However, when used beyond the age of 6 months to the age of 1 year, they may start to influence the positioning of teeth and the development of the jaw.

Long-term pacifier use can lead to:

• Open bite: where the front teeth don’t touch even when the mouth is closed.

• Crossbite: misalignment of the upper and lower jaws.

• Speech issues: due to tongue placement changes.

However, not all pacifiers are equal. Orthodontic pacifiers, designed to mimic the shape of a mother's nipple during breastfeeding, may reduce some of the risks associated with traditional ones. Yet, Dr. Jogani emphasizes that timing and moderation are more crucial than pacifier type.

His advice is clear: restrict pacifier use to the early years and begin weaning off by the right age to avoid long-term dental complications.

Effect of Thumb Sucking on Dental Development

Unlike pacifiers, thumb sucking is a self-soothing mechanism that is entirely child-driven and often harder to control. Dr. Jogani explains that thumb sucking and similar habits like chewing on the corner of a blanket or using two fingers are acceptable up to 18 to 24 months of age. During this time, the behavior is developmentally normal and doesn’t typically impact oral health or facial structure.

Once a child crosses the 2-year mark, persistent thumb or finger sucking can start to affect dental and facial development. If not addressed, it can lead to:

• Forwardly placed (protruding) teeth

• Open bites

• Changes in the jaw structure

• Tongue thrusting

• Mouth breathing, especially during sleep

• Poor sleep quality

These issues can have a lasting impact on oral health, facial aesthetics, and even breathing patterns.

Dr. Jogani encourages parents to begin weaning the child off thumb sucking between 18 and 24 months. This doesn’t have to be abrupt, there are many gentle, effective strategies to guide the transition:

1. Reminder Therapy

Simple home strategies can work wonders:

• Apply something safe but unpleasant-tasting on the thumb, such as asafoetida (hing).

• Dress the child in long-sleeved sleepwear where the sleeves cover the hands, making thumb sucking at night more difficult.

• Avoid using harsh-tasting commercial products from the pharmacy unless advised by a pediatric dentist.

2. Make It a Team Effort

Dr. Jogani emphasizes that if home remedies and reminders don’t work, it’s important to consult a pediatric dentist. Dentists have access to child-friendly, non-invasive tools and devices that can help stop the habit completely. These may include oral appliances that serve as gentle deterrents.

Strategies to Stop Thumb Sucking

Stopping thumb sucking can be challenging, but Dr. Jogani provides a range of parent-friendly strategies to ease the transition:

1. Positive Reinforcement: Praise and reward your child for not sucking their thumb. Small incentives or sticker charts can help track progress.

2. Distraction Techniques: Offer a stuffed toy, soft cloth, or even a pacifier (temporarily) during sleep if the thumb is used mainly at bedtime.

3. Physical Barriers: Use thumb guards, mittens, or bandages as gentle reminders—not punishments.

4. Understand the Trigger: Thumb sucking is often a response to anxiety or boredom. Identifying and addressing the emotional trigger can help reduce dependency.

5. Consult a Pediatric Dentist: If the habit persists beyond the age of 4 or 5, a dental professional may recommend habit-breaking appliances that gently discourage thumb sucking.

Pacifier vs Thumb Sucking – Which Is Better for Soothing?

When it comes to calming a fussy baby, many parents find themselves weighing two popular options: thumb sucking and pacifiers. But which one is better in the long run?

Dr. Vivek Jogani, a pediatric dentist, breaks it down by first explaining the basics.

“You have to understand that there are two types of sucking,” he says.
Nutritive sucking is when the baby nurses or bottle-feeds.
Non-nutritive sucking is when they suck their thumb or a pacifier.”

The Key Difference: Who’s in Control?

With thumb sucking, the behavior is initiated by the child. With pacifiers, the parent introduces the habit. This simple distinction makes a big difference when it comes to breaking the habit later on.

Dr. Vivek Jogani's Perspective:

• Introducing a pacifier does not prevent thumb sucking; in fact, it can increase the chances of it.

• If you wean the child off a pacifier, they may still start thumb sucking later.

• Thumb sucking is self-initiated and can be easier to manage directly.

• Not all children who suck their thumb continue for long—some stop within weeks or months, depending on parental support.

• There is no need to introduce a pacifier if the child hasn't already developed a habit.

If a choice must be made, it’s better to let the child thumb suck naturally rather than introducing a pacifier, which may lead to double weaning efforts.

Dental Care Tips:

Dr. Vivek Jogani’s 5 Commandments for Children’s Dental Care:

1. Avoid refined and starchy foods.

2. Include healthy snacks: vegetables, salads, and fresh fruits.

3. Brushing twice a day—night brushing is a must.

4. No screens (TV/mobiles/tablets) during meals.

5. Visit your pediatric dentist every six months.

Conclusion

Dr. Vivek Jogani's insights on the Modern Indian Parent podcast remind us that early intervention, informed choices, and gentle guidance can go a long way in protecting our children’s oral health. As parents, understanding the impact of these habits empowers us to make balanced decisions that prioritize both comfort and care.