Pacifier teeth can often be fixed, and in many cases, the damage partially corrects itself once the pacifier habit stops, especially if the child is under three. For more significant bite problems that persist, orthodontic treatments like palatal expanders, braces, or habit-breaking appliances can reshape the jaw and realign the teeth. The right fix depends on the child’s age and the type of bite issue involved.
What Pacifier Use Does to Teeth
Prolonged pacifier use reshapes the mouth in several predictable ways. The most common issue is an anterior open bite, where the front teeth don’t meet when the child bites down, leaving a visible gap. The constant pressure of the pacifier also pushes the upper front teeth forward (increasing what dentists call overjet), and it can narrow the upper jaw by pressing the palate upward into a high, narrow arch. That narrowing sometimes causes a posterior crossbite, where the upper back teeth sit inside the lower back teeth instead of outside them.
These changes happen because a young child’s jaw bones are still soft and actively growing. The pacifier essentially molds the bone and tooth positions around itself. One study comparing pacifier types found that even “orthodontic” pacifiers caused measurable increases in overjet and open bite, though slightly less than conventional ones.
When the Problem Fixes Itself
The simplest fix is stopping the pacifier early enough for the mouth to rebound on its own. The American Academy of Pediatric Dentistry recommends ending pacifier use by 36 months of age and notes that an anterior open bite will generally improve on its own after the pacifier is eliminated before age three. That’s because the baby teeth are still shifting, the jaw is still growing, and the constant pressure that created the problem is gone.
Crossbites are less forgiving. The AAPD recommends limiting or discontinuing pacifier use around 18 months, when the canine teeth start coming in, specifically to prevent posterior crossbites from developing. Crossbites are less likely to self-correct because they involve the width of the entire upper jaw, not just tooth position.
If your child is past these windows, self-correction becomes less likely, and active treatment is usually needed to reshape the bite before the permanent teeth come in.
Palatal Expanders for a Narrow Jaw
When pacifier use has narrowed the upper jaw, a palatal expander is the standard treatment. This device sits on the roof of the mouth and attaches to the upper back teeth with metal bands. A small screw or wire spring gradually widens the two halves of the upper jaw over weeks or months.
Expanders work best in younger children because the upper jaw isn’t fused yet. The two halves of the palate are connected by a fibrous layer (a suture) that allows the jaw to be widened with gentle, steady pressure. As kids move into their teens, that fibrous layer turns to bone, making expansion much harder and sometimes requiring surgery instead. The American Association of Orthodontists recommends an orthodontic evaluation by age seven, partly to catch crossbites early enough for an expander to work well.
Treatment with an expander typically lasts several months: a few weeks of active widening, followed by a longer period of wearing the device while new bone fills in the gap. After the expander is removed, the child may still need braces later to fine-tune tooth alignment.
Habit-Breaking Appliances
Some children struggle to give up the pacifier (or switch to thumb-sucking after the pacifier is taken away). For these kids, a dentist or orthodontist can place a habit-breaking appliance in the mouth. The most common type is a palatal crib: a small metal framework cemented to the upper back teeth with vertical bars or “fences” that sit behind the front teeth. These bars make sucking less satisfying and serve as a physical reminder not to place a finger or pacifier in the mouth.
Palatal cribs are remarkably effective. In clinical use, nearly 80% of children stopped their sucking habit within seven days of having the appliance placed. The crib also creates a favorable environment for the front teeth to move back together and close an open bite, particularly when the child’s permanent incisors are actively erupting.
Variations exist, including the Bluegrass appliance, which has a small roller on the palate that gives the tongue something to play with as a substitute for sucking. Removable versions are available but tend to be less successful because children with a strong urge to suck can simply take them out. Fixed appliances cemented in place are far more reliable.
Braces and Phase-One Orthodontics
If pacifier-related bite problems persist into the mixed-dentition stage (when a child has both baby and permanent teeth, roughly ages six to twelve), early orthodontic treatment, sometimes called Phase One, can correct the alignment before the full set of adult teeth arrives. This might involve braces on just the front teeth, an expander, or both.
Starting treatment early tends to shorten overall treatment time and can prevent the need for more extensive (and expensive) orthodontics in the teen years. Full braces, when needed, typically take 14 to 33 months and cost between $5,000 and $13,000 depending on severity and type. Phase One treatment is usually shorter and less costly than a full course of braces, though many children who undergo Phase One still need a second phase of treatment once all permanent teeth have erupted.
What to Expect at Different Ages
The fix for pacifier teeth looks very different depending on how old your child is when you address it:
- Under 18 months: Simply stopping the pacifier is usually enough. The jaw and teeth have plenty of time to remodel naturally.
- 18 months to 3 years: Stopping the pacifier should still allow an open bite to close on its own. A crossbite may need monitoring. If the child can’t quit, behavioral strategies (cutting the tip of the pacifier, limiting it to bedtime, or gradual weaning) are the first step before considering an appliance.
- 3 to 6 years: Self-correction is less reliable. A pediatric dentist will monitor the bite and may recommend a habit-breaking appliance if the child still sucks a thumb or finger. Some early intervention with an expander may begin toward the end of this window.
- Age 7 and older: This is when orthodontic evaluation becomes critical. Palatal expanders are most effective before the jaw suture fuses. Open bites, crossbites, and protruding front teeth can all be addressed with Phase One orthodontics, and early treatment at this stage often reduces the complexity of later braces.
- Teens and adults: The jaw suture has typically turned to bone, so expansion may require surgical assistance. Braces or clear aligners can still correct tooth position, but treatment tends to be longer and more involved than it would have been at a younger age.
Preventing Further Damage
If your child is still using a pacifier and you’re noticing changes to their teeth, the single most impactful thing you can do is work on ending the habit. Even switching to an orthodontic-shaped pacifier, while slightly better, still causes measurable bite changes with prolonged use. No pacifier design eliminates the risk entirely.
Weaning strategies that work for many families include restricting pacifier use to nap and bedtime only, then gradually eliminating those sessions. Some parents snip the tip of the pacifier to reduce suction, making it less appealing. For older toddlers, a “pacifier fairy” ritual or trading the pacifier for a desired toy can ease the emotional transition. If none of these approaches work and bite changes are progressing, a habit-breaking appliance placed by a pediatric dentist offers a reliable solution with a high success rate.