The Role of a Pacifier Shield: A Unique Perspective on Mandibular Growth and Airway Health: Part 2.

BACKGROUND: Daily, perhaps for hours at a time, pacifiers are put in baby's mouths for the primary purpose of soothing. A causal relationship exists between the use of pacifiers and the development of malocclusions and disturbances to the cranio-facial-respiratory complex (CFRC). Finite element analysis (FEA) has enabled us to understand how pacifier bulbs behave under negative pressure and tongue movement in the mouth. It is now realized that the design and size of pacifiers should be based on infant and toddler biometrics of the maxillary palatal width and should contribute to proper oral function and development. Attention has shifted toward the interaction between the pacifier shield, the lips, chin and developing tempro-mandibular joint (TMJ). Free mandibular motion is essential to normal TMJ development, essential to maintaining airway space and promoting forward mandibular growth. This is especially relevant in infants with retrognathia, when shield pressure may restrict free movement of the jaw and anterior mandibular advancement.

CONCLUSIONS: When the pacifier shield interacts with the chin, it impacts the growth and development of the infant mandible and airway physiology. Interference with free movement of the mandible must be made a functional concern in design of the pacifier shield. Technological advances in smartphone photogrammetry now make development of non-invasive diagnostic tools that can advantage the future oral health of children.