# The Role of Digit- and Pacifier-Sucking Habits on Malocclusion Development in Children: Anterior Open Bite and Posterior Crossbite—A Systematic Review & Meta-Analysis

## TL;DR

This study finds that both digit-sucking and pacifier-sucking habits increase the risk of certain types of malocclusion in children, with pacifier use posing a higher risk for one type.

## Contribution

The study compares the effects of digit-sucking and pacifier-sucking on two specific malocclusions using a systematic review and meta-analysis.

## Key findings

- Both digit-sucking and pacifier-sucking increase the risk of anterior open bite and posterior crossbite.
- Pacifier-sucking significantly increases the risk of posterior crossbite more than digit-sucking.
- No significant difference was found between the two habits for anterior open bite prevalence.

## Abstract

Background/Objectives: Malocclusion is one of the most prevalent oral health concerns in paediatric dentistry, with anterior open bite (AOB) and posterior crossbite (PCB) being among the most common forms. Non-nutritive sucking habits (NNSHs), including digit-sucking habits (DSHs) and pacifier-sucking habits (PSHs), have been linked to malocclusion development. While both habits are known to impact dental and skeletal development, their comparative effects remain unclear. This systematic review and meta-analysis aims to determine the difference in the development and prevalence of anterior open bite and posterior crossbite between patients with digit-sucking and pacifier-sucking habits. Materials and Methods: An exhaustive review of the literature was conducted on the 25 November 2024 across three databases, namely EBSCOhost (including PubMed-Medline), Web of Science and Scopus. The following PICO question was constructed for the systematic review: “In children and teenagers, is there a difference in the development and prevalence of malocclusions (Anterior Open bite & Posterior Crossbite) between patients with a history of digit sucking habits and patients with a history of pacifier sucking habits?”A meta-analysis was also performed with the selected studies, and the software used to carry out the meta-analysis was R 4.3.1 (R Core Team (2023)). Results: From the initial search, 102 articles were found and a further 11 articles were obtained from manual findings. 12 articles were included in the final systematic review and meta-analysis. The meta-analysis indicated that the risk of AOB and PCB was increased by both DSH and PSH. Conclusions: Both DSH and PSH significantly increased the risk of AOB and PCB. PSH posed a significantly higher risk than DSH for PCB development (OR = 2.66, p < 0.001), while no significant difference in AOB prevalence was observed between DSH and PSH (OR = 1.77, p = 0.150).