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Where’s the evidence?

Cochran Collaboration-nothing PubMed: 1. Non-Nutritive Sucking Habits in Sleeping Infants. Hanzer M, Zotter H, Sauseng W, Pichler G, Müller W, Kerbl R. Neonatology. 2009 Jul 31;97(1):61-66.

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Where’s the evidence?

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  1. Cochran Collaboration-nothing PubMed: 1. Non-Nutritive Sucking Habits in Sleeping Infants. Hanzer M, Zotter H, Sauseng W, Pichler G, Müller W, Kerbl R. Neonatology. 2009 Jul 31;97(1):61-66. 2. Risks and Benefits of Pacifiers, Sexton S, Ruby N. Am Family Physician.2009 ;79 (8): 681-685 3. Infant Pacifiers: An Overview. Schwartz RH, Guthrie KL. Clinical Pediatrics. 2008; 47:327-331. 4. Changes in prevalence of non-nutritive sucking patterns in the first 8 years of life. Bishara S, Warren JJ et al. Am J Orthod Dentofacial Orthop. 2006;130: 31-36. ADA EBD- nothing AAPD Reference Manual : 1. Management of the Developing Dentition. http://www.aapd.org/media/Policies_Guidelines/G_DevelopDentition. Where’s the evidence?

  2. NNS Effect on Teeth and Jaws • Duration - Days, weeks, months, years • Frequency - Number of times per day • Intensity - How strong? • Placement of pacifier/digit - Where and how • Discontinuation - When did NNS stop?

  3. Iowa Studies on Oral Facial Development

  4. Influence Of Feeding And NNS on Development of the Dental Arches: Longitudinal Study at 30-36 Months* Purpose • The effects of initial feeding methods and NSS on dental arch development at 30-36 months. Subjects • 104 children from midwest communities; healthy full-term infants; no apparent congenital anomalies. *Nowak, Bishara et al. Pediatric Dent

  5. Influence of Feeding and NNS on Development of The Dental Arches: Longitudinal Study at 30-36 Months*(continued) Methods • Clinical examination. • Health, feeding, NNS and trauma histories. • Nine arch measurements on plaster casts; overbite and overjet Findings • Dental arch changes are minimal between feeding and NNS groups • NNS habits reduce substantially by 30 months. • No one feeding/sucking method can be recommended

  6. Effect of Prolonged Non-Nutritive Sucking on Dental Arch Parameters* Purpose • Effects of non-nutritive sucking and the primary dentition Subjects • 123 healthy, full-term infants at 4-5 years old • 20 habit; 90 no-habit Methods • Non-nutritive sucking behavior data collected from birth • At 4-5 years-old, study models obtained • Categorized into groups depending on length of habit • Dental arch measurements *Warren, J., Bishara, S., Nowak, A. et al., J Dent Res 79:283A, 2000

  7. Effect of Prolonged Non-Nutritive Sucking on Dental Arch Parameters (cont.) Findings • Prolonged habit (3 years of age or older) • Mandibular canine arch width greater • Maxillary molar arch depth greater • % overbite significantly less • Overjet significantly greater • More anterior open bites Conclusions • Prolonged habits may have a profound impact on occlusal and dental arch characteristics in the primary dentition *Warren J., Bishara, S., Nowak, A. et al J Dent Res 79:283A, 2000

  8. Non-Nutritive Sucking Habits by Age 6 wk 6 mo. 12 mo. 24 mo. 36 mo. 48 mo. (n=1,237) (n=1,046) (n=794) (n=606) (n=496) (n=221) Any sucking habit (%) 87 89 68 53 23 21 Pacifier (%) 78 56 38 25 10 5 Digit (%) 48 73 31 22 14 12 Pacifier and/or digit (%) 85 87 60 44 22 17 Other objects (%) 19 66 32 15 6 6 *Pediatric Dentistry 22:189, 2000

  9. Factors Predictive of Prolonged Non-Nutritive Sucking • 600+ children followed 36 months or longer • 23% -- prolonged habit at 36 months or older • Factors associated: • Older maternal age • Higher maternal education level • First-born child Pediatric Dent 22:187-191, 2000

  10. Effects of Prolonged NNS Digits Pacifiers Anterior Open bite Anterior Open bite Narrowed Maxillary Arch Width Posterior Cross Bite Elongated Maxillary Arch Depth Mandibular Arch Width Shallower Palatal Depth

  11. Duration and Posterior Crossbite • No habits – 12 months – 5.8% • Ceased Habit – 24- 36 months – 13.0% • Continued habit – 48 months - >20% JADA 2001

  12. Duration of Prolonged NNS 12 Months vs. 36 Months  Mandibular Canine Width  Maxillary Canine Arch Depth  Overjet JADA 2001

  13. Duration of Prolonged NNS* 48 Months or Longer • Narrow Maxillary Arch  Overjet  Prevalence of Open Bite  Prevalence of Posterior Cross Bite *JADA 2001

  14. Discontinuation Of NNS PACIFIER DIGITS Germany 2-3 Years 3 – 7 Years Finland 5 – 8 Years 8 Years USA - 2 – 6 Years USA - 3 – 8 Years USA 13.8 MO - USA 20.5 MO - Average 2 – 4 YEARS 5 – 6 Years

  15. Sucking Prevalence

  16. To minimize dental/oral effects, intervention to address sucking habits should be addressed by 2- 3 years of age • Interventions may include: a. Positive reinforcement b. Aversive tasting solutions c. Manage child’s stress and anxiety d. Intraoral and extraoral reminder devices. Evidenced Based Conclusions • NNS associated with increased prevalence of malocclusion in the primary dentition • Prevalence increases with increasing duration • NNS associated with an increase in Class II malocclusion in the mixed dentition

  17. Other NS and NNS facts or myths? Is there evidence? • Pacifiers interfere with the duration of breastfeeding. • Pacifier use increases the risk for otitis media. • Pacifiers should be given to infants at nap and bed-time to reduce the risk of SIDS • Breastfeeding and ECC • Ankyloglossia- treat? MYTHBUSTERS Trooth-busters

  18. Pacifers and breastfeeding Evidence Conclusions • 1. Evidence does not support an adverse relationship between pacifier use and breastfeeding duration or exclusivity. • Offering a pacifier at 15 days does not modify the prevalence or duration of breastfeeding. Cochrane: nothing ADA EBD: nothing PubMed: a. Pacifiers and Breastfeeding. O’Connor NR et al. Arch Pediatr Adolescent Med. 2009;163: 378-382 b. Does the recommendation to use a Pacifier Influence the Prevalence of Breastfeeding? Jenik AG et al. J Pediatr 2009; 155: 342.

  19. Pacifiers and increased otitis media risk 1. Cochrane- no 2. ADA EBD- no 3. PubMed- a. Risks and benefits of pacifiers. Sexton S, Natale R. Am Fam Physician. 2009 Apr 15;79(8):681-5. Review b. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG. Fam Pract. 2008 Aug;25(4):233-6. Epub 2008 Jun 17 c. Pacifier use in children: a review of recent literature. Adair SM. Pediatr Dent. 2003 Sep-Oct;25(5):449-58. Review. 4. AAP Guidelines- a. PEDIATRICS .2004;113:1451-1465Diagnosis and Management of Acute Otitis Media Is there evidence? Conclusions Pacifier use associated with increased risk for AOM. Pacifier use appears to be risk factor AAP recommends weaning infants off pacifier in the 2nd 6 months of life

  20. Pacifer and SIDS Evidence? Recommendation • AAP recommends offering a pacifier at nap time and bedtime to reduce the risk to SIDS 1. Cochrane- no 2. PubMed- Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Hauck FR, Omojokun OO, Siadaty MS. Pediatrics. 2005 Nov;116(5):e716-23. 3. AAP Policies- 1. AAP Task Force on SIDS. Pediatrics 2005; 116: 1245

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