Pacifier use and early childhood caries: an evidence-based study of the literature

This evidence-based study of the literature investigated the relationship between pacifier use (with and without sweetening and prolonged or short-term) and early childhood caries (ECC). The review was based on evidence from 3 main sources: a search of several electronic bibliographic databases, a review of the references from relevant studies for additional potentially relevant articles and a review of several dental textbooks. A total of 74 articles were reviewed. Of these, 8 were deemed relevant and were critically appraised according to a "causation checklist" of 13 items. The 8 studies assessed were methodologically inconsistent in terms of definitions of ECC, diagnostic criteria for identifying carious lesions, dental examination procedures, interviewing methods, and descriptions of pacifier use. None of the studies achieved a score greater than 6 and hence none was considered to present strong evidence. Six studies did not control for confounding variables, and the conclusions they generated were inconsistent. The evidence from the other 2 studies, which did control for confounding factors, presented slightly stronger evidence, but they indicated no statistical difference in pacifier use between children with and those without ECC; furthermore, the reported odds ratios suggested that pacifier use might have had a mildly protective effect. Overall, the evidence does not suggest a strong or consistent association between pacifier use and ECC.