Optimum orthodontic prevention right from the start
For many parents they are a blessing, but for orthodontists they are often a curse: dummies, used as an alternative way to accommodate the natural sucking instinct of newborns and infants, can facilitate the development of jaw misalignments, breathing disorders and problems with swallowing. The new Curaprox Baby dummy offers a solution. Dental Tribune Online went to interview distinguished orthodontist Dr Herbert Pick at a Hamburg café, where he talked about the sense, purpose and importance of using dummies—and recent orthodontic findings relating to children.
Dental Tribune Online: How did you come up with the idea of developing a dummy?
Dr Herbert Pick: I studied human medicine and dentistry and have been involved in orthodontics for 40 years. In my career to date I have treated 10,000 patients. It has been 30 years now since I started investigating dummies. I also became a father 27 years ago. My son liked to suck and I couldn't wean him off his dummy. He developed a crossbite and an open bite, and within the space of almost two years this misalignment was noticeable. However, children do not usually have sufficient intellectual abilities for this jaw condition to be treated before the age of seven, so I studied the latest literature on this issue. In Western Europe, 70 to 80 per cent of children have a dummy and one in two or three of them develop a crossbite or an open bite. I wanted to change this and develop a dummy that works perfectly.
Do dummies therefore play a crucial role in the development of the jaw?
Yes, they do. Any normal dummy will push into the middle of the palate and prevent the tongue from pressing on the side of the palate. A normal dummy can therefore lead to what is known as a "gothic" palate, which is usually associated with crossbite. The aim with our dummy is to substitute the tongue function and thus prevent any crossbite or open bite.
Our Curaprox Baby dummy also offers some important health benefits. A narrow palate impedes breathing, as we need a certain amount of space for air in order to breathe through our nose. The main difference between nasal breathers and mouth breathers is that people who breathe through their mouth are more susceptible to infection. Mouth breathers get a lot more middle ear infections. Breathing through the mouth also disrupts our mental development as it causes snoring and sleeping disorders. It can even lead to ADL syndrome. Good nasal breathing relies on having a wide palate, and with the Curaprox Baby dummy we can make that possible.
How does the dummy work?
In the Curaprox Baby dummy, the connection between the teat and the mouth shield is designed to be as flat as possible. This minimises the development of an open bite, which in turn boosts the chances of the condition disappearing spontaneously when a child is weaned off the dummy. The dummy sits against the palate in a concave shape and the side wings prevent crossbites by simulating the pressure of the tongue on the sides of the palate.
The dummy is mainly made of silicone. There are three materials that are commonly used in dummies: rubber, latex and silicone. Medically speaking, silicone is a virtually harmless material and our silicone is produced by only two companies in the world. The soft silicone membrane also feels pleasant and supports the natural swallowing process. Another major advantage is that the dummy imitates the nipple and thus promotes tongue development.
Is there just one dummy for all babies and infants?
Naturally we provide a range of sizes for children of different ages and weights. For newborns we offer size 0, because we have found that they do not always take to dummies with wide wings straight away. This "zero" dummy is designed to get children used to using it. However, jaw development is linked to weight development. The jaw grows as a child gains weight. Once the child's weight has doubled, they need to move up to size 1 and so on.
Did you develop your dummy as a therapeutic aid or as a way of preventing misalignments?
The Curaprox Baby dummy is first and foremost a means of prophylaxis. Many of my colleagues do not work with newborns and only see patients from the age of five or six at the earliest, if they have been diagnosed with a crossbite. Most of them are unaware of how many children have developed a crossbite or an open bite from using a dummy. After all, these conditions can also be congenital or hereditary, such as in the case of Down’s syndrome or a cleft lip or palate. Initial trials involving speech therapists and orthopaedists using dummies for therapeutic purposes are currently under way. There are hardly any other treatment options available for two- or three-year-olds. At that age, traditional orthodontic methods or speech therapy are not feasible, or at least only to a limited extent. Our dummy bridges this gap between the emergence of a misalignment and the opportunity to start orthodontic treatment with remarkable results.
One result being that an emerging crossbite can apparently be cured thanks to the dummy?
That’s right. Even patients with an extremely open bite see a dramatic improvement in their condition when they use the dummy. I once had a three-year-old patient with an extremely open bite, for example, and within around 18 months we managed to more or less completely correct it. This is by no means an isolated case, however. As soon as we spot the first signs of crossbite, we can use the dummy to stop the condition from becoming manifest. At this stage, our dummy seems to facilitate the widening of the palate in a way that causes the emerging crossbite to revert back to a normal bite. The tongue seems to develop a different swallowing pattern, which also promotes widening. The second problem is that the tongue adapts to the “hole“ between the upper and lower incisors created by a wide join between the dummy teat and mouth shield. This leads to speech and swallowing disorders such as lisping. Our dummy seems to be able to correct this tongue dysfunction. There are some initial indications of this which we are in the process of scientifically testing.
What clinical studies are available?
The children’s dental clinic at the University of Basel has been researching dental misalignments. Initial clinical studies have shown that using the dummy significantly improved misalignments within three to six months. We even saw cases where the misalignment resolved itself spontaneously, especially where the crossbite was not manifest. There is evidence of this in some test subjects. The University of Basel is also currently working on an apparatus that can measure the distribution of pressure from the tongue. This will enable us to clinically analyse the adjustment of the tongue with a high degree of precision and thus improve the dummy even further. We, along with the experts from Curaden, will be publishing the first findings from this soon.
Would you recommend the dummy to all parents?
Breastfeeding and not using any dummy at all is the best way of soothing babies. If you breastfeed for long enough, you won’t need a dummy. If you do need to use one, however, then make sure it is a good dummy that promotes development. That was what I was aiming for in developing our dummy. The tongue becomes well-trained during infancy and tongue development is crucial in those first few years. Our dummy is designed to support and enhance the natural development process. To correct a misalignment, children may also suck on the dummy for a couple of hours during the day, but not constantly. In the case of pre-existing misalignments, the dummy may also be used beyond the “critical“ two and a half years as it apparently produces a corrective effect.
During your time as an orthodontist, you have noticed differences in the development of crossbite amongst boys and girls. Can you explain these disparities in more detail?
My theory, based on practical experience, is that crossbites are far more common amongst girls and there are more left-sided crossbites than right-sided ones. I think there are evolutionary reasons for this. Girls are born with a lower birth weight than boys, but then they overtake them. Jaw development runs in parallel with weight development. Girls’ milk teeth and milk canines appear at an earlier stage, with is likely to be during the time when a dummy is being used. The brain also seems to influence the development of the left and right milk canines, as they can erupt at different times and this is apparently controlled by the brain. At my practice, I have been investigating the correlation between whether children are right- or left-handed children and the development of their crossbite. The results may not be precise, but they show that a forced bite or crossbite is determined by the first canine. That’s my theory. The evolutionary theory has, of course, already been proven.
Until now, your discipline has focused more on correcting and improving misalignments than on prophylaxis. How is prophylaxis incorporated into orthodontics?
In principle, as medical practitioners we should practice prevention and try to avoid any diseases or misalignments for ethical reasons. Nevertheless, we still get plenty of work, so we aren't reducing our workload through prevention. Unfortunately, the prevention-oriented approach is still not that widely established amongst orthodontists. Orthodontists may successfully treat a crossbite or an open bite, for example, but so far they haven’t been paying enough attention to what is causing these misalignments, especially in children. I would like to see a change of attitude in this respect. The level of information available in orthopaedics is relatively poor.
How important do you think your development is on an international level?
I think there is great demand for the Curaprox Baby dummy all over the world. In North America, for example, the number of misalignments is similarly high. My colleagues from Scandinavia are also very interested in prevention and this is where most studies come from. In Sweden, for instance, it has been calculated that crossbites occur in 37 per cent of children who used dummies. As I have already mentioned, I think around 30 to 45 per cent of children with dummies in developed countries have a crossbite. There are certainly fewer misalignments in developing countries, but I don’t know of any studies looking into this.
Where do you stand on the view that dummies are magnets for germs? What is your opinion on the hygiene aspect?
I don’t think children should be brought up in too sterile an environment. They need to build up defences and playing outdoors helps them do this. However, I also think that adults should not lick dummies. An adult’s oral flora are different from those of their child. But it doesn't matter if a dummy falls out of a child’s mouth. I would rinse it in water and then carry on using it.
You brought out a dummy back in 2008, but since then you have decided to focus on further development and work with Curaden. What made you enter into this partnership?
Curaden is synonymous with quality and shows impressive commitment in its efforts to support dental medicine as a whole. At my practice, I am often asked why I recommend Curaprox products in particular. Curaden’s focus is first and foremost on the quality and functionality of its products rather than the price. The company understands that we need to get involved at an early stage of a young child’s upbringing. Optimal dental hygiene is invariably the key to a child's development. It’s hard to get excited about going to a high-street chemist’s to buy toothpaste. However, our mouth and teeth are the gateway to our body, the starting point for and key to our development. Curaprox Baby is therefore exclusively available in pharmacies and practices. After all, it is a product that has been designed by dentists. Curaden is the ideal partner for effective dental development through every generation.
And finally, how is your son doing these days?
From a dental perspective, not great. His bite is still asymmetrical and he still has a slightly open bite. However, I’m just pleased that my dummy can help other children and parents.
Thank you for taking part in this interview.