Anterior open bite self-correction after cessation of non-nutritive sucking habits


Non-nutritive sucking habits like digit sucking or prolonged pacifier use are linked with malocclusion although these may self-correct if they are discontinued in early childhood. Anterior open bite (AOB) is the most common malocclusion seen with a non-nutritive habit although posterior cross-bite (PC) and increased overjet (IO) are also strongly linked. However, studies have suggested that discontinuation of the habit between 4 to 6 years may lead to self-correction.

The aim of this review was to assess whether self-correction of AOB occurred after stopping non-nutritive sucking habits after 4 years of age.


A review protocol was registered in PROSPERO. Searches were conducted in the PubMed, Scopus, Web of Science, and Latin American and Caribbean Health Sciences (LILACS) databases, Google Scholar, OpenGrey and the ProQuest Dissertations and Theses Databases. Studies with a minimum of 6 months follow up assessing occlusal changes in children aged 4–12 years old with AOB, who have discontinued their non-nutritive sucking habits were considered. Two reviewers independently selected studies extracted data and assessed risk of bias using the Newcastle-Ottawa Quality Assessment Scale (NOS) for cohort studies and the Joanna Briggs Critical Appraisal Checklist for quasi-experimental studies (JBI).  The outcome was AOB self-correction. A narrative synthesis was conducted because of clinical and methodological heterogeneity. The overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.


  • 5 studies (4 cohort, 1 quasi-experimental) reported in 6 publications were included.
  • All 5 studies were assessed as being of high quality.
  • Studies were conducted in Australia, Brazil, Spain and Sweden.
  • Follow-up periods ranged from 6 months to 8.5 years.
  • Percentage of self-correction of AOB ranged from 50% to 100% even after the age of 4. Values for the 5 included individual studies are shown in the table below.
Study Habit removed Habit maintained
Bertoldi et al. (2005) 96.2% 14.3%
Katz and Rosenblatt (2005) & Heimer et al (2008) 77.0% 0.0%
Heimer et al. (2008) 84.4% 26.5%
Dimberg et al. (2015) 100% 0.0%
Bowden (1966) 50.0% 9.5%
Franco Varas and Gorritxo Gil (2012) 66.7% 16.6%
  • The GRADE overall level of certainty was very low.


The authors concluded: –

AOB self-correction after discontinuing a non-nutritive sucking habit is possible, even after 4 years old, although with very low certainty in the body of evidence. It is not clear after what age the removal from the habit is unlikely to facilitate AOB self-correction.


The reviewers preregistered the protocol for their review and have undertaken searched of a broad range of sources. Only 5 studies could be included and all 5 were considered to be at high risk of bias. Most of the studies are also small and the authors’ note that for some studies participants had discontinued the habit prior to the first assessment. While the data suggest that between 50 – 100% of those ceasing their habit after the age of four years see self-correction of their AOB the quality of the evidence means our level of certainty is very low.  The study also found a level of self-correction even after the age of six years. To improve the levels of certainty high quality prospective cohort studies with larger sample sizes as maintaining a control group would be unethical.


Primary Paper

Adriano LZ, Derech CD, Massignan C, Flores-Mir C, Porporatti AL, Canto GL, Bolan M. Anterior open bite self-correction after cessation of non-nutritive sucking habits: a systematic review. Eur J Orthod. 2023 Apr 20:cjac054. doi: 10.1093/ejo/cjac054. Epub ahead of print. PMID: 37080715.

Review protocol in PROSPERO

Other references

Bertoldi PM, Felfício CM, Matsumoto MA. Efeito da interceptação precoce dos hábitos orais no desenvolvimento da oclusã [Effect of the early intervention of oral habits on the development of dental occlusion]. Pro Fono. 2005 Jan-Apr;17(1):37-44. Portuguese. PMID: 15835568.

Katz CR, Rosenblatt A. Non-nutritive sucking habits and anterior open bite in Brazilian children: a longitudinal study. Pediatr Dent. 2005 Sep-Oct;27(5):369-73. PMID: 16435635.

Heimer MV, Tornisiello Katz CR, Rosenblatt A. Non-nutritive sucking habits, dental malocclusions, and facial morphology in Brazilian children: a longitudinal study. Eur J Orthod. 2008 Dec;30(6):580-5. doi: 10.1093/ejo/cjn035. Epub 2008 Sep 4. PMID: 18775881.

Dimberg L, Lennartsson B, Arnrup K, Bondemark L. Prevalence and change of malocclusions from primary to early permanent dentition: a longitudinal study. Angle Orthod. 2015 Sep;85(5):728-34. doi: 10.2319/080414-542.1. Epub 2015 Apr 13. PMID: 25867255; PMCID: PMC8610411.

Bowden BD. The effects of digital and dummy sucking on arch widths, overbite, and overjet: a longitudinal study. Aust Dent J. 1966 Dec;11(6):396-404. doi: 10.1111/j.1834-7819.1966.tb03800.x. PMID: 5225570.

Franco Varas V, Gorritxo Gil B. Hábito de succión del chupete y alteraciones dentarias asociadas. Importancia del diagnóstico precoz [Pacifier sucking habit and associated dental changes. Importance of early diagnosis]. An Pediatr (Barc). 2012 Dec;77(6):374-80. Spanish. doi: 10.1016/j.anpedi.2012.02.020. Epub 2012 May 18. PMID: 22608913.

Dental Elf – 21st Mar 2018

Pacifier sucking: Limited evidence of impact on orofacial structures

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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