Evaluation of Effect of Orthodontic Pacifiers in Prevention of Sudden Infant Death Syndrome: A Finite Element Method and Questionnaire Based Study

Introduction: Considering the morbidity associated with Sudden Infant Death Syndrome (SIDS) and limitations of absence of such syndrome in animals, a retrospective survey based human study and prospective Finite Element Method (FEM) study was planned to evaluate the effect of orthodontic pacifier in prevention of SIDS. Study design: Two groups, Group I (case) consisting of 48 people, who had lost their infant due to SIDS in past, and Group II (control) consisting of 200 participants with infant in the family, were established. The study was conducted in two parts. An online questionnaire-based survey consisting of 20 multiple choice questions was conducted to establish the correlation of pacifiers in families affected with SIDS. Thereafter, FEM evaluation was carried out in two age groups (up to six months, and between seven to 12 months) with two different pacifiers i.e. conventional and orthodontic, and one human nipples. Results:12 participants from case group and 170 in control group gave history of using pacifier for their infants between 2 to 6 months. The frequency and duration of use of pacifiers in case group generally increased while infant cried as high as 66 percent in frequency and 75 percent in duration in comparison to 90 percent in control group. FEM analysis showed significant stresses incurred with conventional pacifiers in relation to oral cavity and tongue. Orthodontic pacifiers exhibited human nipple like effect with more pronounced effects on posterior oral cavity and lesser strain on soft and hard tissues. Conclusion: Promising results obtained with survey and positive correlation of FEM data with orthodontic pacifiers indicates the superiority and advantages of orthodontic pacifiers in prevention of SIDS.

SIDS; FEM; Orthodontic; Pacifiers

1. US health Services Retrieved from www.cdc.gov/healthcommunication/toolstemplate accessed on 17 July 2018.

2. Task Force on Sudden Infant Death Syndrome, Moon RY. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics 128: e1341-1367, 2011.

3. Bowman L, Hargrove T. Exposing Sudden Infant Death in America. Scripps Howard News Service. “Archived copy”. Archived from the original on 2009-02-26. Retrieved 2008-09-30.

4. Powers DA, Song S. Absolute change in cause-specific infant mortality for blacks and whites in the US: 1983–2002. Popul Re Policy Rev 28: 817-851, 2009.

5. Moon RY, Fu L. Sudden infant death syndrome: an update. Pediatr Rev 33: 314-320, 2012.

6. Kattwinkel J, Hauck FR, Keenan ME, Malloy M. Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 116: 1245-1255, 2005.

7. L’Hoir MP, Engelberts AC, van Well GT, Westers P, Mellenbergh GJ, Wolters WH et al. Case-control study of current validity of previously described risk factors for SIDS in the Netherlands. Arch Dis Child 79: 386-393, 1998.

8. Castilho SD, Rocha MA. Pacifier habit: history and multidisciplinary view. J Pediatr (Rio J) 85: 480-489, 2009.

9. Hauck FR, Omojokun OO, Siadaty MS. Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis. Pediatrics 116: e716- 723, 2005.

10. L’Hoir MP, Engelberts AC, van Well GT, Damsté PH, Idema NK, Westers P, et al. Dummy use, thumb sucking, mouth breathing and cot death. Eur J Pediatr 158: 896-901, 1999.

11. Jaafar SH, Ho JJ, Jahanfar S, Angolkar M. (2016-08-30). Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database Syst Rev 30 (8): 2016 Aug, CD007202.

12. Piccioni MA, Campos EA, Saad JR, Andrade MF, Galvão MR, Rached AA. Application of the finite element method in dentistry. RSBO 10: 369-377, 2013.

13. Singh JR, Kambalyal P, Jain M, Khandelwal P. Revolution in Orthodontics: Finite element analysis. J Int Soc Prev Community Dent 6: 110-114, 2016.

14. Williams A. How to … Write and analyse a questionnaire. J Orthod 30: 245-252, 2003.

15. McNair A, Drage KJ, Ireland AJ, Sandy JR, Williams AC. Piloting a Patient-based Questionnaire to Assess Patient Satisfaction with the Process of Orthodontic Treatment. Angle Orthod 79: 759-765, 2009.

16. Psaila K, Foster JP, Pulbrook N, Jeffery HE. Infant pacifiers for reduction in risk of sudden infant death syndrome. Cochrane Database Syst Rev 4: 2017 Apr 5, CD011147.

17. Levrini L, Merlo P, Parachhini L. Different geometric patterns of pacifiers compared on the basis of finite element analysis. Eur J Paediatr Dent 8: 173-178, 2007.

18. Li DK, Willinger M, Petitti DB, Odouli R, Liu L, Hoffman HJ. Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population-based case-control study. BMJ 332: 18-22, 2006.

19. Mitchell EA, Taylor BJ, Ford RP, Stewart AW, Becroft DM, Thompson JM. Dummies and the sudden infant death syndrome. Arch Dis Child 68: 501-504, 1993.

20. Weiss PP, Kerbl R. The relatively short duration that a child retains a pacifier in the mouth during sleep: implications for sudden infant death syndrome. Eur J Pediatr 160: 60, 2001.

21. Weese-Mayer DE, Berry-Kravis EM, Zhou L, Maher BS, Curran ME, Silvestri JM. Sudden Infant Death Syndrome: case-control frequency differences at genes pertinent at early autonomic nervous system embryologic development. Pediatr Res 56: 391-395, 2004.

22. Ullah S, Griffiths P. Does the use of pacifiers shorten breastfeeding duration in infants? Br J Community Nurs 8: 458-463, 2003.

23. Vogel AM, Hutchison BL, Mitchell EA. The impact of pacifier use on breastfeeding: a prospective cohort study. J Paediatr Child Health 37: 58-63, 2001.

24. Jenik AG, Vain N. The pacifier debate. Early Hum Dev 85: S89-91, 2009.

25. Kramer MS, Barr RG, Dagenais S, Yang H, Jones P, Ciofani L, et al. Pacifier use, early weaning, and cry/fuss behavior: a randomized controlled trial. JAMA 286: 322-326, 2001.

26. Nelson AM. A comprehensive review of evidence and current recommendations related to pacifier usage. J Pediatr Nurs 27: 690-699, 2012.

27. Pinelli J, Symington A. How rewarding can a pacifier be? A systematic review of nonnutritive sucking in preterm infants. Neonatal Netw 19: 41-48, 2000.

28. Adair SM. Nonnutritive sucking habits in infants and preschool children: a review and recommendations for anticipatory guidance. Master Clin Pediatr Dent 4: 14-20, 1996.