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Mar
8

Does Breast Feeding Increase Dental Caries Risk in Children?

written by CariFree

breastfeeding

Have you ever been asked if breastfeeding increases a child’s risk of decay? This study (of 63 papers) points out that up to 12 months breastfeeding does not contribute to decay risk, but might actually offer some protection for the child. It makes sense that nature would not set the child up for decay, but would in fact help in preventing disease. However, beyond 12 months, children did have an increased risk. There is no hard evidence that it is the breast milk or if other things are contributing like cariogenic foods, extended bottle feedings, and the researchers caution about jumping to the conclusion that breast feeding beyond 12 months alone causes an increase in decay risk.

 

“Breastfeeding up to 12 months of age is not associated with an increased risk of dental caries and in fact may offer some protection compared with formula. However, children breastfed beyond 12 months, a time during which all deciduous teeth erupt, had an increased risk of dental caries.” (Richards D. Breastfeeding up to 12 months of age not associated with increased risk of caries. Evid Based Dent. 2016 Sep;17(3):75-76. Sys Rev, 63 papers)

 

Abstract

Two reviewers independently selected studies for inclusion Data extraction and synthesis Study quality was assessed independently by two researchers using the Newcastle Ottawa Scale (NOS). Key data items, exposure and outcome definitions and effect estimates (odds ratios (OR), relative risks, prevalence ratios) with 95% Confidence Interval (95%CI) were abstracted where available for inclusion in a meta-analysis. The aim was to assess breastfeeding in two specific time windows; up to 12 months of age and beyond 12 months of age. Results: Sixty-three papers were included. These consisted of 14 cohort studies of which six were nested within RCTs of breastfeeding promotion interventions, three case-control studies and 46 cross-sectional studies. The studies were predominantly conducted in high and middle income countries with only eight studies from low income countries. Forty-six studies were not included in the meta-analysis because of methodological differences in the measures of exposure and outcomes, or reporting of correlational analyses only.Meta-analysis of one prospective cohort and four cross-sectional studies reported odds ratios for the association between children who were exposed to more versus less breastfeeding up to 12 months OR= 0.50; (95%CI; 0.25-0.99, I2 86.8%).In the two studies which compared ever breastfeeding in the first 12 months with never breastfeeding, both showed a marked protective effect of breastfeeding on dental caries compared with other feeding. Whereas the three studies which compared a longer duration of breastfeeding in the first 12 months to a comparison group which included children who had had some exposure to breastfeeding did not (34,52,59). A meta-analysis of this three study subgroup found OR= 0.92; (95%CI; 0.69-1.23, I2 0%)Meta-analysis of two cohort studies, one case-control study and four cross-sectional studies reported odds ratios for the association between more or less breastfeeding after the age of 12 months and dental caries.Comparison groups for these studies included both those who had never been breastfed and those who had been breastfed for shorter durations. The pooled estimate was OR= 1.99; (95% CI: 1.35-2.95, I2 69.3%).Meta-analysis of one cohort, one case-control and three cross-sectional studies reported odds ratios for the association between more versus less nocturnal breastfeeding and the risk of dental caries amongst the subgroup of children breastfed longer than 12 months. OR= 7.14; (95%CI; 3.14-16.23, I2 77.1%). Conclusions Breastfeeding up to 12 months of age is not associated with an increased risk of dental caries and in fact may offer some protection compared with formula. However, children breastfed beyond 12 months, a time during which all deciduous teeth erupt, had an increased risk of dental caries. This may be due to other factors which are linked with prolonged breastfeeding including nocturnal feeding during sleep, cariogenic foods/drinks in the diet or inadequate oral hygiene practices. Further research with careful control of pertinent confounding factors is needed to elucidate this issue and better inform infant feeding guidelines.

 

What do you say to mothers when they ask about breast feeding and decay risk?

3 Responses to “Does Breast Feeding Increase Dental Caries Risk in Children?”

  1. Jen Zuniga

    I tell mother’s that breast is best, if possible but to still do adequate oral home care. I worked in a pediatric dental clinic for many years, and although there may not be much evidence surrounding breast feeding and decay, I saw many instances where children 6 mos to 1year who were EXCLUSIVELY breast fed, developed decay on several teeth. What seemed to be the common denominator with these families was breast feeding On-Demand throughout the night with no night time cleaning of the teeth at all. I think we need to focus breast feeding and decay studies on this aspect of breast feeding (amount of time during the night the teeth are exposed to breast milk) and maybe we can then offer good education to breast feeding mother’s. Imagine the surprise mother’s would feel if we tell them breast feeding does not lead to tooth decay in children under 12 months, and then their exclusively breast fed child did develop decay in that early age.

  2. Drew Carlin DMD

    Jen makes a very good point. The research I am privy to points to ad libidum nursing, combined with the intake of simple carbohydrates, especially during sleeping periods, as likely contributing factors in elevated caries risk. As for children 6 to 12 months of age who are exclusively breast fed, this is a rare animal. I don’t personally know any children who have had no nourishment but mother’s milk until their first birthday, and my (pediatric) practice has over 7,000 patients of record.

  3. Ellie Phillips

    There are plenty of studies to show it is cariogenic bacteria passed from the parents’ mouth that creates the problem. Why don’t we talk about transmission and the effects of xylitol?
    Eliminate cariogenic bacteria 1) from the Mom’s mouth – and caretakers if possible and 2) wipe erupting teeth with xylitol.
    Without harmful strep mutans there will be no caries.
    As a pediatric dentist, mother of five, and involved grandma of seven – I encourage my kids to breastfeed on demand…even at night – without flossing and brushing….provided those teeth are cared for during the day with xylitol to promote healthy biofilm. At nine months babies have about 4-8 incisors. “Oral xylitol syrup administered topically two or three times each day at a total dose of 8 g was effective in preventing Early Childhood Caries”
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722805/

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Category: Education